Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720090008&lang=es vol. 137 num. 8 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[Factores predictores de inicio y cesación de tabaquismo en una cohorte de mujeres chilenas con 5,5 años de seguimiento]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000800001&lng=es&nrm=iso&tlng=es Background: Chilean women have one of the highest smoking prevalence in the world. Aim To estimate the main factors associated with smoking initiation and quitting among a cohort of adult women living in a low socioeconomic status area of Santiago, Chile. Material and methods: A random population-based sample of 1,100 women, 18 years and older, were selected from a community located in the South East area of Santiago. Sociodemographic, as well as smoking, beliefs, behaviors, stages of change and nicotine addiction level were recorded during a personal interview. After an average follow-up period of 5.5years, women were re-evaluated. Results: Seventy-three percent of women completed the study. At baseline, 39% of women were smokers. At the end of the study, there was an absolute smoking rate reduction of 7.1% (p <0.001). The main variables associated with smoking initiation were younger age (Odds ratio (OR): 1.08, 95% confidence intervals (CI): 1.05-1.12), higher education level (OR: 1.2, 95% CI: 1.07-1.35), and having fewer children (OR: 1.3 95% CI: 1.01-1.66). Factors related with quitting were younger age of onset (OR: 1.06 95% CI: 1.02-1.1), higher level of nicotine dependence (OR: 4.22, 95% CI: 1.74-10.27), and higher perception of smoking addiction (OR: 4.34, 95% CI: 2-9.09). Stage of change was associated with smoking cessation but its effect was diluted after adjusting for the level of nicotine addiction. Conclusions: Sociodemographic and family factors were the main variables related with initiation, whereas age of onset, belief of addiction, and nicotine dependence were the main factors related with cessation. Women with a high motivation for quitting should be evaluated for nicotine addiction level to define the best strategy for intervention. <![CDATA[<b>Enfermedad de Still del adulto</b>: <b>Una gran simuladora. Experiencia clínica basada en 20 casos</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000800002&lng=es&nrm=iso&tlng=es Background: Adult Still's disease is an inflammatory disorder characterized by quotidian fevers, and an evanescent rash. Its presentation can be acute or subacute. Aim: To report our experience with Adult Still's disease. Material and methods: Systematic retrospective review of medical records of nine men and 11 women aged between 17 and 57 years, with Still's disease, followed in two public hospitals of Metropolitan Santiago. Results: Eighty percent of patients had a prior different diagnosis. All presented with fever and joint involvement. Eighty percent had malaise, 80% had odynophagia, 80% had an evanescent rash, 70% had myalgias, 50% had lymph node enlargement and 40% had splenomegaly. Laboratory showed ¡eukocytosis in 80% and a high erythrocyte sedimentation rate in all. High ferritin levels were detected in 80%, and became an important diagnosis clue. Initial treatment was based on non steroidal antiinflammatory drugs, however 80% required steroids and 35% required methotrexate. Azathioprine, sulphalazine, hydroxychloroquine and ¡eflunomide were used occasionally. Eleven patients had a single episode, nine had a relapsing disease and four had a chronic or persistent mode. Conclusions: Adult Still's disease must be suspected in patients with fever of unknown origin. An early diagnosis and adequate treatment of the disease are associated with a favorable evolution and prognosis. <![CDATA[<b>Carcinoma subseroso de la vesícula biliar (pT2)</b>: <b>Valor pronóstico de la expresión de los genes supresores de tumores p53 y p27 en matrices de tejidos</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000800003&lng=es&nrm=iso&tlng=es Background: Subserosal carcinoma is the stage that presents the greatest difficulty in the diagnosis therapeutic handling and prognosis evaluation. Aim To study the expression of p53 and p27 genes in subserosal gallbladder cancer. Material and methods: One hundred twenty seven tissue samples of subserosal gallbladder cancer (coming from 112 females aged 62 ± 13years and 15 men aged 67 ± 17years) and 50 control samples were selected to construct tissue arrays. p53 andp27genes were determined by immunohistochemistry. Results: Thirty eight percent of tumors were not detected at the macroscopic examination, 52% and 17% had lymph node and blood vessel involvement, respectively. Fifty six and 46% were positive for p53 and p27, respectively. No association between the expression of both genes and gender, degree of differentiation, lymph