ABSTRACT This study evaluated the effects of chromium yeast (Cr yeast) and two apparent metabolizable energy (AME) levels on productive performance, egg quality, and lipid and carbohydrate metabolism in laying hens. A total of 192 Bovans White laying hens at 47 weeks of age were randomly assigned to eight dietary treatments (six replicates each) in a 4 × 2 factorial arrangement: four levels of supplemental Cr (0, 0.2, 0.4, and 0.8 ppm as Cr yeast) and two AME levels (2,780 and 2,900 kcal AME kg−1). No significant effect of Cr yeast supplementation on feed intake, egg weight, egg production, intact eggs, egg mass, feed conversion ratio, or egg quality was observed. Egg quality parameters and Cr content in the yolk were not affected by dietary treatments. Plasma glucose and lipid levels were not influenced by either Cr yeast or AME levels used in this study. However, Cr yeast supplementation improved yolk percentage and hepatic glycogen content. The inclusion of Cr yeast at 0.2 and 0.4 ppm induced the highest hepatic glycogen content with the energy levels 2,900 and 2,780 kcal AME kg−1, respectively. Laying hens fed 2,900 kcal AME kg−1 showed the highest abdominal fat. The results observed in the present study support the hypothesis that the lack of positive effects of Cr yeast supplementation on production performance and egg quality may be related to good management practices, as the birds were not subjected to stressful conditions.

Resumo Introdução Não há consenso sobre os efeitos imediatos e tardios da protração maxilar em pacientes com fissura lábio palatal. Objetivo avaliar a estabilidade do tratamento precoce da Classe III em pacientes com fissura labiopalatina por meio da expansão e protração maxilar. Material e método A amostra consistiu de 28 pacientes com fissura lábio palatal com (média de idade pré tratamento de 6.7±1.8) com fissura lábio palatal transforame unilateral, tratados com disjuntor maxilar e com máscara facial de Petit. Por meio de análise em telerradiografias laterais as grandezas angulares (SNA, SNB, ANB, SN.GoGn, FMA, Ângulo Z) e lineares (overjet, Co-A, Co-Gn, Nperp-A, Nperp-Pg, AO-BO) foram avaliadas, com o software Dolphin®, nos tempos: inicial (T0), após o tratamento (T1) e acompanhamento de 2 a 6 anos (T2). Os dados foram submetidos à ANOVA e teste Tukey-Kramer. A correlação entre as grandezas cefalométricas e a idade do paciente foi determinada pelo teste de Pearson. Todas as análises foram realizadas com nível de significância de 5%. Resultado SNA, ANB e AO-BO aumentaram significativamente (p<0,05) e após o período de acompanhamento voltaram a ser semelhantes às iniciais (p>0,05). O overjet aumentou significativamente após o tratamento e mesmo tendo diminuído com o tempo, ainda se apresentava maior quando comparado ao momento inicial (p<0,05). O ângulo Z apresentou melhora com o tratamento e se manteve estável no período de acompanhamento (p<0,05). Conclusão após o tratamento (disjunção associada à protração maxilar) houve melhora do padrão esquelético. No período de acompanhamento, verificou-se que essas melhoras voltaram a medidas próximas das iniciais. Houve melhora no padrão dentário e no perfil facial que se manteve no período de controle.

Abstract Introduction There is no consensus about the immediate and latte follow-up effects of maxillary protraction in cleft lip and palate patients. Objective To evaluate the stability of Class III early treatment in cleft lip and palate patients through maxillary expansion and protraction. Material and method The sample consists in three lateral cephalometric radiographs of 28 patients (mean pre-treatment age of 6.7±1.8 years) who presented cleft lip and palate and were treated with maxillary expansion and Petit facial mask. The angular (SNA, SNB, ANB, SN.GoGn, FMA, Z Angle) and linear (overjet, Co-A, Co-Gn, Nperp-A, Nperp-Pg, AO-BO) cephalometric measures were evaluated through the Dolphin® software, in three moments: T0 (initial), T1 (after treatment), and T2 (follow-up). Data were submitted to the analysis of variance (ANOVA) and Tukey-Kramer test. The correlation between cephalometric measures and patient’s age was determined by Pearson’s chi-squared test. Result The SNA, ANB, and AO-BO measures increased considerably (p<0.05), and they did not present any differences compared to the initial ones after the follow-up time. The overjet measure increased (p<0.05) after treatment and, even with its decrease at the follow-up time, it was still higher than at the beginning (p<0.05). The Z angle showed improvement with treatment and remained stable at the follow-up time. Conclusion After treatment (maxillary expansion associated with protraction), there was a skeletal pattern improvement. During the follow-up period, those alterations decreased to a measure close to the beginning. There was an improvement in the dental pattern and facial profile that continued in the follow-up period.

