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Galaxias maculatus aquaculture objectives is to produce millions of eggs. Wild females are small (2 g), have quick sexual maturity and low mean fecundity (500 eggs/female), requiring larger fishes with higher fecundity. This study aim is to evaluate experimentally the effect of the levels of protein, lipid and dietary energy on weight increases in adults. Five independent experiments were performed at different sequential time periods at the UCT hatchery, Chile. Specimens were obtained from a) Crystalline sea return specimen catches in the Tolten estuary (4 -6 cm, 0.3-0.4 g.). b) Hatchery cultured fish. Fish were fed by hand ad libitum. In experiments 1 to 4, pelleted diets were prepared with 3 to 5 levels of protein (treatments 27 up to 57%), crumble size, three 100 L fibre ponds replicates. In experiment 5 the effect of two lipid levels (8 and 21%) was evaluated with commercial extruded Salmon Nutra Starter isoproteic crumble 1 diet at 63%, replicated in 4 ponds. The results show: A tendency to increased weight in all sizes with an increased protein level in the pelleted diet.A maximal adult growth is obtained with a diet containing a minimum of 37% crude protein, with 40% the optimal value. A higher % protein in the diet or growth in weight lower feed conversion ratio. The feed conversion ratio in the extruded diet reaches up to 0.5 and in the pelleted vary from 0.7 to 1.5. Fish 0.6 g fed with 63% protein, extruded commercial diet with two different lipid levels (8 and 21%, 20.40 and 23.84 MJ kg-1, PE/TE 0.62 and 0.71) increased weight the first month 67 and 105% each. It has been established that high-energy diets with optimal levels of protein and lipid are a good short-term solution to obtain G. maculatus of higher weight. Resumo O objetivo da aquicultura de Galaxias maculatus é produzir milhões de ovos. As fêmeas selvagens são pequenas (2 g) e têm maturidade sexual rápida e fecundidade média baixa (500 ovos/fêmea), necessitando de peixes maiores e com fecundidade superior. O objetivo deste estudo é avaliar experimentalmente o efeito dos níveis de proteínas, lipídios e energia da dieta sobre o aumento de peso em adultos. Cinco experimentos independentes foram realizados em diferentes períodos sequenciais de tempo no incubatório UCT, Chile. Os espécimes foram obtidos a partir de: a) capturas de espécimes de retorno do mar cristalino no estuário de Tolten (4-6 cm, 0,3-0,4 g); b) peixes de cultura em incubatório. Os peixes foram alimentados à mão ad libitum. Nos experimentos de 1 a 4, dietas peletizadas foram preparadas com três a cinco níveis de proteína (tratamentos 27 a 57%), tamanho do crumble, três repetições de tanques de fibra de 100 L. No experimento 5, o efeito de dois níveis de lipídios (8 e 21%) foi avaliado com dieta comercial isoproteica crumble 1 de Salmon Nutra Starter extrusada a 63%, replicada em quatro tanques. Os resultados mostram: uma tendência ao aumento de peso em todos os tamanhos, com um aumento do nível de proteína na dieta peletizada; um crescimento adulto máximo com uma dieta contendo um mínimo de 37% de proteína bruta, com 40% do valor ideal; uma porcentagem maior de proteína na dieta ou crescimento em peso com menor taxa de conversão alimentar. A taxa de conversão alimentar na dieta extrusada chega a 0,5, e na peletizada varia de 0,7 a 1,5. Peixes de 0,6 g alimentados com 63% de proteína e dieta comercial extrusada com dois níveis lipídicos diferentes (8 e 21%; 20,40 e 23,84 MJ kg-1; PE / TE 0,62 e 0,71) aumentaram de peso no primeiro mês em 67 e 105% cada, respectivamente. Foi estabelecido que dietas de alta energia com níveis ótimos de proteínas e lipídios são uma boa solução de curto prazo para obter G. maculatus de peso mais alto.

The exposure of a research team to chigger mites in southern Chile allowed the first identification of a trombiculid species as vector and reservoir of scrub typhus outside the tsutsugamushi triangle, providing unique insights into the ecology and transmission of this recently discovered rickettsial infection in South America.

Background: The career of Technician in Higher-Level Nursing (TENS in Spanish) is the technical career that has the higher number of students in Chile. There are important disparities among the higher education institutions that teach it. Aim: To analyze differences in competencies declared in TENS career graduate profiles by type of higher education institution. Material and Methods: Using Atlas.ti 7, we carried out a content analysis of 31 graduate profiles of TENS, published in websites of Universities, Professional Institutes and Technical Training Centers that teach the career, during 2019. Results: Procedural competencies are predominant in graduate profiles, followed by interpersonal ones, with cognitive and ethics competencies being the least declared. Accredited higher education institutions consistently declare more cognitive and ethics competencies than those that are not accredited. Conclusions: There is a procedural bias in graduate profiles, which tends to under declare cognitive and ethics competencies, fundamental for decision-making processes.

Background The available evidence of the health effects of urban regeneration is scarce In Latin America, and there are no studies focused on formal housing that longitudinally evaluate the impact of housing and neighborhood interventions on health. The “Regeneración Urbana, Calidad de Vida y Salud” (Urban Regeneration, Quality of Life, and Health) or RUCAS project is a longitudinal, multi-method study that will evaluate the impact of an intervention focused on dwellings, built environment and community on the health and wellbeing of the population in two social housing neighborhoods in Chile. Methods RUCAS consists of a longitudinal study where inhabitants exposed and unexposed to the intervention will be compared over time within the study neighborhoods (cohorts), capitalizing on interventions as a natural experiment. Researchers have developed a specific conceptual framework and identified potential causal mechanisms. Proximal and more distal intervention effects will be measured with five instruments, implemented pre- and post-interventions between 2018 and 2021: a household survey, an observation tool to evaluate dwelling conditions, hygrochrons for measuring temperature and humidity inside dwellings, systematic observation of recreational areas, and qualitative interviews. Survey baseline data (956 households, 3130 individuals) is presented to describe sociodemographics, housing and health characteristics of both cohorts, noting that neighborhoods studied show worse conditions than the Chilean population. Discussion RUCAS’ design allows for a comprehensive evaluation of the effects that the intervention could have on various dimensions of health and health determinants. RUCAS will face some challenges, like changes in the intervention process due to adjustments of the master plan, exogenous factors –including COVID-19 pandemic and associated lockdowns– and lost to follow-up. Given the stepped wedge design, that the study capitalizes on within household changes over time, the possibility of adjusting data collection process and complementarity of methods, RUCAS has the flexibility to adapt to these circumstances. Also, RUCAS’ outreach and retention strategy has led to high retention rates. RUCAS will provide evidence to inform regeneration processes, highlighting the need to consider potential health effects of regeneration in designing such interventions and, more broadly, health as a key priority in urban and housing policies.

