Medicina y Ciencias de la Salud

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The effectiveness of joint mobilization techniques for range of motion in adult patients with primary adhesive capsulitis of the shoulder: a systematic review and meta-analysis
(01/11/2018) Zavala-González, Jonathan; Pavez-Baeza, Francisco; Gutiérrez-Espinoza, Héctor; Olguín-Huerta, Cristián
Objective : To determine the effectiveness of joint mobilization techniques in the range of motion in adult patients with primary adhesive shoulder capsulitis. Methods : Systematic review with meta-analysis. The search was performed in the MEDLINE/PubMed, PEDro, CENTRAL, LILACS, EMBASE, CINAHL, Scopus and Web of Science databases. The eligibility criteria were studies that used an oscillatory and/or maintained joint mobilization technique applied alone or added-on to a treatment program in patients with primary adhesive capsulitis at any stage. Two authors carried out the selection of studies and the extraction of data, independently. Risk of bias was evaluated according to the tool proposed by Cochrane. Results : We included 14 studies with variable risk of bias. Posterior mobilization compared to any other technique was not significantly different (0.95 degrees; 95% CI: -5.93 to 4.02), whereas compared to a control group, the difference is 26.80 degrees (CI 95%: 22.71 to 30.89). When applying a set of joint techniques versus a control group, for abduction the difference is 20.14 degrees (95% CI: 10.22 to 30.05). In both cases, the results are statistically significant, and the effect size is moderate. Conclusions : The evidence is not conclusive about the effectiveness of joint mobilization. When compared with treatments that do not include manual therapy, joint mobilization seems to have a favorable effect on the range of motion and pain reduction in patients with primary adhesive shoulder capsulitis.
Flat-head positioning increases cerebral blood flow in anterior circulation acute ischemic stroke. A cluster randomized phase IIb trial.
(Sage Publications, 11/09/2017) Olavarria, Veronica; Lavados, Pablo; Muñoz Venturelli, Paula; Gonzalez, Francisca; Gaete, Javier; Martins, Sheila; Arima, Hisatomi; Anderson, Craig; Brunser, Alejandro
Background Whether lying-flat improves blood flow in patients with acute ischemic stroke is unknown. Our aim was to investigate if lying-flat "changes" cerebral blood flow velocities assessed by transcranial Doppler in acute ischemic stroke patients. Methods In a multicenter cluster clinical trial, we randomly assigned patients within 12 h from onset of a neurological deficit due to cerebral ischemia of the anterior circulation to lying-flat or upright head positioning. The primary outcome was a change of 8 cm/s or more in mean cerebral blood flow velocities on transcranial Doppler to the middle cerebral artery at 1 and 24 h post-randomization, adjusted for imbalance in baseline variables. Secondary outcomes included serious adverse events and physical functioning at 90 days. Results Ninety-four of 304 patients screened were recruited. The primary outcome occurred in 11 (26%) of 43 patients in the lying-flat group and in 6 (12%) of 51 in the upright group at 1 h (adjusted odds ratio, 3.81; 95% CI, 1.07 to 13.54), and in 23 (53%) and 18 (36%) patients in these respective groups at 24 h (adjusted odds ratio, 3.04; 95% CI, 1.08 to 8.53). There were no between-group differences in serious adverse events, including pneumonia, heart failure or mortality, nor in functional outcome at 3 months (adjusted common odds ratio, 1.38; 95% CI 0.64 to 3.00). Conclusion The lying-flat head position was associated with a significant increase in cerebral blood flow velocities at one and 24 h within the ipsilateral hemisphere of anterior circulation acute ischemic stroke, without serious safety concerns. Clinical trial registration-URL: http://www.clinicaltrials.gov . Unique identifier: NCT01706094.