ABSTRACT Background: Test-seeking is associated with HIV in Brazilian blood donors. This study sought to investigate the frequency with which three different donor groups: deferred donors, accepted donors who tested HIV positive [HIV (+)], and accepted donors who tested infectious disease markers negative [IDM (−)], came to the blood bank at the suggestion of a health care professional. Study design and methods: Donors deferred for reporting high-risk behaviors and participants in an HIV risk factor case-control study completed a confidential audio computer-assisted self-interview (ACASI) that included two questions related to health care professionals and test-seeking. Results: Of 4013 enrolled deferred donors, 468 (11.8%) reported a health care professional suggested donation as a way to be tested for infection. Of 341 HIV (+) and 791 IDM (−) participants, 43 (12.6%) and 11 (1.4%), respectively, reported a health care professional suggested donation as a way to be tested for infection. Physicians were the most frequently reported source of referral: [(61.5% of deferred, 69.1% of HIV (+), and 9.1% of IDM (−) donors)]. Conclusion: HIV (+) donors and deferred donors were 10 times more likely to report test-seeking behavior by suggestion of health care professional than IDM (−) donors. If true, efforts should be made to educate health care professionals and blood donors on how to safeguard the blood supply, emphasizing that HIV testing should be done at volunteer testing centers rather than at the blood centers.

Abstract Fructose consumption has increased worldwide, and it has been associated with the development of metabolic diseases such as insulin resistance (IR) and steatosis. The aim was to evaluate if lower fructose concentrations may cause pancreatic structural abnormalities, leading to a glucose intolerance without steatosis in male rats. Young male rats orally received 7% fructose solution for 12 weeks. Body weight, food, water, and energy intake were measured. An oral glucose tolerance test (OGTT) was performed. After final experimental period, all rats were anaesthetized and killed. Blood samples were collected for biochemical analyses and organs (liver and pancreas) were processed for morphological analyses. Fructose consumption was not associated with lipid accumulation in liver. However, fructose administration was associated with an increased area under curve from OGTT and an increased percentage of insulin-positive cells, high beta cell mass and reduced pancreatic islet area. Fructose supplementation (7%) did not cause steatosis, but it led to abnormal morphology and function of pancreatic islet cells, contributing for glucose intolerance development. Our findings demonstrate that even low fructose concentrations may cause deleterious effects in animals.

Abstract Feeding children during school hours is essential, so to adapt the food supply, it is necessary to know what students’ food preferences are. Thus, the purpose of this study was to identify the reasons for preferences and food consumption during school breaks. Thirty-eight children with an age range of 9 to 10 years (55% girls and 45% boys), from a full-time public primary school participated. This ethnographic study comprised the recording of commonly consumed and preferred foods, as well as children’s narratives, through directed observation, unstructured interviews and drawings. It was found that children’s food preferences are closely linked to the family context and the feelings linked to them. However, these preferences also influence the food education received (school and extra-school), as well as the availability-restriction of food within the school. In conclusion, although children could not consume their favorite food at school, they adapted their preferences according to the foods available at school, so the selection varied based on the perception and weighting of the organoleptic properties of the food (e.g., taste, consistency, temperature).

Resumen La alimentación de los niños durante el horario escolar es fundamental, por lo que a fin de adecuar la oferta alimentaria, es indispensable conocer cuáles son las preferencias alimentarias del alumnado. Así, el propósito de este estudio fue identificar los motivos de las preferencias y el consumo de alimentos durante el recreo escolar. Participaron 38 niños de 9-10 años de edad (55% niñas y 45% niños), alumnos de una escuela primaria pública de tiempo completo. Este estudio etnográfico comprendió el registro de alimentos consumidos y preferidos habitualmente, así como las narrativas de los niños, a través de observación dirigida, entrevistas no estructuradas y elaboración de dibujos. Se encontró que las preferencias alimentarias de los niños están estrechamente vinculadas al contexto familiar y los sentimientos ligados a éste. No obstante, en dichas preferencias influyen también la educación alimentaria recibida (escolar y extra-escolar), así como la disponibilidad-restricción de alimentos dentro de la escuela. En conclusión, aunque las y los niños podían no consumir en el recreo escolar su alimento favorito, adaptaban sus preferencias en función de los alimentos disponibles en la escuela, de modo que la selección variaba en función de la percepción y ponderación de las propiedades organolépticas del alimento (e.g., sabor, consistencia, temperatura).