Background Girls exposed to violence have a high risk of being victimized as adults and are more likely than non-abused women to have children who are treated violently. This intergenerational transmission may be especially serious when women suffer violence during pregnancy and early motherhood, as it impairs maternal wellbeing and infant health and development. This study examined the intergenerational effects of being exposed to childhood maltreatment (CM) and prenatal intimate partner violence (p-IPV) on perinatal mental distress and birth outcomes in central Vietnam. Methods A birth cohort study in Hue City, Vietnam was conducted with 150 women in the third trimester of pregnancy (Wave 1) and 3 months after childbirth (Wave 2). Using multivariable logistic regression models, augmented inverse-probability-weighted estimators and structural equation modelling (SEM), we analyzed a theoretical model by evaluating adjusted risk differences and pathways between CM, p-IPV and subsequent perinatal adversity and indicators of infant health problems. Results One in two pregnant women experienced at least one form of CM (55.03%) and one in ten pregnant women experienced both CM and p-IPV (10.67%). Mothers who experienced p-IPV or witnessed IPV as a child were approximately twice as likely to experience poor mental health during pregnancy [ARR 1.94, 95% CI (1.20–3.15)]. Infants had a two-fold higher risk of adverse birth outcomes (low birth weight, preterm birth, admission to neonatal intensive care) [ARR 2.45 95% CI (1.42, 4.25)] if their mothers experienced any form of p-IPV, with greater risk if their mothers were exposed to both CM and p-IPV [ARR 3.45 95% CI (1.40, 8.53)]. Notably, significant pathways to p-IPV were found via adverse childhood experience (ACE) events (β = 0.13), neighborhood disorder (β = 0.14) and partner support (β = − 1.3). Conclusion These results emphasize the detrimental and prolonged nature of the effect of violence during childhood and pregnancy. Exposure to childhood maltreatment and violence during pregnancy increases the risk of maternal mental health difficulties and adverse birth outcomes. Antenatal care systems need to be responsive to women’s previous experiences of violence and maternal mental health. The significant protective role of partner support and social support should also be considered when designing tailored interventions to address violence during pregnancy.

A mudança para um paradigma de economia circular deve ser estabelecida mediante a implementação de diferentes ações e estratégias de tomada de decisão que geralmente são apoiadas pela sobreposição de dinâmicas sustentáveis criadas pelo encontro das abordagens natural, econômica, humana e cultural. Esta nova abordagem para a gestão do patrimônio cultural requer conhecimento científico de múltiplas disciplinas para decidir sobre uma ação específica. O estudo considera um total de 26 variáveis relacionadas com o patrimônio construído, a vulnerabilidade física dos edifícios e os riscos exteriores ao qual estão submetidos. Além disso, desenvolve um índice de degradação funcional para os edifícios estudados. Essas informações ajudam a ampliar o conhecimento existente sobre o processo de tomada de decisão na gestão de um conjunto de edifícios patrimoniais na América do Sul. Um total de 20 edifícios de madeira, localizados em Valdivia (sul do Chile), foram examinados por inspeção visual no local. Os edifícios foram classificados em termos de prioridade segundo sua funcionalidade intrínseca. Esses tipos de abordagens são novas contribuições para a área da sustentabilidade na gestão do patrimônio cultural, que inclui uma integração equilibrada de desempenho tecnológico, ambiental, econômico, social, governamental e comportamental.Keywords: Economia circular, gestão, degradação funcional, patrimonio, Chile.

El centro de Río Gallegos, presenta una gran variedad de estados de las aceras/veredas en el cual se puede llegar a ocasionar algún tipo de riesgo para el peatón. Este trabajo tiene como finalidad analizar e indagar sobre la Caminabilidad en el centro de Río Gallegos; conocer los parámetros que determinan a este concepto. La Caminabilidad es un concepto contemporáneo que tomó preponderancia luego de que surgieran las ciudades sostenibles en Europa. Esta concepción conlleva a que el espacio público sea más equilibrado entre los medios de transporte y el peatón. Esto requiere a la vez una verdadera implicancia de políticas de urbanización para lograr un ambiente más “caminable”. Metodológicamente, la información se obtiene con la recolección de datos a través de la observación directa, donde se aplicaron fórmulas utilizadas por el programa de Excel, y posteriormente es procesada a través de un SIG (Sistemas de Información Geográfica). Los resultados reflejaron datos significativos, obteniendo valoraciones generales de estados desde Muy Malo a Muy Bueno, que posee cada lado de las manzanas del centro de Río Gallegos. Por último, se presentan sugerencias para tomar consciencia sobre el estado del centro de la ciudad, ayudar a la planificación urbana, y al cuidado del centro. A la vez, darle una valoración a este espacio, sabiendo que es un lugar donde transitan muchas personas continuamente.

The CoVID-19 pandemic has impacted in a lesser extent and intensity to patients younger than 15 years The role of different imaging studies of lung involvement has been extensively addressed, from the first cases of severe pneumonia and respiratory distress syndrome in adults There are fewer reports of the comparative usefulness of conventional radiology, ultrasound, and computed axial tomography in children Of those, ground glass opacities, crazy paving pattern and surrounding halo consolidation are the most characteristic Even though none of them allows diagnostic confirmation, their correct interpretation helps in decision flows Computed axial tomography is more accurate for defining the type and extent of lung parenchymal involvement The role of the ultrasound in early stages in the emergency department is clearer in adults than in children, in whom there is a good correlation with chest tomography This article addresses the different radiological patterns, their pathophysiological representation and differential diagnoses, in order to alert pediatricians of their interpretation, as well as the potential role of imaging diagnoses most frequently used in children with low acute respiratory infection La pandemia CoVID-19 ha impactado en una proporcion e intensidad menor a los pacientes menores de 15 anos El rol de los diferentes estudios por imagenes del compromiso pulmonar ha sido extensamente abordado, desde los primeros casos de neumonias graves y sindrome de distres respiratorio en adultos En ninos existen menos reportes de la utilidad de la radiologia convencional, ecografia y tomografia axial computarizada Sin embargo, los patrones mas caracteristicos observados en adultos se repiten en los ninos De ellos, el vidrio esmerilado, el patron en empedrado y la consolidacion con halo circundante son los mas caracteristicos Aun cuando ninguno de ellos permite confirmacion diagnostica, su correcta interpretacion ayuda en los flujos de decisiones La tomografia axial computarizada es mas certera para la definicion de tipo y extension del compromiso parenquimatoso pulmonar El rol en los estadios tempranos en el servicio de urgencia de la ecografia es mas claro en adultos que en ninos, donde existe buena correlacion con la tomografia de torax Este articulo aborda los diferentes patrones radiologicos, su representacion fisiopatologica y diagnosticos diferenciales, con el objeto de apoyar a los pediatras en su interpretacion, como tambien reconocer el rol de las tecnicas de imagenes diagnosticas mas frecuentemente utilizadas en ninos con infeccion respiratoria aguda baja

