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INTRODUCCIÓN: La litiasis urinaria es una patología frecuente, que afecta principalmente a adultos en edad productiva, y que en el último tiempo ha presentado un aumento en la incidencia global. Cerca del 80 % de los cálculos se componen mayoritariamente de calcio. Existe controversia en la literatura sobre el rol que podría tener el consumo de aguas con altos índices de dureza y el riesgo de padecer litiasis. El objetivo de este estudio es identificar una posible asociación entre dureza de agua para consumos e incidencia de litiasis urinaria en la poblacion de Maipú. MATERIALES Y METODOS: Se incluyen en el estudio todos los pacientes atendidos por urólogos en forma ambulatoria electiva en el Hospital El Carmen de Maipú, por diagnóstico de litiasis urinaria, en los años 2015 y 2016, que residen en la comuna. Se georreferenciaron de acuerdo a sus direcciones en los distintos sectores de distribución de agua potable.Se realizó análisis fisicoquímico de muestras de agua extraídas de cada sector para determinar su dureza. Se estudiaron a través del índice de correlación de Pearson las posibles asociaciones entre dureza del agua e incidencia de litiasis. RESULTADOS: La dureza promedio del agua de Maipú es de 484 mg/L de CaCO3, valor que se encuentra por sobre el promedio regional y nacional. La incidencia anual de litiasis en la poblacion estudiada fue de 4,4 casos/10.000 habitantes, valor similar al promedio nacional. El índice de correlación de Pearson entre dureza de agua e incidencia anual fue de -0,51. CONCLUSIONES: No fue posible establecer una relación causal entre dureza de agua e incidencia de litiasis en la población estudiada. Se sugiere avanzar en esta misma línea con estudios futuros de casos y controles.AU

INTRODUCTION: Urinary lithiasis is a frequent pathology, which mainly affects adults in a productive age, and which-in recent times- has increased in terms of global incidence. About 80 % of the stones are composed mainly of calcium.There is controversy in literature addressing the possible relation amongst water consumption with high hardnessindexes and the risk of lithiasis. The objective of this study is to identify a possible association between water hardnessfor consumption and urinary lithiasis incidence in the Maipu population. MATERIALS AND METHODS: All patients assisted by urologists on an elective ambulatory basis, at the El Carmen Hospital in Maipú, diagnosed with urinary lithiasis, in the years 2015 and 2016, and who reside in the Borough have been included in the study. They were georeferenced according to their address in the different drinking water distribution areas. Physiochemical analysis of water samples extracted from each sector was carried out to determine its hardness. The possible associations between hardness of water and incidence of lithiasis were studied through the Pearson correlation index. RESULTS: The average water hardness in Maipu is 484 mg / L of CaCO3, a value that is above the regional and national average. The annual incidence of lithiasis in the studied population was 4.4 cases / 10,000 inhabitants, a value that is similar to the national average. The Pearson correlation index between water hardness and annual incidence was -0.51. CONCLUSIONS: It was not possible to establish a causal relation between water hardness and incidence of lithiasis in the studied population. It is suggested to advance in this same line with future case and control studies.

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Introduction: A number of patients have been studied after undergoing Radical Cystectomy (RC) for bladder cancer, to review prognostic factors and analyze perioperative outcomes. A contemporary benchmark was established for future comparisons. Material and Methods: Retrospective study of 46 patients that underwent RC for bladder cancer between July 2003 and September 2012, assessing demographic characteristics, comorbidities, anesthetic risk and clinical status, interval between transurethral resection (TUR) and cystectomy, operative times, bleeding and transfusions, surgical technique, nutritional management, pathologic findings, hospital stay and complications. Complications were detailed by type and frequency and classified as early (within 30 days) or late. In addition, we used the Clavien-Dindo classification for reporting postoperative complications. Mortality rates at 30, 60 and 90 days after cystectomy were estimated. Results: Average patient age was 70 years (49-88) and mean ASA classification was 2.7. The average between TUR and cystectomy was 68.2 days (median = 57.5 days). Mean operative time for cutaneous ureterostomy was 194 minutes, 320 for ileal conduit and 342 for neobladder. 60.8 percent had pathological stage major than pT2 and 41 percent had nodal involvement. There were 19.5 percent of positive margins. The 23.9 percent had Clavien-Dindo postoperative complications grade 3 or 4. The 90-day global mortality was 17.3 percent. Conclusions: CR was associated with a high morbidity and mortality, which seems to be explained by an advanced stage of the disease and the high presence of poor prognostic factors.

