Abstract Background: Chlamydia trachomatis is recognized as the causative agent of one of the most common and curable sexually transmitted infections (STIs). In women, it can be a trigger for pelvic inflammatory disease, a risk factor for infertility or acquisition of other STIs. Aim: To determine CT in women with vaginitis and associate it with sociodemographic, sexual, clinical, and vaginal microbiota factors. Methods: 121 female volunteers > 18 years of age, with a clinical diagnosis of vaginitis and abnormal vaginal discharge, attending in primary health care services (PHC) in Temuco-Chile were recluted. A vaginal discharge sample was taken, determining C. trachomatis by polymerase chain reaction and vaginal microbiota by Gram stain. Clinical, sociodemographic and sexual data were collected by survey. Results: Age range was 18-61 years. The frequency of C. trachomatis was 14.9%. C. trachomatis was associated with a higher number of sexual partners in the last 5 years (p = 0.001), oral plus anal sex (p = 0.055) and sex toys (p = 0.027); there was a non-significant association with bacterial vaginosis 31.2% (p = 0.091) and initiation of sexual activity < 18 years 20.6% (p = 0.07). Conclusions: It would be beneficial to incorporate in the gynecological semiology of the women attended in PHC services, the factors found to favor C. trachomatis infection, as this could help the management of this STI.

Resumen Introducción: Chlamydia trachomatis es reconocida como el agente causal de una de las infecciones de transmisión sexual (ITS) más común y curable. En mujeres, puede ser gatillante de enfermedad inflamatoria pélvica, un factor de riesgo para infertilidad o adquisición de otras ITS. Objetivo: Determinar C. trachomatis en mujeres con diagnóstico clínico de vaginitis asociando factores sociodemográficos, sexuales, clínicos y microbiota vaginal. Pacientes y Métodos: Participaron 121 mujeres voluntarias > 18 años, con diagnóstico clínico de vaginitis y descarga vaginal anormal, atendidas en servicios de atención primaria en salud (APS) en Temuco-Chile. Se tomó muestra de flujo vaginal, determinándose C. trachomatis por una reacción de polimerasa en cadena convencional y microbiota vaginal por tinción de Gram. Se colectaron datos clínicos, sociodemográficos y sexuales mediante encuesta. Resultados: Rango de edad 18-61 años. La frecuencia de C. trachomatis fue 14,9%. Se asoció C. trachomatis a mayor número de parejas sexuales en los últimos 5 años (p = 0,001), relaciones sexuales oral más anal (p = 0,055) y juguetes sexuales (p = 0,027). Asociación no significativa hubo con vaginosis bacteriana 31,2% (p = 0,091) e inicio de la actividad sexual < 18 años 20,6% (p = 0,07). Conclusiones: Sería beneficioso incorporar en la semiología ginecológica de las mujeres atendidas en servicios de APS, los factores encontrados como favorecedores de infección por C. trachomatis, pues ello podría ayudar al manejo de esta ITS.