Do not resuscitate orders for pediatric patients: The role of a clinical ethics committee in a developing country
(1996) Beca, Juan Pablo; Guerrero, José Luis
Coadministration of a 9-Valent Human Papillomavirus Vaccine With Meningococcal and Tdap Vaccines
(Elsevier, 2001) Schilling, Andrea; Macias Parra, Mercedes; Gutierrez, Maricruz; Restrepo, Jaime; Ucros, Santiago; Herrera, Teobaldo; Engel, Eli; Huicho, Luis; Shew, Marcia; Maansson, Roger; Caldwell, Nicole; Luxembourg, Alain; Sobanjo ter Meulen, Ajoke
BACKGROUND: This study in 11- to 15-year-old boys and girls compared the immunogenicity and abstract safety of GARDASIL 9 (9-valent human papillomavirus [9vHPV] vaccine) administered either concomitantly or nonconcomitantly with 2 vaccines routinely administered in this age group (Menactra [MCV4; Neisseria meningitidis serotypes A/C/Y/W-135] or Adacel [Tdap; diphtheria/tetanus/acellular pertussis]). METHODS: Participants received 9vHPV vaccine at day 1 and months 2 and 6; the concomitant group (n = 621) received MCV4/Tdap concomitantly with 9vHPV vaccine at day 1; the nonconcomitant group (n = 620) received MCV4/Tdap at month 1. Antibodies to HPV-, MCV4-, and Tdap-relevant antigens were determined. Injection-site and systemic adverse events (AEs) were monitored for 15 days after any vaccination; serious AEs were monitored throughout the study. RESULTS: The geometric mean titers for all HPV types in 9vHPV vaccine 4 weeks after dose 3, proportion of subjects with a fourfold rise or greater in titers for 4 N meningitidis serotypes 4 weeks after injection with MCV4, proportion of subjects with antibody titers to diphtheria and tetanus $0.1 IU/mL, and geometric mean titers for pertussis antigens 4 weeks after injection with Tdap were all noninferior in the concomitant group compared with the nonconcomitant group. Injection-site swelling occurred more frequently in the concomitant group. There were no vaccine-related serious AEs. CONCLUSIONS: Concomitant administration of 9vHPV vaccine with MCV4/Tdap was generally well tolerated and did not interfere with the antibody response to any of these vaccines. This strategy would minimize the number of visits required to deliver each vaccine individually.
Medicina en televisión: un problema ético
(Sociedad Médica de Santiago, 2004) Beca, Juan Pablo; Salas Ibarra, Sofía
Television programs where medical procedures are shown with progressive realism generate problems that physicians need to know and analyze. The authors analyze this issue, based on the respect to patient's dignity and the principles of bioethics. Medical programs on TV present specific problems to the different agents involved in them: TV media, physicians, health organization, public and patients or relatives that are exposed. Physicians have the responsibility to educate the society using the most efficient methods of public communication, including television. The problem is not how much can be shown but how to do it, making sure that the dignity of patients, the privacy of their stories and their own and their relative's feelings are always strictly cherished. The respect towards the patient is accomplished through a valid informed consent, the reverence to his face as an expression of his personhood, and the way in which his body is exposed. The authors conclude that TV programs on health and medical subjects are valuable methods to educate society and that physicians, in their function of social educators, should take part in them truly reassuring the respect to patient's dignity and to the bioethical principles of beneficence, autonomy and justice.
How the carotid body works: Different strategies and preparations to solve different problems
(Sociedad de Biología de Chile, 2005) Zapata, Patricio; Larraín, Carolina
This is a review of the different experimental approaches developed to solve the problems in our progress towards a comprehensive understanding of how arterial chemoreceptors operate. An analysis is performed of the bases, advantages and limits of the following preparations: studies of ventilatory reflexes originated from carotid bodies (CBs) in the entire animal; recordings of CB chemosensory discharges in situ; CB preparations perfused in situ; CB explants in oculo; CB explants in ovo; CB preparations incubated in vitro; CB preparations superfused in vitro; CB preparations perfused and superfused in vitro; CB tissue slices in vitro; cells acutely dissociated from CBs; CB cells in tissue culture; petrosal ganglia superfused in vitro; petrosal ganglion cells in tissue culture; and co-cultures of CB and sensory ganglion cells. A brief historical account is given of the passage from one preparation to the next one. Emphasis is placed on personal experience with the different preparations whenever possible. Examples are given of the importance of selecting the appropriate experimental preparation for solving each particular theoretical problem. In fact, brilliant ideas on how the CB works have been unproductive until finding the adequate experimental approach to explore the validity of such ideas.
