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Objectives: To: 1. Describe the frequency of viral RNA detection in stools in a cohort of patients infected with SARS-CoV-2, and 2. Perform a systematic review to assess the clearance time in stools of SARS-CoV-2., Methods: We conducted a prospective cohort study in two centers between March and May 2020. We included SARS-CoV-2 infected patients of any age and severity. We collected seriated nasopharyngeal swabs and stool samples to detect SARS-CoV-2. After, we performed a systematic review of the prevalence and clearance of SARS-CoV-2 in stools (PROSPERO-ID: CRD42020192490). We estimated prevalence using a random-effects model. We assessed clearance time by using Kaplan-Meier curves., Results: We included 32 patients; mean age was 43.7±17.7 years, 43.8% were female, and 40.6% reported gastrointestinal symptoms. Twenty-five percent (8/32) of patients had detectable viral RNA in stools. The median clearance time in stools of the cohort was 11[10-15] days. Systematic review included 30 studies (1392 patients) with stool samples. Six studies were performed in children and 55% were male. The pooled prevalence of viral detection in stools was 34.6% (twenty-four studies, 1393 patients; 95%CI:25.4-45.1); heterogeneity was high (I 2 :91.2%, Q:208.6; p≤0.001). A meta-regression demonstrates an association between female-gender and lower presence in stools (p=0.004). The median clearance time in stools was 22 days (nineteen studies, 140 patients; 95%CI:19-25). After 34 days, 19.9% (95%CI:11.3-29.7) of patients have a persistent detection in stools., Conclusions: Detection of SARS-CoV-2 in stools is a frequent finding. The clearance of SARS-CoV-2 in stools is prolonged and it takes longer than nasopharyngeal secretions., (Copyright © 2022 Elsevier España, S.L.U. All rights reserved.)

Introduction: Both premature birth and low birth weight compromise nephron development. The lower nephron endowment is subjected to compensatory hyperfiltration that overloads the glomeruli and leads to the vicious circle of progressive deterioration of renal function., Objective: To emphasize the risk of renal involvement in this susceptible population by describing the case of a patient with long-term follow-up., Clinical Case: Low-weight premature newborn, who presented at 3 years of age severe hypertension, which was controlled with different types of antihypertensive drugs. However, 10 years later subnephrotic proteinuria was detected; a renal biopsy confirmed a focal and segmental glome rulosclerosis. Despite blocking the renin-angiotensin system for 23 years, his renal function progres sively deteriorated, until requiring chronic hemodialysis during the last 3 years., Conclusion: It is essential to increase the awareness of the risk of renal damage in premature and low weight newborns in order to establish management that covers from gestation to adult life and to achieve an individual and epidemiological impact on renal health.

Introduction: Inflammatory bowel disease (IBD) is a group of chronic pathologies that have impli cations in several factors that affect the quality of life in pediatric patients., Objectives: To describe the health related quality of life (HRQL) in pediatric patients with IBD., Patients and Methods: A Multicenter cross-sectional descriptive study was conducted. Patients aged between 8-18 and with IBD diagnosis were included; IMPACT III quality of life questionnaire and a sociodemographic questionnaire were applied between September 2015 and January 2017., Results: A total of 30 pa tients were recruited, 60% male, with an average age of 13.6 years. 80% of patients were diagnosed with Ulcerative Colitis (UC). The predominant pharmacological treatment was combined therapy in 63.3%, being the most frequent aminosalicylates and immunomodulator. The IMPACT III quality of life score had an average of 129,5 points and when analyzing by section, there was no statistically significant difference between the averages. In our sample, there was no correlation between HRQoL and the number of flares, disease duration gender., Conclusions: This is a first approach to the study of HRQoL in pediatric patients in Chile. Since HRQoL is an important aspect to be explored in the routine evaluation of IBD patients, the identification of a lower HRQoL is the first step to perform interventions in these patients, thus we recommend performing this measurement as a screening method in all of them.

There is a relation between brain development in children and the acquisition of the five subcom ponents for a mature conceptualisation of biological death: Irreversibility, applicability, inevitability, functional cessation and casuality. Current theories propose that knowledge (among them about death) is acquired through a series of confluent waves with advances and setbacks, thus explaining the important differences encountered among children of the same age and good intellectual develop ment. Generally speaking children under four years of age do not have a consciousness of death. They later discover, albeit with difficulty, the concept of irreversibility and much discussion exists about the order in which the remaining concepts are acquired-which is related to incorporating dualistic thought and a degree of biological understanding. There is no agreement on the influence culture, socioeconomic background and previous experience of deaths in the family may have. The mature concept is thought to be acquired around the age of 12. We look at the inclusion of supernatural ele ments in classical and current chidren's literature, proving that is more prevalent in western literature in the 21st century.