OBJECTIVES: We evaluated the validity and reliability of ultrasonography measurement of rectus femoris cross-sectional area compared to computed tomography in patients in pre-dialysis chronic kidney disease and analyzed the association between these measurements and the diagnosis of sarcopenia. METHODS: One hundred patients with nondialysis chronic kidney disease were evaluated. Sarcopenia was defined using the criteria of the Foundation for the National Institutes of Health Sarcopenia Project (FNIH). The rectus femoris cross-sectional area was evaluated using ultrasonography and computed tomography. RESULTS: The prevalence of sarcopenia was 29% according to the FNIH criteria. The difference in mean rectus femoris cross-sectional area by ultrasonography and computed tomography was 3.97 mm, with a strong correlation between the two methods (p<0.001). Bland-Altman plot analysis showed good agreement between computed tomography and ultrasonography. Rectus femoris cross-sectional area was significantly correlated with muscle strength (r=0.300, p=0.002), lean body mass in the upper limbs (r=0.286, p=0.004), and lean body mass in the lower limbs (r=0.271, p=0.006). The prevalence of sarcopenia was 12% (n=12) based on the definition of low muscle mass according to ultrasonography of the rectus femoris cross-sectional area. CONCLUSION: Ultrasonography was demonstrated to be a valid and reliable method for evaluating the rectus femoris cross-sectional area in patients in pre-dialysis chronic kidney disease.

Resumo Introdução: A associação entre anti-histamínicos e corticosteroides orais é frequentemente empregada no tratamento de sintomas agudos de rinite alérgica. Objetivo: Avaliar a segurança e eficácia da associação desloratadina + prednisolona no tratamento de sintomas agudos de crianças (2-12 anos) com rinite alérgica e compará-las com as da associação dexclorfeniramina + betametasona. Método: Crianças com rinite alérgica persistente moderada/grave e sintomáticas (escore de sintomas nasais [0-12] ≥ 6) foram alocadas de modo duplo-cego e randômico para receber dexclorfeniramina + betametasona (n = 105; três doses diárias) ou desloratadina + prednisolona (n = 105; dose única seguida por duas de placebo) por 7 dias. No início e no fim da avaliação foram obtidos: escore de sintomas nasais, escore de sintomas extranasais, pico de fluxo inspiratório nasal, bioquímica sanguínea e eletrocardiograma. Do total, 96 crianças do grupo dexclorfeniramina + betametasona e 98 do grupo desloratadina + prednisolona concluíram o protocolo. Resultados: Os dois grupos foram iguais com relação ao escore de sintomas nasais, escore de sintomas nasais extranasais e pico de fluxo inspiratório nasal iniciais e finais. Observou-se queda de 76,4% e 79,1% nos escores para escore de sintomas nasais, de 86,0% e 79,2% para escore de sintomas extranasais, assim como incremento de 25,2% e de 24,3% para o pico de fluxo inspiratório nasal para os grupos desloratadina + prednisolona e dexclorfeniramina + betametasona, respectivamente. Não houve alterações significativas da bioquímica sanguínea. Taquicardia sinusal foi a alteração do eletrocardiograma mais encontrada, mas sem significância clínica. Sonolência foi significantemente mais referida entre os tratados com dexclorfeniramina + betametasona do que entre os desloratadina + prednisolona (8,57% × 17,14%, respectivamente). Conclusão: A associação desloratadina + prednisolona foi capaz de controlar efetivamente os sintomas agudos de rinite em crianças, melhorou sintomas e a função nasal. Na comparação com a associação dexclorfeniramina + betametasona, demonstrou ação clínica semelhante, mas com menor incidência de eventos adversos e maior comodidade posológica.

