Hugo Salinas

Propuesta de índices de gestión de servicios médico-quirúrgicos hospitalarios mediante técnicas estadísticas multivariantes

Data on admissions to a University Hospital during 2003 were analyzed. Number ofdischarges, lethality rate, re-admission rate, number of outpatient consultations, length ofhospital stay and surgical complexity index were analyzed, using information obtained by theOperations Management Department. The Principal Components Analysis (PCA) technique wasapplied and the R correlation matrix was used.

Comparación de los criterios de Nugent y Spiegel para el diagnóstico de vaginosis bacteriana y análisis de los resultados discordantes por el método de Ison y Hay

Background: Vaginal infection is the commonest cause of genital symptoms and has obstetric and gynecological implications. Aim: To compare the Nugent and Spiegel methods for the diagnosis of bacterial vaginosis (BV) and to analyze discordant specimens using Ison and Hay (Ison/Hay) criteria. Material and Methods: After discarding cases with Candidiasis, defi cient specimens or those lacking bacteria, a total of 348 Gram-stained smears vaginal specimens received for the diagnosis of BV, were analyzed. Results: Vaginal microbiota was classifi ed as normal in 203 and 237 samples (58 and 68% of samples), according to Nugent and Spiegel criteria, respectively. One hundred and fi ve (30%) and 111 samples (32%), were classifi ed as VB according to Nugent and Spiegel criteria, respectively. Both criteria were concordant in 308 samples (88.5%). The 40 (11.5%) discordant specimens were classifi ed as intermediate microfl ora by the Nugent system and as normal or BV by Spiegel. Among these, the Ison/Hay procedure identifi ed four categories of microbiota. Ten (25%) specimens were classifi ed as grade II microbiota, confi rming their categorization by Nugent as intermediate microbiota, six (15%) were classifi ed in the III category, confi rming the diagnosis of BV by Spiegel, 13 (32.5%) corresponded to the category III, that does not exist in the Nugent and Spiegel categorization systems. Finally, 11 specimens could not be assigned to one category due to microscopic limitations to distinguish bacterial morphotypes. Conclusions: The systems proposed by Spiegel, Nugent and Ison / Hay are comparable for the diagnosis of BV. However, we recommend the use of Ison/ Hay procedure to evaluate vaginal microbiota, due to its wider range of categories, allowing a better discrimination of the vaginal microbiota

Estudio de variables asociadas al cáncer de piel en Chile mediante análisis de componentes principales

Resumen Fundamento La incidencia de cancer de piel en Chile ha aumentado en los ultimos anos. Objetivo Asociar variables al cancer de piel en Chile a traves de indices generados mediante tecnicas estadisticas descriptivas multivariantes. Material y metodo Durante el mes de mayo de 2004 se recopilo informacion de datos demograficos, meteorologicos y clinicos de Chile, correspondientes al ejercicio 2001, ultima informacion completa y oficial disponible para la totalidad de los Servicios de Salud del pais. Se estudiaron las variables confeccionadas por el Instituto Nacional de Estadistica (INE), el Ministerio de Salud (MINSAL), el Ministerio de Planificacion y Cooperacion (MIDEPLAN), el Fondo Nacional de Salud (FONASA), la Direccion Meteorologica de Chile, la Universidad Tecnica Federico Santa Maria y la Direccion General de Aguas. Se aplico a los datos obtenidos un analisis de components principales (ACP). Resultados Se seleccionaron las tres primeras components principales, con un porcentaje acumulado de variabilidad explicada de 54,48 %. La primera componente principal explica el 24,92 % de la variabilidad y tiene relacion con variables del orden climatico y geografico. La segunda componente principal explica el 15,77 % de la variabilidad y se relaciona principalmente con la poblacion beneficiaria de FONASA y el indice de pobreza. En ella se opone de manera importante la tasa de letalidad por cancer cutaneo. La tercera componente principal explica el 13,79% de la variabilidad y se relaciona con caracteristicas poblacionales como poblacion total asignada, poblacion femenina y poblacion urbana. Conclusion La aplicacion del ACP es util para el estudio de los factores asociados con el cancer de piel.