Resumo Objetivo Determinar a concordância entre o diagnóstico clínico de mulheres com corrimento vaginal anormal (AVD) e os resultados laboratoriais por meio da detecção molecular e observação da microbiota vaginal. Métodos Estudo transversal realizado em 2018 em Temuco, Chile. Participaram 25 parteiras de 12 centros de saúde. Um total de 125 mulheres>18 anos, voluntárias, foramrecrutadas. A amostra do fórnice vaginal posterior foi obtida por especuloscopia. Foram observadas características da secreção e da genitália externa e interna. A coloração de Gram foi usada para observar a microbiota vaginal, blastoconídios e pseudo-hifas, e a reação em cadeia da polimerase foi usada para a detecção de Trichomonas vaginalis e Candida albicans. O coeficiente kappa de Cohen foi usado na análise de concordância. Resultados De um total de 125 mulheres com AVD, 85,6% consultaram espontaneamente e 14,4% foram diagnosticados clinicamente durante um check-up de rotina. A concordância absoluta foi significativa (p=0,0012), com concordância de 13,6%. A concordância relativa foi significativa, mas razoável para vaginose bacteriana (Kappa =0,21; p=0,003) e candidíase (Kappa=0,22; p=0,001), e leve para tricomoníase (Kappa=0,14; p=0,009). O percentual de coincidência dos diagnósticos (solteiros ou mistos) por laboratório e parteiras foi: vaginose bacteriana 63,2% (12/19), candidíase 36,5% (27/74) e tricomoníase 12,5% (4/32). Houve 20% de coinfecção. Umtotal de 36% dos diagnósticos clínicos de AVD tiveram exames laboratoriais negativos. Conclusão As condições de vulvovaginite candidíase e tricomoníase parecem ser sobrediagnosticadas, e a vaginose bacteriana parece ser subdiagnosticada pelo diagnóstico clínico quando comparado com o diagnóstico laboratorial. A baixa concordância obtida mostra a importância de complementar o diagnóstico clínico comestudo laboratorial de AVD, principalmente emmulheres com falha de tratamento e / ou coinfecções com sinais e sintomas inespecíficos e variáveis.

Abstract Objective To determine the concordance between the clinical diagnosis of women with abnormal vaginal discharge (AVD) and laboratory results using molecular detection and observation of the vaginal microbiota. Methods Cross-sectional study conducted in 2018 in Temuco, Chile. A total of 25 midwives from 12 health centers participated. A total of 125 women>18 years old, volunteers, were recruited. The sample of the posterior vaginal fornix was obtained by speculoscopy. Characteristics of the discharge and of the external and internal genitalia were observed. Gram staining was used to observe vaginal microbiota, blastoconidia and pseudohyphae, and polymerase chain reaction was used for the detection of Trichomonas vaginalis and Candida albicans. The Cohen kappa coefficient was used in the concordance analysis. Results Out of a total of 125 women with AVD, 85.6% consulted spontaneously and 14.4% were diagnosed clinically during a routine check-up. Absolute concordance was significant (p=0.0012), with an agreement of 13.6%. The relative concordance was significant, but fair for bacterial vaginosis (Kappa=0.21; p=0.003) and candidiasis (Kappa=0.22; p=0.001), and slight for trichomoniasis (Kappa=0.14; p=0.009). The percentage of coincidence of the diagnoses (single or mixed) by laboratory and midwives was: bacterial vaginosis 63.2% (12/19), candidiasis 36.5% (27/74), and trichomoniasis 12.5% (4/32). There was 20% coinfection. A total of 36% of the clinical diagnoses of AVD had negative laboratory tests. Conclusion The vulvovaginitis conditions candidiasis and trichomoniasis appear to be overdiagnosed, and bacterial vaginosis appears to be underdiagnosed by the clinical diagnosis when compared with the laboratory diagnosis. The low concordance obtained shows the importance of complementing the clinical diagnosis with a laboratory study of AVD, particularly in women with failed treatments and/or coinfections with unspecific and varying signs and symptoms.

Background: The early onset of sexual activity can promote the development of cervical alterations and sexually transmitted infections, especially the human papillomavirus (HPV) very common in adolescents and young people. Aim: The condition of the cervix, HPV and sexual behavior in young women under 25 years of age were analyzed. Methods: 182 university students, healthy, sexually active, 18-24 years old, without vaccine for HPV participated. Papanicolaou (Pap) test and classification of high and low risk HPV (HR and LR) were performed by real time polymerase chain reaction. The sexual behaviors were consulted in private. Results: The 46.9% of Pap presented cytological alterations, non-specific inflammation/hemorrhagic (29.4%) and atypical smear (10.2%) being de most frequent. The overall frequency of HPV-HR was 24.3%, of these 67.4% presented an altered Pap. There was an association between cytological alterations and HPV (p < 0.0001) and years of sexual activity and atypical smear or cervical intraepithelial neoplasia grade I (CIN I) (p = 0.009). 11.9% of young women (21/177) presented atypical smear or CIN I, with 66.7% of cases HPV-HR. Conclusions: These findings alert the vulnerability of these young women who would have a potential risk of viral persistence, CIN and eventually cancer. It is important to emphasize counseling and prevention prior to the regular age of admission to the screening program for cervical cancer. This study was financed by the Universidad de La Frontera through Projects DI15-0047 and DI17-0123.

