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Cardiovascular diseases are a significant cause of morbidity and mortality in the general population. In this sense, the autonomic imbalance is the cornerstone of the pathophysiology underlying the development of these diseases. The aim of this study was to determine the efficacy of exercise training on heart rate variability (HRV) in adult patients with chronic heart failure., Methodology: A systematic literature review was conducted in electronic databases. The considered studies were randomised clinical trials, quasi-experimental studies with non-randomised control group, quasi-experimental studies with analysis of pre- and post- intervention, and crossover studies with randomly assigned training and non-training periods. The standardised mean differences were calculated between pre- and post-intervention in both the control and experimental group., Results: Within-subject analysis of the control group showed no statistical significance in the standardised mean differences of HRV. In the experimental group, the standardised mean differences were positive for the root mean square of successive difference (+0.468±0.215; P=.032), high frequency band (HF) (0.934±0.256; P < .001) and low frequency band (LF) (< 0.415±0.096; P=.001). Moreover, the standardised mean difference was negative for LF/HF (-0.747±0.369, P=<.044). On the other hand, only 3 studies entered the comparative meta-analysis. The effect of exercise training was favourable for the experimental group in LF/HF (-2.21±95% CI: -3.83 to -0.60), HF, and LF., Conclusion: The exercise training was effective in increasing HRV and restoring the autonomic balance in patients with heart failure., (Copyright © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.)

The objective of this study was to establish an association between academic performance in Math, Language Arts, and Science and the presence of sleep-related breathing disorders (SRBDs) among healthy schoolchildren from the city of Concepción, Chile. Healthy children were defined as those without comorbidities. Outcome measures of interest included the analysis of academic performance in Math, Language Arts, and Science and the presence of SRBD assessed using the Pediatric Sleep Questionnaire. Two-hundred and fifty-six children were included in the study (59.8% were boys). In the studied sample, SRBD prevalence was 24.6%. A significant association was observed between SRBD and a low performance in Math (odds ratio |-#91;OR|-#93;: 3.1, 1.5-6.8), Language Arts (OR:2.5, 1.1-5.5), and Science (OR: 4.2, 1.7-10.0). To conclude, in the studied sample, the presence of SRBD was associated with a low academic performance in Language Arts, Math, and Science., (Sociedad Argentina de Pediatría.)

The aim of this study was to present the results of organ and effective doses for paediatric patients for different types of interventional cardiology procedures for age and weight groups, derived from a patient dosimetry pilot programme carried out in Chile, under the auspices of the International Atomic Energy Agency. Over seven years, a retrospective collection of demographic and patient dose data was obtained: age, gender, weight, height, number of cine series, total number of cine frames, fluoroscopy time, dose-area product (DAP) and cumulative dose at patient entrance reference point. Monte Carlo software was used to calculate organ and effective doses. 1506 procedures were divided into four age and seven weight groups. Organ doses (median values) for diagnostic and therapeutic procedures were: active bone marrow 0.90 and 0.64mGy; heart 1.99 and 1.46mGy; lungs 3.56 and 2.59mGy; thyroid 1.27 and 0.83; and breast (in the case of females) 1.78 and 1.36mGy. The ranges for effective doses (median values) and weight bands were 1.2-3.9mSv for diagnostic procedures and 1.0-2.5mSv for therapeutic procedures. The resulting conversion factors (median values) to estimate effective dose from DAP (in mSv/Gy.cm2) were: 1.70; 0.89; 0.58; and 0.40, for age groups of <1year, 1-<5years, 5-<10years and 10-<16years, respectively. The obtained set of dose values will enable comparisons with other imaging procedures (comparing the same age bands) for justification and optimization purposes., (Copyright © 2017. Published by Elsevier Ltd.)

Introduction: Thoracic involvement (TIHE) is one of the evolutionary complications of hepatic echinococcosis (HE)., Aim: The aim of this study was to describe the clinical characteristics and postoperative morbidity (POM) of a series of patients with TIHE treated surgically., Material and Methods: Series of cases of patients treated for TIHE between 2000 and 2014 in the Hospital Regional and Clínica Mayor in Temuco, Chile, with a minimum 12-month follow-up. The outcome variable was "development of POM". Descriptive statistics were used., Results: The series was composed of 37 patients with a mean age of 53.2 ± 47.4 years (51.4% female). Mean cyst diameter was 19.4 ± 15.5 cm, and 75.7% of the lesions were located in the right hepatic lobe. The most frequent surgical technique used for the cyst was subtotal pericystectomy (56.8%); the residual cavity was treated by capitonnage (27.0%) or omentoplasty (21.6%), and a phrenoplasty with or without prosthetic material was performed for the TIHE. Mean hospital stay was 6.0 ± 5.7 days and follow-up was 61.4 ± 79.9 months; a mortality rate of 2.7% (one patient) and a POM of 24.3% (9 patients) were verified., Conclusion: TIHE is an uncommon evolutionary complication of HE associated with significant POM rate.

Introduction: In pediatrics, identifying the severity of bronchial obstruction in an early manner is a decisive factor., Objetive: To assess the psychometric properties of the scales for grading the severity of bronchial obstruction in pediatric patients., Population and Method: This was a systematic review of studies on the validity and reliability of scales for grading the severity of bronchial obstruction conducted in infants and children younger than 3 years old. The search was conducted in Medline, WoS, EMBASE, SciELO, and Google Scholar. The correlation coefficient corresponding to each article was included in a random effects model to establish the criterion validity and reliability using the weighted averages of coefficients as per the sample size., Results: A total of 9 articles were included, which accounted for 2699 children; 3 articles had an adequate or excellent methodological quality. Four articles established the concurrent criterion validity considering oxygen saturation, with a weighted correlation coefficient of -0.627 (95% confidence interval [CI]: -0.767 to -0.431, p < 0.001); 2 articles established the convergent criterion validity, with a weighted correlation coefficient of 0.809 (95% CI: 0.721 to 0.871, p < 0.001); 6 articles established the inter-observer reliability, with a weighted correlation coefficient of0.500for kappa and 0.891 for the intraclass correlation coefficient., Conclusion: The assessment of psychometric properties to support the use of scales for grading the construct "severity of bronchial obstruction" showed a moderate to adequate criterion validity. The percentage of agreement among observers in terms of the studied measure (severity of bronchial obstruction) was adequate; however, weaknesses such as the article design should be taken into account since it may affect the internal validity of results.