Abstract Introduction: A combination of antihistamines and oral corticosteroids is often used to treat acute symptoms of allergic rhinitis. Objective: To evaluate safety and efficacy of desloratadine plus prednisolone in the treatment of acute symptoms of children (2-12 years) with allergic rhinitis, and to compare it to dexchlorpheniramine plus betamethasone. Methods: Children with moderate/severe persistent allergic rhinitis and symptomatic (nasal symptoms score [0-12] ≥ 6) were allocated in a double-blind, randomized fashion to receive dexchlorpheniramine plus betamethasone (n = 105; three daily doses) or desloratadine plus prednisolone (n = 105; single dose followed by two of placebo) for 7 days. At the beginning and end of the evaluation, the following were obtained: nasal symptoms score, extra nasal symptoms score, peak nasal inspiratory flow, blood biochemistry, and electrocardiogram. Ninety-six children of the dexchlorpheniramine plus betamethasone group and 98 of the desloratadine plus prednisolone group completed the protocol. Results: The two groups were similar regarding initial and final nasal symptoms scores, extra nasal symptoms scores and peak nasal inspiratory flow. A drop of 76.4% and 79.1% for nasal symptoms score, 86.0% and 79.2% for extra nasal symptoms score, as well as an increase of 25.2% and 24.3% for peak nasal inspiratory flow occurred for those treated with desloratadine plus prednisolone and dexchlorpheniramine plus betamethasone, respectively. There were no significant changes in blood chemistry. Sinus tachycardia was the most frequent electrocardiogram change, but with no clinical significance. Drowsiness was reported significantly more often among those of dexchlorpheniramine plus betamethasone group (17.14% × 8.57%, respectively). Conclusion: The desloratadine plus prednisolone combination was able to effectively control acute symptoms of rhinitis in children, improving symptoms and nasal function. Compared to the dexchlorpheniramine plus betamethasone combination, it showed similar clinical action, but with a lower incidence of adverse events and higher dosing convenience.

We report the case of a male patient, 80 years old, with a history of dyspepsia and no family history of neoplasias. In the upper digestive endoscopy in the distal esophagus, a flat depressed lesion with the appearance of early carcinoma, type IIC of Paris classification, was diagnosed by biopsy as a squamous carcinoma in situ, infiltrating, moderately differentiated non-keratinizing grade II carcinoma. He underwent submucosal endoscopic dissection without complications. Histopathology concluded: carcinoma of squamous cells, predominantly in situ of distal esophagus, measuring 0.6 cm, with focus of 0.1 cm of infiltration in the own lamina; absence of angiolymphatic or perineural invasion. The histopathology specimen had margins of surgical resection free of neoplasia. Stage pT1a. Three months later, in the endoscopy control with biopsy of the area, there was no evidence of carcinoma. We present the case because it is still a challenge to establish the diagnosis of esophageal cancer at an early stage, especially in patients without symptoms, highlighting the importance of chromoendoscopy and a good endoscopic examination to reach the diagnosis. Submucosal endoscopy dissection could be considered as a safe and effective alternative treatment to radical surgery.

Reportamos el caso de un paciente masculino, 80 años, con historia de dispepsia y sin antecedente familiar de neoplasias. En la endoscopia digestiva alta, en tercio distal, se observó una lesión deprimida plana con aspecto de carcinoma precoz IIC que fue diagnosticada por biopsia como carcinoma escamoso in situ e infiltrante, no queratinizante moderadamente diferenciado grado II. Fue sometido a disección endoscópica submucosa, sin complicaciones. La histopatología concluyo: carcinoma de células escamosas, predominantemente in situ de esófago distal, midiendo 0,6 cm, con foco de 0,1 cm de infiltración en la lámina propia; ausencia de invasión neoplásica angiolinfática o perineural con márgenes de resección quirúrgica libre de neoplasia. Estadio pT1a. Tres meses después, en la endoscopia de control con toma de biopsias de la zona, no hubo evidencia de carcinoma. Presentamos el caso debido a que sigue siendo todo un reto establecer el diagnóstico de cáncer de esófago en etapa temprana, sobre todo en pacientes poco sintomáticos, resaltando la importancia de la cromoendoscopia y de una buena exploración endoscópica para llegar al diagnóstico. La disección endoscopia submucosa podría considerarse como un tratamiento alternativo seguro y eficaz a la cirugía radical.