Resumen Introducción: Los pacientes con leucemia linfoblástica aguda (LLA) tienen alto riesgo de influenza grave y la vacunación es altamente recomendada. La inmunogenicidad y efectividad de la vacuna es menor comparada a los sujetos sanos. Objetivo: Evaluar la respuesta inmune inducida por vacuna anti-influenza en niños con LLA y observar su efectividad. Métodos: Se reclutaron niños con LLA en terapia de mantención y niños sanos. Se tomaron muestras de sangre el día de la vacuna (D0) y al día 28 (D28), y se realizó test de inhibición de hemaglutinación (IHA) contra H1N1. Los pacientes fueron seguidos por un año, registrando datos clínicos y episodios de influenza. Resultados: Se incluyeron 34 niños con LLA y 9 niños sanos. Respecto al IHA en D28, 12/34 pacientes y 5/8 niños sanos presentaron títulos ≥ 1/40, resultando una tasa de seroprotección de 35 y 63%, respectivamente. Los niños seroprotegidos eran significativamente mayores. Durante el seguimiento, sólo tres pacientes, no seroprotegidos, presentaron infección por influenza, ninguno requirió oxigeno o cuidados intensivos. Discusión: Los niños con LLA alcanzaron una tasa seroprotección más baja que la observada en niños sanos. Sin embargo, ninguno de los niños seroprotegidos presentó infección por influenza, reforzando la recomendación de vacunación anual.

Introducción. Las caídas son un importante problema de salud pública. La Organización Mundial de la Salud (OMS) estima que anualmente se producen 646,000 caídas con consecuencias fatales, convirtiéndolas en la segunda causa de muerte por lesiones no intencionales a nivel mundial. Las mayores tasas de mortalidad asociadas a este evento corresponden a los mayores de 60 años. Como resultado, los adultos mayores disminuyen su movilidad, pueden presentar alteraciones cognitivas y resultar socialmente aislados, lo que aumenta el riesgo de caídas posteriores, costos de salud e índices de mortalidad. Durante el proceso de hospitalización, factores intrínsecos del adulto mayor, sumado al ambiente hospitalario, generan un entorno propicio para la producción de eventos adversos, impulsando al personal de salud a tomar medidas de prevención específicas enfocadas en este grupo etario en particular. El presente manuscrito tiene como objetivo describir el proceso de implementación de la guía de Prevención de Caídas y disminución de las lesiones derivadas de las caídas de la Registered Nurses’ Association of Ontario (RNAO), en la Unidad de cuidados del adulto mayor (UCAM) en Clínica las Condes (CLC). Temas de reflexión. A través de un enfoque interdisciplinar el cual desarrolla 5 puntos principales de acción: adquisición de infraestructura específica, contratación de personal médico y de enfermería especializado en cuidados del adulto mayor, capacitación continua que incluya actualización de conocimientos sobre cuidados del adulto senescente y, finalmente, supervisión de enfermería durante todo el proceso de prevención. Conclusiones. La implementación de estrategias interdisciplinares para la prevención de caídas en adultos mayores es una herramienta basada en evidencia científica que genera disminución de este evento adverso y de las lesiones que posteriormente se desarrollan producto de una caída durante la hospitalización del adulto senescente. Introduction. Falls are a serious public health problem. The World Health Organization (WHO) estimates that there are 646,000 falls per year, which have a fatal outcome, making them the second leading cause of unintentional injury death worldwide. The highest mortality rates associated with these falls are among senior citizens aged over 60 years. Falls can reduce senior citizens’ mobility, cause them to suffer from cognitive disorders and make them socially isolated, increasing the risk of subsequent falls, health costs and mortality rates. During the hospitalization process, intrinsic factors for elderly patients, added to the hospital conditions, generate an environment conducive to the occurrence of adverse events, driving health staff to take specific prevention measures focused on this age group in particular. This article aims to describe the implementation process of the guidelines for fall prevention and injury reduction of the Registered Nurses’ Association of Ontario (RNAO) in the Elderly Care Unit (UCAM, for the Spanish original) of Clínica las Condes (CLC). Reflection topics. through an interdisciplinary approach that develops five main action points: acquisition of a specific infrastructure; procurement of medical and nursing staff specialized in elderly care; ongoing training that includes knowledge refresher courses on elderly care; and, finally, nursing supervision throughoutthe prevention process. Conclusions. The implementation of interdisciplinary strategies for preventing falls in senior citizens is a tool based on scientific evidence that reduces the cases of this adverse event and of the injuries that subsequently develop as a result of a fall during the hospitalization of the elderly patient. Introdução. As quedas são um grande problema de saúde pública. A Organização Mundial da Saúde (OMS) estima que, anualmente, ocorrem 646.000 quedas com consequências fatais, tornando-as a segunda principal causa de morte por lesões não intencionais em todo o mundo. As taxas mais altas de mortalidade associadas a esse evento correspondem a pessoas com mais de 60 anos. Como resultado, os idosos diminuem sua mobilidade, podem apresentar alterações cognitivas e serem socialmente isolados, aumentando o risco de quedas subsequentes, custos de saúde e taxas de mortalidade. Durante o processo de hospitalização, fatores intrínsecos do idoso, agregados ao ambiente hospitalar, geram um ambiente propício à produção de eventos adversos, incentivando o pessoal de saúde a tomar medidas específicas de prevenção focadas nessa faixa etária específica. O objetivo deste manuscrito é descrever o processo de implementação da Guia de Prevenção de Quedas e redução de lesões resultantes de quedas da Registered Nurses’ Association of Ontario (RNAO), na Unidade de Atendimento ao Idoso (UCAM) na Clínica Las Condes (CLC). Reflexão. mediante uma abordagem interdisciplinar que desenvolve cinco pontos principais de ação: aquisição de infraestrutura específica, contratação de equipe médica e de enfermagem especializada no cuidado ao idoso, capacitação contínua que inclua a atualização do conhecimento sobre o atendimento ao adulto senescente e, por fim, a supervisão de enfermagem em todo o processo de prevenção. Conclusões. A implementação de estratégias interdisciplinares para a prevenção de quedas em idosos é uma ferramenta baseada em evidências científicas que promove uma diminuição desse evento adverso e das lesões que subsequentemente se desenvolvem como resultado de uma queda durante a hospitalização do adulto senescente. Cómo citar: Coltters-Miranda C, Belmar-Valdebenito A. Experiencia de implementación de una guía de prevención de caídas como trabajo interdisciplinar en una unidad de cuidados del adulto mayor. MedUNAB. 2020;23(1):95-106. doi:10.29375/01237047.3610