Background: One of the evolutionary complications of hepatic echinococcosis (HE) is cholangiohydatidosis, a rare cause of obstructive jaundice and cholangitis. The aim of this study was to describe the results of surgical treatment on a group of patients with cholangiohydatidosis and secondary cholangitis in terms of post-operative morbidity (POM)., Material and Method: Case series of patients operated on for cholangiohydatidosis and cholangitis in the Department at Surgery of the Universidad de La Frontera and the Clínica Mayor in Temuco, Chile between 2004 and 2014. The minimum follow-up time was six months. The principal outcome variable was the development of POM. Other variables of interest were age, sex, cyst diameter, hematocrit, leukocytes, total bilirubin, alkaline phosphatase and transaminases, type of surgery, existence of concomitant evolutionary complications in the cyst, length of hospital stay, need for surgical re-intervention and mortality. Descriptive statistics were calculated., Results: A total of 20 patients were studied characterized by a median age of 53 years, 50.0% female and 20.0% having two or more cysts with a mean diameter of 13.3 ± 6.3 cm. A median hospital stay of six days and follow-up of 34 months was recorded. POM was 30.0%, re-intervention rate was 10.0% and mortality rate was 5.0%., Conclusion: Cholangiohydatidosis is a rare cause of obstructive jaundice and cholangitis associated with significant rates of POM and mortality.

Background: Environmental pollution is a risk factor for cardiorespiratory diseases. Energy generated by thermoelectric power plants (TEPP) represents a relevant source of pollution. The aim of this study was to evaluate the relationship between living near a coal-fired TEPP and the consultation rates for bronchial obstructive crises (BOC) in the province of Concepción, Chile., Methods: Population-based study. The epidemiological weeks from 2012 to 2014 were analyzed. The dependent variable was the emergency consultation rate for BOC in two health centers within 5 km of a TEPP (Coronel) and two that were more than 40 Km away from a TEPP (Talcahuano). The independent variables were the commune, climatological variables (air temperature and relative atmospheric humidity), environmental pollutants (PM 10 , PM 2.5 and nitrogen oxide), weeks with the highest consultation rate and the years. Rates, Pearson's correlation and gross risk measures were calculated and adjusted for environmental and climatological variables., Results: BOC rates were significantly higher in Coronel (RR = 4.9 95% CI 4.0-5.8; p < 0.05). The PM 2.5 it showed the strongest correlation with BOC rates (r = 0.3; p < 0.01) in Coronel, but not Talcahuano. Linear regression modelling indicated that proximity to a TEPP (health center location) and temperature explained 26 and 18% of the variance in BOC rates, respectively., Conclusions: Rates of emergency consultation for BOC were significantly higher among a population living within 5 km of a coal-fired TEPP than those living 40 km away.

The aim of this study is to describe the trends of transport accident mortality in Chile from 2000 to 2012 by year, geographic distribution, gender, age group, and type of accident. Population-based study. Data for transport accident mortality in Chile between 2000 and 2012 were used. The crude and adjusted per region transport accident mortality rates were calculated per 100,000 inhabitants. The annual percentage change (APC) of the rates and relative risks (RR) were calculated. The average transport accident mortality rate (TAMR) in Chile (2000-2012) was 12.2. The rates were greater in men (19.7) than in women (4.8), with a RR of 4.1. The rates were higher in the country's southern zone (15.9), increasing in recent years in the southern zone, with a significant positive APC in the northern and central zones. The Maule region had the highest rate (21.1), although Coquimbo was the region with the most significant APC (2.2%). The highest rate (20.3) was verified in the 25-40 age group. The highest rate (14.3) was recorded in 2008. The most frequent type of accident was pedestrian. In general the APC trends of the rates are increasing significantly. This, added to rapid annual automotive growth, will only exacerbate mortality due to transport accidents.

Introduction: Respiratory muscle training is the most commonly used method to revert respiratory muscle weakness; however, the effect of protocols based on non-respiratory maneuvers has not been adequately studied in the pediatric population. The objective of this study was to establish the effect of abdominal muscle training on respiratory muscle strength and forced expiratory flows in healthy adolescents., Methods: This was a quasi-experiment. The sample was made up of healthy adolescents divided into two groups: an experimental group who completed eight weeks of active abdominal muscle training, and an equivalent control group. The following indicators were measured: abdominal muscle strength, maximal inspiratory pressure, maximal expiratory pressure (MEP), peak expiratory flow, and peak cough flow, before and after protocol completion. A value of p < 0.05 was considered significant., Results: All studied outcome measures increased significantly in the experimental group but only MEP increased in the control group. In addition, a higher MEP was observed in the experimental group compared to the control group at the end of the protocol, together with a greater increase in MEP and peak expiratory flow. Finally, the increase in MEP was associated with an increase in cough peak flow in the experimental group but not in the control group., Conclusion: After eight weeks of abdominal muscle training, MEP and peak expiratory flow increased in healthy (sedentary) adolescents. Such effects were associated with intervention-induced increases in cough peak flow., (Sociedad Argentina de Pediatría.)

The objective of this study was to determine the validity and reliability of the EPInfant pediatric perceived exertion rating scale among Chilean children. Children aged 8-12 years old were selected; their heart rate, perceived exertion and workload were recorded during two consecutive Chester tests performed with a one week interval. Pearson's r coefficient and the intraclass correlation coefficient were estimated. Thirty-one children (17 boys) were included in the study. A strong correlation was observed between perceived exertion and reference criteria, in addition to a high intraclass correlation coefficient. The average difference between the perceived exertion in each test was 1.4 (95% CI: -1.4 to 4.1) and 0.2 (95% CI: -1.8 to 2.2) for boys and girls, respectively. The EPInfant scale showed an acceptable criterion validity and interobserver reliability among children during an incremental step test., (Sociedad Argentina de Pediatría.)