Extra-pulmonary tuberculosis (TB) represents the 26.2% of total TB cases in Chile. Culture is the gold standard method, but the process is extremely slow. Xpert®MTB/RIF technique detects Mycobacterium tuberculosis complex (MTBc) through real time PCR in less than 3 h. However, it has been validated only for respiratory specimens. We aimed to determine the performance of Xpert®MTB/RIF test in detecting MTBc in extra-respiratory specimens compared with a combined gold standard consisting in a positive (liquid and solid) mycobacterial culture and/or a positive validated molecular method (q-RPC, Cobas®TaqMan®-MTB). Fifty extra-respiratory specimens were analyzed, from which 25 were positive and 25 negative for MTBc based on the combined gold standard. The 25 positive specimens had a positive result by Xpert®MTB/RIF; from the 25 negative specimens, 24 had a negative result and one had a positive result. We obtained an overall concordance of 98% between Xpert®MTB/RIF and the combined gold standard. Xpert®MTB/RIF test was able to detect 12 smear-negative specimens and 3 culture-negative specimens, all of them corresponding to extra-pulmonary TB cases. Xpert®MTB/RIF showed similar sensitivity to q-RPC in detecting MTBc in extra-respiratory specimens. This procedure allowed a substantial reduction in the time of diagnosis.

Resumen La tuberculosis (TBC) extra-pulmonar alcanza al 26,2% de los casos totales de TBC en Chile. El cultivo es el método estándar de oro, pero es lento. La técnica Xpert® MTB/RIF permite detectar Mycobacterium tuberculosis complex (MTBc) por RPC en tiempo real en menos de 3 h, sin embargo, ha sido validada sólo para muestras respiratorias. El objetivo de este estudio fue determinar la utilidad de la prueba Xpert® MTB/RIF en la detección de MTBc en muestras extra-pulmonares en comparación con un estándar de oro combinado consistente en un cultivo de micobacterias positivo (medio sólido y líquido) y/o un método molecular validado positivo (q-RPC, Cobas® TaqMan-MTB). Se analizaron 50 muestras extra-pulmonares, de las cuales 25 fueron definidas positivas y 25 negativas para MTBc en base a estándar de oro combinado. Las 25 muestras definidas positivas tuvieron un resultado positivo por Xpert® MTB/RIF; de las 25 muestras definidas negativas, 24 tuvieron un resultado negativo y una de ellas un resultado positivo. Se obtuvo una concordancia global entre Xpert® MTB/RIF y el estándar de oro combinado de 98%. La prueba Xpert® MTB/RIF fue capaz de detectar 12 casos de TBC extra-pulmonar con baciloscopia negativa y 3 casos con cultivo negativo. El método Xpert® MTB/RIF ha demostrado tener una sensibilidad similar al q-RPC para detectar MTBc en muestras extra-pulmonares y permite reducir sustancialmente el tiempo de diagnóstico.

This essay is an approach to the private letters of Wanda Morla Lynch, a Chilean woman from the early XX century. This approach considers the epistolary genre as a complex and often contradictory genre, propitious to describe a feminine intimacy, feelings and subjectivity, due to the relationship of complicity between the letters and the historically acquired status of subordination, imposed by the patriarchal society. In this sense, this epistolary corpus will allow us establishing a characterization of these private letters as they have a formal/discursive singularity in relation to other genres that conform the corpus of autobiographic writing, as well as exploring and rescuing the value of those letters as a documentary source as they unveil the voice of a woman, who was a privileged witness of the changes that took place in Paris in the 1920’s, epicenter of the modernist avant-garde of the time. Regarding this last consideration, Wanda Morla Lynch’s letters can be also described as a “journey diary” (historically known as a particularly masculine experience), giving us the possibility of reading these letters as a secretly transgressor gesture towards the social conventions of an era.

El presente trabajo se plantea como un acercamiento a las cartas privadas de una mujer chilena de comienzos del siglo XX: Wanda Morla Lynch. Esta aproximación considera al género epistolar como un género discursivo complejo y contradictorio, pero propicio para dar cuenta de una intimidad, de unos sentimientos y de una subjetividad femenina dada la relación de complicidad que se establece entre las cartas y el estado de vida del sujeto femenino, marcado históricamente por una posición de subordinación y “deber ser” impuesto por la sociedad patriarcal. De esta forma, este corpus epistolar nos permitirá analizarlo a la luz de una previa caracterización de las cartas privadas como un género discursivo en sí mismo y que posee una determinada singularidad formal en relación a los otros géneros que conforman el corpus de la escritura autobiográfica; pero también explorar y rescatar el valor de estas cartas como fuente documental, ya que ponen al descubierto la voz de una mujer chilena que fue testigo privilegiada de los cambios que se produjeron en el París de los años ’20, epicentro de la vanguardia modernista de ese tiempo.

