Resumen: El blastoma pleuropulmonar (BPP) es el tumor pulmonar primario maligno pediátrico más común. Se asocia a variantes patogénicas de línea germinal del gen DICER1. La presentación antenatal es infrecuente y determina un desafío en el diagnóstico diferencial de malformación pulmonar congénita (MPC). Objetivo: comunicar un caso de presentación inhabitual de BPP asociado a síndrome DICER1 y describir la dificultad en diferenciarlo de MPC. Caso Clínico: Paciente masculino con diagnóstico antenatal de lesión pulmonar izquierda hipervascularizada, con desplazamiento medias- tínico y crecimiento progresivo, interpretada como MPC. Nació de 38 semanas y progresó con deterioro ventilatorio. La Tomograña Computada (TC) con contraste mostró una extensa masa quística multilocular con contenido aéreo con efecto de masa. Se realizó lobectomía superior izquierda abierta. La histología fue compatible con BPP tipo I, con bordes negativos y estudio genético para DICER1 positivo. Siete semanas post-resección se pesquisó imagen aérea en la parte superior del tórax izquierdo, requiriendo nueva resección tumoral y segmentectomía superior, con biopsia correspondiente a recidiva de BPP tipo 1 con bordes negativos. Recibió tratamiento adyuvante con quimioterapia, con seguimiento por 2 años, manteniéndose asintomático, sin nuevas recidivas, screening negativo para otras neoplasias asociadas a DICER1. Entre los antecedentes familiares, destacaba cáncer papilar de tiroides de la madre, quien resultó positiva para la mutación. Conclusión: el BPP es un cáncer poco frecuente, siendo difícil distinguirlo de MPC, especialmente en su presentación antenatal. Conocer su asociación al Síndrome DICER1 y hacer estudio genético son claves para detectar precozmente el BPP y buscar otros tumores asociados al síndrome.

Abstract: Pleuropulmonary blastoma (PPB) is the most common pediatric malignant primary lung tumor. It’s associated with the DICER1 gene pathogenic germline variants. Antenatal presentation is infrequent and poses a challenge in the differential diagnosis of congenital pulmonary airway malformation (CPAM). Objective: to report a case of unusual presentation of PPB associated with DICER1 syndrome and to describe the difficulty in differentiating it from CPAM. Clinical Case: Male patient with prenatal diagnosis of hypervascular left lung lesion, with mediastinal shift and progressive growth, initially interpreted as CPAM. He was born at 38 weeks, requiring transitory treatment with positive pressure due to ventilatory impairment. A CT scan with contrast showed a large multilocular cystic mass containing air causing mass effect, requiring open left upper lobectomy. Histology results were compatible with type I PPB, with negative margins, and positive genetic study for DICER1 syndrome. Seven weeks post-resection, an aerial image was detected in the upper left side of the chest, with progressive growth, requiring a new tumor resection and upper segmentectomy, with biopsy corresponding to recurrence of type I PPB with negative margins. He received adjuvant treatment with chemotherapy, with follow-up for 2 years, remaining asymptomatic, without recurrence, and with negative screening for other neoplasms associated with DICER1 syndrome. Among the family history, the mother had papillary thyroid cancer and tested positive for the mutation. Conclusion: PPB is a rare cancer, difficult to distinguish from CPAM, especially in its antenatal presentation. Nowing its association with DICER1 syndrome and performing a genetic study are key to the early detection of BPP and the search for other tumors associated with the syndrome.

Resumen El trabajo se propone explorar los aspectos centrales de las gramáticas de producción del conocimiento y sus proyecciones como criterios de validez, o invisibilización, para la integración de éstos al reservo- rio cultural de las comunidades humanas. A partir del análisis y discusión de las categorías de “ecología de saberes”; “traducción intercultural” y “re- contextualización” se busca desentrañar cómo estas estructuras de conocimiento se transforman en marcadores de relaciones sociales. Se concluye haciendo una valoración crítica de las posibilidades que la praxis social de recontextualizar el conocimiento supone a la hora de valorar el conocimiento tradicional indígena como saber constitutivo del reservorio de conocimientos que estructuran el pensar desde sus contextos culturales.