The purpose of this study was to report the results of laparoscopic treatment of nonparasitic cysts of the liver (NPCL) in terms of postoperative morbidity (POM) and recurrence. Prospective case series of patients operated on for NPCL at the Clínica Mayor in Temuco, Chile (2008 to 2015). The preoperative study consisted of general examinations, abdominal ultrasound or computed tomographic scan. The outcome variable was POM. Other variables of interest were surgical time, need for conversion, hospital stay, mortality, and recurrence. In the study period, 41 patients with NPCL underwent surgery. Median age of the series was 58 years, and 75.6% of the cases were female. The median ultrasound diameter of the lesions was 10 cm and surgical time was 50 minutes. All patients underwent a cystectomy. There was no conversion, no record of POM, mortality or recurrence. The treatment applied in this series of NPCL is associated with an adequate postoperative evolution.

Introduction: Physiological parameters used to measure exercise intensity are oxygen uptake and heart rate. However, perceived exertion (PE) is a scale that has also been frequently applied. The objective of this study is to establish the criterion-related validity of PE scales in children during an incremental exercise test., Methods: Seven electronic databases were used. Studies aimed at assessing criterion-related validity of PE scales in healthy children during an incremental exercise test were included. Correlation coefficients were transformed into z-values and assessed in a meta-analysis by means of a fixed effects model if I2 was below 50% or a random effects model, if it was above 50%., Results: wenty-five articles that studied 1418 children (boys: 49.2%) met the inclusion criteria. Children's average age was 10.5 years old. Exercise modalities included bike, running and stepping exercises. The weighted correlation coefficient was 0.835 (95% confidence interval: 0.762-0.887) and 0.874 (95% confidence interval: 0.794-0.924) for heart rate and oxygen uptake as reference criteria. The production paradigm and scales that had not been adapted to children showed the lowest measurement performance (p < 0.05)., Conclusion: Measuring PE could be valid in healthy children during an incremental exercise test. Child-specific rating scales showed a better performance than those that had not been adapted to this population. Further studies with better methodological quality should be conducted in order to confirm these results., (Sociedad Argentina de Pediatría.)

Introduction: Perceived exertion scales quantify the sensation caused by metabolic changes during exercise. Children need tailored tools due to their cognitive immaturity such as the EPInfant scale recently developed in Chile. , Objective: To determine the validity and reliability of the EPInfant scale in children during a graded exercise test. , Materials and Methods: We conducted a cross-sectional study for which we selected healthy children younger than 18 years and grouped them according to Piaget's stages of cognitive maturity: Concrete operations (8-12 years) and formal intelligence (13-15 years). The Chester step test was used and heart rate, workload and perceived exertion were recorded during the test. Pearson r and intraclass correlation coefficients were used to assess validity and reliability, respectively. , Results: 75 children were admitted, 35 (18 male) from the concrete operations group and 40 (20 male) from the formal intelligence group. In the four groups, heart rate and perceived exertion increased significantly with exercise intensity (p<0.0001). Perceived exertion was correlated with heart rate in both the concrete operation and the formal intelligence groups and in males and females (r=0.73, r=0.58,r=0.43, r=0.62, respectively; p<0.0001). Regression models were significant in all groups (p<0.0001). In the concrete operations group the intraclass correlation coefficient was 0.88 (0.82-0.92) in men and 0.94 (0.91-0.96) in women. , Conclusion: EPInfant scale was a reliable and valid instrument to measure perceived exertion during exercise in children with different levels of cognitive maturity, and it was reliable in the concrete operations group of children.

Introduction: Hepatic echinococcosis (HE) surgery is common in southern's Chile hospitals; however, related publications are scarce and with conflicting results, especially with regard to postoperative morbidity (POM), due to the diversity in it severity. The aim of this study is to determine POM in patients undergoing surgery for complicated HE (CHE)., Material and Methods: Case series part of a prospective cohort. Patients undergoing surgery for CHH in hospitals Hernán Henríquez Aravena hospital and Clínica Mayor of Temuco, between 2000 and 2012 were included. The main outcome variable was development of POM using the Clavien scale. Other variables of interest were hospital stay, mortality and recurrence. Descriptive statistics were applied and incidence of POM was determined., Results: 73 patients with a median age of 41 years and 58.9% female were studied. The median ultrasound diameter cysts were 15.0 cm. The average surgical time was 125.4 ± 26.3 min. The surgical procedure used most often was the pericystectomy (84.9%); and 84.9% of cases was performed concomitantly some other surgical procedure. The incidence of POM was 19.2%, 78.6% of whose cases were Grade I or II Clavien. The aetiology was 10.9% of medical complications and 8.2% of surgical complications. 1.4% of mortality was recorded; and with a median follow up of 97 months, no recurrence was verified., Conclusions: POM in a cohort of patients with CHE is lower than the published and low severity. Subgroups with higher POM were: patients with coexistence of more than one complication, those with colangiohydatidosis and patients with liver abscess of hydatid origin.

There are multiple proposals and classifications that hierarchize evidence, which may confuse those who are dedicated to generate it both in health technology assessments, as for the development of clinical guidelines, etc. The aim of this manuscript is to describe the most commonly used classifications of levels of evidence and grades of recommendation, analyzing their main differences and applications so that the user can choose the one that better suits your needs and take this health decisions basing their practice on the best available evidence. A systematic literature search was performed in PubMed and MEDLINE databases and in Google, Yahoo and Ixquick search engines. A wealth of information concerning levels of evidence and degrees recommendation was obtained. It was summarized the information of the 11 proposals more currently used (CTFPHC, Sackett, USPSTF, CEBM, GRADE, SIGN, NICE, NHMRC, PCCRP, ADA y ACCF/AHA), between which it emphasizes the GRADE WORKING GROUP, incorporated by around 90 national and international organizations such as the World Health Organization, The Cochrane Library, American College of Physicians, American Thoracic Society, UpToDate, etc.; and locally by the Ministry of Health to create clinical practice guidelines.

