Introduction: Appendicitis is one of the main reasons for consultation and surgery in the emergency department. It must be treated promptly because it can evolve into a ruptured appendix and thus to peritonitis or an appendiceal plastron, by approximately 10%, and increasing the morbidity, as downtime or hospital stay. There is currently no consensus on the treatment of appendicular plastron, therefore, the objective of this work is to support and promote alternative deferred surgical versus medical management, as the most suitable treatment of appendiceal plastron. Case presentation: A girl of 8 years 11 months old consult for pain in lower abdomen of three weeks of evolution, accompanied by feverish feeling, unquantified, vomiting and diarrhea; Is diagnosed a plastron appendiceal opting for medical management, evolving favorably and giving the discharge. In subsequent controls was planned appendectomy, taking place successfully months later. Biopsy of removed appendix showed a appendix cancer, reason why an extension study of neoplasia was initiated without pathological findings. Discussion: Currently the management of appendicular plastron is dependent on the treating physician and judgment. There are advantages and disadvantages of choosing a medical or surgical treatment, immediate or delayed, inside the advantages of the latter include the prevention of recurrent appendicitis and early detection of appendiceal carcinoma, as in the case presented, thus allowing better prognosis for the patient and avoiding the use of more aggressive therapies.

Introducción: La apendicitis es uno de los principales motivos de consulta e intervención quirúrgica en los servicios de urgencias. Debe tratarse oportunamente dado que puede evolucionar hacia una perforación apendicular y con ello a una peritonitis o un plastrón apendicular, en aproximadamente un 10%, e incrementando las morbilidades, como tiempo de reposo o estadía hospitalaria. Actualmente no existe consenso acerca del tratamiento del plastrón apendicular, por ello, el objetivo del presente trabajo es respaldar y promover la alternativa quirúrgica diferida, versus el manejo médico, como el tratamiento más idóneo del plastrón apendicular. Presentación del caso: Se derivó al Hospital Base Valdivia a una escolar, de 8 años y 11 meses de edad, por dolor en hemiabdomen inferior de 3 semanas de evolución acompañado de sensación febril no cuantificada, vómito y diarrea; se diagnosticó un plastrón apendicular, optándose por el manejo médico; evolucionó favorablemente, dándole el alta. En controles posteriores se planificó una apendicectomía, llevándose a cabo con éxito meses después. La biopsia del apéndice extraído evidenció un carcinoma de apéndice cecal, por lo que se inició el estudio de extensión de neoplasia sin encontrar hallazgos patológicos. Discusión: Actualmente el manejo del plastrón apendicular depende del médico tratante y su criterio. Existen ventajas y desventajas entre la elección de un tratamiento médico o quirúrgico, sea inmediato o diferido; dentro de las ventajas del último destacan la prevención de apendicitis recurrentes y detección temprana del carcinoma apendicular, como en el caso presentado, permitiendo de esta forma un mejor pronóstico para el paciente y evitando el uso de terapias más agresivas.

Objetivos: Determinar qué antecedentes clínicos del paciente y factores del procedimiento quirúrgico se asocian con la aparición de insuficiencia renal postoperatoria en pacientes sometidos a cirugía de revascularización miocárdica. Métodos: estudio llevado a cabo entre enero de 2005 y diciembre de 2013, de casos y controles anidado en una cohorte, en la que se incluyeron pacientes sometidos a cirugía de revascularización miocárdica electiva que presentaron insuficiencia renal postoperatoria durante el postoperatorio inmediato hasta el egreso. Los controles estuvieron conformados por pacientes sometidos a cirugía de revascularización miocárdica electiva que no desarrollaron insuficiencia renal postoperatoria inmediata hasta el egreso. Se realizó un modelo de regresión logística para determinar los factores asociados a insuficiencia renal postoperatoria. Las asociaciones se expresaron en razones de disparidad con sus respectivos intervalos de confianza. Resultados: la edad avanzada {OR 1,03 IC95% (1,01-1,04){, la presencia preoperatoria de diabetes mellitus {OR 1,8 IC95% (1,9-3,4){, la insuficiencia cardiaca {OR 2,7 IC 95% (1,1-6,7){ y el mayor tiempo de perfusión {OR 1,02 IC 95% (1,01-1,03){ se asociaron con mayor riesgo de insuficiencia renal postoperatoria, en tanto que el mayor hematocrito {OR 0,86 IC95% (0,82-0,91){ y la mayor fracción de eyección {OR 0,94 IC95% (0,92-0,96){ se relacionaron con disminución del riesgo de insuficiencia renal postoperatoria. Conclusiones: En quienes se realizó revascularización miocárdica los factores asociados a la presentación de insuficiencia renal postoperatoria fueron comorbilidades que se relacionaron con daño renal progresivo dentro y fuera del contexto de la cirugía. Esto implica que las estrategias para minimizar este evento estarán enfocadas a identificar de manera oportuna a estos pacientes y proporcionarles nefroprotección adecuada.