Evolution and Conservation on Top of the World: Phylogeography of the Marbled Water Frog (Telmatobius marmoratus Species Complex; Anura, Telmatobiidae) in Protected Areas of Chile

The Andean Altiplano has served as a complex setting throughout its history, driving dynamic processes of diversification in several taxa. We investigated phylogeographic processes in the Telmatobius marmoratus species complex occurring in this region by studying the geographic patterns of genetic variability, genealogies, and historical migration, using the cytochrome b (cyt-b) gene as a marker. DNA sequences from Telmatobius gigas and Telmatobius culeus, Bolivian species with an uncertain taxonomic status, were also included. Additionally, we evaluated the phylogenetic diversity (PD) represented within Chilean protected areas and the complementary contribution from unprotected populations. Phylogenetic reconstructions from 148 cyt-b sequences revealed 4 main clades, one of which corresponded to T. culeus. T. gigas was part of T. marmoratus clade indicating paraphyletic relationships. Haplotypes from Chilean and Bolivian sites were not reciprocally monophyletic. Geographic distribution of lineages, spatial Bayesian analysis, and migration patterns indicated that T. marmoratus displays a weaker geographic structure than expected based on habitat distribution and physiological requirements. Demographic and statistical phylogeography analyses pointed out to a scenario of recent population expansion and high connectivity events of a more recent age than the post Last Glacial Maximum, probably associated to more humid events in Altiplano. PD of T. marmoratus populations within protected areas represents 55.6% of the total estimated PD. The unprotected populations that would contribute the most to PD are Caquena and Quebe (21%). Recent evolutionary processes and paleoclimatic changes, potentially driving shifts in habitat connectivity levels and population sizes, could explain the phylogeographic patterns recovered herein.

Nueva propuesta de indicadores de gestión de los servicios médico-quirúrgicos mediante técnicas estadísticas multivariantes

Resumen Objetivo Obtener indicadores utiles para la gestion hospitalaria mediante la utilizacion de tecnicas estadisticas multivariantes descriptivas. Material y metodo Durante abril del ano 2006 se analizo la informacion del Hospital Clinico de la Universidad de Chile correspondiente a los egresos hospitalarios del ano 2003. Se estudiaron las variables monitorizadas por la Gerencia de Operaciones del Hospital Universitario: numero de egresos, tasa de letalidad, tasa de reingresos, numero de consultas externas, numero de dias de camas ocupadas, estadia en unidad de cuidados intensivos, edad de los pacientes e indice de complejidad quirurgica. Las variables se midieron para un total de 24.345 egresos. Aplicamos la tecnica de analisis de componentes principales (ACP), y se utilizo la matriz de correlaciones R. Resultados Se seleccionaron las primeras 2 componentes, con un porcentaje acumulado de variabilidad del 71,3%: del 49,4%, la primera, y del 21,9%, la segunda. Conclusiones La primera componente puede ser relacionada a un nuevo indice que tiene que ver con la dificultad de los casos atendidos; lo hemos denominado complejidad asistencial . La segunda explicaria la cuantia de personas atendidas, y denominamos demanda asistencial . Ambos indices nos permiten dar una clasificacion de los servicios hospitalarios.

The taxonomic status of two Telmatobius frog species (Anura: Telmatobiidae) from the western Andean slopes of northernmost Chile

On the basis of molecular and morphological evidence, we evaluated the taxonomic identity of two species of Andean frogs of the genus Telmatobius: Telmatobius pefauri and T. zapahuirensis, present in the western Andean slopes at the northern extreme of Chile. We also investigated the taxonomic assignment of five populations of Telmatobius recently discovered around the type localities of these two species. The results indicate that T. pefauri inhabits, not only Murmuntani its type locality, but also the montane localities of Belén, Copaquilla, Lupica, Saxamar and Socoroma. Our study also shows that T. pefauri and T. zapahuirensis are the same taxon. Therefore, Telmatobius zapahuirensis Veloso, Sallaberry, Navarro, Iturra, Valencia, Penna & Díaz, 1982 would be a subjective junior synonym of Telmatobius pefauri Veloso & Trueb, 1976.