Background: Suicide is an important public health problem accounting for an important proportion of deaths in Chile., Aim: To describe trends in suicide mortality in Chile between 1998 and 2011, by year, region, sex and age., Material and Methods: A population survey study was conducted using suicide mortality data of Chile from 1998 to 2011, provided by the statistics department of the Ministry of Health, Coroners' offices and the Pan American Health Organization (PAHO/WHO). Age-adjusted suicide mortality rates were calculated per 100,000 habitants. Variables analyzed included year, age, sex, etiology and geographical distribution. An analysis of the average annual variation (AAV) was performed and the logarithm of the age-adjusted rates by year and region was fitted by applying linear regression models. Relative risks (RR) by sex, geographical distribution and age were also calculated., Results: The mean suicide rate in Chile, was 12.11 per 100.000 in the period 2000-2011. The rates were higher in men, with a higher AAV in women and a relative risk for men was 5.14 higher than in women. The rates were higher in the southern regions of the country. Atacama had the highest AAV. By age, the rates are consistently higher in subjects aged 40 to 59 years until 2006, when this pattern started to change. Between 2006 and 2009, subjects aged 25-39 years had the highest rates. Subjects aged 0 to 14 years, exhibit the highest AAV., Conclusions: The distribution of suicide rates by sex in Chile is similar to other countries, but it is different by age. The age range with the highest suicide rates changed over time.

Introduction: Physical disability is the most common disability (10.3 %) in the central area of Chile. The cerebral palsy is one of the diseases that generates motor deficits and loss of balance. Balance is crucial for maintaining postural stability., Objective: To establish the differences in area and average velocity of the center of pressure between typically developing children and cerebral palsy patients, and to determine the degree of use of different sensory systems., Materials and Methods: This was a cross-sectional study. A convenience sample was divided into two groups: typically developing children (n=7) and cerebral palsy patients (n=7). The parameters measured by a force plate were the area and average velocity of excursion of the center of pressure, as well as the frequency bands ( 0.0625, 0.125, 0.25, 0.5, 1, 2 and 4 Hz) ., Results: During the eyes open condition, the cerebral palsy subject had an average velocity of the center of pressure significantly higher than the typically developing children group (p=0.043). The frequency bands 0.25 Hz and 0.5 Hz related to the vestibular system showed significant differences between groups (p=0.021 y p=0.036). In the eyes closed phase a significant increase in the area of the center of pressure and a higher use of the otolithic vestibular system were observed in the cerebral palsy group., Conclusions: Cerebral palsy patients showed a lower standing balance in addition to using the vestibular system significantly more both in eyes open and eyes closed phases.

There is controversy about the effectiveness of mesh techniques for inguinal hernia repair (IHR) when compared with non-mesh procedures. The aim of this study was to systematically review the available evidence on the effectiveness of mesh compared to non-mesh IHR techniques. Cochrane Central and MEDLINE databases and the TRIP Database engine were reviewed looking for systematic reviews (SR) and clinical trials (CT) published from 1990 to 2012, comparing the effectiveness, in terms of operative time, postoperative pain, morbidity, hospital stay, return to work, costs and recurrence, of mesh and non-mesh IHR techniques. We retrieved 3,069 articles, 17 of which met the selection criteria (3 SR and 14 RCT), representing a population of 15,124 subjects (7361 mesh and 7763 non-mesh IHR). According to these studies, mesh IHR techniques are associated with less surgical time, pain, hospital stay, recurrence and sooner return to work than non-mesh techniques. It is concluded that mesh techniques are more effective than those not using a mesh.

The objective of this study was to evaluate sleeve gastrectomy with jejunal bypass (SGJB) as a surgical treatment for type 2 diabetes mellitus (T2DM) in patients with a body mass index (BMI) <35 kg/m(2). This is a prospective cohort study. Patients with T2DM and BMI <35 kg/m(2) who underwent SGJB between January 2009 and June 2011 at DIPRECA Hospital, in Santiago, and Hospital Base, Osorno, Chile were included. SGJB consists of creating a gastric tube, which preserves the pylorus, and performing a jejunoileal anastomosis 300 cm distal to the angle of Treitz. Excess weight loss (EWL) and complete or partial remission of T2DM were reported. Forty-nine patients met the inclusion criteria. The mean age was 49 years (36-62), and 53 % of patients were female. Mean preoperative BMI was 31.6 kg/m(2) (25-34.9 kg/m(2)). Operation time was 123 ± 14 min, with 94.7 % of operations performed laparoscopically. Mean postoperative hospital stay was 2 days. Mean postoperative follow-up was 12 months. Median EWL at 1, 3, 6, 12, and 18 months postoperatively was 31.9 %, 56.9 %, 76.1 %, 81.5 %, and 76.1 %, respectively. Complete T2DM remission was achieved in 81.6 % of patients (40/49) and partial remission in 18.4 % (9/49). Forty of 41 patients (97.6 %) on oral hypoglycemic agents achieved complete T2DM remission, and 100 % of insulin-dependent patients stopped using insulin but were still being treated for T2DM. One patient experienced postoperative gastrointestinal bleeding. There were no deaths. SGJB is an effective treatment for T2DM in patients with BMI <35 kg/m(2).

Background: The aim of this study was to determine if intrabiliary rupture (IBR), an evolutive complication of hepatic echinococcosis (HE), is a risk factor for developing postoperative morbidity (POM)., Methods: This was a concurrent cohort study that included patients operated on for HE between 1996 and 2006 and who had clinical check-ups at 1, 6, 12, 24, 36, 48, and 60 months postoperatively. Principal outcome variable was "development POM," considered dichotomously. The exposure variable was the presence of IBR, analyzed dichotomously (present or absent) and according to the number of IBR (without, with one, and with two or more). The sample size was considered on the basis of a 95% confidence interval (95% CI), a power of 80%, a 1:2 ratio of patients without and with IBR, and a 10% proportion of POM in patients without IBR and 26% in patients with IBR. Descriptive statistics and bivariate and multivariate analyses were used. Relative risks (RR) and 95% CI were calculated., Results: The cohorts (median age of 42 years, 56.4% female, a median cyst diameter of 15 cm, and a follow-up of 118 months) were composed of 96 patients without IBR (38.1%) and 156 patients with IBR (61.9%). A morbidity rate of 17.1% was verified (9.4% in the group without IBR and 21.8% in the group with IBR [p = 0.011]). An adjusted RR of 3.4 (95% CI = 2.64, 4.18) was verified for the comparison of subgroups without IBR vs. with two or more IBR (p < 0.001)., Conclusion: The presence of two or more IBR constitutes a risk factor for developing POM in patients with HE.