Neutralizing antibodies in survivors of Sin Nombre and Andes hantavirus infection
(Centers for Disease Control and Prevention, 2006) Valdivieso, Francisca; Vial, Pablo; Ferres, Marcela; Ye, Chunyan; Goade, Diane; Cuiza, Analía; Hjelle, Brian
We evaluated titers of homotypic and heterotypic neutralizing antibodies (NAbs) to Andes and Sin Nombre hantaviruses in plasma samples from 20 patients from Chile and the United States. All but 1 patient had high titers of NAb. None of the plasma samples showed high titers against the heterologous virus.
XV-2c and KM 19 haplotype analysis in Chilean patients with cystic fibrosis and unknown CFTR gene mutations
(Sociedad de Biología de Chile, 2007) Repetto, Gabriela; Puga, Alonso; Delgado, Iris
Cystic fibrosis (CF) is caused by mutations in the CFTR gene. More than 1600 mutations have been described, with frequencies that differ worldwide according to the ethnic origin of patients. A small group of mutations are recurrent on several populations. It has been shown that they each tend occur on specific chromosome 7 haplotypes, supporting the notion of a single origin for them. Less than 50% of mutations in Chilean patients have been identified to date. To indirectly assess the possible presence of a predominant founder mutation in the remaining unknown alíeles, we evaluated 2 polymorphic markers, XV-2c and KM.19, tightly linked to the CFTR locus. The study was done in Chilean CF patients with unknown or deltΔF508 (ΔF508) CFTR mutations and their haplotypes were compared to affected family-based controls. ΔF508 showed marked linkage disequilibrium with XV-2c/KM.19 haplotype B, with 90% of alíeles on that haplotype. There was no difference in haplotype distribution between unknown mutations and normal controls. These results support a European origin for ΔF508 alíeles in Chilean patients, and make unlikely the presence of a predominant founder mutation in the so-far unknown alíeles.
Relación estudiante de medicina-enfermo: visión de los estudiantes.
(Sociedad Médica de Santiago, 2007) Beca, Juan Pablo; Browne, Francisca; Repetto, Paula; Ortiz, Armando; Salas, Camila
Background: The relationship between medical students and patients has special characteristics that require to be well understood to prepare both students and tutors. Aim: To learn about medical students' thoughts and experiences once they start working with patients, how do they solve difficulties or problems and their perceptions about professional roles and patient rights. Material and methods: Qualitative study based on semi-structured interviews applied to 30 volunteer third year medical students who were beginning their clinical practice. The answers to open questions were transcribed and then analized and grouped by topics and categories. Results: Helping others was the main motivation to go to medical school. Other reasons were scientific interest and social status. Students felt prepared to communicate with patients. However they felt anxious, stressful and fearful of not being competent or not being able to answer patients' questions. There were some differences between male and female students' feelings. Nevertheless students declared that they had rewarding experiences with patients. They all recognized that patients have the right to reject being treated by students. The answers also showed that the first clinical experiences led to significant changes in their views of the medical profession. Conclusions: Students are aware of their trainee condition, the benefits that they obtain being in contact with patients and of their limitations. Patients must voluntarily accept to be subject of the students' training program and informed consent procedures need to be developed.