Variable selection plays an important rule in identifying possible factors that could predict the behavior of clients with respect to the bill payments. The Cox model is the standard approach for modeling the time until starting the lack of payments. Parsimony and capacity of predicting are some desirable characteristics of statistical models. This paper aims at proposing a new forward stagewise Lasso (least absolute shrinkage and selection operator) algorithm and applying it for variable selection in the Cox model. The algorithm can be easily extended to run the Adaptive Lasso (ALasso) approach.

Introduction: obesity is currently a public health problem worldwide. It has become a determining factor in the appearance of numerous diseases, increasing the morbi-mortality rates of the adult population. However, there are many studies that indicate that it starts in early ages. Youth is a critical stage to promote health and generate life styles. Because of this, it is necessary to identify the young people with this problem in order to initiate the corrective measures that could avoid the development of complications. Objective: to determine the prevalence of overweight and obesity in students of the Faculty of Medicine of the National University of Itapúa. Material and methods: prospective, descriptive and observational design carried out in students of the Faculty of Medicine from 2011 to 2013. Results: out of 165 students, 61.8% had normal weight and 38.2% overweight or obesity. Concerning family history, blood hypertension and obesity were present in the 58.7% and 47.6% respectively. The remarkable clinical feature of the cardiovascular exam was the finding of a blood pressure of > 130/85 in 22.2% of the students. Conclusions: the prevalence of overweight and obesity was 38.2%.

Introducción: la obesidad es actualmente un problema de salud pública mundial, se ha convertido en un factor determinante en la aparición de numerosas enfermedades, incrementando con ello los índices de morbimortalidad de la población adulta. Sin embargo, existen numerosos estudios que señalan que se inicia en edades tempranas. La juventud es una etapa decisiva para promover la salud y generar estilos de vida. Es por ello necesario identificar a los jóvenes con este problema, con el fin de iniciar medidas correctivas que eviten el desarrollo de complicaciones. Objetivo: determinar la prevalencia de sobrepeso y obesidad en estudiantes de la Facultad de Medicina de la Universidad Nacional de Itapúa. Metodología: diseño observacional, descriptivo, prospectivo realizado en estudiantes de la Facultad de Medicina del período 2011 al 2013. Resultados: de 165 alumnos estudiados, 61,8% presenta normopeso y 38,2% sobrepeso u obesidad. Dentro de antecedentes familiares, la hipertensión arterial y la obesidad están presentes en el 58,7% y 47,6%, respectivamente. La característica clínica resaltante del examen cardiovascular fue el hallazgo una presión arterial > 130/85 en el 22,2% de los estudiantes. Conclusión: la prevalencia de sobrepeso y obesidad fue 38,2%.

Background: Genotyping of Mycobacterium tuberculosis complex (cMtb) allows us to know geographically predominant lineages. Some lineages spread more rapidly and are associated with multidrug resistance, particularly Beijing, which has been reported in Latin America (Peru). There is little information about this topic in Chile and there are no reports of the presence of the Beijing genotype. Aim: To determine the most prevalent lineages in the Metropolitan Region of Chile with emphasis on the search for Beijing in two health centers. Methods: Two complementary molecular methods were used: spoligotyping, based on the variations of the direct repeat regions in the genome of cMtb and MIRU-VNTR, based in the variable number of tandem repeats of mycobacterial interspersed repetitive units, and subsequent analysis in international databases. A designed lineage was assigned to 37 of the 43 strains studied (86%); 6 isolates could not be assigned to any genotype. LAM and T genotype were the most frequent (39.5 and 32.5%, respectively) followed by Haarlem (7.0%), Beijing (4.7%) and X (2.3%). Conclusion: We describe for the first time the presence of the Beijing genotype in Chile. cMtb molecular surveillance should be implemented in our country in order to know the dynamics of its transmission.