Gallbladder carcinoma (GBC) is a highly malignant neoplasm and represents the leading cause of cancer death in Chilean women. In order to determine the potential role of promoter methylation in gallbladder carcinogenesis, we investigated the frequency of this epigenetic mechanism by methylation-specific polymerase chain reaction (MSP) in 35 chronic cholecystitis (CC, separated according to the presence or absence of metaplasia), 19 early cancers (mucosa or muscularis propia invasion) and 48 advanced carcinomas with invasion of the gallbladder subserosa (25 cases) and serosa (23 cases). We examined 14 genes and observed an increase of multigenic methylation during tumoral progression which was not significantly associated with the patient's age. Four genes (DAPK1, DLC1, TIMP3, and RARbeta2) displayed a progressive increase in their methylation status from CC without metaplasia to advanced carcinoma invading the serosa layer (P

Introduction: Echinococcus granulosus species has a wide variety in both geography and hosts; indeed, 10 genotypes have been reported in studies on material of animal origin. The aim of this study was to genotype E. granulosus obtained from human hydatid cysts., Materials and Methods: The hydatid fluid and sand was collected from patients who underwent surgery for hepatic and pulmonary hydatidosis at Hospital Regional in Temuco, Chile, between 2004 and 2005. Two PCR systems were used: PCR Eg 9 and PCR Eg 16. The RsaI enzyme was used for RFLP. The genotype was confirmed using the sequence of one fragment of 366 bp from a mitochondrial gene (cox1)., Results: The DNA of protoscolices from 24 samples was analyzed, 4 of them from pulmonary cysts and 20 from hepatic cysts. The 366 bp fragment was amplified in 20 out of 24 samples (83.3%). Enzymatic digestion revealed the presence of 3 possible genotypes: in 20 out of 21 samples (95,2%), a restriction was observed corresponding to the G1 or G7 genotypes; in the remaining sample genotype G4 or G7 was observed. Sequencing confirmed the presence of G1 genotype for 19 samples and G6 genotype for the remaining sample (G4 or G7 according to PCR-RFLP)., Conclusion: The PCR-RFLP technique enabled three possible genotypes present (G1 or G7, G4 or G7) to be established. Sequencing allowed us to decisively identify the G1 and G6 genotypes in our study group. Previous studies agree with the identification of the G1 genotype in our country. We consider it significant that the G6 genotype is present in Chile for its epidemiological implications.

Publishing a manuscript is the logical result of any research study, allowing information to be shared with the scientific community, and providing personal satisfaction and career enhancement. The present article reviews some of the rules and recommendations for drafting the main sections of an original study (introduction, methodology, results, discussion). We discuss several aspects of the editorial process and the main reasons why manuscripts are returned. However well a manuscript is written, it cannot hide the methodological defects of a poorly designed study. The best way to avoid difficulties when writing is to have a good working hypothesis, clear objectives, and impeccable methodology.

Introduction: The use of analgesics during the diagnosis and decision-making process in patients with acute nontraumatic abdominal pain is controversial. The aim of the present study was to determine whether the use of opioid analgesics in patients with acute nontraumatic abdominal pain increases the risk of diagnostic error., Method: We performed a systematic review of the literature. Randomized clinical trials (RTCs) comparing the use of opioid analgesics with placebo administered before any procedure in patients with acute nontraumatic abdominal pain were included. There was no restriction on language. RTCs unrelated to this subject were excluded. The variables analyzed were age, gender, and the percentage of adverse effects, appendicitis, changes on physical examination and diagnostic error, modification of pain severity measured by a visual analog scale, and methodological quality of the studies. A search was performed in the MEDLINE and Cochrane databases, using MeSH terms. Each article was analyzed by applying a methodological quality score through which weighted means were applied for each variable. The Chi-square and Student's t-test were applied to compare the groups., Results: Six articles meeting the selection criteria were found. The mean methodological quality score was 21.6 points. The studies represented a population of 363 patients treated with opioids and 336 patients treated with placebo. There were no differences in the mean age of the patients (39.4 vs 39.6 years), distribution by gender, prevalence of acute appendicitis (23.3% vs 24%) or diagnostic error (15.6% vs 21.1%; p = 0.0637). Differences were found in the variable of pain reduction (27.2 vs 7.2 mm, respectively; p = 0.0167)., Conclusions: The use of opioid analgesics in patients with acute nontraumatic abdominal pain does not increase the risk of diagnostic error and reduces pain during the decision-making process.

Introduction: Follow-up of patients undergoing surgery for hepatic echinococcosis (HE) is essential to ensure the absence of infection. The aim of this study was to determine the behavior over time of specific IgG and IgE to Echinococcus granulosus determined by the ELISA technique (ELISA-IgG and ELISA-IgE) in patients undergoing surgery for HE., Material and Method: We performed a concurrent cohort study of patients who underwent surgery for HE between 1994 and 2003 in the Regional Hospital of Temuco, Chile. Non-probabilistic convenience sampling was performed in patients with a minimum follow-up of 48 months and annual qualitative determinations of ELISA-IgE and ELISA-IgG. Descriptive statistics were applied, with calculation of percentages, medians, and extreme values., Results: Fifty-two patients were studied, of whom 38 (73.1%) were women. The median age was 40 years (16 to 75 years). Most of the patients had a single cyst (34 patients, 65.4%); the median cystic diameter was 12 cm. In 35 (67.3%) patients, biliary communications were found. Progressive negativization of ELISA-IgE and ELISA-IgG was observed, reaching 98% and 84% in the fourth year of follow-up respectively. Erratic behavior of ELISA-IgG was detected, with a change from negative to positive in 11% of the patients, none of whom had radiological or ultrasonographic evidence of cysts in the thorax or abdomen., Conclusions: A high percentage of negativization of ELISA-IgE was observed. The erratic behavior of ELISA-IgG is difficult to interpret.