Confirmation of the presence of Alsodes pehuenche Cei, 1976 (Anura, Alsodidae) in Chile: morphological, chromosomal and molecular evidence

La presencia de Alsodes pehuenche en Chile fue reportada en el ano 2010, a partir de la observacion de larvas en las cercanias del limite entre Chile y Argentina, aproximadamente a 3 km al este del extremo noreste de la Laguna del Maule (Region del Maule, Chile). La historia taxonomica de esta especie se remonta a 1965, cuando se redescubrio a Telmatobius montanus (especie que luego fue transferida al genero Alsodes) en dos localidades, cerca de la Laguna del Maule y Valle Pehuenche, ubicadas en Chile y Argentina, respectivamente. La revision bibliografica muestra que la localidad de Argentina descrita en 1965 paso a ser la localidad tipo de A. pehuenche, mientras que la de Chile fue ignorada posteriormente, por lo que esta ultima continua siendo un registro valido de A. montanus. En este trabajo se provee evidencia morfologica, cromosomica y molecular que confirma la presencia de a A.pehuenche en Chile, en dos localidades ubicadas cerca del sitio reportado en 2010 y de la Laguna del Maule. Ademas, se incluyen algunas observaciones de terreno que son discutidas en el contexto de la informacion disponible de la especie.

AUDITORIA POR INDICADORES ECONOMICOS APLICADOS A PRESTACIONES DE CIRUGIA DE MAMAS

Se presenta el diseno, implementacion y resultados obtenidos por auditoria por indicadores economicos aplicados a prestaciones de cirugia de mamas que ha sido elaborado por el Departamento de Obstetricia y Ginecologia y la Gerencia de Operaciones del Hospital Clinico de la Universidad de Chile. Se pone especial enfasis en el trabajo realizado para la determinacion de los costos de los paquetes de prestaciones, la comparacion de estos con los estandares, la determinacion de incidencia de costos y la obtencion de una metodologia de control de gestion eficaz que pudiera contribuir al monitoreo de la atencion medica. Este modelo ha supuesto el calculo de los costos de los componentes de 2 paquetes de prestaciones para intervenciones quirurgicas de mama: a) mastectomia radical o tumorectomia con vaciamiento ganglionar y b) mastectomia parcial o cuadrantectomia o similar o mastectomia total sin vaciamiento ganglionar; el establecimiento de los paquetes de prestaciones que se encuentran fuera del intervalo del 98% de confianza y el estudio individual de las fichas clinicas y su correspondiente auditoria, con el objeto investigar las causas y proponer las correcciones que sean necesarias a la gestion clinica involucrada en el manejo de dichas intervenciones y a la construccion de nuevos y mas adecuados paquetes de prestaciones

Genetic, morphological, and life history traits variation in freshwater snails from extremely high environments of the Andean Altiplano

BackgroundThe isolated watersheds of the southwestern Andean Altiplano constitute a natural laboratory to study the evolutionary divergence of freshwater biota. Field observations showed that Biomphalaria snails from Parinacota, Colpa, and Caquena have different shell sizes. We performed morphometric analysis and common garden experiment to evaluate whether the observed shell variation has a genetic base and if this variation is manifested in other morphological characters and life history traits.ResultsNetwork analysis revealed that the snails of Parinacota form a lineage genetically distinct from Caquena and Colpa. The morphometric analysis of the shell showed that the Parinacota snails were larger than Caquena and Colpa, both in nature and laboratory conditions, but there was no evidence of difference in the shape of the shell when compared using multivariate analyses. The number of eggs per ovicapsule was the only life history trait that was significantly different between lineages, although this difference may be also attributed to size of the progenitor; the oviposition rate did not differ between lineages or localities, and the hatching size and growth rate differed only at the locality level, not lineages.ConclusionThe results suggest that shell size of the snails has a genetic basis associated to the phenotype, while the expression and evolution of life history traits in extreme high environments are highly influenced by proximal causes.

Estudio comparativo de variables clínicas y costo de la técnica quirúrgica de histerectomía por vía abdominal y laparoscópica

The purpose of the present study is to compare clinical and economic outcomes of abdominal versus laparoscopic hysterectomy. The study design was retrospective and observational, and it was conducted on 1.663 patients aged between 27 and 83 undergoing hysterectomy for benign gynecologic conditions between 1997-2005, at the Hospital Clinico of the University of Chile. Of the 1.663 surgeries, 11,36% were laparoscopic hysterectomies and 88,63% accounted for abdominal hysterectomies. The global complication rate was 42,8%for abdominal hysterectomy and 16,4% for laparoscopic hysterectomy. Laparoscopic hysterectomy offers advantages such as a fewer complications and a shorter hospital stay when compared to abdominal hysterectomy. However, its cost is significantly higher than that of the abdominal approach.