Motivation: To determine which medical history and surgical procedure factors are associated to the onset of postoperative kidney failure in patients undergoing myocardial revascularisation. Methods: Case-control cohort study carried out between January 2005 and December 2013 which included patients who had undergone elective myocardial revascularisation and showed postoperative kidney failure immediately after surgery and until discharge. Controls consisted of patients who had undergone elective myocardial revascularisation and did not develop postoperative kidney failure immediately after surgery. A logistic regression model was used to determine the factors associated to postoperative kidney failure. Associations were expressed as grounds of disparity with their corresponding confidence intervals. Results: old age {OR 1.03 CI 95% (1.01-1.04){, preoperative presence of diabetes mellitus {OR 1.8 CI 95% (1.9-3.4)}, cardiac insufficiency {OR 2.7 CI 95% (1.1-6.7)} and a longer perfusion time {OR 1.02 CI 95% (1.01-1.03)} were associated to a higher risk of postoperative kidney failure, while higher hematocrit {OR 0.86 CI 95% (0.82-0.91)} and higher ejection fraction {OR 0.94 CI 95% (0.92-0.96)} were associated with a decrease of the risk of postoperative kidney failure. Conclusions: In patients who had undergone myocardial revascularisation, risk factors associated to postoperative kidney failure where comorbidities related to internal and external gradual kidney damage outside the context of the surgery. This implies that strategies to minimise this event should be focused on identifying these patients in a timely manner and offering appropriate nephroprotection.

Dos cepas de Trypanosoma cruzi, una originaria de Costa Rica (TCR-4) y otra de El Salvador (UES-1) fueron comparadas in vitro en cuanto a su infectividad y multiplicación en células miocárdicas de ratón blanco NGP, ratón C3H y rata Sprague Dowley con el fin de determinar la resistencia natural de las células de estos animales. Las células miocárdicas fueron cultivadas en cubreobjetos y posteriormente infectadas con tripomastigotos sanguíneos de la cepa respectiva en una relación de un parásito por célula miocárdica y posteriormente incubados a 37 ºC con 10 % de CO2 en atmósfera húmeda. Para determinar la capacidad infectante y multiplicación intracelular se analizaron muestras a las 24, 72, 96 y 120 h de infección, determinándose la curva de crecimiento y la tasa de multiplicación intracelular. Se encontró que las dos cepas fueron capaces de multiplicarse en las células miocárdicas de ratón C3H, muy poco en ratón NGP y prácticamente nada en rata, lo que sugiere una resistencia natural de las células de estos últimos dos animales. La cepa UES-1 tuvo una tasa de multiplicación e invasión mayor (p=0.001) sugiriendo por lo tanto una virulencia, al menos in vitro superior a la cepa TCR-4.

In vitro growth kinetics of two Trypanosoma cruzi (Kinetoplastida: Trypanosomatidae) clones in myocardial cells from rodents of different susceptibility. Two Trypanosoma cruzi isolates, TCR-4 from Costa Rica and UES-1 from El Salvador, were studied in vitro to compare their infectivity or resistance and intracellular replication in myocardial cells in three strains of mice and rats: NGP white mice, C3 H mice and Sprague Dowley rats. Myocardial cells were cultured on coverslips at 37 º C in a humid 10 % CO2 atmosphere and then infected at a ratio of one tripomastigote per cell. Samples were studied after 24, 72, 96 and 120 h of infection to determine parasite infection capacity and intracellular multiplication. Both parasites had the highest infection capacity in C3 H mice, followed by NGP mice cells with a very low infection rate. Lastly, almost no Trypanosoma cruzi multiplication was observed in Sprague Dowley rats, suggesting a strong natural resistance in this animal to both strains of the parasite. The UES-1 isolate presented higher multiplication and greater invasion than the TCR-4 strain, showing greater virulence of UES-1 in heart cells, at least in vitro. Rev. Biol. Trop. 55 (1): 121-126. Epub 2007 March. 31.