We report a 55-year-old woman with a history of hypothyroidism and type 2 diabetes mellitus who consulted at the emergency room because of intermittent oppressive chest discomfort. At admission, electrocardiogram showed a complete atrioventricular block. A transthoracic echocardiogram disclosed severe left ventricular dysfunction. The patient developed cardiogenic shock that required the installation of the Impella system. An emergency coronary angiography showed an ostial occlusion of the anterior descending artery. Despite successful primary angioplasty, she persisted with refractory shock and progressive hypoxemia. A concomitant connection to the extracorporeal membrane oxygenation system (ECMO) was decided. The support of both devices allowed the stabilization of the patient and the improvement of perfusion parameters.

Constructed facilities should be robust with respect to the loss of load-bearing elements due to abnormal events. Yet, strengthening structures to withstand such damage has a significant impact on construction costs. Strengthening costs should be justified by the threat and should result in smaller expected costs of progressive collapse. In regular frame structures, beams and columns compete for the strengthening budget. In this paper, we present a risk-based formulation to address the optimal design of regular plane frames under element loss conditions. We address the threat probabilities for which strengthening has better cost-benefit than usual design, for different frame configurations, and study the impacts of strengthening extent and cost. The risk-based optimization reveals optimum points of compromise between competing failure modes: local bending of beams, local crushing of columns, and global pancake collapse, for frames of different aspect ratios. The conceptual study is based on a simple analytical model for progressive collapse, but it provides relevant insight for the design and strengthening of real structures., Comment: 36 pages 12 figures

Funder: Consuelo Zobel Alger Foundation, Inc., Funder: British Academy; FundRef: http://dx.doi.org/10.13039/501100000286, Funder: Cambridge Humanities Research Grants Scheme, Funder: University of Cambridge GCRF Quality Research, Funder: Jacobs Foundation; FundRef: http://dx.doi.org/10.13039/501100003986, Funder: Wolfson discretionary research, Introduction: Violence against children is a health, human rights and social problem affecting approximately half of the world’s children. Its effects begin at prenatal stages with long-lasting impacts on later health and well-being. The Evidence for Better Lives Study (EBLS) aims to produce high-quality longitudinal data from cities in eight low- and middle-income countries—Ghana, Jamaica, Pakistan, the Philippines, Romania, South Africa, Sri Lanka and Vietnam—to support effective intervention to reduce violence against children. EBLS-Foundational Research (EBLS-FR) tests critical aspects of the planned EBLS, including participant recruitment and retention, data collection and analysis. Alongside epidemiological estimates of levels and predictors of exposure to violence and adversity during pregnancy, we plan to explore mechanisms that may link exposure to violence to mothers’ biological stress markers and subjective well-being. Methods and analyses: EBLS-FR is a short longitudinal study with a sample of 1200 pregnant women. Data are collected during the last trimester of pregnancy and 2 to 6 months after birth. The questionnaire for participating women has been translated into nine languages. Measures obtained from mothers will include, among others, mental and physical health, attitudes to corporal punishment, adverse childhood experiences, prenatal intimate partner violence, substance use and social/community support. Hair and dry blood spot samples are collected from the pregnant women to measure stress markers. To explore research participation among fathers, EBLS-FR is recruiting 300 fathers in the Philippines and Sri Lanka. Ethics and dissemination: The study received ethical approvals at all recruiting sites and universities in the project. Results will be disseminated through journal publications, conferences and seminar presentations involving local communities, health services and other stakeholders. Findings from this work will help to adjust the subsequent stages of the EBLS project.

International audience; Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a major public health issue. COVID-19 is considered an airway/multi-systemic disease, and demise has been associated with an uncontrolled immune response and a cytokine storm in response to the virus. However, the lung pathology, immune response, and tissue damage associated with COVID-19 demise are poorly described and understood due to safety concerns. Using post-mortem lung tissues from uninfected and COVID-19 deadly cases as well as an unbiased combined analysis of histology, multi-viral and host markers staining, correlative microscopy, confocal, and image analysis, we identified three distinct phenotypes of COVID-19-induced lung damage. First, a COVID-19-induced hemorrhage characterized by minimal immune infiltration and large thrombus; Second, a COVID-19-induced immune infiltration with excessive immune cell infiltration but no hemorrhagic events. The third phenotype correspond to the combination of the two previous ones. We observed the loss of alveolar wall integrity, detachment of lung tissue pieces, fibroblast proliferation, and extensive fibrosis in all three phenotypes. Although lung tissues studied were from lethal COVID-19, a strong immune response was observed in all cases analyzed with significant B cell and poor T cell infiltrations, suggesting an exhausted or compromised immune cellular response in these patients. Overall, our data show that SARS-CoV-2-induced lung damage is highly heterogeneous. These individual differences need to be considered to understand the acute and long-term COVID-19 consequences.