Búsqueda de afecciones genéticas como etiología de déficit intelectual en individuos que asisten a escuelas de educación especial
(Sociedad Médica de Santiago, 2008) Alliende, María Angélica; Campora, Laura; Curotto, Bianca; Toro, Jessica; Valiente, Alf; Castillo, Marcela; Cortés, Fanny; Trigo, César; Alvarado, Cecilia; Silva, Manuel; Caru, Margarita
Background: Mental retardation or intellectual disability affects 2% ofthe general population, but in 60% to 70% of cases the real cause ofthis retardation is not known. An early etiologic diagnosis of intellectual disability can lead to opportunities for improved educational interventions, reinforcing weak areas and providing a genetic counseling to the family Aim: To search genetic diseases underíying intellectual disabilities of children attending a special education school. Material and methods: A clinical geneticist performed the history and physical examination in one hundred and three students aged between 5 and 24 years (51 males). A blood sample was obtained in 92 of them for a genetic screening that included a standard karyotype, fragile X molecular genetic testing and search for inborn errors of metabolism by tándem mass spectrometry. Results: This approach yielded an etiological diagnosis in as much as 29 patients. Three percent of them had a fragile X syndrome. Inborn errors of metabolism were not detected. Conclusions: This type of screening should be done always in children with intellectual disability to establish an etiological diagnosis.
Deactivating Cardiac Pacemakers and Implantable Cardioverter Defibrillators in Terminally Ill Patients
(2009) Beca, Juan Pablo; Rosselot, Eduardo; Asenjo, René; Anguita, Verónica; Quevedo, Rafael
A 68-year-old patient who suffered from gastric cancer diagnosed 8 months earlier presented with multiple peritoneal and hepatic metastasis, despite several rounds of chemo- and radiotherapy. After admission to hospital, his general condition quickly became severely compromised. He was nearly emaciated, despite being on partial parenteral feeding. Four years earlier, due to a cardiac arrhythmia that was refractory to medication, the patient had a cardiac pacemaker (CPM) implanted, regulated to go off at frequencies of below 70 beats per minute. Given the patient's terminal situation, the team started developing some doubts about the pacemaker's effects during his dying process. The patient had mentioned his intention to donate his pacemaker after his death, but had not asked for its deactivation. The specialists were not sure about the effect of the pacemaker in unnecessarily prolonging the patient's final hour. Nevertheless, they opposed deactivation, which they considered ethically uncertain. The family, who had been initially for the deactivation, decided against it. The patient's condition was progressively deteriorating, as he was falling into a state of sopor and, later, into a coma
Botulismo infantil. Comunicación de un caso clínico y revisión de la literatura
(Sociedad Chilena de Infectología, 2009) Arriagada, Daniela; Wilhelm, Jan; Donoso, Alejandro
El botulismo es un trastorno poco frecuente en nuestro país. De las formas conocidas, el botulismo infantil da cuenta de la mayoría de los casos. Comunicamos el caso clínico de un paciente de siete meses, sexo masculino, sin antecedentes mórbidos. Historia de dos semanas de coriza, tos y decaimiento. Tras la ingesta de miel presentó exacerbación de la sinto-matología respiratoria, constipación y debilidad muscular progresiva. Se analizó muestra de heces resultando positiva para Clostridium botulinum grupo I tipo A. El estudio electromiográñco fue compatible con el diagnóstico. Presentó hipertensión arterial, atribuyéndose a disfunción autonómica, con buena respuesta a bloqueadores de los canales de calcio. Recuperó progresivamente el tono muscular. En un control ambulatorio se apreciaba importante regresión de la sinto-matología. El botulismo infantil es una enfermedad potencialmente letal de no tratarse oportunamente y de difícil diagnóstico, ya que su presentación es similar a otros cuadros clínicos. Es necesario educar a padres y personal médico sobre las medidas de prevención para los lactantes bajo doce meses de edad.