Resumen Introducción: El inicio precoz de actividad sexual puede favorecer el desarrollo de alteraciones cervicales y de infecciones de transmisión sexual, en especial del virus papiloma humano (VPH) muy frecuente en adolescentes y jóvenes. Objetivo: Analizar el estado del cuello uterino, presencia del VPH y conductas sexuales en mujeres menores de 25 años. Material y Métodos: Participaron 182 estudiantes universitarias de 18-24 años, sanas, sexualmente activas y no vacunadas para VPH. Se realizó Papanicolaou (Pap) y clasificación del VPH en alto y bajo riesgo (AR y BR) mediante reacción de polimerasa en cadena en tiempo real. Las conductas sexuales fueron consultadas privadamente. Resultados: El 46,9% de los Pap presentaron alteraciones citológicas (inflamación inespecífica/hemorrágico: 29,4% y frotis atípicos (FA):10,2%). La frecuencia de los VPH-AR fue 24,3%; de éstos, 67,4% presentó un Pap alterado. Hubo asociación entre alteraciones citológicas y presencia de VPH (p < 0,0001) y años de actividad sexual y FA o neoplasia intraepitelial grado I (NIE I) (p = 0,009). El 11,9% de las jóvenes estudiadas (21/177) presentó FA o NIE I, con 66,7% de casos VPH-AR. Conclusiones: Estos hallazgos alertan la vulnerabilidad de estas jóvenes que tendrían un riesgo potencial de persistencia viral, NIE y eventualmente cáncer. Es importante enfatizar consejería y prevención previo a la edad normada de ingreso al programa de cribado para cáncer cérvico uterino en Chile.

Background: Human papilloma virus (HPV) and Chlamydia trachomatis are the most prevalent sexually transmitted infections (STIs), among teenagers and young people, with risk factors: active sex life and multiple partners. Chlamydia trachomatis infection may favor HPV infection and this, the development of cervical cancer. Both infections can lead to consequences on sexual and reproductive health. Objective: To determine frequency of HPV and C. trachomatis in asymptomatic university women less than 25 years, associating them with number of sexual partners (n°SxP) and time of sexual activity (TSxA). Material andMethods: 151 cervical samples for HPV and C. trachomatis, were processed by conventional and in real time reaction polymerase chain. Results: HPV 21, 8%, C. trachomatis 11, 2% and co-infection (HPV/C.trachomatis), 4.6%. Aimong HPV +, 80, 6% showed high risk HPV. The n°SxP was strongly associated with HPV. Aimong young coinfected HPV/C. trachomatis, 71.4% had 3 or more PSx. Chlamydia trachomatis was more frequent (64,7%) that HPV within range of 3-5 years according to the TSxA, Discussion: A high prevalence of HPV and C. trachomatis was observed. Young women with coinfection HPV/C. trachomatis could be a high-risk group need to monitor their infections. It suggests the implementation of university programs in education, counseling and prevention in sexual health.