node or blood vessel involvement, was observed. Overall five years actuarial survival was 32%. Patients with positive or negative p53 expression had a 22% and 53% survival, respectively (p =0.05). No association between survival and p27 expression was observed. Conclusions: p53 gene expression is a prognostic factor for subserosal gallbladder cancer. <![CDATA[<b>Utilidad de la tomografía computarizada de emisión de fotón único sincronizada con el electrocardiograma para la detección de isquemia miocárdica silente en diabéticos tipo 2</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000800004&lng=es&nrm=iso&tlng=es Background: Asymptomatic patients with severe coronary atherosclerosis may have a normal resting electrocardiogram and stress test. Aim: To assess the yield of Gated Single Photon Emission Computer Tomography (SPECT) for the screening of silent myocardial ischemia in type 2 diabetic patients. Material and methods: Electrocardiogram, stress test and gated-SPECT were performed on 102 type 2 diabetic patients aged 60 ± 8 years without cardiovascular symptoms. AH subjects were also subjected to a coronary angiography whose results were used as gold standard. Results: Gated-SPECT showed myocardial ischemia on 26.5% of studied patients. The sensibility, specifity accuracy, positive predictive value and negative predictive value were 92.3%, 96%, 95%, 88.8%, 97.3%, respectively. In four and six patients ischemia was detected on resting electrocardiogram and stress test, respectively. Eighty percent of patients with doubtful resting electrocardiogram results and 70% with a doubtful stress test had a silent myocardial ischemia detected by gated-SPECT There was a good agreement between the results of gated-SPECT and coronary angiography (k =0.873). Conclusions: Gated-SPECT was an useful tool for the screening of silent myocardial ischemia. <![CDATA[<b>Diseño de una escala ecográfica predictora de malignidad en nódulos tiroideos</b>: <b>Comunicación preliminar</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000800005&lng=es&nrm=iso&tlng=es Background: Thyroid nodules are common and associated to a low risk of malignancy. Their clinical assessment usually includes a fine neddle aspiration biopsy (FNAB). Aim To identify ultrasonographic characteristics associated to papillary thyroid carcinoma (PTC) and generate a score that predicts the risk of PTC. Material and methods: Retrospective review of all fine needle aspiration biopsies of the thyroid performed in a lapse of two years. Biopsies that were conclusive for PTC were selected and compared with an equal amount of randomly selected biopsies that disclosed a benign diagnosis. Results: One hundred twenty two biopsies of a total of 1,498 were conclusive for PTC. Univariate analysis showed associations with PTC for the presence of micro-calcifications (Odds ratio (OR) 49.2: 95% confidence intervals (CI) 18.7-140.9), solid predominance (OR 25.1; 95% CI 6-220), hypoechogenicity (OR 23.5, 95% CI 6.5-122.6), irregular borders (OR 17, 95% CI 7.2-42.9), lymph node involvement (OR 12.3, 95% CI2.7-112), central vascularization (OR 12.2, 95% CI 4.8-33.3), local invasion and hyperechogenicity (OR 0.2; CI95% CI 0.03-0.6). Multivariate analysis disclosed microcalcifications (OR 28.1; CI 95% 8.9-89), hypoechogenicity (OR 9.4; 95% CI 1.5-59.5) and irregular borders (OR 4.7; CI 95% 1.5-15) as the variables independently associated with the presence of PTC. The prevalence of PTC in the presence of the three variables was 97.6% (Likelihood ratio (LR) 45) and 5.4% in their absence (LR 0.06). Conclusions: This scale predicts the presence or absence of PTC using simple ultrasound characteristics. <![CDATA[<b>Efectos clínicos a largo plazo en niños intoxicados con plomo en una región del sur de Chile</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000800006&lng=es&nrm=iso&tlng=es Background: In 1996 there was a massive lead poisoning in a southern rural community in Chile. The contamination source was a mill whose grinding stone was repaired with lead and contaminated the flour. Aim: To assess the presence of sequelae ten years later, among subjects that were exposed to lead on that occasion. Material and methods: Cross sectional study of 77 individuals (47 males), aged 10 to 25 years, that were exposed to lead in 1996 and were treated with EDTA. Results: Twenty one percent of subjects had a subnormal intellingence quotient (IQ). The risk of having a low IQ was significantly higher among those exposed before the age of six years. IQ was significantly lower among subjects that, immediately after the exposure, had a lead level over 48 fig/dl, compared with those that had a lead level below 43 fig/dl (86.7±7.3 and 93±11.6 respectively). No subjects with high blood pressure or evidences of nephrotoxicity were