The results of a research study can be presented through oral communications, posters, conferences and publications, etc. The present article suggests ways in which oral communications and posters can be presented. The sequence of steps leading up to an oral presentation can be divided into writing a summary, designing the graphic material, giving the presentation and defending the results. Posters have a similar structure but this format allows complex experiments to be clearly presented and a variety of illustrations to be introduced, without the strict time constraints that apply to oral presentations. Whichever format is followed, we recommend that authors answer the following questions: what was the question studied and why?, how was it studied?, what were the results?, and what do they mean? These questions help to structure the presentation effectively.

Background: Surgery is a curative treatment for gastric cancer (GC). As relapse is frequent, adjuvant therapies such as postoperative chemo radiotherapy have been tried. In Chile, some hospitals adopted Macdonald's study as a protocol for the treatment of GC., Aim: To determine methodological quality and internal and external validity of the Macdonald study., Material and Method: Three instruments were applied that assess methodological quality. A critical appraisal was done and the internal and external validity of the methodological quality was analyzed with two scales: MINCIR (Methodology and Research in Surgery), valid for therapy studies and CONSORT (Consolidated Standards of Reporting Trials), valid for randomized controlled trials (RCT). Guides and scales were applied by 5 researchers with training in clinical epidemiology., Results: The reader's guide verified that the Macdonald study was not directed to answer a clearly defined question. There was random assignment, but the method used is not described and the patients were not considered until the end of the study (36% of the group with surgery plus chemo radiotherapy did not complete treatment). MINCIR scale confirmed a multicentric RCT, not blinded, with an unclear randomized sequence, erroneous sample size estimation, vague objectives and no exclusion criteria. CONSORT system proved the lack of working hypothesis and specific objectives as well as an absence of exclusion criteria and identification of the primary variable, an imprecise estimation of sample size, ambiguities in the randomization process, no blinding, an absence of statistical adjustment and the omission of a subgroup analysis., Conclusion: The instruments applied demonstrated methodological shortcomings that compromise the internal and external validity of the.

Introduction: The adequate treatment for hydatidosis requires a knowledge of certain aspects related to the survival of infectious agents, especially protoscoleces. The aim of this study is to evaluate the viability of protoscoleces in human hepatic hydatid cysts in order to determine the prevalence of their fertility and to study the association with variables typical of the host and of the parasite., Materials: A cross-sectional study was done in biological material (the fluid from human hepatic hydatid cysts). The viability criteria used were: ovoid form, invaginated scolices and intact calcareous corpuscles, the presence of vibrating movements, and the absence of "vital" staining. The cysts were grouped as univesicular cysts (UVC), multivesicular cysts (MVC) and abscessed cysts (LAHO). Fertility was defined as living protoscoleces in relation to the total number of protoscoleces. Descriptive statistics were for the calculation of the prevalence of fertility, analytical statistics for the comparison of groups, and a multivariate analysis for the examination of the association between cyst fertility and clinical variables., Results: A total of 163 cysts with a median diameter of 15 cm were studied in this way. Of these lesions, 79 (48.5%) were UVC, 54 (33.1%) MVC, and 30 (18.4%) LAHO. On 99 occasions (60.7%), macroscopic communication was evident in the bile duct, and a prevalence of general fertility of 57.1% (94.4% for MVC, 53.2% for UVC, and 0% for LAHO, with a value of P<0.001). Association with location, type, and diameter of the cyst, and presence of biliary communications was verified by applying a bivariate analysis, and association between fertility and the variables of the type of the cyst and the existence of biliary communications was verified employing a multivariate analysis (P values of 0.004 and <0.001, respectively)., Conclusions: The prevalence of fertility found was low. The main prevalence of fertility was observed in MVCs. Fertility is associated with the type of cyst and the presence of biliary communications.

Introduction: The aim of this study was to determine the methodological quality of articles on therapeutic procedures published in Cirugía Española and to study its association with the publication year, center, and subject-matter., Material and Method: A bibliometric study that included all articles on therapeutic procedures published in Cirugía Española between 2001 and 2004 was performed. All kinds of clinical designs were considered, excluding editorials, review articles, letters to editor, and experimental studies. The variables analyzed were: year of publication, center, design, and methodological quality. Methodological quality was determined by a valid and reliable scale. Descriptive statistics (calculation of means, standard deviation and medians) and analytical statistics (Pearson's chi2, nonparametric, ANOVA and Bonferroni tests) were used., Results: A total of 244 articles were studied (197 case series [81%], 28 cohort studies [12%], 17 clinical trials [7%], 1 cross sectional study and 1 case-control study [0.8%]). The studies were performed mainly in Catalonia and Murcia (22% and 16%, respectively). The most frequent subject areas were soft tissue and hepatobiliopancreatic surgery (23% and 19%, respectively). The mean and median of the methodological quality score calculated for the entire series was 10.2 +/- 3.9 points and 9.5 points, respectively. Methodological quality significantly increased by publication year (p < 0.001). An association between methodological quality and subject area was observed but no association was detected with the center performing the study., Conclusions: The methodological quality of articles on therapeutic procedures published in Cirugía Española between 2001 and 2004 is low. However, a statistically significant trend toward improvement was observed.

The incidence of esophageal adenocarcinoma has risen rapidly over the past 25 years in the United States as well as in several Western European countries. This increase had been most dramatic among white males. The majority of these cancers arise from a background of premalignant Barrett esophagus. However, less than 10% of the patients with esophageal adenocarcinoma were known to have Barrett esophagus previously. It is uncertain which risk factors contribute to the increasing incidence of esophageal adenocarcinoma, although gastroesophageal reflux disease, cigarette smoking, and obesity have been implicated. Whereas infection with Helicobacter pylori and use of non-steroidal anti-inflammatory drugs are associated with reduced risk, low intakes of fruit, vegetables, and cereal fibers seem to increase the risk of esophageal adenocarcinoma. Presently there is no evidence that strongly supports any specific strategy to screen a subgroup of the population at risk for Barrett esophagus and adenocarcinoma of the esophagus., ((c) 2005 Wiley-Liss, Inc.)

