Abstract Introduction: Persistent Postural Perceptual Dizziness (PPPD) is one of the most common causes of chronic vertigo. While patients with PPPD have spatial perception alterations, it is unknown whether they present alterations in fear of heights. To avoid exposing patients with PPPD to high places, we aimed to use virtual reality to quantify fear of heights. Aim: To quantify fear of heights in patients with PPPD and controls using simulated environments with virtual reality. Material and Method: A prospective cross-sectional study of age- and sex-matched case-control pairs. PPPD patients were recruited from the Otolaryngology Service of the Clinical Hospital of the University of Chile between 2020 and 2021. Presence of subjective fear and tachycardia were measured. The scenarios were developed using Blender 2.8 and Oculus Link for the Oculus Quest. Five scenarios at different heights (floors 1, 3, 6, 12, 19) were used. Results: Twenty subjects were recruited (12 women, average age of 47 years), including 10 PPPD patients and 10 controls without vestibular symptoms. None of the control group subjects presented fear in the presented scenarios, while seven patients in the PPPD group had subjective fear at a height lower than virtual 40 meters (Fischer, p < 0.05). Conclusion: Patients with PPPD present a greater proportion of subjective fear to heights than controls, but further studies are required to determine if this fear is specific to PPPD or is general to other causes of chronic vertigo.

Resumen Introducción: El mareo postural perceptual persistente (MPPP) es una de las causas más frecuentes de vértigo crónico. Si bien, los pacientes con MPPP tienen alteraciones de la percepción espacial, se desconoce si presentan alteraciones en el miedo a las alturas. Para no exponer a pacientes con MPPP a ambientes reales con altura, nos propusimos utilizar la realidad virtual para estudiar el miedo a las alturas. Objetivo: Cuantificar el miedo a las alturas en pacientes con MPPP y controles mediante ambientes simulados con realidad virtual. Material y Método: Estudio transversal, prospectivo de casos y controles pareados por edad y sexo. Se reclutaron pacientes con MPPP del Servicio de Otorrinolaringología del Hospital Clínico de la Universidad de Chile entre los años 2020 y 2021. Se midió presencia subjetiva de miedo y taquicardia. Los escenarios se desarrollaron con el programa Blender 2.8 y Oculus Link para equipo Oculus Quest. Se utilizaron cinco escenarios a diferentes alturas (pisos 1, 3, 6, 12, 19). Resultados: Se reclutaron 20 sujetos (12 mujeres, 47 años en promedio), incluyendo 10 pacientes con MPPP y 10 controles sin síntomas vestibulares. Ningún sujeto del grupo control presentó miedo en los escenarios presentados, mientras que siete pacientes del grupo MPPP tuvieron miedo subjetivo a una altura menor a 40 metros virtuales (Fischer, p < 0,05). Conclusión: Los pacientes con MPPP presentan, con mayor frecuencia, miedo subjetivo a las alturas que los controles, pero se requiere de nuevos estudios para determinar si este miedo es específico de MPPP, o es general a otras causas de vértigo crónico.

Introduction: The most common extramuscular manifestation of the idiopathic inflammatory myopathies (IIM) is interstitial lung disease (ILD) and the diagnosis is based on serum autoantibodies. The new specific and associated antibodies to IIM have helped to identify new clinical entities in the spectrum of IIM. The objective of this study is to evaluate the diagnostic contribution of a myositis antibodies panel (MP) in a cohort of Chilean patients with ILD without a definitive connective tissue disease (CTD). Materials and Methods: Starting on January 2017 we performed a MP to 111 consecutive patients with ILD and suspected CTD but without a definitive diagnosis through another diagnostic tools in the Lung-Rheumatological Program at the “Instituto Nacional del Tórax”, Santiago, Chile. The clinical and serological baseline characteristics of the patients that were most frequently associated with the probability of having a positive panel were compared. Results: The MP was positive in 56 of 111 patients. Anti synthetase syndrome (ASS) was the most prevalent diagnosis. The most frequent antibodies were Ro-52, PM/Scl-75 and Ku. The most frequent variables in the positive MP group were the presence of Raynaud’s phenomenon, myositis, mechanic’s hands, positive Ro and La antibodies and the presence of combined pattern of nonspecific interstitial pneumonia and organizing pneumonia in chest computed tomography scan. Conclusions: The incorporation of the MP has helped us to improve our diagnostic precision of patients with CTD/ILD. We present clinical and serological elements that refine the performance of the test.