Objetivos: Estudiamos una serie de pacientes sometidos a cistectomía radical (CR) por cáncer vesical para examinar factores pronósticos y analizar los resultados perioperatorios, estableciendo así un punto de referencia para futuras evaluaciones. Material y Método: Estudio retrospectivo de 46 pacientes sometidos a CR por cáncer vesical entre julio de 2003 y septiembre de 2012, evaluando características demográficas, comorbilidades, riesgo anestésico y condición clínica, lapso entre la resección transuretral (RTU) y la cistectomía, tiempos operatorios, sangrado y transfusiones, técnica quirúrgica utilizada, manejo nutricional, resultados anatomopatológicos, estada hospitalaria y complicaciones. Estas últimas fueron detalladas según tipo y frecuencia y catalogadas como precoces (durante los primeros 30 días) o tardías. Además, se utilizó la clasificación de Clavien-Dindo para reportar las complicaciones postoperatorias. Se estimaron las tasas de mortalidad a 30, 60 y 90 días post cistectomía. Resultados: El promedio de edad fue 70 años (49-88) y la media de la clasificación ASA fue 2,7. El promedio entre la RTU y la cistectomía fue 68,2 días. Los tiempos operatorios promedio fueron de 194 min la ureterostomía cutánea, 320 el conducto ileal y 342 la neovejiga. Un 60,8 por ciento tenía un pT > 2 y un 41 por ciento compromiso ganglionar. Hubo 19,5 por ciento de márgenes positivos. Un 23,9 por ciento tuvo complicaciones grado 3 ó 4 según Clavien-Dindo. La mortalidad global a 90 días fue 17,3 por ciento. Conclusiones: la CR se asoció a una elevada morbimortalidad, lo que parece explicarse por un estado avanzado de la enfermedad y por la alta presencia de factores de mal pronóstico.

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Examinar factores pronósticos y analizar la supervivencia en pacientes sometidos a cistectomía radical (CR) por cáncer vesical. MATERIAL Y MÉTODO: estudio de cohortes retrospectivo de 46 pacientes sometidos a CR por cáncer vesical entre julio de 2003 y septiembre de 2012, considerándose como variable dependiente la supervivencia y como variables independientes: las características demográficas, comorbilidades, riesgo anestésico, condición clínica, lapso entre la RTU y la cistectomía, derivación urinaria utilizada, resultados anatomopatológicos y complicaciones postoperatorias. Se analizó la supervivencia mediante Kaplan-Meier, elaborando curvas que fueron comparadas mediante el método de Mantel-Cox. Se efectuó un análisis de supervivencia a 2 años de la cistectomía, mediante regresión logística binaria multivariante. RESULTADOS: La media de la supervivencia global fue 31,8 meses (mediana = 12 meses) y la de la específica 38,2 meses (mediana = 16). La supervivencia global fue mayor en enfermos menores de 70 años, con función renal o albuminemia normales, ASA <3 y en quienes se elaboró una neovejiga. La supervivencia específica fue mayor en los pacientes con estadio tumoral (pT) <3, densidad ganglionar <20 por ciento, margen quirúrgico negativo, sin compromiso ganglionar o masa residual (R0) y en los sometidos a linfadenectomía. Los factores de riesgo para fallecer dentro de los primeros 2 años fueron edad sobre 69 años, ASA >2, pT >2 (OR 25), compromiso ganglionar, metástasis a distancia, masa residual y margen positivo. CONCLUSION: La infiltración local, la afectación ganglionar y una edad mayor a 69 años fueron los tres factores de riesgo más determinantes de un peor pronóstico.

To review prognostic factors and analyze the survival of patients treated with radical cystectomy (RC) for bladder cancer. MATERIALS AND METHODS: Retrospective cohort study of 46 patients underwent RC for bladder cancer between July 2003 and September 2012 was carried out, considering survival as the dependent variable and as independent variables the following: demographic characteristics, comorbidities, anesthetic risk, clinical condition, delay between transurethral resection (TUR) and cystectomy, urinary diversion performed, pathologic findings, and postoperative complications. A survival analysis using the Kaplan-Meier method was performed; as a result curves were obtained and compared using the Mantel-Cox test. A multivariate binary logistic regression was performed, and prognostic factors of survival at 2 years of cystectomy were evaluated. RESULTS: The median overall survival was 31.8 months (median 12 months) and specific overall survival was 38.2 months (median = 16). Overall survival was higher in patients younger than 70 years, with normal renal function and normal albumin, ASA minor than 3 and in those that a neobladder was developed. Specific survival was higher in patients with tumor stage (pT) <3, node density <20 percent, negative surgical margins, without lymph node involvement or residual mass (R0) and in those underwent to lymphadenectomy. Risk factors for death within the first 2 years were: age over 69 years, ASA> 2, pT> 2 (OR 25), nodal involvement, distant metastases, residual mass and positive margins. CONCLUSIONS: Local infiltration, lymph node involvement and age over 69 years were the three most crucial risk factors for a worse prognosis.