Introduction.The absence of home hospitalization (HH) of children and youth with special health care needs (CYSHCN) generates prolonged hospitalizations in closed care (CC).Objective:To compare the estimated cost of HH of high complexity CYSHCN versus the actual cost of the same patient in CC and its impact on hospital production.Methods:Descriptive and comparative study between costs of both hospitalization modalities of high complexity CYSHCN. From January to December 2016, non-oncological CYSHCN hospitalizations were registered by the Pediatric Service (PS) according to the Ministry of Health-Chile (MINSAL) norm. It was classified for clinical groups and similar consumption of resources according to groups related to diagnosis (DRG). The stay was adjusted, and financial analysis of both modalities (CC) and (HH) was performed to evaluate the impact on hospital production.Results:Of 3690 discharges, 126 (3.4%) were related to 27 CYSHCN, the average age was 4.6 years (± 5 SD) with technological dependencies to live. The mean CYSHCN stay was 16 days, compared with 5.9 for patients without special health needs. CYSHCN stays reached 2017 days (8.6%). Disregarding the CYSHCN discharges would have contributed 320 additional discharges, and his HH would have saved US $ 15 / day per patient, which for the total number of stays consumed would have been an annual saving of US $ 29170.Conclusion:HH has an estimated cost lower than the CA of high complexity CYSHCN, improves hospital productivity, and frees critical beds with financially viable investment. Introducción.La ausencia de hospitalización domiciliaria (HD) de niños y adolescentes con necesidades especiales en salud de alta complejidad (NANEAS) genera hospitalizaciones prolongadas en la atención cerrada (AC).Objetivo:Comparar el gasto estimado de HD de NANEAS de alta complejidad versus costo real del mismo paciente en AC y su impacto en la producción hospitalaria.Métodos:Estudio descriptivo y comparativo entre costos de ambas modalidades de hospitalización de NANEAS de alta complejidad. De enero a diciembre 2016 se registraron hospitalizaciones NANEAS no oncológicos del Servicio de Pediatría (SP) según norma del Ministerio de Salud-Chile (MINSAL). Se clasificó para grupos clínicos y consumos similares de recursos según grupos relacionados al diagnóstico (GRD). Para evaluar el impacto en la producción hospitalaria la estancia fue ajustada y se realizó un análisis financiero de ambas modalidades (AC) y (HD).Resultados:De 3690 egresos, 126 (3,4%) se relacionaron a 27 NANEAS, la edad promedio fue 4,6 años (± 5 DS) con dependencias tecnológicas para vivir. La estancia media NANEAS fue 16 días, comparada con 5,9 de los pacientes sin necesidades especiales en salud. Las estancias NANEAS llegaron a 2017 días (8,6%). Prescindir de los egresos NANEAS hubiera aportado 320 egresos adicionales y su HD habría ahorrado US $15/día por paciente, que para el total de estancias consumidas habría sido un ahorro anual de US $ 29 170.Conclusiones:La HD tiene un costo estimado menor a la AC de NANEAS de alta complejidad, mejora la productividad hospitalaria y libera camas críticas con inversión financieramente viable.

Background : Mothers from middle-income countries (MIC) are estimated to have higher rates of adverse childhood experiences (ACEs) and depression during pregnancy compared to mothers from high income countries. Prenatal depression can adversely impact on a mother's feelings towards her foetus and thus may be partially responsible for intergenerational transmission of risk associated with maternal ACEs. However, the extent to which prenatal depressive symptoms mediate the association between maternal ACEs and foetal attachment is unknown. Methods : Data on foetal attachment, ACEs, and prenatal depression came from mothers in their third trimester of pregnancy (n = 1,185) located across eight MICs, participating in the prospective birth cohort Evidence for Better Lives Study – Foundational Research (EBLS-FR). Data were from the baseline measurement.Results : Full-sample path mediation analyses, adjusting for relevant covariates, suggested a full mediating effect of prenatal depression. However, at the individual-country level, both positive and negative effects of ACEs on foetal attachment were observed after the inclusion of depressive symptoms as a mediator, suggesting cultural and geographical factors may influence a mother's empathic development after ACE exposure. Limitations : As no follow-up measurements of depressive symptoms or postnatal attachment were included in the analyses, the findings cannot be extrapolated to the postnatal period and beyond. Further, causality cannot be inferred as the study was observational. Conclusions : The findings reinforce the importance of screening for prenatal depression during antenatal care in MICs. Addressing prenatal depression within maternal health care may support foetal attachment and contribute to reducing the intergenerational transmission of disadvantage.

Background This study evaluated the psychometric properties of three self-reported scales including WHO Well-Being Index (WHO-5), Patient Health Questionnaire-9 items (PHQ-9), and Perceived Stress Scale (PSS) for determining the severity of antenatal depression and suicide risk. Methods Extracted from a multi-site birth cohort study in eight countries, we test the reliability and validity of tri-scales among 148 women in the third trimester and 3-months after childbirth in Vietnam. Results Reliability testing achieved good internal consistency for the set of scales (Alpha = 0.75–0.81). The multitrait-multimethods matrix and SEM model indicated a good fit [Chi-square (230) = 337.5, p Conclusions This present study suggested adequate validity and reliability of the WHO-5, PHQ9 and PSS to measure antenatal depression and suicide risk in Vietnam. Key messages Further studies might consider to use one or a set of scales to understand multiple domains of mental disorder as it is simple to administer and acceptable duration for completion in the community.

Los pacientes hospitalizados por asma agudo tratados con un algoritmo preestablecido, podrían disminuir la estancia hospitalaria y requerimiento de cama crítica (UCIP). El objetivo de este trabajo fue el de implementar y evaluar el impacto de un algoritmo preestablecido para tratar a niños hospitalizados por asma aguda. Es un estudio transversal y comparativo, con una muestra prospectiva por conveniencia, de niños asmáticos entre 5 y 15 años ingresados durante el 2017 sin respuesta a la primera línea de tratamiento en el servicio de urgencia. Se excluyeron pacientes con comorbilidades cardiorespiratorias y con ingreso directo a UCIP. Se aplicó un algoritmo durante 2 horas evaluando su efectividad mediante puntaje clínico (PAS, por su sigla en inglés Pediatric Asthma Score). Ingresaron 55 pacientes, edad media 8,02 años, 41,8% sexo femenino. El PAS disminuyó de 8 a 5 puntos al finalizar algoritmo (p