Resumen Introducción: La manifestación extramuscular de las miopatías inflamatorias idiopáticas (MII) es la enfermedad pulmonar intersticial (EPI) y el diagnóstico se basa en autoanticuerpos séricos. Los nuevos anticuerpos específicos y asociados a MII han ayudado a identificar nuevas entidades clínicas en el espectro de MII. El objetivo de este estudio es evaluar la contribución diagnóstica de un panel de anticuerpos de miositis (PM) en una cohorte de pacientes chilenos con EPI sin una enfermedad del tejido conectivo (ETC) definitiva. Materiales y Métodos: A partir de enero de 2017 se realizó un panel de miositis a 111 pacientes consecutivos con EPI y sospecha de ETC, pero sin un diagnóstico definitivo a través de otra herramienta diagnóstica, en el programa de Pulmón-Reumatológico del Instituto Nacional del Tórax, Santiago, Chile. Se compararon las características basales clínicas y serológicas de los pacientes que se asociaban más frecuentemente a la probabilidad de tener un panel positivo. Resultados: El PM fue positivo en 56 de 111 pacientes. El síndrome antisintetasa (SAS) fue el diagnóstico más frecuente. Los anticuerpos más frecuentes fueron Ro-52, PM / Scl-75 y Ku. Las variables más frecuentes en el grupo PM(+) fueron la presencia del Raynaud, miositis, manos de mecánico, los anticuerpos Ro y La positivos, la presencia de un patrón combinado de neumonía intersticial inespecífica y neumonía organizada en la tomografía computarizada de tórax. Conclusiones: la incorporación del PM nos ha ayudado a mejorar nuestra precisión diagnóstica en pacientes con EPI / ETC. Presentamos elementos clínicos y serológicos que perfeccionan el rendimiento de la prueba.

Giant cell arteritis (GCA) is a primary granulomatous systemic vasculitis involving the aorta and its main branches that affects people aged over 50 years with a genetic predisposition. Its main phenotypes are cranial and extracranial involvement, with or without symptoms of polymyalgia rheumatica. These phenotypes can overlap. The extracranial form can be oligosymptomatic and must be sought directly. The main complications of the disease are ischemia of essential territories such as the optic nerve or cerebral circulation, and aneurysmal dilations of the aorta and its large branches. Clinicians must be aware of all the presentation forms of the disease, to start a timely treatment and avoid potentially serious or fatal consequences. To date, the diagnosis of GCA is based on clinical and pathological criteria, with the temporal artery biopsy as the “gold standard” for diagnosis, although its sensitivity is variable. This can lead to an underdiagnosis in patients with negative biopsies or predominant extra-cranial symptoms. The emergence of new and valuable imaging tools substantially improved the timely diagnosis, mainly in subclinical and oligosymptomatic forms. Among them we highlight ultrasonography of the temporal and axillary arteries, Computed Tomography Angiography, Magnetic Resonance Angiography, and PET-CT. These imaging techniques are complementary, and their use is highly recommended. GCA treatment is based on steroidal therapy, often associated with a corticosteroid-sparing immunosuppressive agent. The follow-up is eminently clinical.

Connective Tissue Diseases (CTD) comprise a heterogeneous group of multisystemic pathologies of autoimmune origin. Interstitial lung disease (ILD) associated with CTD (CTD-ILD) is common and and it worsens the prognosis of CTD. CTD-ILD represent approximately 15-30% of the universe of ILD and have the same histopathological and radiological forms described for idiopathic ILD. This highlights the importance of routinely incorporate a rheumatologist into the multidisciplinary committee for the diagnosis and management of ILD.

Resumen Las Enfermedades del Tejido Conectivo (ETC) comprenden un grupo heterogéneo de patologías multisistémicas de origen autoinmune. La Enfermedad pulmonar intersticial (EPI) asociada a ETC (EPI-ETC) es frecuente y empeora el pronóstico de la ETC. Las EPI-ETC representan aproximadamente 15-30% del total las EPI y se presentan con las mismas formas histopatológicas y radiológicas descritas para las EPI idiopáticas. Esto pone en evidencia la importancia de incorporar en forma rutinaria a reumatología en el comité multidisciplinario para el diagnóstico y manejo de las EPI.