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Proteins containing repetitive amino acid domains are widespread in all life forms. In parasitic organisms, proteins containing repeats play important roles such as cell adhesion and invasion and immune evasion. Therefore, extracellular and intracellular parasites are expected to be under different selective pressures regarding the repetitive content in their genomes. Here, we investigated whether there is a bias in the repetitive content found in the predicted proteomes of 6 exclusively extracellular and 17 obligate intracellular protozoan parasites, as well as 4 free-living protists. We also attempted to correlate the results with the distinct ecological niches they occupy and with distinct protein functions. We found that intracellular parasites have higher repetitive content in their proteomes than do extracellular parasites and free-living protists. In intracellular parasites, these repetitive proteins are located mainly at the parasite surface or are secreted and are enriched in amino acids known to be part of N- and O-glycosylation sites. Furthermore, in intracellular parasites, the developmental stages that are able to invade host cells express a higher proportion of proteins with perfect repeats relative to other life cycle stages, and these proteins have molecular functions associated with cell invasion. In contrast, in extracellular parasites, degenerate repetitive motifs are enriched in proteins that are likely to play roles in evading host immune response. Altogether, our results support the hypothesis that both the ability to invade host cells and to escape the host immune response may have shaped the expansion and maintenance of perfect and degenerate repeats in the genomes of intra- and extracellular parasites.

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Schistosoma mansoni is a digenetic trematode and a human parasite responsible for high social and economic impact. Although some authors have studied the effect of host hormones on parasites, not much is known about the effects of host sex on gene expression in Schistosomes. In order to study gene transcripts associated with the host sex, we compared the gene expression profiles of both male and female unisexual adult S. mansoni parasites raised on either male or female hosts, using DNA microarrays. Our results show that host sex caused differential expression of at least 11 genes in female parasites and of 134 in male parasites. Of the differentially expressed genes in female worms, 10 were preferentially expressed in female worms from male mice, while of the 134 differentially expressed genes in male parasites, 79 (59%) were preferentially expressed in worms from female mice. Further investigation of the role of each of those genes will help understand better their importance in the pathogenesis of Schistosomiasis.

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Medical professionals in general, and medical oncologists in particular, have highly stressful practices because they are under constant pressure to have the highest-quality, up-to-date evidence available in order to make the right decision for each individual patient. From a practical point of view, being updated on oncological and other medical specialties may seem an insurmountable task because the number of scientific publications has increased dramatically. The use of systematic reviews of randomised controlled trials or the application of results obtained from high-quality randomised controlled trials are some of the most common ways to address this need. Unfortunately, they do not cover all complex clinical situations that the majority of medical oncologists face in their outpatient consultations. In this review, we report the conclusions achieved in a multiexpert meeting where five important controversies in the treatment of breast cancer were analysed. Five highly experienced medical oncologists were required to defend an affirmative answer and another five were required to defend a negative answer for each of the clinical questions. After that, a one-day meeting was organised to debate each clinical question and to reach a consensus. We report here the content of this multi-expert meeting along with the conclusions drawn.

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INTRODUCTION: The purpose of this phase II study was to evaluate the efficacy and safety of neoadjuvant docetaxel/gemcitabine treatment in a biweekly regimen. MATERIALS AND METHODS: Patients with stage II/III breast cancer were treated with docetaxel (65 mg/m(2)) followed by gemcitabine (2500 mg/m(2)) every 2 weeks for 6 cycles. Patients with a clinical response or stable disease underwent mastectomy or breast-conserving surgery plus axillary dissection. After surgery, patients received 4 cycles of standard doxorubicin 60 mg/m(2) and cyclophosphamide 600 mg/m(2) every 21 days. RESULTS: Thirty-five patients were included in the trial. The overall response rate was 71.4% (95% CI: 53.7-85.4), with 8 complete and 17 partial responses. Breast conservation was possible in 59% of the patients. Toxicity was manageable. CONCLUSIONS: We consider biweekly docetaxel and gemcitabine could be an active and tolerable regimen option in the neoadjuvant setting sequentially with standard adjuvant doxorubicin-cyclophosphamide in patients with stage II or III breast cancer.

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This is the report of a 46-year-old patient with the preoperative diagnosis of an atrial septal defect (ASD) of the ostium secudum type. After sternectomy, partial agenesis of the left pericardium was diagnosed. It is our opinion that, if the radiographic picture is suggestive of this entity, a clinical search for cardiopulmonary anomalies should be performed, because the majority of these associated anomalies can and should be surgically corrected.

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Os autores relatam o caso de paciente de 58 anos de idade do sexo masculino, com quadro de características miastênicas tanto clínica como eletromiograficamente, no qual a biópsia muscular com histoquímica e microscopia eletrônica permitiu fazer o diagnóstico de miopatia associada a agregados tubulares. É chamada a atençäo para o fato de que as alteraçöes anátomo-patológicas encontradas podem estar presentes em um grupo heterogênero de pacientes com grande variedade de sintomas, näo havendo portanto motivo para considerar-se a existência de uma miopatia com agregados tubulares, já que os achados anátomo-patológicos säo inespecíficos e näo configuram moléstia específica

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