Funder: University of Cambridge, Research Question: How did the use of diversion from prosecution and criminal sentencing change in Victoria, Australia, in the 10 years to 2016/2017, with what estimated effects on repeat offending? Data: We tracked 1,163,113 criminal cases brought against both juveniles and adults by police in the state of Victoria, Australia, including 181,836 diversions, during the 10-year time period from the fiscal year of 2007/2008 through 2016/2017. Methods: Taking the percentage of all cases diverted in the first year (25.6%), we calculated for each of the study years how many more cases would have been diverted from prosecution across the subsequent 9 years if the diversion rate had stayed the same (“missed opportunities”). We multiplied the estimated number of these “missed opportunities” by the reduced frequency of repeat offences that the prosecuted offenders were likely to have committed, after adjusting for the time at risk by the number of years left in the study period. Then, based on a systematic review of diversion experiments (Petrosino et al. 2010), we applied the standardised effect size of diversion in those studies to Farrington’s (1992) annualised crime frequency per 100 offenders aged 25, multiplying that effect across all of the person-years after a case was prosecuted rather than diverted, using both population-based rates and rates based only on detected offenders at that age. Findings: The diversion rate in Victoria dropped in half over 10 years, from 25.6% to 12.5%. The total missed opportunities for diversion, compared to the counterfactual of applying diversion at a constant rate of 25% over that time period, totalled 115,885 cases over the 10 years. Taking an average effect size (d = − 0.232) across seven experiments with a mean follow-up time of 12–13 months, as derived from a systematic review of diversion experiment outcomes, our illustrative estimate is that at least 8 crimes per year per 100 offenders could have been prevented among the missed opportunity cases. Using a population rate of offending, the estimate equals 1474 crimes that could have been prevented. Using the offending population rate, we estimate that 37,050 offences could have been prevented. Conclusions: While the exact amount of crime prevented remains speculative, the application of best evidence to the missed opportunity cases suggests that more diversion could have resulted in substantially less repeat offending, and hence less total crime.

Este artículo presenta un instrumento destinado a evaluar habilidades comunicativas de estudiantes de último año de la carrera de Nutrición y Dietética de Universidad de Las Américas con sus pacientes. El instrumento responde a la observación de la relación que los alumnos establecen con los usuarios en salud durante la práctica profesional integrada en el Centro de Atención Nutricional (CAN) y puede ser aplicable a estudiantes de la misma carrera en otras instituciones. Estas habilidades son fundamentales para garantizar un óptimo desempeño profesional y deben adecuarse a la realidad de cada paciente, por lo tanto, deben ser capaces de responder a las distintas situaciones comunicativas.

La creación de nuevos espacios discursivos en internet que reivindican políticamente la importancia de las lenguas indígenas para la diversidad cultural, a partir del uso de las nuevas tecnologías, ha facilitado la convergencia de distintas expresiones artísticas que constituyen estrategias emergentes de artivismo digital. Este artículo presenta un estudio sobre la propuesta educativa Kimeltuwe y particularmente el análisis de las publicaciones de su página de Facebook, durante el periodo de un año, que comprende el ciclo anual mapuche. Se analizaron las diferentes formas de artivismo que a través de esta plataforma promueven sus autores, utilizando una metodología mixta, que por una parte analiza cuantitativamente los datos y cifras de sus publicaciones, y por otra, nos permite a través de categorías conceptuales, un acercamiento cualitativo a las diferentes interpretaciones y significados simbólicos de las publicaciones realizadas. The creation of new discursive spaces on the Internet that politically claim the importance of indigenous languages for cultural diversity, using the new technologies, has facilitated the convergence of different artistic expressions that constitute emerging strategies of digital artivism. This article presents a study about the Kimeltuwe educational proposal and particularly the analysis of the publications of its Facebook page, during the period of one year, which includes the mapuche annual cycle. We analyzed the different forms of artivism that through this platform are promote, using a mixed methodology that on the one hand quantitatively analyzes the data and figures of their publications, and on the other allows us, through conceptual categories, a qualitative approach to the different interpretations and symbolic meanings of the publications made.

The compound hazard effects of multiple process cascades severely affect Chilean river systems and result in a large variety of disturbances on their ecosystems and alterations of their hydromorphologic regimes leading to extreme impacts on society, environment and infrastructure. The acute, neo-tectonically pre-determined susceptibility to seismic hazards, the widespread volcanic activity, the increasing glacier retreat and the continuous exposure to forest fires clearly disturb entire riverine systems and concur to trigger severe floods hazards. With the objective to refine the understanding of such cascading processes and to prospect feasible flood risk management strategies in such a rapidly changing environment we first classify the large river basins according to a set of disturbances (i.e. volcanic eruptions, earthquakes, glacier lake outburst floods, wild fires and mass movements). Then, we describe emblematic cases of process cascades which affected specific Chilean drainage basins and resulted in high losses as tangible examples of how the cascading processes may unfold in other river basins with similar characteristics. As an attempt to enrich the debate among management authorities and academia in Chile, and elsewhere, on how to sustainably manage river systems, we: a) highlight the pivotal need to determine the possible process cascades that may profoundly alter the system and b) we suggest to refine hazard and risk assessments accordingly, accounting for the current and future exposure. We advocate, finally, for the adoption of holistic approaches promoting anticipatory adaptation which may result in resilient system responses.

New World hantaviruses are important human pathogens that can cause a severe zoonotic disease called hantavirus cardiopulmonary syndrome (HCPS). HCPS patients can progress quickly to a severe condition with respiratory failure and cardiogenic shock that can be fatal in 30% of the cases. The role of the host’s immune responses in this progression towards HCPS remains elusive. In this study, 12 patients hospitalized with severe HCPS were analyzed using a transcriptome approach combined with clinical laboratory data to gain a better insight into factors associated with a severe clinical course. Patients were further classified in two levels of severity, a first group that required mechanical ventilation and vasoactive drugs (VM+VD) and a second group that also needed ECMO or died (ECMO/Fatal). Their transcriptional profile was compared during acute (early and late) and convalescent phases. Our results showed that overexpression of the interferon response is correlated with a worse (ECMO/Fatal) outcome and an increased viral load and proinflammatory cytokines in the early-acute-phase. This report provides insights into the differences in innate immune activation between severe patients that associates with different clinical outcomes, using a non-biased approximation.Author SummaryHantavirus are rodent-borne zoonotic pathogens that when transmitted to humans cause two diseases: hantavirus renal syndrome in Europe and Asia, and hantavirus cardiopulmonary syndrome (HCPS) in the Americas. The latter, the goal of this work, is a highly lethal disease with a case fatality rate of 30%. Moreover no specific treatment or vaccine is available for this disease. In this study, we analyzed hospitalized HCPS patients with severe disease, to understand how they respond to hantavirus infection. We used a method that can measure every mRNA that is being transcribed in one moment (transcriptome analysis) and thus provide an accurate idea of how cells (specifically peripheral blood mononuclear cells) are responding to infection. The knowledge gained in this study helps us further understand the pathogenesis of this disease and might help us to design specific therapies to treat it.