Abstract The objective of the paper is to explore the grammars of knowledge production and their projections as criteria of validity, or invisibility, for the in- tegration of these into the cultural reservoir of the communities in which they are participants. From the analysis and discussion of the categories of "ecology of knowledge"; "intercultural translation" and "recontextualization" seek to un- ravel the mechanics of how these knowledge structures of validated knowled- ge are transformed into markers of social relations. That is, the relationships established by the different elements that make up the structure of knowledge and the type of realities-knowledge that they account for. It concludes by ma- king a critical assessment of the horizon of possibilities that the social praxis of recontextualizing knowledge allows in terms of its possibilities of valuing traditional indigenous knowledge as constitutive knowledge of the reservoir of knowledge that structures the thinking of their cultural contexts, to the extent that. For this reason, it is postulated as a sine qua non condition to implement Bernstein's "recontextualization" or Santos’s "ecology of knowledge" in its poli- tical nature based on collective and explicit moral principles.

Sediments and mussel specimens of Mytilus chilensis were analyzed for organic pollutant fingerprints and heavy metals in the Corral Bay area of Valdivia, South Central Chile during the period 2003-2004. GC-MS analysis show hydrocarbon fingerprints corresponding mainly to mixed inputs of aliphatic hydrocarbons of the TPH-diesel fraction and biogenic hydrocarbons, indicating low to medium contamination by petroleum hydrocarbons with high biodegradation of petroleum in sediments at Las Coloradas, La Escuela and Corral Bay (C17/Pri < 1 and C18/Phy < 1). Mussel TPH fingerprints show weathered hydrocarbons resulting in a zone of increased concentration of cyclic respect to acyclic aliphatic components (UCM), indicating the presence of petroleum hydrocarbons. No temporal variation the in concentration of TPH-diesel found in sediments as well as mussels were observed except for samples collected during January 2004. TPH concentration levels in the sediments varied from 0.4 μgg-1 to 33.8 μgg-1 d.w. whereas in mussels varied between 61 μg g-1 and 287 μgg-1 d.w. Heavy metals were also analyzed by atomic absorption spectrometry and low concentration as well as no seasonal variations of concentration were found in mussels at each sampling point and a relatively even distribution of metals among stations was observed. Maximum concentrations in all sampling points of sediments were found for Fe (24128-43791 μgg-1) and Mn (181-388 μgg-1) while the minimum concentration was found for Pb (nd-12 μgg-1). According to the Sediment Quality Guidelines (SQGs-NOAA), the concentration levels of Cu and As in all sediment sampling points are above the "Effects Range-Low" (ERL), indicating that there may be a probable toxicity effect over the biota and attention must be paid on a moderate range of priority.

Segundo as evidências, há uma necessidade mais profunda de avaliação e quantificação da dimensão e da forma corporal e o risco de câncer de mama (CM). Utilizando a metodologia do somatotipo, realizamos uma pesquisa original com o objetivo de explorar possíveis associações entre a forma corporal e o risco de CM nas mulheres uruguaias. Com essa finalidade, 254 casos recentes de CM e 1.000 controles emparelhados por freqüência foram entrevistadas sobre história menstrual e reprodutiva, e uma série de dobras cutâneas, circunferências e diâmetros foram medidas especificamente para se fazer o cálculo do somatotipo. Foi encontrada uma associação positiva com CM para forte endomorfismo (OR = 2.82, p < 0.001), especialmente nas mulheres premenopáusicas (OR = 4.98, p < 0.001) e com normopeso (OR = 5.12, p = 0.002); entretanto, não foram observadas diferenças para mesomorfismo e ectomorfismo. As análises apresentaram um elevado padrão meso-endomórfico na população estudada. São necessários novos estudos para confirmar os resultados presentes, obtidos em um país com elevada incidência da enfermidade.