detected. Conclusions: Subjects aged ¡ess than six years at the moment of lead exposure had a lower IQ when assessed ten years later. <![CDATA[<b>Neumomediastino espontáneo (síndrome de Hamman)</b>: <b>Una enfermedad benigna mal diagnosticada</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000800007&lng=es&nrm=iso&tlng=es Background: Hamman syndrome or spontaneous pneumomediastinum is uncommon and its clinical manifestations are chest pain, dyspnea and subcutaneous emphysema. Aim: To report a series of patients with spontaneous pneumomediastinum. Material and methods: Medical records of patients with the diagnosis of pneumomediastinum, managed between 2002 and 2007 in a public hospital, were retrieved and reviewed. Results: Eight patients aged between 16 and 41 years (five males) were identified. The most common symptom was chest pain and the most common sign was subcutaneous emphysema. A chest X ray was performed in all and a chest CT scan in seven. AH were managed conservatively with oxygen, analgesia and rest. No patient required surgery and the evolution was favorable. Conclusions: The most common presenting complaint of spontaneous pneumomediastinum is chest pain and its management does not require surgery. <![CDATA[<b>Fiebre de origen desconocido como forma de presentación atípica de mieloma múltiple</b>: <b>Caso clínico</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000800008&lng=es&nrm=iso&tlng=es Fever of unknown origin (FUO) can be caused by tumors, especially those arising from the hematopoietic system. Multiple myeloma can also cause fever but it is not a common cause of fever of unknown origin. We report a 53 year-old man presenting with fever lasting eight weeks. An extensive study for common causes of FUO was negative. The appearance of hypercalcemia and proteinuria during the evolution suggested the presence of a multiple myeloma, that was confirmed with a bone marrow biopsy. Thalidomide and dexametasone were prescribed with resolution of fever. <![CDATA[<b>Trasplante con precursores hematopoyéticos de cordón umbilical en adultos con neoplasias hematológicas en Chile</b>: <b>Serie clínica</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000800009&lng=es&nrm=iso&tlng=es Hematopoietic precursors transplantation is a therapeutic alternative for leukemia, some metabolic diseases and some immune deficiency syndromes. In its allogeneic variety leukemia eradication is based in the conditioning prior to transplantation and the allograñ effect against leukemia. Umbilical cord blood is an alternative source of hematopoietic precursors when there are no HLA compatible relatives available. Between 2003 and 2007 we have performed five umbilical cord blood transplant in adult patients in a University hospital. All patients had malignant diseases. Conditioning protocols were ablative in all except in one patient and in all, more than one unit of umbilical cord blood was used. Hematopoietic engraftment was confirmed in all patients and the main complications registered were infectious and associated to immunosuppression. <![CDATA[<b>Fenómeno de acomodación inmunológica</b>: <b>Trasplante hepático ABO incompatible. </b><b>Caso clínico</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000800010&lng=es&nrm=iso&tlng=es We report a 33 year-old female with a diagnosis of halothane-induce fulminant hepatic failure who was subjected to a liver transplant with an ABO-incompatible graft. The patient received a therapeutic protocol that included total plasma exchange, splenectomy and quadruple immunosuppression. After 5 years, the patient remains asymptomatic and with normal liver enzymes, while she has been treated with low dose of immunosuppressive drugs. This case demonstrates an example of how the immunological process of accomodation opens the possibility of using ABO-incompatible organs as a definitive grafts. <![CDATA[<b>Síndrome moyamoya en paciente con síndrome de Down y déficit de antitrombina III</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000800011&lng=es&nrm=iso&tlng=es Moyamoya disease is a unique chronic progressive cerebrovascular disease characterized by bilateral stenosis or occlusion of the arteries around the circle of Willis with prominent arterial collateral circulation. It can be primary or secondary to genetic syndromes such as Down syndrome. We report a seven year-old girl with a Down syndrome that presented with a disturbance of consciousness, seizures and a right hemiparesia at the age of five. Magnetic resonance imaging showed old cortical ischemic lesions in both cerebral hemispheres and a recent infarction in the territory of the ¡eft middle cerebral artery. Brain angiography showed a proximal stenosis of both medial cerebral arteries and a net of collateral vessels, consistent with the diagnosis