Aims This paper explores the number and characterization of latent classes of adverse childhood experiences across the Evidence for Better Lives Study cohort and investigates how the various typologies link to prenatal substance use (i.e., smoking, alcohol, and illicit drugs) and poor infant outcomes (i.e., infant prematurity and low birth weight). Participants and setting A total of 1,189 mother-infant dyads residing in eight diverse low- and middle-income countries (LMICs) were recruited. Methods Latent class analysis using the Bolck, Croon, and Hagenaars (BCH) 3-step method with auxiliary multilevel logistic regressions with distal outcomes were performed. Results The LCA identified three high-risk classes and one low-risk class, namely: (1) highly maltreated (7%, n = 89), (2) emotionally and physically abused with intra-familial violence exposure (13%, n = 152), (3), emotionally abused (40%, n = 474), and (4) low household dysfunction and abuse (40%, n = 474). Overall, across all latent classes, there were low probabilities of prenatal substance use and poor infant outcomes. However, pairwise comparisons between classes indicate that class 1 and 3 had higher probabilities of prenatal illicit drug use compared to class 4. Additionally, class 2 had higher probability of low birth weight compared to the three remaining classes. Conclusion The results further our understanding of the dynamic and multifaceted nature of ACEs. More research grounded on LMICs is warranted with more attention to various parameters of risk exposure (i.e., severity, duration, chronicity).

El ‘estallido social’ ocurrido en Chile durante el año 2019, ha suscitado una serie de interrogantes respecto a sus fuentes, manifestaciones y perspectivas de reestabilización. Este estudio presenta un examen crítico sobre la representación realizada por medios de comunicación de masas durante el transcurso de la rebelión. Concretamente, se atienden sus principales hitos y controversias.La ejecución del análisis involucra una comparación entre las coberturas periodísticas realizadas por cadenas de televisión abierta, con aquellas publicadas en periódicos con líneas editoriales politizadas. Los resultados indican que sus diferenciaciones se encuentran principalmente en las distinciones normativas subyacentes a la identificación del origen del estallido, caracterización de su propagación y proyección de alternativas de reestructuración. Tal normatividad se expresa en relativos énfasis y cegueras con que se presentan los hechos en sus tribunas. Y específicamente, en el caso de la televisión abierta chilena, se constatan adherencias manifiestas entre sus valoraciones y aquellas presentes en periódicos afines a la centro-derecha nacional. Desde ahí se discute sobre la caída en los indicadores de confianza en la televisión chilena, destacando la necesidad de democratizar sus perspectivas desde el pluralismo informativo

The first step in any genome research after obtaining the read data is to perform a due quality control of the sequenced reads. In a de novo genome assembly project, the second step is to estimate two important features, the genome size and ‘best k -mer’, to start the assembly tests with different de novo assembly software and its parameters. However, the quality control of the sequenced genome libraries as a whole, instead of focusing on the reads only, is frequently overlooked and realized to be important only when the assembly tests did not render the expected results. We have developed GSER, a Genome Size Estimator using R, a pipeline to evaluate the relationship between k -mers and genome size, as a means for quality assessment of the sequenced genome libraries. GSER generates a set of charts that allow the analyst to evaluate the library datasets before starting the assembly. The script which runs the pipeline can be downloaded from http://www.mobilomics.org/GSER/downloads or http://github.com/mobilomics/GSER .

Perinatal domestic violence (P-DV) is a common form of violence experienced by women and is associated with adverse impacts on their own physical and mental health and that of their offspring. Illuminating the risk factors for and potential effects of P-DV, and promising interventions is essential for informing policies to reduce P-DV and mitigate its negative impacts. This umbrella review of recent high-quality systematic reviews and meta-analyses of research on P-DV provides a systematic synthesis of current knowledge relating to the prevalence, risk factors for, possible outcomes of, and interventions to reduce and prevent P-DV. Thirteen reviews identified through systematic searches of computerised databases, manual search and expert consultation met our inclusion criteria (i.e., English systematic reviews and/ or meta-analyses that were from recent ten years, focused on women exposed to P-DV, assessed risk factors, possible outcomes, and/ or interventions, and were of fair to high methodological quality). Our results suggest that while there is a growing understanding of risk factors and possible outcomes of P-DV, this knowledge has far been translated into effective interventions for P-DV. P-DV intervention programmes that have been subject to rigorous evaluation are mostly relatively narrow in scope and could benefit from targeting a wider range of maternal and child wellbeing outcomes, and perpetrator, relationship, and community risk factors. The overall quality of the evidence syntheses in this field is reasonable; however, future studies should involve multiple reviewers at all key stages of systematic reviews and meta-analyses to help enhance the reliability of review conclusions.