The differential diagnosis of cavitary pulmonary nodules is a great challenge, where the clinical context in addition to the image studies and laboratory tests are part of the key tools to guide the diagnostic process through 4 major etiological groups: infectious, neoplastic, rheumatologic and miscellaneous. We describe a case of a heavy smoker and complicated diabetic patient with cavitary pulmonary nodules, with a clinical context that induces certain etiologies such as infectious and neoplastic, but whose biopsy was compatible with Granulomatosis with polyangiitis (ex Wegener 's granulomatosis), without a clinical exam nor laboratory tests suggesting this finding.

El diagnóstico diferencial de nódulos pulmonares cavitados constituye un gran desafo en el cual, la clínica, la imagenología y los exámenes de laboratorio permiten una orientación etiológica en cutro grandes grupos: infecciosa, neoplásica, reumatológica y miscelánea. Presentamos el caso de una paciente gran fumadora y portadora de una diabetes mellitus descompensada, con nódulos pulmonares cavitados, en la cual el contexto clínico obligaba a plantear ciertas etiologías como las infecciosas y neoplásicas, pero cuya biopsia fue compatible con Granulomatosis con Poliangeítis (ex Granulomatosis de Wegener), sin una clínica ni exámenes de laboratorio concordantes con dicho hallazgo.

RESUMO Escherichia coli é reconhecida como causa freqüente de diarréia em suínos em todo o mundo. O objetivo do presente estudo foi caracterizar fenotipicamente os tipos fimbriais de 349 linhagens de E. coli isoladas de suínos com diarréia, em diferentes faixas etárias, utilizando os testes de microhemaglutinação e soroaglutinação, bem como determinar o perfil de suscetibilidade frente aos principais antimicrobianos utilizados em granjas de suínos. Do total de 159 linhagens de E. coli que não aglutinaram eritrócitos no teste de hemaglutinação manose-resistente (HAMR), 57 (35%) foram positivas para a expressão do antígeno fimbrial F6 no teste de soroaglutinação rápida em placa. Considerando a faixa etária e o fenótipo fimbrial, os sorotipos de E. coli, potencialmente patogênicos mais prevalentes até a terceira semana de idade, foram F5 (K99), F6 (987P), F42 e F41 em, respectivamente, 29%, 23%, 11% e 10% das linhagens. Em leitões com mais de 25 dias, predominaram fimbrias F4 (K88) em 44,6% (58) das linhagens. Os animais foram suscetíveis às cepas contendo F4, durante todas as faixas etárias, mas com maior predominância em idades mais avançadas, acima de 76 dias. Os maiores índices de resistência das linhagens foram observados para oxitetraciclina (84,0%), gentamicina (76,0 %) e amoxicilina (72,0%). Os menores valores de Concentração Inibitória Mínima (CIM) 50 e 90 foram observados para o ceftiofur.

ABSTRACT Escherichia coli is recognized as a frequent cause of diarrhea in swine. The objective of this study was to phenotypically characterize the fimbrial types of 349 E. coli strains isolated from swine with diarrhea, in different age groups, through the microhemagglutination and seroagglutination tests and to determine the susceptibility profile in regard to the more common antimicrobials used on pig farms. Of the 159 strains that not agglutinate eritrocytes in the manose-resistant hemagglutination test (HAMR), 57 (35%) were positive for the expression of the fimbrial antigen F6, in the fast seroagglutination test carried out in plates. Considering the age group and the fimbrial phenotype, the potentially pathogenic serotypes of E. coli more prevalent until the third week of age were: F5 (K99), F6 (987P), F42 and F41 in, respectively, 29%, 23%, 11% and 10% of the strains. In piglets over 21 days old, fimbriae F4 (K88) predominated in 44.6% (58) of the strains. The animals were susceptible to strains containing F4, in all of the age groups, but with more frequency at more advanced ages, above 76 days. The largest resistance indexes were observed for oxytetracycline (84.0%), gentamicin (76.0%) and amoxicilin (72.0%). The smallest CIM 50 and 90 values were observed for ceftiofur.