of moyamoya syndrome. The patient had also an antithrombin III deficiency. Aspirin was indicated and a surgical correction was recommended. However, prior to the procedure, the patient had a new infarction in the territory of the right middle cerebral artery, which caused a severe disability. <![CDATA[<b>Diagnóstico del Síndrome de Ovario Poliquístico</b>: <b>nuevos fenotipos, nuevas incógnitas</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000800012&lng=es&nrm=iso&tlng=es Polycystic ovarian syndrome (PCOS), includes a wide spectrum of clinical symptoms and signs. Three different diagnostic classifications have been proposed to define this disease. The first one, published in 1990, known as the "NIH criteria" requires the simultaneous presence of hyperandrogenism and menstrual dysfunction in order to diagnose PCOS. Later on, in 2004, an expert panel met in Rotterdam and added to the previous criteria the presence ofpolycystic ovarian morphology (PCOM) detected by transvaginal ultrasonography The later classification broadened the spectrum of PCOS and also included women with oligomenorrhea and PCOM without hyperandrogenism or hyperandrogenism and PCOM without menstrual dysfunction. Finally, the Androgen Excess Society, published in 2006 new diagnostic criteria which required the presence of clinical or biochemical hyperandrogenism, with either PCOM or menstrual dysfunction to diagnose PCOS. We review the different classifications employed in the diagnosis of PCOS, the diverse phenotypes that may lead to the diagnosis of PCOS and their association with cardiovascular and metabolic complications. <![CDATA[<b>Manejo del aneurisma de la aorta abdominal</b>: <b>Estado actual, evidencias y perspectivas para el desarrollo de un programa nacional</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000800013&lng=es&nrm=iso&tlng=es Open and endovascular surgery are therapeutic alternatives for the treatment of abdominal aortic aneurism. The development of guidelines for its treatment requires a thorough analysis of available evidence to recommend the best treatment for each country's reality. Prospective randomized trials have shown best initial results with endovascular surgery, with higher hospital costs than open surgery. The requirement of anatomical suitability for the placement of endovascular prostheses limits the universal use of endovascular surgery. Moreover, this type of surgery needs a strict imaging and clinical follow up due to the high rates of late complications, which range from 20% to 40%. Many of these complications require further surgical interventions, elevating costs of treatment. The initial benefit of endovascular surgery is lost during long follow up as survival curves become similar to those of open surgery. Even for patients with a high surgical risk, the benefits of endovascular surgery are doubtful. <![CDATA[<b>La <i>Revista Médica de Chile </i>en el año 2009</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000800014&lng=es&nrm=iso&tlng=es During the first semester of 2009 Revista Médica de Chile has received an increasing number of manuscripts. Close to 30% were rejected while most other are in the process of being improved by the authors after receiving criticisms by external peer reviewers and the editors. The time lag between acceptance and publication of manuscripts is on an average six months. During 2008, 10% of articles published were submitted by authors from countries other than Chile and most of them were printed in English. Impact factor and other indexes provided by the ISI Web of Knowledge showed a promising improvement in 2008. The International Advisory Committee and the National Editorial Committee were renewed, a new Section on Laboratory Medicine was incorporated and several minor changes were done in design and format, in the title page and the issues' content. The main problems to be faced relate to the increasing cost of editing and printing, with a reduction in commercial advertising historically contributed by the pharmaceutical industry. Another major concern is to stimulate governmental agencies, scientific societies and universities to establish a national independent registry of clinical trials, that should become a mandatory requisite for every manuscript submitted to Chilean medical journals, reporting clinical trials performed in the country; foreign manuscripts should document the satisfaction of an identical requisite in their original source. <![CDATA[<b>Medicina Interna y Salud Pública</b>: <b>Claves para una relación virtuosa</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000800015&lng=es&nrm=iso&tlng=es A special Committee on Internal Medicine and Public Health was established by Sociedad Médica de Santiago (Chilean Society of Internal Medicine) in April 2007 with