Abstract: The Community Based Rehabilitation (CBR) approach represents a strategy whose purpose is to achieve full social integration and inclu sion of people with disabilities. Considering that communication and human language represent tools of expression of thought, the American Speech, Language and Hearing Association (ASHA) advo cates the development of effective communication promotion, as a human right accessible to all people, considering its inherent dignity. Objective: to analyze speech and language pathologist‘s CBR prac tices in the fifth region of Valparaíso. Method: qualitative research, with a phenomenological approach. A semi-structured interview was conducted followed by a content analysis. Results: speech and Language pathologists carry out actions related to the five CBR key components and also the practice of actions in accord to intersector. Conclusions: The professionals adopt the CBR approach incorporat ing the institutional vision of service in which they are inserted and adopting a profile oriented to transdisciplinary.

Resumen: El enfoque de Rehabilitación Basada en la Comunidad (RBC) repre senta una estrategia cuyo propósito es lograr la plena integración e inclusión de las personas en situación de discapacidad (PsSD) a nivel social. Considerando que la comunicación y el lenguaje humano representan herramientas de expresión del pensamiento, la Asociación Americana de Habla, Lenguaje y Audición (ASHA) insta a promover el desarrollo de una comunicación efectiva como un derecho humano accesible para todas las personas, en consideración de su dignidad inherente. Objetivo: conocer el quehacer de fonoaudiólogos(as) que se desempeñan en el contexto de RBC, en la Quinta Región de Valparaíso. Método: investigación de tipo cualita tiva, con enfoque fenomenológico. Se realizó una entrevista semiestructurada y posteriormente se procedió a realizar un análisis de contenido. Resultados: Los fonoaudiólogos(as) ejecutan acciones atingentes a los cinco pilares de la RBC y se observa la práctica de actos vinculados a la gestión del intersector. Conclusiones: Los pro fesionales adoptan la estrategia RBC incorporada en la visión de la institución en la que se encuentran insertos, adoptando un perfil orientado a la transdisciplina.

ABSTRACT This study was conducted to determine the effects of dietary inclusion with linseed and pumpkin seed meals on growth performance, carcass traits and breast meat fatty acids profile of helmeted guinea fowls. A total of 120 meat-type helmeted guinea fowl females of 12 weeks of age were fed with 0 (T0), 100 (T1) and 200 (T2) g/kg of linseed (LM) and pumpkin seed meals (PSM) for 56 days, in a completely randomized design with 10 replicates per treatment and four birds per replicate. The inclusion up to 200 g/kg of LM and PSM did not affect the livability, initial live weight and feed intake (p>0.05). However, final live weight and feed:gain ratio improved significantly (p<0.05). The T1 increased (p<0.05) the carcass yield and the T2 improved the breast weight and weight and yield of leg. Also, these experimental diets did not affect the carcass weight, breast yield and sensory quality of meat (p>0.05). The oleaginous seeds (LM and PSM) decreased (p<0.05) the mystic, palmitic and octadecanoic acids and the w-6/w-3 ratio, as well as increased the linoleic, a-linolenic, eicosapentanoic and docosahexanoic acids (p<0.05), but did not modify the concentration of monounsaturated fatty acids (p>0.05) and the eicosatrienoic and arachidonic acids in breast meat (p<0.05). It is recommended the inclusion of 100 g/kg of LM and PSM to improve the live weight, weight and yield of the edible portions and the essential fatty acids in breast meat of guinea fowl, without affecting the sensory quality of the meat.

La raza bovina Carora de Venezuela, se originó mediante cruces empíricos entre las razas Criollo Amarillo de Quebrada Arriba y Pardo Suizo, principalmente. Es la raza bovina criolla que más contribuye a la economía ganadera de Venezuela y forma parte de un escaso número de razas locales que son parte de nuestro invaluable patrimonio genético. El conocimiento exhaustivo de sus características genéticas es primordial si se quiere contribuir con su preservación en el tiempo. El presente estudio tuvo como objetivo principal la realización de una caracterización genética de la raza Carora, el estudio de su variabilidad genética, así como de las relaciones genéticas con sus ancestros conocidos. Dado que el criollo Amarillo de Quebrada Arriba ya se extinguió se utilizaron muestras de la raza Criollo Limonero, pariente más cercano de esta y muestras de ejemplares de la raza Pardo Suizo para evaluar la estructura poblacional y fi logenia. Se analizaron 35 muestras de la raza Carora, 20 de la raza Criollo Limonero y 20 de la raza Pardo Suizo, utilizando 10 marcadores microsatélites recomendados por FAO/ISAG, mediante los cuales fue posible estimar variables genético poblacionales, realizar pruebas de equilibrio de Hardy y Weinberg , para detectar la conformación de grupos genéticamente diferenciados. Como resultado se observó que la raza Carora posee una alta variabilidad genética, encontrándose cinco subtipos. Este estudio también evidenció, que la raza Carora a pesar de ser un hibrido producto de dos razas, ha evolucionado y desarrollado una identidad propia.