Introducción: La genotipificación del complejo Mycobacterium tuberculosis (cMtbc) permite conocer los genotipos geográficamente predominantes. Algunos genotipos se diseminan con mayor rapidez y se asocian a multi-resistencia, tal como Beijing, reportado en América Latina en Perú. Existe poca información al respecto en Chile, sin reportes de la presencia de Beijing. Objetivo: Conocer los genotipos prevalentes en dos centros de salud de la Región Metropolitana de Chile con énfasis en la búsqueda de Beijing. Métodos: Se utilizaron dos métodos moleculares complementarios basados en la variación de las regiones de repeticiones directa en el genoma de M. tuberculosis (espoligotipificación) y número variable de repeticiones en tandem de las unidades repetitivas de interespaciadores micobacterianos (MIRU-VNTRs) y posterior análisis en bases de datos internacionales. Resultados: Se asignó un genotipo conocido a 37 de las 43 cepas estudiadas (86%), mientras que en 14% no se asignó alguno. Los genotipos LAM y T fueron los más frecuentes (39,5 y 32,5%, respectivamente), seguidos por Haarlem (7,0%), Beijing (4,7%) y X (2,3%). Conclusión: Se describe por primera vez en Chile la presencia del genotipo Beijing en cepas de cMtb. Es necesario realizar una vigilancia epidemiológica molecular en el cMtb para conocer la dinámica de la transmisión en nuestro país.

The incidence of whooping cough in Chile ranges from 4.1 and 7.5 per hundred thousand inhabitants. B. pertussis detection is performed by Real Time PCR (Q-PCR) directed to the insertion sequence IS481. However, this sequence is also found in the genome of B. bronchiseptica and B. holmesii. The latter is also a respiratory pathogen whose clinical features are similar to B. pertussis. However, it is important to differentiate between these species because in immunosuppressed patients B. holmesii is more likely to cause bacteremia and is less susceptible to erythromycin. The goal of this work is to measure prospectively and retrospectively the presence of B. holmesii in samples reported positive for B. pertussis in the period 2010-2011. During this period, 1994 nasopharyngeal specimens entered the laboratory for Bordetella sp. PCR, of which 224 were positive. The analysis by Q-PCR directed to the recA gene of B. holmesii of all 224 positive samples determined a prevalence of B. holmesii of 0.6% (12/1994). Because of its more aggressive behavior in immunosupressed patients and its different resistance pattern, routine screening of B. pertussis and B. holmesii is currently performed for all samples in which Bordetella sp PCR is initially detected.

La incidencia de coqueluche en Chile varía entre 4,1 y 7,5 por 100.000 habitantes. La detección de Bordetella pertussis se realiza por RPC-tiempo real (Q-RPC) dirigida a la secuencia de inserción IS481. Sin embargo, esta secuencia se encuentra también en el genoma de B. bronchiseptica y B. holmesii. Este último es también un patógeno respiratorio que produce un cuadro similar a B. pertussis. Sin embargo, es importante diferenciar entre estas especies porque en pacientes inmunosuprimidos B. holmesii tiene mayor tendencia a causar bacteriemia y además es menos susceptible a eritromicina. El objetivo de este trabajo es determinar, prospectiva y retrospectivamente, la presencia de B. holmesii en muestras informadas positivas para B. pertussis en el período 2010-2011. Durante ese período ingresaron al laboratorio 1. 994 muestras de hisopado nasofaríngeo para RPC de Bordetella sp., de las cuales 224 fueron positivas. El análisis por Q-RPC dirigido al gen recA de B. holmesii de las 224 muestras positivas determinó una prevalencia de B. holmesii de 0,6% (12/1994). Debido al comportamiento más agresivo en inmunosuprimidos y al patrón de resistencia de B. holmesi, se decide incorporar la detección de rutina de B. pertussis y B. holmesii en todas las muestras en que se detecta inicialmente la presencia de Bordetella sp.

Relatamos um caso de histiocitose cefálica benigna em uma criança do sexo masculino, de um ano e três meses de idade que desenvolveu múltiplas pápulas na região malar bilateralmente, sem outros comemorativos associados. A histopatologia caracterizou-se pelo padrão derme papilar, com imuno-histoquímica negativa para S100 e CD1a, e positiva para CD68, ficando assim estabelecido o diagnóstico desta histiocitose não- Langerhans, baseado nos aspectos clínicos, histopatológicos e imuno-histoquímicos característicos.

The present paper reports a case of benign cephalic histiocytosis in a 15-month baby boy, who developed multiple papules bilaterally in the malar region with no other associated manifestations. Histopathology revealed a papillary dermal pattern, while immunohistochemistry was negative for S100 and CD1a and positive for CD68. Therefore, diagnosis was established as non-Langerhans cell histiocytosis, based on the clinical, histopathological and immunohistochemical features present.