Introducción: El virus papiloma humano (VPH) y Chlamydia trachomatis son las infecciones de transmisión sexual (ITS) más frecuentes, en adolescentes y jóvenes, con factores de riesgo: vida sexual activa y múltiples parejas. Chlamydia trachomatis puede favorecer el ingreso de VPH y éste el desarrollo del cáncer cérvico uterino. Ambas infecciones pueden dejar secuelas en la salud sexual y reproductiva. Objetivo: Determinar frecuencias VPH y C trachomatis en estudiantes universitarias asinto-máticas bajo 25 años, asociándolas con número de parejas sexuales (n°PSx) y tiempo de actividad sexual (TASx). Material y Método: Se procesaron 151 muestras/exo y endo cervicales para VPH y C. trachomatis, mediante reacción de polimerasa en cadena convencional y en tiempo real. Resultados: La frecuencia fue: VPH 21,8%, C. trachomatis 11,2% y co-infección 4,6%. De las jóvenes con infección por VPH, 80,6% presentó VPH alto riesgo oncogénico. El n°PSx se asoció fuertemente a VPH. Entre las jóvenes con co-infección VPH/C. trachomatis, 71,4% tenían tres o más PSx. Según TASx, C. trachomatis fue más frecuente (64,7%) entre 3-5 años que VPH. Conclusión: Se observó alta prevalencia de VPH y C trachomatis. Mujeres jóvenes con co-infección VPH/C. trachomatis podrían ser un grupo de alto riesgo con necesidad de mo-nitorear sus infecciones. Es sugerida la implementación de programas universitarios en educación, orientación y prevención en ITS.

Background: In Chile, cervical cancer (CC) is the second leading cause of death from malignancy in women. The main causal agent of cervical cancer is the human papillomavirus (HPV). This virus is the most common sexually transmitted infection among sexually active youth. An early onset of sexual life increases the chances of HPV infection; this may involve a possible early development of cervical intraepithelial neoplasia and CC, creating a major public health problem. Objective: To present HPV frequency in women under the age of 25, treated in the CC screening program and their follow-up after histopathological diagnosis. Methods: 173 cervical samples were genotyped by polymerase chain reaction and non-radioactive reverse hybridization (line blot). Results: The overall frequency of HPV was 84.8%. HPV16 was the most prevalent. In 12.1% of women the cervical lesion persisted or progressed. 28.9% of women had irregular follow-up; in this group, 88% were HPV(+) and 52% had no record of Pap smear in the past 3 years. Discussion: The results reaffirm the usefulness of complementing the Pap and HPV detection as a primary screening tool in sexually active women. They also suggest the possibility of extending the age coverage of the national screening program.

Introducción: En Chile, el cáncer cérvico-uterino (CCU) es la segunda causa de muerte por neoplasias malignas en la mujer. El principal agente causal es el virus papiloma humano (VPH), descrito como la infección de transmisión sexual más frecuente entre jóvenes sexualmente activas. El comienzo precoz de la vida sexual incrementa las posibilidades de infección con VPH; esto puede implicar un eventual desarrollo prematuro de neoplasia intraepitelial cervical y CCU, creando un importante problema de salud pública. Objetivo: Presentar la frecuencia del VPH en mujeres bajo 25 años de edad, participantes del programa de CCU y su seguimiento post-lesión. Material y Métodos: Se genotipificaron 173 muestras cervicales, mediante reacción de polimerasa en cadena e hibridación no radioactiva (reverse line blot). Resultados: La frecuencia global del VPH fue 84,8%. El genotipo más frecuente fue VPH16. En 12,3% la lesión cervical persistió o evolucionó a una mayor. Se encontró 28,9% de mujeres con seguimiento post-lesión irregular; en este grupo, 88% fue VPH (+) y 52% no tuvo registro de Papanicolaou en los últimos tres años. Discusión: Los resultados obtenidos reafirman la utilidad de complementar el Papanicolaou con detección del VPH como herramienta de tamizaje primario en mujeres sexualmente activas. Además sugieren la posibilidad de ampliar la edad de cobertura del programa de tamizaje.