Intestinal failure is defined as the reduction of a functional gut mass below the minimal necessary for adequate digestion and absorption of nutrients and fluids. Intestinal failure is the final result of a number of different causes, being short bowel syndrome the most recognized. Its prevalence is low, but the impact in quality of life among patients and their families is critical. Furthermore, is associated with high economic costs, both for the patient and the health provider. Its main feature is the need for long-term parenteral nutritional support with high morbidity and mortality associated complications, such as line-derived bloodstream infections and liver disease. The management of these patients should be performed by a multidisciplinary team, and be aimed at promoting adaptation and recovery of bowel function to achieve intestinal autonomy.

Background: Thiopurines (azathioprine and 6-mercaptopurine) are highly effective medications but with potential adverse effects. Thiopurine methyltransferase (TMPT) is the key enzyme in their pharmacokinetics and is genetically regulated. A low activity of TPMT is associated with myelotoxicity. The genotype and enzyme activity can vary by ethnicity., Aim: To study the activity and genotype of TPMT in a group of Chilean subjects., Material and Methods: In 200 healthy adult blood donors, TPMT activity was determined by high performance liquid chromatography (HPLC). Deficient, low, normal or high levels were defined when enzymatic activity was < 5, 6-24,25-55 and > 56 nmol/grHb/h, respectively. Genotyping of TPMT (*1, *2, *3A, *3B, *3C) was performed by PCR., Results: Seventy seven women (38.5%) and 123 men (61.5%), with an average age of 34.9 years were studied. Eighteen subjects (9%) had a low enzymatic activity, 178 (89%) had normal activity, 4 (2%) had high activity and no genotype deficient subjects were identified. The wild type genotype (*1) was found in 184 (92%) individuals and 16 (8%) were heterozygous for the variants: *2 (n = 2), *3A (n = 13) and *3C (n = 1). No homozygous subjects for these variants were identified. Wild type genotype had an increased enzymatic activity (40.8 ± 7.2 nmol/gHb/h) compared to heterozygous group (21.2 ± 3 nmol/ gHb/h; p < 0.001)., Conclusions: Less than 10% of a Chilean population sample has a low enzymatic activity or allelic variants in the TPMT gene, supporting the use of thiopurines according to international recommendations.

Chile should become a member of the "society of knowledge". Therefore, undergraduate curricula of university careers should be revised, to offer shorter programs that prepare for a permanent training during the whole professional life. This proposal requires an agile academic team, endowed with the adequate methodological tools, but also a contingent of interested and motivated students with comprehension and expression skills and a study discipline. This article comments on the training deficiencies of students that are admitted to Chilean universities and the difficulties of university teachers to compensate this training deficiencies in order to teach their subjects in shorter lapses.

Tumor Necrosis Factor Receptor Associated Periodic Syndrome (TRAPS) is an autoinflammatory disorder associated to a mutation of the Tumor Necrosis Factor Receptor 1 (TNFR1) whose clinical presentation consists on recurrent episodes of prolonged fever, abdominal pain, myalgias, migratory cutaneous erythema, conjunctivitis or periorbitary edema. The diagnosis is confirmed by genetic analysis of the TNFR1 gene. Its main complication is amyloidosis and the treatment is based on the use of corticosteroids or anti-TNF antibodies. We report a 17 year-old male and 23 year-old female with the syndrome. Both cases had heterozygous mutations of the TNFR1 gene, C30R in the first case and T50M in the second case.

In 1997, the Chilean Government and the International Bank for Development convened on a strategy to improve Chilean university education. It was based on quality improvement, effectiveness, relevancy and innovation on university education programs. A US$ 245 millions fund was afforded, for a five years competitive grants program, among certain traditional Universities and Technical Education Institutes. The authors reviewed the projects that won the contests during the first three years in the health area, to determine their impact, demands supported, difficulties and assets. These projects obtained 13.6% of the assigned funds (a total of US$ 16.5 millions). Funds were requested mostly to build spaces, obtain equipment, laboratories and computational support. Funds were also requested to carry out methodological changes and teaching improvements. The importance of teaching health sciences in locations outside the Metropolitan area of Santiago, the modification of undergraduate medical curriculum and the development of post graduate networks are emphasized.

This article reviews the conceptual evolution of bioethics, conditioned by cultural changes. The discipline could be strengthened with new analytical methodologies and with an empirical approach. The dangers of a purely descriptive bioethics, solely linked to practical experience are also discussed. This may cause the loss of the regulatory frame, that allows bioethics to enrich medical practice from a humane and moral viewpoint. Therefore, there is a need to find the balance between the theoretical analysis and an empirical approach, to face the growing complexity of contemporary ethical problems.

Sustaining quality control of learning programs for health professions has become a central issue in university systems, under the pressure of an unexpected merging of new medical schools in Chile, during the last decade, and the massive arrival of other Latin American physicians. Accreditation of institutions and programs represents valid safeguards used in most countries where professional training processes take place. Due guarantee of its quality is required to assure proper health care to people. The authors provide specific arguments to support systematic evaluation and accreditation processes, as those introduced in our country to fulfill the requirements of a high level medical practice.