Effect of tendon tensioning: An in vitro study in porcine extensor tendons
(2010) Figueroa, David; Calvo, Rafael; Vaisman, Alex; Meleán, Patricio; Figueroa, Francisco
Graft tensioning is a controversial issue in anterior cruciate ligament reconstruction (ACLR) that has not achieved consensus between peers. The purpose of this study is to determine if after tensioning tendón length and resistance to maximal load changes. We performed an in vitro study with 50 porcine extensors tendons. The first group (P= 25) was tensioned with 80 N (19.97 lb) for 10 min, using an ACL graft preparation board. The second group (C= 25) was used as control and was not tensioned. The average initial (groups P and C) and post tensioning tendon length (group C) were measured; the average initial and post tensioning tendon diameter were measured as well. All samples were fixated in a tube–clamp system connected to a tension sensor. The samples were stressed with continuous and progressive tensión until ultimate failure at maximum load (UFML) occurs. The initial mean length was: P before tensioning= 13.4 mm± 1.4 mm (range 10.5–16.5); P after tensioning= 13.8 mm± 1.4 mm (range 11.5–16.5); C= 13 mm± 1.35 mm (p= 0.005). The mean diameter was: P= 5.6 mm (4.5–6); C= 5.5 mm (range 4.5–6) (p> 0.05). The UFML was: P= 189.7 N (114–336); C= 229.9 N (143–365) (p= 0.029). Tendon tensioning with 80 N for 10 min produced 3% average elongation. These could be beneficial in ACLR since tendon tensioning decreases elongation of the graft after fixation. Regardless, tendón tensioning is not innocuous since it diminishes their resistance when continuously stressed until complete failure occurs
Neuro-retinitis asociada a enfermedad por arañazo de gato: Presentación de dos casos y revisión de la literatura
(2010) Munita, José; Pérez G, Jorge; Araos, Rafael; López G, Juan P; Stevenson A, Ricardo; González A., Patricia; Pérez C, Daniel; Noriega R, Luis M
La infección por Bartonella henselae se presenta característicamente con adenopatías regionales y fiebre de intensidad variable, entidad conocida como enfermedad por arañazo de gato . Alrededor de 5 a 10% de los casos desarrolla compromiso ocular, entre los que destacan el síndrome óculo-glandular de Parinaud, la neuro-retinitis y la retino-coroiditis focal. A continuación se presentan dos pacientes con infección aguda por B. henselae y compromiso ocular. Ambos recibieron tratamiento y evolucionaron con recuperación completa de la visión.
Conocimientos, actitudes y percepciones de enfermeros y estudiantes de enfermería hacia VIH/Sida
(2010) Cabieses, Báltica; Conejeros, Irma; Emig, Helga; Ferrer, Lilian; Cianelli, Rosina
Objetivo. Describir las actitudes, conocimientos y percepciones que tienen los enfermeros y estudiantes de Enfermería en torno a las personas que viven con VIH/SIDA (PVVS). Metodología. Estudio bibliográfico en el que se hizo búsqueda en seis bases de datos electrónicas con las palabras claves: “actitud”, “conocimientos”,“enfermería”, “percepciones”, “VIH/SIDA”. Se consideraron publicaciones entre 1998-2007. Resultados. Se recuperaron 560 artículos que se limitaron por su pertenencia a publicaciones de investigaciones científicas o reportes ministeriales. Finalmente se seleccionaron un total de 38 publicaciones, cuyo análisis mostró que el nivel de conocimientos de enfermeros y estudiantes de Enfermería en torno a PVVS es bueno y las actitudes frente a VIH/SIDA han mejorado en el tiempo. Los enfermeros y estudiantes de enfermería han sido capaces de identificar tanto aspectos positivos como negativos en el cuidado de PVVS, a nivel personal y profesional, debido a que existe una percepción más favorable. Conclusión. Existen pocos estudios en Latinoamérica y Chile que estudien las actitudes y conocimientos de la población de estudio en torno a PVVS. Según las publicaciones encontradas el conocimiento y las actitudes han mejorado debido a que la percepción es más favorable
Colgajo de avance en V-Y de gastrocnemio medial basado en perforante para cierre de defectos del tercio medio de la pierna
(2010) Spröhnle, V.; Las Heras, R.; Llanos, S; Calderón, D; Calderón, W