Cattle Carora breed originated from empirical crossing of cattle breeds Criollo Amarillo de Quebarada Arriba and Brown Swiss. Carora is the creole cattle breed that makes the greatest contribution to local cattle farming economy and it is part of a scarce number of local breeds that form Venezuela’s invaluable genetic patrimony. The exhaustive knowledge of its genetic characteristics is indispensable to contribute to its preservation. Main objective of present study was to undertake a genetic characterization, genetic variability determining and establishing of philogenetic relationships with its known ancestors. Since Criollo Amarillo of Quebrada Arriba is extinct 20 samples of closest relative Criollo Limonero were used among 35 of Carora and 20 Brown Swiss blood samples. 10 DNA molecular markers recommended by FAO/ISAG microsatellites were used to estimate a number of population genetic variables, test for Hardy and Weinberg, and to detect the formation of genetically distinct groups. Results show that the Carora breed possesses a high genetic variability. Five subtypes were observed. It can be concluded that despite of being a hybrid product of at least two races, Carora cattle has evolved and developed a proper identity.

The use of Platelet-rich plasma (PRP) involves a very complex network of molecular effects favoring tissue regeneration, due the presence of multiple mediators and growth factors. There are several communications about its use on the dental implantology field, plastic surgery and orthpedics. Besides, its utility has been suggested on peripheral nerves regeneration after trauma. In this article we present our experience on the use of PRP on acute injury of the respiratory system. We present a clinical series of 8 patients treated with PRP with positive response. Four of them presenting a massive hemoptysis were treated by direct endoscopic instillation of autologous PRP on the site of lesion; an immediate favorable result was obtained in all of them, without recurrence of bleeding on the follow-up period. A fifth case was a HIV seropositive patient with a spontaneous pneumothorax on intersticial pneumonia. He was treated by direct instillation of PRP through a thoracic tube. Full lung reexpansion was achieved within 72 h. Finally two patients with a respiratory fistula and another patient who suffered a traumatic tracheal rupture were treated with PRP endoscopic instillation, all of them with favorable clinical outcome. The use of autologous products as PRP has shown a good performance in all the clinical situations described, proposing it as a potentially very useful technique, particularly when a minimally invasive approach is required.

El uso de plasma rico en plaquetas (PRP) involucra una compleja red de efectos moleculares que favorecerían la regeneración tisular, dada la presencia en él de múltiples mediadores y factores de crecimiento. Se ha comunicado su uso con éxito en implantología odontológica, cirugía plástica y ortopedia como también se ha sugerido su utilidad en la regeneración de nervios periféricos posterior a trauma. No existe difusión acerca de su uso en patología respiratoria. Comunicamos nuestra experiencia en el uso de PRP en daño agudo del aparato respiratorio. En esta serie de casos, se trataron 4 pacientes con hemoptisis masiva mediante preparación de PRP autólogo previo al procedimiento e instilación vía endoscópica en el sitio del defecto, con buen resultado inmediato y sin recidiva del sangrado al seguimiento; 1 caso de neumotórax espontáneo con infiltrados pulmonares con fracaso del manejo con sonda endopleural (SEP), que resultó ser una neumonía intersticial con quistes pulmonares en un paciente VIH sero-positivo, instilándose PRP por SEP, reexpandiendo el pulmón a las 72 h; 2 pacientes portadores de fístula respiratoria y 1 paciente portador de ruptura traqueal traumática, todos con buena respuesta. El uso de productos autólogos como PRP ha logrado un favorable rendimiento en todas las situaciones clínicas planteadas, lo que lo sitúa como una herramienta con notable potencial de desarrollo particularmente en casos que por sus características particulares requieren de un manejo mínimamente invasivo.

Introduction: The splenic aneurysm (AAE) is a rare disease that occurs mainly in women, being mostly asymptomatic until rupture. Clinical case: We report a case of a woman aged 65, previously healthy, who complains of pain in the left upper quadrant, two-month history, performing a CT of the abdomen showing a 4.7 cm AAE without signs of rupture. Aneurysm resection was performed with splenic preservation with no signs of complication.

Introducción: El aneurisma esplénico (AAE) es una enfermedad poco frecuente, que ocurre principalmente en mujeres, siendo en su mayoría asintomático, hasta su ruptura. Caso clínico: Presentamos el caso de una mujer de 65 años, previamente sana, que consulta por dolor en hipocondrio izquierdo, de dos meses de evolución, realizándose una tomografía de abdomen, que muestra un AAE de 4,7 cm sin signos de ruptura. Se realiza resección de aneurisma con preservación esplénica, sin signos de complicación en el postoperatorio. Aunque presenta infartos esplénicos en el control se mantiene asintomática.