Background: The purpose of the present paper was to determine the association between clinical evolutionary and laboratory variables with postoperative morbidity in patients surgically treated for liver hydatidosis (LH)., Methods: A case-control nested cohort study was undertaken. Patients were studied and surgically treated in Hospital Regional of Temuco between 1994 and 2001. The morbidity variable registered with a minimum 12-month follow-up period was considered in a dichotomous way. The association with clinical, laboratory, evolutionary, and surgical variables was studied. Descriptive statistics, bivariate analysis using chi(2) and Fisher's exact test for categorical variables; t-test, anova, and Kruskal-Wallis for continuous variables; odds ratio calculations, and ordinal and multivariate logistic regression models were applied., Results: The cohort was composed of 202 patients surgically treated for LH, 112 women (55.5%) and 90 men (44.5%), with an average age of 45.2 years. Average morbidity of the series, with a median follow-up period of 53 months, was 16.4%. Six variables were significantly associated in the bivariate analysis (age, haematocrit, total leucocyte count, alkaline phosphatase, history of previous surgery for LH and existence of biliary communications), but only two achieved statistical significance in the multivariate model (age and history of previous surgery for LH; P = 0.017 and 0.018; and odds ratio of 1.0 and 4.1, respectively)., Conclusions: In surgical decision making for patients with LH, the history of previous surgery for LH must be considered as a risk factor for postoperative morbidity.

Introduction: The aim of this study was to determine the association between the IF of surgery journals and the level of evidence of articles on therapeutic procedures published in these journals., Material and Method: A bibliometric study was performed. Journals listed in the 2002 ISI under the subject heading of Surgery were included. Journals were classified by applying the 33rd percentile of their IF (group 1 from 0.128 to 1.690, group 2 from 1.691 to 2.886, and group 3 from 2.887 to 6.674). Simple randomized sampling was conducted of journals in each group (group 1: Eur J Surg, Am Surg and World J Surg; group 2: J Am Coll Surg, Surgery and Arch Surg; and group 3: Br J Surg and Ann Surg). A crossover analysis was performed by 2 independent teams of reviewers., Results: There were 751 article on therapy (41.2%). The mean IF was 1.66 +/- 0.48 for group 1, 2.61 +/- 0.15 for group 2, and 4.69 +/- 1.57 for group 3 (P<.001). There were 16 systematic reviews, 82 randomized clinical trials, 96 cohort studies, 474 case series and 79 review articles. Level 1 evidence was found in only 4.8% of the articles. Statistical differences were verified in 15.1% of the study sample, which was represented by systematic reviews and randomized clinical trials (most frequent in group 3 (P<.001)., Conclusions: An association between the IF of scientific surgical journals and the level of evidence in articles published on therapy was verified.

Introduction: The objective of this study was to determine the best surgical option for elective surgery in non-complicated colon cancer by comparing open (OR) and laparoscopic resection (LR)., Patients and Method: A systematic review of the literature was performed. Studies of non-complicated colon cancer in adults treated by OS and LS published between 1990 and 2002 were analyzed. The MEDLINE, LILACS and COCHRANE databases were used, employing MeSH terms and free words. Selected studies were analyzed using a specially designed score of methodological quality to examine and compare studies with different types of design. The number of treated patients, 3-year actuarial survival rate, 3-year disease-free survival, recurrence, morbidity, mortality and the methodological quality of primary studies were analyzed. Means, medians, extreme values and weighted means were calculated, and the methodological quality of primary studies was compared using median 95% confidence intervals., Results: Six hundred eighty related articles were found; of these, 11 were analyzed. Hospital stay was 10.1 days for OR and 6.5 days for LR. Morbidity was 19.5% for OR and 26.9% for LR and mortality was 1.6% and 1.7% respectively. With mean follow-up periods of 58 months for OR and 30 months for LR, actuarial and free-disease survival rates were 74.3% and 75.6% for OR and 87.0% and 89.5% for LR. The median score for methodological quality was 16 for OR and 18.5 for LR., Conclusions: The early and medium-term results of LR are similar to those observed in OR in patients with non-complicated colon cancer.

To determine the plasmatic and intracystal concentrations of albendazole sulfoxide (AS) and correlate them with the viability of the scolices in patients surgically treated for hepatic hydatid cysts (HHC) that received albendazole preoperatively, as an indirect way of evaluating the scolicide efficacy of the drug. A non-consecutive series of patients with uncomplicated HHC, underwent operation at the Department of Surgery, Regional Hospital of Temuco, Chile, between 2001 and 2002. The patients were given 10 mg/kg/day of albendazole for 4 days prior to the surgery. Intraoperative samples of venous blood and hydatid fluid were taken, in which the plasmatic concentration (PIC) and intracystal concentration (ICC) of AS were measured by means of high-performance liquid chromatography. With the remaining hydatid fluid, the viability of the scolices was examined. The following variables were taken into consideration: diameter, type of cyst, number of cysts, and development of cyst-biliary communications. Descriptive statistics were used in the calculation of medians, averages, and standard deviations, and analytical statistics were used for the comparison of continuous variables applying the t-test and the Mann-Whitney U-test. A total of 26 patients with HHC, with a median age of 39.5 years (range: 16-80 years); 16 were women (61.5%). Nineteen patients presented only one cyst (73.1%), and the diametric median of the cysts was 14.5 cm (range: 7-30). Fourteen patients presented univesicular cysts (53.9%), and the remaining 12 had multivesicular cysts (46.1%). The average PIC of AS in the whole series was 1.88 +/- 0.5 microg/ml and the ICC was 0.26 +/- 0.2 microg/ml. The ICC in viable hydatid cysts was 0.25 microg/ml versus 0.28 microg/ml in non-viable cysts (p = 0.7556). The absence of association between intracystal levels of AS and the viability of the scolices allows one to posit indirectly that albendazole is ineffective as a scolicidal agent administered preoperatively for 4 days.