Los colgajos de avance en V-Y han sido una alternativa popular para el cierre de heridas profundas, pero su movilidad es limitada. Los colgajos basados en perforantes son especialmente útiles cuando se necesita un mayor avance y cobertura. Diseñamos un colgajo de gastrocnemio que utiliza ambas técnicas para cubrir los defectos del tercio medio y superior de la pierna en sus caras lateral y posterolateral. Evaluamos en forma retrospectiva 5 pacientes con heridas en el tercio medio y superior de la pierna, tratados entre enero de 2005 y septiembre de 2007 en un solo centro y por un mismo cirujano. Todos fueron varones, con un promedio de edad de 48 años y la etiología fue traumática en todos los casos. El vaso perforante se evaluó preoperatoriamente por medio de doppler color en todos los casos. Valoramos telefónicamente la satisfacción del paciente en el postoperatorio tardío. En todos los casos, encontramos los vasos perforantes identificados en el preoperatorio; el tiempo operatorio promedio fue de 1.8 horas. No hubo complicaciones; la cobertura fue exitosa en todos los casos y los pacientes se mostraron satisfechos en la encuesta realizada. El tiempo medio de seguimiento postoperatorio fue de 19 meses. En conclusión, creemos que el colgajo de avance en V-Y de gastrocnemio basado en perforante se presenta como una alternativa segura para el cierre de defectos del tercio medial y superior de la pierna, en un sólo tiempo quirúrgico y con buenos resultados estéticos y funcionales a largo plazo.
Intramolecular loop/tail interactions are essential forconnexin 43-hemichannel activity
(2010) Ponsaerts, Raf; De Vuyst, Elke; Retamal, Mauricio; D’hondt, Catheleyne; Vermeire, Dieter; Wang, Nan; De Smedt, Humbert; Zimmermann, Pascale; Himpens, Bernard; Vereecke, Johan; Leybaert, Luc; Bultynck, Geert
Connexin-assembled gap junctions (GJs) and hemichannels coordinate intercellular signaling processes. Although the regulation of connexins in GJs has been well characterized, the molecular determinants controlling connexin-hemichannel activity are unresolved. Here we investigated the regulation of Cx43-hemichannel activity by actomyosin contractility and intracellular [Ca2 ] [Ca2 ]i ) using plasma membrane-permeable TAT peptides (100 M) designed to interfere with interactions between the cytoplasmic loop (CL) and carboxy-terminal (CT) in primary bovine corneal endothelial cells and HeLa, C6 glioma, and Xenopus oocytes ectopically expressing Cx43. Peptides corresponding to the last 10 CT aa (TAT-Cx43CT) prevented the inhibition of Cx43-hemichannel activity by contractility/high [Ca2 ]i , whereas a reverse peptide (TAT-Cx43CTrev) did not. These effects were independent of zónula occludens-1, a cytoskeletal-associated Cx43- inding protein. In contrast, peptides corresponding to CL (TAT-L2) inhibited Cx43-hemichannel responses, whereas a mutant peptide (TAT-L2H126K/I130N) did not inhibit. In these assays, TAT-Cx43CT acted as a scaffold for TAT-L2 and vice versa, a finding supported by surface plasmon resonance measurements. Loop/tail interactions appeared essential for Cx43-hemichannel activity, because TAT-Cx43CT restored the activity of nonfunctional hemichannels, consisting of either Cx43 lacking the C-terminal tail (Cx43M239) or intact Cx43 ectopically expressed in Xenopus oocytes. We conclude that intramolecular loop/tail interactions control Cx43- hemichannel activity, laying the basis for developing hemichannel-specific blockers.—Ponsaerts, R., De Vuyst, E., Retamal, M., D’hondt, C., Vermeire, D., Wang, N., De Smedt, H., Zimmermann, P., Himpens, B., Vereecke, J., Leybaert, L., Bultynck, G. Intramolecular loop/tail interactions are essential for connexin 43-hemichannel activity. FASEB J. 24, 4378–4395 (2010). www.fasebj.org
Permanent group effect on nucleofugality in aryl benzoates
(2010) Campodónico, Paola; Ormazábal-Toledo, Rodrigo; Aizman, Arie; Contreras, Renato
We herein report on the group electrophilicity of molecular fragments present in the title compounds to describe leaving group abilities in reactions of aryl benzoates toward CN. It is found that the presence of electron-withdrawing substituents in the permanent group enhances its electrophilicity, thereby contributing to the stabilization of the tetrahedral intermediate involved in the stepwise pathway. On the other hand electron-releasing substituents attached to the permanent group enhance the nucleofugality of the leaving groups in these systems. Substituent effects are used to rationalize the activation/deactivation patterns induced by electron-withdrawing and electron-releasing groups at the aromatic rings.