Background: The epidemic of cardiovascular diseases in Chile, requires the development of strategies in health promotion and prevention. Aim: To assess the prevalence of risk factors for chronic non communicable diseases among workers of a financial company in Metropolitan Santiago. Material and Methods: Assessment of 2,225 workers (1,383 males with a median age of 49 years and 842 females with a median age of 43 years). All answered an enquiry about education, medical history, smoking habits and physical activity. Body mass index and blood pressure were measured and a blood sample was obtained to measure blood glucose and lipid levels. Logistic repression models were used to determine the main risk factors for hypertension, diabetes, obesity, hypercholesterolemia and hyperuricemia. Results: Sixteen percent of studied subjects were obese, 49% had overweight, 57% had hypercholesterolemia, 28% had high blood pressure, 4% were diabetic, 4% had hyperuricemia, 45% smoked and 83% were sedentary. Each worker had a mean of 2.4±1.1 risk factors. This figure was significantly higher among men, obese subjects, those older than 40 years and those with a lower educational level. Conclusions: There is an important disease burden among the studied subjects, specially among obese and older individuals. Healthy lifestyles should be promoted in this population

Cardiovascular diseases are the main causes of death in Chile and there is a high prevalence of cardiovascular risk factors in the population. Aim: To assess the prevalence of those risk factors in a group of employees. Subjects and methods: We studied 2,219 individuals, 1,378 males with a mean age of 46.2±10.4 years and 841 females with a median age of 41.9±10.3 years. Results: High blood pressure was observed in 39.7% of men and in 21.8% of women. A serum cholesterol between 200 and 239 mg/dl was observed in 38% of men and 31.3% of women. A cholesterol over this value was seen in 23.7% of men and 18.8% of women. A low proportion of those with high blood pressure, or elevated cholesterol, were under treatment. Prevalence of smoking was high in men and women: 43.5 and 48.9.2%, respectively. Eighty four percent of men and 61.3% of women over 54 years were overweight or obese. The prevalence of diabetes mellitus was 4.5%. Twenty percent of men and 13% of women exercised regularly, at least 3 times a week. Conclusions: There is a high prevalence of untreated cardiovascular risk factors in this population (Rev Méd Chile 2003; 131: 129-34)

In the ancient world, the heroism was understood as the personification of human excellence. Ayax, the tragedy written by Sofocles, deal whit the problems the son of the king of Salamina have to face. Ayax as a character, is after Aquiles the best hero being present in Troya. When Aquiles died, Ayax is prompt to receive the heraldic weapons from the dead hero. However these coat of arms were given to Oydisseo, causing madness in the prince of Salamina, and his death aftermath.

En el mundo antiguo, la heroicidad fue entendida como personificación de la excelencia humana. Ayax de Sófocles trata acerca del hijo del rey de Salamina. Como personaje Ayax es después de Aquiles, el mejor de los héroes que concurrió a Troya. Cuando Aquiles ha desaparecido, bien podía esperar Ayax que le adjudicaran las armas del héroe muerto. Sin embargo, dichas armas fueron dadas a Odiseo, causando la locura del príncipe de Salamina y luego, su muerte.

The mith of Andrómaca is essential in classical antiquity. It is Homer who first creates a literary vision of this myth. In his perspective, Homer depicys Andrómaca as a paradigm of maternal love and conjugal fauthfulness characteristic of her class. Centuries later Jean Racine re-interprets the calssical mork of Andrómacain the context of seventeenth century Paris as he confers the mythical figure traits of his own invention. This essay depicts the way wich the classical work Andrómaca is interpreted by Racine in the context of XVII th. century Paris. As is a essencial myth in classical literature and such is reinvented by Racine.

El mito de Andrómaca es esencial en la Antigüedad Clásica. Es Homero quien primero hace una visión literaria de este mito. En su perspectiva, Homero nos muestra a Andrómaca como paradigma del amor maternal y como símbolo de las ideas de su clase social. Siglos más tarde, Jean Racine reinterpreta la figura de Andrómaca en el contexto de su tiempo, es decir, del siglo XVII. Este ensayo, pretende seguir el camino que hace Racine frente al mito de Andrómaca, y cómo el autor francés reinventa este clásico mito de la literatura del mundo clásico.

Se hace un análisis general de la literatura y del trabajo de los autores sobre microsporidiosis, una parasitosis que se ha puesto en boga a raíz de los problemas de inmunosupresión, especialmente en personas infectadas con el virus del SIDA. Se hace una revisión histórica, se describe básicamente la morfología de los géneros más importantes de los microsporidios y se comentan algunos aspectos de la epidemiología. Se revisan los cambios patológicos debidos a la infección con estos parásitos, los métodos de diagnóstico más usados, el tratamiento y la prevención contra esta parasitosis. Se enfatiza sobre el hallazgo por primera vez en Costa Rica y probablemente en Centro América, de casos humanos de infección con Enterocytozoon bieneusi y con el género Nosema.

Microsporidiosis is a recent and important disease related particularly specially with problems of immunosuppression as is the case in AIDS. The authors mention several studies related with this parasitosis, especially the presentation, for the first time in Costa Rica and probably in Central America, of Enterocytozoon bieneusi or Nosema infestation in human. Some data dealing with the history of this parasitosis are mentioned, and the morphology of the known genera and species is briefly described. Notes on the epidemiology and transmissión of these organisms, as well as the pathology produced by microsporidial infection are also presented. The more relevant and useful diagnostic methods, and the known treatment and prevention measures are indicated.