Introduction: Environmental variability of Echinococcus granulosus (Eg) has been described. 10 genotypes have been reported as well as a certain intergenotype heterogenicity in studies with material of animal origin. The aim of this study is to describe the results of an Eg genotypification protocol in samples of human hydatidosis. Materials and methods: Cross-sectional study. The hydatid fluid was collected from a consecutive sample of patients operated on for hepatic and pulmonary hydatidosis at hospitals in Temuco between July, 2004 and September, 2005. A DNA extraction protocol was designed for Eg in homogenized samples of hydatid cyst aspirate. 2 polymerase chain reaction (PCR) systems were used: PCREg9 and PCREg16; both in concentrations of 2mM MgCl2. For PCREg9, Eg9F and Eg9R primers were used at concentrations of 0.5 mM, using 35 cycles with a hybridization temperature of 60°C. For PCREg16 Eg16F and Eg16R primers were used at concentrations of 0.5 mM, using 35 cycles with a hybridization temperature of 65°C. The PCR products were absorbed with a restriction enzyme (Rsa1) in order to distinguish the genotypes. Results: 25 samples were analyzed, 4 from pulmonary cysts and 21 from hepatic cysts. Eg amplification was achieved in 22 of the 25 samples (88%). The enzymatic digestion revealed the presence of 3 possible genotypes: in 21 of 22 samples (95.45%) a restriction pattern was observed corresponding to the G1 or G7 genotypes, and the remaining samples to the G4 or G7 genotypes. Conclusion: With the PCR systems used, Eg DNA was detected

Introducción: Se ha descrito variabilidad ambiental de Echinococcus granulosus (Eg). Se han reportado 10 genotipos y cierta heterogenicidad intergenotipo en estudios con material proveniente de animales. El objetivo de este estudio es describir los resultados de un protocolo de genotipificación de Eg en muestras de hidatidosis humana. Material y método: Estudio de corte transversal. Se recolectó el líquido hidatídico de una muestra consecutiva de pacientes intervenidos quirúrgicamente por hidatidosis hepática y pulmonar en hospitales de Temuco entre julio de 2004 y septiembre de 2005. Se diseñó un protocolo de extracción de ADN para Eg en muestras homogeneizadas de aspirado de quistes hidatídicos. Se emplearon 2 sistemas de reacción de polimerasa en cadena (PCR): PCREg9 y PCREg16; ambos en concentraciones de MgCl2 al 2mM. Para PCREg9, se utilizaron los primers Eg9F y Eg9R a concentraciones de 0.5 mM, empleándose 35 ciclos con temperatura de hibridación a 60°C. Para PCREg16 se utilizaron los primers Eg16F y Eg16R a concentraciones de 0,5 mM, empleándose 35 ciclos con temperatura de hibridación a 65°C. Los productos de las PCR fueron digeridos con una enzima de restricción (Rsa1) para la discriminación de los genotipos. Resultados: Se analizaron 25 muestras, 4 provenientes de quistes pulmonares y 21 de quistes hepáticos. Se logró amplificación de Eg en 22 de 25 muestras (88%). La digestión enzimática reveló la presencia de 3 genotipos posibles: en 21 de 22 muestras (95,45%) se observó un patrón de restricción correspondiente a los genotipos G1 ó G7 y en la muestra restante a los genotipos G4 ó G7. Conclusión: Con los sistemas de PCR empleados se detectó ADN de Eg

Background:Promoter genomic DNA methylation is an important inactivation mechanism of tumor suppressor genes. This genetic-molecular pathway for cancer may separate a subset of patients with different prognoses and eventually different responses to specific therapies. Aim: To analyze the methylation pattern of important genes related to different carcinogenic mechanisms in patients with gastric cancer (GC) and the relationship with its morphological features and biological behavior. Material and methods: Forty-seven fresh-frozen GC samples were selected. The methylation-specific PCR (MSP) test was used to analyze promoter methylation status for genes MLH1, CDKN2A (p16), APC, CDH1 (Cadherin E) and FHIT. Follow-up and complete morphological features were obtained for all cases. Results: We found methylation in at least one of the genes studied in 83% of the cases. The frequencies of promoter hypermethylation of MLH1, CDKN2A, APC, CDH1 and FHIT were 31%, 43%, 46%, 80% y 62%, respectively. We found a relationship between APC methylation and good histological differentiation (p=0.03); CDH1 methylation with diffuse type by Lauren and 3 or more metastasic lymph nodes (p <0.05); FHIT, CDKN2A and CDH1 methylation and female condition (p <0.04). We also found a non-significant relationship between CDKN2A methylation and better survival (p=0.07). Conclusions: The high frequency promoter methylation found confirms its importance in gastric carcinogenesis. The finding of alterations in the methylation pattern of genes studied and its association with prognostic factors is a helpful tool in the search for new criteria in clinical and therapeutic decision making