"Profilaxia del Abandono": Cien Años de Protección de la Infancia en Chile
(2010) Schonhaut, Luisa
Durante los Siglos XIX y principios del XX, la mortalidad infantil en Chile se encontraban entre las más elevadas del mundo y en los sectores populares era frecuente que los niños crecieran en medio de la orfandad, el abandono y la vagancia. Las instituciones de acogida y protección, que eran sustentadas por filantropía religiosa y aristocrática, tenían pobres indicadores de sobrevida; los derechos de la infancia recién emergían. Tras las grandes epidemias de fines del 1900 se sensibilizó el cuerpo médico, impulsando actividades de promoción y prevención primaria, que iban más allá del ámbito biomédico puro, lo que derribó los paradigmas existentes. En la segunda mitad del siglo se avanzó a pasos agigantados en las condiciones de vida, en el saneamiento ambiental y los niveles de educación. Con la creación del Servicio Nacional de Salud se organizó la atención médica y se generaron políticas públicas de amplia cobertura, las que nos llevaron a estándares comparables con países desarrollados. Objetivo: Recorrer la historia de la infancia en nuestro país y comentar la labor de algunas instituciones que tuvieron gran impacto en la salud materno infantil, como la Casa Nacional del Niño, el Patronato Nacional de la Infancia y el Seguro Obrero Obligatorio. A partir de ello, se reflexiona sobre los retos actuales y futuros de la pediatría. Conclusiones: Chile ha pasado por una rápida transición epidemiológica y demográfica que ha traído consigo nuevos desafíos en el ámbito de la salud infantil, relacionados fundamentalmente con los estilos de vida, desarrollo y salud mental. En consonancia, los pediatras deberíamos ampliar la mirada asistencialista incorporando el enfoque de desarrollo y las dimensiones psicosocial y emocional en el cuidado de los niños. Siguiendo nuestra herencia de pediatría social, deberíamos continuar abogando por la igualdad de oportunidades y por el efectivo cumplimiento de los derechos de la infancia.
A search for activation of C-nociceptors by sympathetic fibers in complex regional pain syndrome
(2010) Campero, Mario; Bostock, Hugh; Baumann, Thomas; Ochoa, José
Objective—Although the term ‘reflex sympathetic dystrophy’ has been replaced by ‘complex regional pain syndrome’ (CRPS) type I, there remains a widespread presumption that the sympathetic nervous system is actively involved in mediating chronic neuropathic pain [“sympathetically maintained pain” (SMP)], even in the absence of detectable neuropathophysiology. Methods—We have used microneurography to evaluate possible electrophysiological interactions in 24 patients diagnosed with CRPS I (n=13), or CRPS II (n=11) by simultaneously recording from single identified sympathetic efferent fibers and C nociceptors, while provoking sympathetic neural discharges in cutaneous nerves. Results—We assessed potential effects of sympathetic activity upon 35 polymodal nociceptors and 19 mechano-insensitive nociceptors, recorded in CRPS I (26 nociceptors) and CRPS II patients (28 nociceptors). No evidence of activation of nociceptors related to sympathetic discharge was found, although nociceptors in 6 CRPS II patients exhibited unrelated spontaneous pathological nerve impulse activity. Conclusion—We conclude that activation of nociceptors by sympathetic efferent discharges is not a cardinal pathogenic event in either CRPS I or CRPS II patients. Significance—This study shows that sympathetic-nociceptor interactions, if they exist in patients communicating chronic neuropathic pain, must be the exception

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