Aortic arch abnormalities and vascular rings are a rare cause of compression of trachea and esophagus causing respiratory and digestive symptoms in adults. We report a 64 years old woman with exercise induced asthma not resolving with adequate treatment. Flow/volume loop shape suggested an intrathoracic major airway obstruction. Chest X ray showed a right sided aortic notch and CT scan revealed a vascular ring composed by a right aortic arch with aberrant left subclavian artery and Kommerell's diverticulum compressing trachea and esophagus. Bronchoscopy confirmed posterior wall compression of trachea exacerbated by tachycardia as a cause of symptoms. We think that is important to consider vascular rings as a differential diagnostic entity in difficult to treat asthma.

Las anomalías del arco aórtico y sus ramas son infrecuentes. La presencia de un anillo vascular determina la aparición de sintomatologia relacionada con compresión traqueal o esofágica. El diagnóstico en la edad adulta es extremadamente inusual. Se presenta el caso de una mujer de 64 años con diagnóstico de Asma inducida por ejercicio, refractaria a tratamiento, la cual presentó disnea sibilante en relación al ejercicio, que no cedió con tratamiento bien llevado. La curva flujo-volumen sugirió obstrucción variable de la vía aérea central intratorácica, la radiografía de tórax mostró botón aórtico situado a derecha, la tomografía computada del tórax demostró un anillo vascular formado por un arco aórtico derecho, con la arteria subclavia izquierda aberrante, divertículo de Kommerell comprimiendo el esófago y con la aorta descendente que en su trayecto comprime la pared posterior de la tráquea, lo que es corroborado por videobroncoscopía, describiéndose compresión pulsátil, que se exacerbaba con la taquicardia. Se concluye que la paciente tiene un anillo vascular causante de los síntomas descritos y nos orienta a establecer que en el esquema de estudio de pacientes con asma atípica o de difícil manejo, es necesario incluir las malformaciones del arco aórtico en el diagnóstico diferencial, realizando al menos radiografía de tórax y revisando atentamente la gráfica de la curva flujo-volumen.

Kidney graft loss because arterial thrombosis is not common and is related to risk factors such as recurrent vascular hemodialysis access thrombosis, collagen-vascular disease, repeated miscarriage, diabetes mellitus and thrombophilia. Patients having this last disorder have an increased risk of repeated thrombosis in successive transplants unless they receive anticoagulation therapy. We report a 51 year-old diabetic woman who had a history of recurrent vascular hemodialysis access thrombosis (both native and prosthetic) while on dialysis and received a cadaveric donor kidney. One month after transplantation she had axillary vein thrombosis complicated with pulmonary embolism and received anticoagulants for six months. Just days after stopping the anticoagulation, she became suddenly anuric due to renal artery thrombosis and complete graft infarction. The coagulation study showed moderate hyperhomocysteinemia and a significant protein C deficiency (39%). Days after nephrectomy she suffered a femoral vein thrombosis and anticoagulation was prescribed for life

A 28 years old male on chronic hemodialysis for 40 months due to a IgA crescentic glomerulonephritis developed pancytopenia (hematocrit 16%, white blood cell count 3.800 mm³ and platelets 11.000 mm³. The bone marrow aspirate showed erythropoietic hyperplasia. Hemolytic anemia, folate or vitamin B12 deficiency and paroxysmal nocturnal hemoglobinuria were ruled out. Steroids were given with a transient elevation of red cells and platelets, which lasted only for some weeks. Afterwards, intravenous immunoglobulin was given without benefit. Two months after, a bone marrow biopsy and a bone marrow magnetic resonance imaging showed severe aplasia. Cyclosporine was started with a rapid increase in blood cells count. Eight months later, he received a renal transplant from a cadaveric donor. Immunosupression was achieved with cyclosporine, prednisone and mycofenolate mofetil. The patient required hemodialysis for the first three weeks and a mild acute cellular rejection was treated with methylprednisolone. At discharge, 6 weeks later, serum creatinine was 2.4 mg/dl and creatinine clearance 37.6 ml/min. During the first months after transplant, platelet count and hemoglobin decreased and a bone marrow biopsy showed only mild hypoplasia. Four months after renal transplant the hematocrit was 43%, white blood cell count 6.600 mm³ and platelets, 150.000 mm³ and did not change during the first year of follow up (Rev Méd Chile 2004; 132: 989-94

We report a 22 years old male, admitted to the emergency room due to a life threatening coagulation disorder, with prothrombin times fluctuation between 5 and 37% and very low activity of factors II, VII, IX and X. In the month prior to the admission, the patient had used the rodenticide difethialone, without any precaution to avoid accidental exposure. The patient was maintained with fresh frozen plasma until oral vitamin K1 was obtained. This medication corrected the coagulation disorder. (Rev Méd Chile 2000; 128: 647-9).