The most frequent cytogenetic aberration in the chronic myeloid leukemia (CML) is the Philadelphia chromosome, which is produced by the translocation t(9;22), molecular expression of BCR-ABL fusion gene, encodes a protein tyrosine kinase activity. Two different fusion proteins are produced depending on the breakpoint 210-kD (p210) and 190-kD (p190). The detection of this gene in the CML has diagnostic importance. Our goal was to detect fusion transcripts in patients with CML from the IX region of Chile. We studied 14 samples of blood from 11 patients with CML. Two of these patients were treated with Gleevec. The BCR-ABL gene was detected by reverse transcriptase polymerase chain reaction (RT-PCR). We found p210 fusion transcripts in 9/14 samples and p210 and p190 co-expression in 5/14. In two patients with Gleevec treatment, disappeared p190 transcript and remained p210 transcript. Our results reaffirm the importance of BCR-ABL fusion transcripts detection for diagnostic and following CML treatment

La anormalidad citogenética más común en la leucemia mieloide crónica (LMC) es el cromosoma Philadelphia, producida por la t(9;22), cuya expresión molecular es el gen de fusión BCR-ABL, que codifica proteínas con actividad tirosinquinasa. Según el punto de ruptura de los genes BCR o ABL se produce una proteína de fusión de 210-kD(p210) o 190-kD(p190). La presencia de este gen de fusión en pacientes con LMC tiene implicancia diagnóstica. Con el propósito de detectar transcriptos de fusión del gen BCR/ABL en pacientes con leucemia mieloide crónica, procedentes de la IX Región de Chile, se estudiaron 14 muestras de sangre de 11 pacientes con LMC. A 2 de ellos, se les realizó seguimiento durante su tratamiento con Gleevec. Se aplicó la técnica de reacción en cadena de la polimerasa con transcriptasa reversa (RT-PCR), usando una PCR en nido. Para la detección de los transcriptos de fusión p210 y p190 del gen BCR/ABL, se utilizaron 4 pares de iniciadores. En 9/14 muestras se detectó el transcripto de fusión p210 y en 5/14 los transcriptos de fusión p210 y p190. En los 2 pacientes en seguimiento, hubo desaparición del transcripto p190, permaneciendo el transcripto p210. Estos resultados reafirman la importancia de detectar transcriptos de fusión BCR/ABL para el diagnóstico y seguimiento durante el tratamiento de la LMC

Background: Gallbladder cancer frequency and mortality renders it one of the most important neoplastic diseases in Chile. P53 tumor suppressor gene has been studied in most types of cancer, but there is scarce information about it in gallbladder cancer. Aim: To study the frequency of P53 gene mutation in gallbladder cancer in the ninth region of Chile. Material and methods: In 25 pathological samples of gallbladder cancer, the direct amplification and sequencing of p53 gene exons 5,6,7,8-8 was possible. Results: Seventeen punctual mutations were observed in 13 cases (52%). There were 10 transitions, 5 transversions, one insertion (codon 194) and one deletion (codon 186). Eight cases had mutations in exon 5, six had mutations in exon 6, two had mutations in exon 7 and one had mutations in exons 8-9. In 14 of 25 cases, gene p53 protein was positive. When immunohistochemical expression of gene p53 protein was positive in more than 20% of cells, there was a high correlation between genetic alterations and immunohistochemical expression of the protein, with a specificity, sensitivity, positive and negative predictive values over 80%. Conclusions: P53 gene mutation is observed in a high proportion of gallbladder cancers at it can be accurately detected with conventional immunohistochemical techniques. The importance of this gene in the genesis of this carcinoma should be determined studying preneoplastic lesions and early carcinomas