OBJECTIVE: To describe the clinicopathologic profile of breast disease in Jamaica. METHODS: The Jamaican Breast Disease Study is an ongoing prospective, multidisciplinary investigation of breast disease at the University Hospital of the West Indies (UHWI). The initial phase was a prevalence survey comprising all consenting patients referred to the Surgical Outpatient Department (SOPD) UHWI, for breast disease. Demographic, clinical, radiologic and pathologic information were recorded for each patient and the data for the first three years (2000-2002) were analyzed. RESULTS: A total of 1189 patients was enrolled for the study period (28.8% of all new SOPD patients). The age range was10 to 93 years (mean/SD = 36.5 +/- 16.4 years) with a female : male ratio of 14:1. Most patients (67.8%) presented with a palpable lump and the clinical diagnosis was benign in the majority (70.4%) of patients. Fibroadenoma was the most common benign histologic result (39.4% of all biopsies) followed by non-proliferative (fibrocystic) disease (19.3% of all biopsies). Proliferative disease without atypia, complex fibroadenoma and atypical ductal hyperplasia accounted for 6.9%, 2.6% and 0.4% of biopsies respectively. Overall, 23.4% of biopsies showed malignant histology (10.8% patients); invasive ductal carcinoma accounted for the majority of these cases (69.5%). CONCLUSIONS: The majority of patients with breast disease in Jamaica are young women with clinically benign disease. There was a low prevalence of clinically significant premalignant disease. This is the first study to prospectively describe the clinicopathologic features of breast disease in Jamaica and supports the need for advocating breast cancer screening to facilitate detection of significant premalignant disease and early stages of breast cancer.

OBJETIVO: Describir el perfil clínico-patológico de la enfermedad de mamas en Jamaica. MÉTODOS: El "Estudio jamaicano de la enfermedad de mamas" - que continua realizándose en la actualidad en el Hospital Universitario de West Indies (HUWI) - consiste en una investigación prospectiva y multidisciplinaria de la enfermedad de mamas. La fase inicial fue un estudio de prevalencia que abarcó a todos los pacientes que dieron su consentimiento, y que fueron remitidos al Departamento de Cirugía Ambulatoria (DCA) de HUWI a causa de la enfermedad de mamas. Se registró información demográfica, clínica, radiológica y patológica de cada paciente, así como los datos referidos a los primeros tres años (2000-2002). RESULTADOS: Un total de 1189 pacientes fueron captados para el periodo de estudio (28.8% de todos los pacientes nuevos del DCA). El rango de edad fue de 10 a 93 años (media/SD = 36.5 + / - 16.4 años) con una proporción hembra:varón de 14:1. La mayoría de los pacientes (67.8%) presentó un nódulo palpable y el diagnóstico clínico fue benigno en la mayoría (70.4%) de los pacientes. El fibroadenoma fue el resultado histológico benigno más común (39.4% de todas las biopsias) seguido por la enfermedad (fibrocística) no proliferativa (19.3% de todas las biopsias). La enfermedad proliferativa sin atipia, el fibroadenoma complejo y la hiperplasia ductal atípica representaron el 6.9%, 2.6% y 0.4% de las biopsias respectivamente. En general, el 23.4% de las biopsias mostraron histología maligna (10.8% de los pacientes); el carcinoma ductal invasivo representó la mayoría de estos casos (69.5%). CONCLUSIONES: La mayor parte de los pacientes con la enfermedad de mamas en Jamaica son mujeres jóvenes con enfermedades clínicamente benignas. Hubo una baja prevalencia de enfermedades premalignas clínicamente significativas. Este es el primer estudio dirigido a describir prospectivamente las características clínico-patológicas de la enfermedad de mamas en Jamaica, y respalda la necesidad de abogar por el pesquisaje del cáncer de mamas, a fin de facilitar la detección de enfermedades premalignas significativas y las fases tempranas del cáncer de mamas.

Several scientific publications have reported a progressive shift in the distribution of the histologic subtypes of lung carcinoma in the latter decades of the 20th century, with adenocarcinoma now surpassing squamous cell carcinoma as the most commonly diagnosed morphologic pattern. A 30-year review (1968-1997) of lung cancer cases registered in the Jamaica cancer registry shows a similar trend among males in Kingston and St Andrew with a progressive increase in the documented cases of adenocarcinoma relative to squamous cell carcinoma. Similar changes were not observed in females.

Varias publicaciones científicas han reportado un desplazamiento progresivo en la distribución de los subtipos histológicos del carcinoma pulmonar en las últimas décadas del siglo 20. En las mismas se evidencia que, en el presente, el adenocarcinoma supera al carcinoma celular escamoso como patrón morfológico más comúnmente diagnosticado. Una revisión de 30 años (1968-1997) de casos de cáncer pulmonar registrados en el registro de cáncer de Jamaica, muestra una tendencia similar entre los hombres en Kingston y Saint Andrew, con un aumento progresivo en los casos documentados de adenocarcinoma en relación con el carcinoma celular escamoso. No se observaron cambios similares en las mujeres.