the duty to write a Consensus Paper on the interaction between both branches of medical profession. The main objective was to find the common grounds on which to construct a positive approach to regain space for Internal Medicine, based on prevalent epidemiológica! features related to adult health issues. The authors describe the reasons to explain the gap between clinical medicine and population health and identify the nature and evolution of chronic diseases as the point of encounter between both. With Chilean health surveys data, they state that chronic diseases explain the high proportion of burden of disease, mortality and disability, and stress that by the year 2025 one in every five inhabitants will be over 65years of age, with ageing as another main problem for the health care sector. Population with multiple risks and multimorbidity is the most important challenge for the Chilean Health Care System. A new model of care is needed to tackle this scenario with new skills regarding psychosocial determinants of health. The leading role of internists and ideally geriatricians, will be crucial in this process and will help the implementation of sound population based interventions. Both individual and community level interventions will help to improve quality of life of Chilean families. <![CDATA[<b>Las nuevas escuelas de medicina en el panorama médico actual</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000800016&lng=es&nrm=iso&tlng=es There is concern about the possible consequences caused by the proliferation of private Medical Schools in Chile. Most of these schools have consolidated as health professional training centers, but its presence is changing the scenario of public health and medical profession. The most important consequence is the increase in the number of physicians that will occur, that may exceed the demand of the Chilean population and generate medical unemployment or emigration. There is also concern about the quality of the training process and the preparation and experience of teachers, that derives in the need for accreditation of medical schools. Private Universities are aware of these problems and are working on them. The struggle for clinical fields in the Public Health System has been regulated by an administrative norm of the Ministry of Health. <![CDATA[<b>Docencia de pregrado en medicina interna en un hospital privado</b>: <b>Diez años de experiencia</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000800017&lng=es&nrm=iso&tlng=es There is a 10 years teaching experience for fourth year medical students and interns in a Chilean private hospital. The students attend an eight weeks practical course. The interns rotate during 16 weeks by specialties and make shifts. The hospital structure with Clinical Services and Medical-Surgical departments facilitates the teaching process. There are approximately 30,000 admissions per year with a mean stay of 3.7 days, that allow the students to be in touch with patients with different diseases that are managed with updated technology. We emphasize the ethical and clinical management of concrete problems of patients, self ¡earning and communication skills. The students evaluate their stay answering surveys and with semi structured interviews. Teaching is assessed by tutors and heads of departments, in clinical rounds, sometimes prepared by the students, by a thorough revision of problem oriented medical records and with practical and theoretical tests. The results of the program have been quite satisfactory for participants. <![CDATA[<b>La carrera académica del Profesor Clínico de Medicina</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000800018&lng=es&nrm=iso&tlng=es An important challenge for medical schools is to recognize and stimulate the academic career of its clinical faculty. These professionals are mainly dedicated to teaching activities and play a role in the modeling of its students. Therefore, they contribute to the development of medical education. The aim of this paper is to analyze the main features of this particular kind of academics and to stimulate physicians to embrace the teaching career. The development channels of teaching academic activity are direct teaching, curricular innovation and administration, counseling, clinical investigation, education administration, leadership and assessment of the learning process. We define each of these activities, giving examples of the activities that can be carried out and how to assess them. <![CDATA[<b>Declaración de Estambul en relación al tráfico de órganos y turismo en trasplante</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000800019&lng=es&nrm=iso&tlng=es This is a translation into Spanish, done by Mario Uribe, M.D., F.A.C.S., and authorized by the Conference Organization, of the