According to the evidence, there is a need for more thorough assessment and quantification of body size and shape and the risk of breast cancer. Using the somatotype methodology, we carried out an original research in order to explore possible associations between body shape and the risk of breast cancer in Uruguayan women. With this objective, 254 recent breast cancer cases and 1,000 frequency-matched healthy controls were interviewed on menstrual and reproductive story, and a series of skinfolds, circumferences and diameters were measured specifically to calculate somatotype. A positive association with breast cancer was found for high endomorphy (Odds Ratio [OR] = 2.82, p < 0.001), mainly among pre-menopausal women (OR = 4.98, p <0.001) and normoweight women (OR = 5.12, p = 0.002), whereas almost no differences were observed for mesomorphic and ectomorphic women. Analysis showed a high meso-endomorphic pattern in the study population. Further studies are needed to confirm the present results obtained in a country with high incidence of the disease.

Segundo as evidências, há uma necessidade mais profunda de avaliação e quantificação da dimensão e da forma corporal e o risco de câncer de mama (CM). Utilizando a metodologia do somatotipo, realizamos uma pesquisa original com o objetivo de explorar possíveis associações entre a forma corporal e o risco de CM nas mulheres uruguaias. Com essa finalidade, 254 casos recentes de CM e 1.000 controles emparelhados por freqüência foram entrevistadas sobre história menstrual e reprodutiva, e uma série de dobras cutâneas, circunferências e diâmetros foram medidas especificamente para se fazer o cálculo do somatotipo. Foi encontrada uma associação positiva com CM para forte endomorfismo (OR = 2.82, p < 0.001), especialmente nas mulheres premenopáusicas (OR = 4.98, p < 0.001) e com normopeso (OR = 5.12, p = 0.002); entretanto, não foram observadas diferenças para mesomorfismo e ectomorfismo. As análises apresentaram um elevado padrão meso-endomórfico na população estudada. São necessários novos estudos para confirmar os resultados presentes, obtidos em um país com elevada incidência da enfermidade.

According to the evidence, there is a need for more thorough assessment and quantification of body size and shape and the risk of breast cancer. Using the somatotype methodology, we carried out an original research in order to explore possible associations between body shape and the risk of breast cancer in Uruguayan women. With this objective, 254 recent breast cancer cases and 1,000 frequency-matched healthy controls were interviewed on menstrual and reproductive story, and a series of skinfolds, circumferences and diameters were measured specifically to calculate somatotype. A positive association with breast cancer was found for high endomorphy (Odds Ratio [OR] = 2.82, p < 0.001), mainly among pre-menopausal women (OR = 4.98, p <0.001) and normoweight women (OR = 5.12, p = 0.002), whereas almost no differences were observed for mesomorphic and ectomorphic women. Analysis showed a high meso-endomorphic pattern in the study population. Further studies are needed to confirm the present results obtained in a country with high incidence of the disease.

Background: The Objective Structured Clinical Examination (OSCE) has become a respected and widely used tool for the assessment of clinical competence in medical education. Aim: To describe the first experience of an OSCE as a summative assessment in undergraduate Pediatric Internship, in two universities. Material and Methods: The OSCE was structured by a committee of faculty members of the 5 campi of University of Chile and I campus of the Catholic University. A 21 station OSCE was administered simultaneously to 124 Pediatric Interns (University of Chile =104, Catholic University=20), in 3 centers. A total of 50 faculty members participated in the examination. The OSCE consisted of 20 clinical problems, including videotape recordings, photographs, x-rays and laboratory exams, phantoms and 7 simulated standardized parents. Results: The average total OSCE score was 67.3% (range: 84.5%-43.5%). The maximum theoretic score was achieved in 19 stations. A significant correlation between station and total score, was found for 18 of the 20 clinical problems. Conclusions: The experience of using OSCE has been a success. The OSCE was an adequate procedure to assess a large number of interns simultaneously and it allowed us to measure the main objectives in all domains and a wide range of clinical competence of Pediatric Internship Programs (Rev Méd Chile 2002; 130: 817-824).