Background and Objective: To determine the efficacy of immunoprecipitation (DD5), enzyme immunoanalysis (ELISA-IgG), and immunoelectrotransference or Western blot (WB) in patients with liver echinococcosis (LE) used separately, in parallel and in series., Methods: Diagnostic test study. DD5, ELISA-IgG, and WB were applied in 75 patients with LE and 75 with cholelithiasis. Surgery was considered a reference standard. The sample size was calculated assuming a 99% confidence interval (99% CI), expected sensitivity (S) of 90% and a worst result of 80%; expected specificity (SP) of 95% and a worst result of 85%. S, SP, and predictive values (PPV and NPV) were calculated., Results: The best S was verified with ELISA-IgG and WB (82.7%) and the best SP with DD5 (94.7%). DD5 presented a better PPV (92.9%) and WB a better NPV (83.5%). When applying the tests in parallel, the best S was obtained from the combination of DD5 and WB (82.7%); and the best SP, PPV and NPV with ELISA-IgG and WB (88.0%, 87.3%, and 83.5%, respectively)., Conclusions: DD5 appears as the most specific test and as having greater PPV; ELISA-IgG and WB are more sensitive. The combined use of these tests does not improve diagnosis validity.

Background: Bariatric surgery is the therapy for morbid obesity. There are a number of surgical procedures, which are performed by open surgery (OS) and more recently also by laparoscopy (LS). The objective of this study was to consider the evidence for the best bariatric surgical options., Methods: Systematic review of the literature was conducted. Morbid obesity studies published between 1990 and 2002 were analyzed. MEDLINE, LiLACS and COCHRANE databases were used, utilizing MeSH terms and free words. Selected studies were analyzed using a specially designed score of methodological quality, to analyze and compare studies. This validated scale is composed by 3 items, and the final score may range between 6 and 36 points. Means, medians and weighted means were calculated, and a comparative analysis by therapy was performed using median 95% confidence intervals (CI). Number of treated patients, reduction in body mass index (BMI), reduction in co-morbidity, %EWL, morbidity and mortality, hospital stay, follow-up, success and failure of operations, and methodological quality were analyzed., Results: 283 related articles were considered. Only 31 of them had selection criteria (these include 5,216 patients operated by OS and 3,230 by LS). Operative mortality was 0.0% for OS and 0.4% for LS. At 36 months, OS techniques show reduction in BMI, %EWL and reductions in co-morbidity of 30.9%, 61.9% and 74.1% respectively. At 36 months, LS techniques show reduction in BMI, %EWL and reduction in comorbidity of 23.7%, 55.9% and 70.9%. Hospital stay was 3.8 days for LS and 7 for OS. At 2-year follow-up, morbidity was 14.8% for LS and 16.7% for OS, and reoperations were 17.7% for LS and 11.3% for OS. Median score for methodological quality was 13 for OS and 11 for LS., Conclusions: Methodological quality of primary studies to 2002 has been poor.

Background: There are few studies looking for collagen matrix defects in patients with inguinal bernia., Aim: To study the skin connective tissue in patients with and without inguinal bernia., Patients and Methods: Skin from the surgical wound was obtained from 23 patients with and 23 patients without inguinal bernia. The samples were processed for conventional light microscopy. Collagen fibers were stained with Van Giesson and elastic fibers with Weigert stain., Results: Patients without hernia had compact collagen tracts homogeneously distributed towards the deep dermis. In contrast, patients with hernia had zones in the dermis with thinner and disaggregated collagen tracts. Connective tissue had a lax aspect in these patients. Collagen fiber density was 52% lower in patients with hernia, compared to subjects without hernia. No differences in elastic fiber density or distribution was observed between groups., Conclusions: Patients with inguinal bernia have alterations in skin collagen fiber quality and density.

Background: Cyst infection and subsequent liver abscess formation are complications of liver echinococcosis. Traditionally, this condition has been treated by simple drainage, a procedure associated with unsatisfactory postoperative evolution., Methods: The present paper examines a series of cases involving infected liver echinococcal cysts. Surgery was performed at the Temuco Regional Hospital after assessment was made of general and liver laboratory parameters, chest X-ray and abdominal ultrasound were performed and antibiotic treatment was administered. The procedure consisted of surgical drainage, parasite material extirpation and pericystic membrane resection with surrounding healthy liver parenchyma. The morbidity and mortality rate, hospital stay and evidence of recurrent hydatid disease were evaluated., Results: Forty-nine patients (21 male and 28 female), with a median age of 45 years (range 16-84 years), with infected cysts measuring 14 cm in ultrasonographical diameter (range 5-30 cm) were operated on. In the majority of cases, liver abscesses were located in the right lobe (37 patients, 75.4%) and the most frequent computed tomography scan pattern was heterogeneous (40 patients, 81.6%). The median hospital stay was 5 days, the median follow-up period was 32 months (range 2-91 months) and perioperative morbidity was 24.4%. Surgical complications were verified in five patients (10.2%) and medical complications occurred in seven cases (14.3%). No recurrence of hydatid disease was observed. Mortality was 2% (one patient)., Conclusions: Good results were obtained when hydatid liver abscesses were treated aggressively.

There is a high prevalence of gastroesophageal reflux disease (GERD) in the general population. Prevalence studies are scarce, and there is a lack of valid instruments for measuring them. The aim of this paper is to validate a questionnaire for detecting GERD. A validity study design with pathologic GERD patients and controls was used. A sample of 240 subjects age and sex paired was selected in the ratio of 3:1 (patients to controls). The initial structured questionnaire contained a variety of GERD symptoms. Internal consistency, interobserver reliability, criteria validity using 24-h esophageal pH monitoring, construct validity, and extreme group validation were assessed. Sensitivity, specificity, and predictive values were also obtained in different cutoff points of the definitive scale. A total of 180 confirmed GERD patients and 60 controls were included in the study. Mean age in years was 45 +/- 13, with no statistical difference by gender (67% were female). Internal consistency of 0.75 and interobserver reliability of 0.87 was achieved in building the scale. Extreme group validation was highly significant by assessing the scale score with 24-h esophageal pH monitoring (P <.0001). At cutoff point 3 of the scale and with a correct classification of subjects of 92.4%, sensitivity, specificity, positive, and negative predictive values were 92, 95, 98, and 79%, respectively. The conclusion of this article is that a reliable and valid instrument was built to detect GERD.