official statements signed by The Transplantation Society, The International Society of Nephrology and the representatives who participated at a WHO sponsored Conference held in Istambul, Turkey, April 30 to May 2, 2008. <![CDATA[<b>PCR universal o de amplio espectro</b>: <b>Un aporte a la detección e identificación de bacterias y hongos en la práctica clínica</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000800020&lng=es&nrm=iso&tlng=es The use of techniques for the detection of nucleic acids such as the polymerase chain reaction (PCR) has had a major impact on microbiological analysis, playing an important role in the clinical laboratory. Most of the techniques currently used are designed for specific detection of a particular microorganism. However, infectious agents can also be identified even if genus or species are unknown, using universal primers to amplify bacterial or fungal DNA and then identify the species by sequency (universal or wide spectrum PCR). This methodology is applied in cultures that are difficult to identify usingphenotypic techniques, and more recently it is also being used directly in clinical samples, where the detection and identification of the infectious agent by traditional techniques is difficult or not possible.<hr/>El uso de técnicas para la detección de ácidos nucleicos como la reacción en cadena de la polimerasa (PCR) ha tenido un gran impacto en el diagnóstico microbiológico, ocupando un lugar importante en el laboratorio clínico. La mayoría de ¡as técnicas en uso han sido diseñadas para la detección específica de un microorganismo. Sin embargo, también es posible identificar el agente etiológico aunque se desconozca la especie o el género, utilizando partidores universales para amplificar el ADN de bacterias y hongos, y luego secuenciar para identificar la especie (PCR universal o de amplio espectro). Esta metodología se aplica en cultivos difíciles de clasificar por técnicas fenotípicas, pero también se ha comenzado a utilizar directamente en muestras clínicas, en las que la detección e identificación del agente infeccioso por técnicas tradicionales resulta difícil o no es posible. <![CDATA[<b>Estado actual e implicancias de la acreditación de Escuelas de Medicina en Chile</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000800021&lng=es&nrm=iso&tlng=es The use of techniques for the detection of nucleic acids such as the polymerase chain reaction (PCR) has had a major impact on microbiological analysis, playing an important role in the clinical laboratory. Most of the techniques currently used are designed for specific detection of a particular microorganism. However, infectious agents can also be identified even if genus or species are unknown, using universal primers to amplify bacterial or fungal DNA and then identify the species by sequency (universal or wide spectrum PCR). This methodology is applied in cultures that are difficult to identify usingphenotypic techniques, and more recently it is also being used directly in clinical samples, where the detection and identification of the infectious agent by traditional techniques is difficult or not possible.<hr/>El uso de técnicas para la detección de ácidos nucleicos como la reacción en cadena de la polimerasa (PCR) ha tenido un gran impacto en el diagnóstico microbiológico, ocupando un lugar importante en el laboratorio clínico. La mayoría de ¡as técnicas en uso han sido diseñadas para la detección específica de un microorganismo. Sin embargo, también es posible identificar el agente etiológico aunque se desconozca la especie o el género, utilizando partidores universales para amplificar el ADN de bacterias y hongos, y luego secuenciar para identificar la especie (PCR universal o de amplio espectro). Esta metodología se aplica en cultivos difíciles de clasificar por técnicas fenotípicas, pero también se ha comenzado a utilizar directamente en muestras clínicas, en las que la detección e identificación del agente infeccioso por técnicas tradicionales resulta difícil o no es posible. <![CDATA[<b>Diagnóstico genético disponible para la enfermedad de huntington en chile</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000800022&lng=es&nrm=iso&tlng=es The use of techniques for the detection of nucleic acids such as the polymerase chain reaction (PCR) has had a major impact on microbiological analysis, playing an important role in the clinical laboratory. Most of the techniques currently used are designed for specific detection of a particular microorganism. However, infectious agents can also be identified even if genus or species are unknown, using universal primers to amplify bacterial or fungal DNA and then identify the species by sequency (universal or wide spectrum PCR). This methodology is applied in cultures that are difficult to identify usingphenotypic techniques, and more recently it is also being used directly in clinical samples, where the detection and identification of the infectious agent by traditional techniques is difficult or not possible.<hr/>El uso de técnicas para la detección de ácidos nucleicos como la reacción en cadena de la polimerasa (PCR) ha tenido un gran impacto en el diagnóstico microbiológico, ocupando un lugar importante en el laboratorio clínico. La mayoría de ¡as técnicas en uso han sido diseñadas para la detección específica de un microorganismo. Sin embargo, también es posible identificar el agente etiológico aunque se desconozca la especie o el género, utilizando partidores universales para amplificar el ADN de bacterias y hongos, y luego secuenciar para identificar la especie (PCR universal o de amplio espectro). Esta metodología se aplica en cultivos difíciles de clasificar por técnicas fenotípicas, pero también se ha comenzado a utilizar directamente en muestras clínicas, en las que la detección e identificación del agente infeccioso por técnicas tradicionales resulta difícil o no es posible. <![CDATA[<b>XVI Congreso Panamericano de Reumatología PANLAR 2010</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000800023&lng=es&nrm=iso&tlng=es The use of techniques for the detection of nucleic acids such as the polymerase chain reaction (PCR) has had a major impact on microbiological analysis, playing an important role in the clinical laboratory. Most of the techniques currently used are designed for specific detection of a particular microorganism. However, infectious agents can also be identified even if genus or species are unknown, using universal primers to amplify bacterial or fungal DNA and then identify the species by sequency (universal or wide spectrum PCR). This methodology is applied in cultures that are difficult to identify usingphenotypic techniques, and more recently it is also being used directly in clinical samples, where the detection and identification of the infectious agent by traditional techniques is difficult or not possible.<hr/>El uso de técnicas para la detección de ácidos nucleicos como la reacción en cadena de la polimerasa (PCR) ha tenido un gran impacto en el diagnóstico microbiológico, ocupando un lugar importante en el laboratorio clínico. La mayoría de ¡as técnicas en uso han sido diseñadas para la detección específica de un microorganismo. Sin embargo, también es posible identificar el agente etiológico aunque se desconozca la especie o el género, utilizando partidores universales para amplificar el ADN de bacterias y hongos, y luego secuenciar para identificar la especie (PCR universal o de amplio espectro). Esta metodología se aplica en cultivos difíciles de clasificar por técnicas fenotípicas, pero también se ha comenzado a utilizar directamente en muestras clínicas, en las que la detección e identificación del agente infeccioso por técnicas tradicionales resulta difícil o no es posible. <![CDATA[<b>VI Curso de Medicina Interna Avanzada</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000800024&lng=es&nrm=iso&tlng=es The use of techniques for the detection of nucleic acids such as the polymerase chain reaction (PCR) has had a major impact on microbiological analysis, playing an important role in the clinical laboratory. Most of the techniques currently used are designed for specific detection of a particular microorganism. However, infectious agents can also be identified even if genus or species are unknown, using universal primers to amplify bacterial or fungal DNA and then identify the species by sequency (universal or wide spectrum PCR). This methodology is applied in cultures that are difficult to identify usingphenotypic techniques, and more recently it is also being used directly in clinical samples, where the detection and identification of the infectious agent by traditional techniques is difficult or not possible.<hr/>El uso de técnicas para la detección de ácidos nucleicos como la reacción en cadena de la polimerasa (PCR) ha tenido un gran impacto en el diagnóstico microbiológico, ocupando un lugar importante en el laboratorio clínico. La mayoría de ¡as técnicas en uso han sido diseñadas para la detección específica de un microorganismo. Sin embargo, también es posible identificar el agente etiológico aunque se desconozca la especie o el género, utilizando partidores universales para amplificar el ADN de bacterias y hongos, y luego secuenciar para identificar la especie (PCR universal o de amplio espectro). Esta metodología se aplica en cultivos difíciles de clasificar por técnicas fenotípicas, pero también se ha comenzado a utilizar directamente en muestras clínicas, en las que la detección e identificación del agente infeccioso por técnicas tradicionales resulta difícil o no es posible.