Background Convalescent plasma (CP), despite limited evidence on its efficacy, is being widely used as a compassionate therapy for hospitalized patients with COVID-19. We aimed to evaluate the efficacy and safety of early CP therapy in COVID-19 progression. Methods and findings The study was an open-label, single-center randomized clinical trial performed in an academic medical center in Santiago, Chile, from May 10, 2020, to July 18, 2020, with final follow-up until August 17, 2020. The trial included patients hospitalized within the first 7 days of COVID-19 symptom onset, presenting risk factors for illness progression and not on mechanical ventilation. The intervention consisted of immediate CP (early plasma group) versus no CP unless developing prespecified criteria of deterioration (deferred plasma group). Additional standard treatment was allowed in both arms. The primary outcome was a composite of mechanical ventilation, hospitalization for >14 days, or death. The key secondary outcomes included time to respiratory failure, days of mechanical ventilation, hospital length of stay, mortality at 30 days, and SARS-CoV-2 real-time PCR clearance rate. Of 58 randomized patients (mean age, 65.8 years; 50% male), 57 (98.3%) completed the trial. A total of 13 (43.3%) participants from the deferred group received plasma based on clinical aggravation. We failed to find benefit in the primary outcome (32.1% versus 33.3%, odds ratio [OR] 0.95, 95% CI 0.32–2.84, p > 0.999) in the early versus deferred CP group. The in-hospital mortality rate was 17.9% versus 6.7% (OR 3.04, 95% CI 0.54–17.17 p = 0.246), mechanical ventilation 17.9% versus 6.7% (OR 3.04, 95% CI 0.54–17.17, p = 0.246), and prolonged hospitalization 21.4% versus 30.0% (OR 0.64, 95% CI, 0.19–2.10, p = 0.554) in the early versus deferred CP group, respectively. The viral clearance rate on day 3 (26% versus 8%, p = 0.204) and day 7 (38% versus 19%, p = 0.374) did not differ between groups. Two patients experienced serious adverse events within 6 hours after plasma transfusion. The main limitation of this study is the lack of statistical power to detect a smaller but clinically relevant therapeutic effect of CP, as well as not having confirmed neutralizing antibodies in donor before plasma infusion. Conclusions In the present study, we failed to find evidence of benefit in mortality, length of hospitalization, or mechanical ventilation requirement by immediate addition of CP therapy in the early stages of COVID-19 compared to its use only in case of patient deterioration. Trial registration NCT04375098., In this randomized trial, María Elvira Balcells and colleagues demonstrate that there is no benefit in immediate versus delayed convalescent plasma administration for COVID-19 patients., Author summary Why was this study done? The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has become a matter of worldwide concern, and except for corticosteroids, no other validated treatment against SARS-CoV-2 has been found so far. Plasma from convalescent patients containing antibodies against the virus is being widely used as a treatment alternative against this virus, but few randomized clinical trials have been carried out to show any clinical benefit for patients with COVID-19. What did the researchers do and find? We conducted a randomized clinical trial. Fifty-eight hospitalized patients in the early stages of COVID-19 (≤7 days of symptoms) and with a high risk of progression into respiratory failure were recruited. Patients were randomized into 2 groups: The early plasma group received convalescent plasma at enrollment, and the deferred plasma group received convalescent plasma only in case of respiratory aggravation or if the patient still required hospitalization for symptomatic COVID-19 >7 days after enrollment. The proportion achieving the combined primary outcome of mechanical ventilation, prolonged hospitalization, or in-hospital death was 32.1% with immediate plasma versus 33.3% in the arm deferring plasma until aggravation, a non-significant difference. What do these findings mean? Our study failed to show that early convalescent plasma administration improves the outcome compared to convalescent plasma use only in case of clinical deterioration. The small sample size of the study precludes any definitive conclusions, but the results are in agreement with observations from other trials on convalescent plasma for patients hospitalized with COVID-19.

The deployment of a percutaneous aortic valve is challenging in patients with a mitral prosthesis. The risk of prosthetic deformation, embolization or dysfunction is higher in this group of patients, which requires a series of technical considerations. We report a successful implantation of an Evolut Pro # 29 self-expanding valve in a 67-year-old female with a previous Starr-Edwards caged-ball mitral prosthesis.

Measures that produce valid and reliable antenatal depressive symptom scores in low resource country contexts are important for research efforts to better understand risk factors, outcomes, and effective interventions in these contexts. Establishing the psychometric comparability of scores across countries also facilitates cross-country analysis of similarities and differences across contexts. To date, however, very few studies have evaluated the psychometric properties and comparability of widely used antenatal depressive symptom measures across diverse cultural, political and social contexts. To address this gap, we used data from the Evidence for Better Lives Study – Foundational Research (EBLS-FR) to examine the reliability, validity, and cross-country invariance of the 9-item version of the Patient Health Questionnaire (PHQ-9) in antenatal samples across eight low- and middle-income countries (LMICs). We found that the PHQ-9 scores had good internal consistency and construct validity across all eight countries. However, in measurement invariance analyses, only partial metric invariance held and only across four of the countries. Further, there were some notable between-site contrasts in the nomological networks of PHQ-9 scores. Our results suggest that the PHQ-9 yields reliable scores when administered in antenatal populations; however, the meaning of the scores varies by country. Thus, interpretation of PHQ scores should consider local meanings of depression to ensure that local conceptualisations and manifestations of antenatal depressive symptoms are adequately reflected.

Reactive oxygen species (ROS) have been proposed as one of the main causes of the impairment of fish spermatozoa integrity and functionality during cryopreservation. The high content of unsaturated fatty acids in sperm cells and the low antioxidant capacity of diluted semen are key factors in making sperm cells susceptible to ROS attacks. For this reason, some recent studies have determined the antioxidant status of the seminal plasma and spermatozoa of fish species. Additionally, some studies have evaluated the effects of antioxidants on post-thaw sperm quality. Although ROS are certainly involved in sperm damage, other factors, such as ice crystal formation, seem to play a crucial role in cryodamage. This challenge has not yet been resolved because both the endogenous antioxidant capacity of the semen and its response to different supplementation practices seem to present specific inter- and intraspecies characteristics and effects. This review summarises knowledge on antioxidant defence and oxidative stress in fish semen, as well as antioxidant supplementation in cryopreservation media, in order to establish perspectives for future studies. Catholic University of Temuco [4136-2018, FEQUIP2019-INRN-03] FONDECYT/Post-doctoral grantComision Nacional de Investigacion Cientifica y Tecnologica (CONICYT)CONICYT FONDECYT [3180765] doctorate programme in Agricultural Sciences of Catholic University of Temuco, Chile info:eu-repo/semantics/publishedVersion

Transcatheter aortic valve implantation (TAVI) outcomes during the coronavirus disease 2019 (COVID-19) pandemic have not been fully evaluated and some structural programs in the world have been suspended during this period. We sought to evaluate and compare clinical outcomes in patients undergoing TAVI in pandemic versus nonpandemic era. In a single center, we compared 198 TAVI patients performed during 2019 to 59 patients performed during the COVID-19 pandemic period (March 1st to June 30th, 2020). Primary outcome was procedural success according to VARC criteria and 30-day mortality rates. VARC-defined procedural success was high in both groups (93.3% vs 96.6%; p = 0.53). There were no differences in any vascular complications (26% vs 19%; p = 0.3), permanent pacemaker implantation (11.8% vs 15.3%; p = 0.63), and length of hospital stay (5.2 vs 4.2 days; p = 0.29). Thirty-day mortality was similar (3% vs 3.4%; p = 1.0). We had no documented COVID-19 disease in our patients during follow up. In conclusion, TAVI procedures can be performed effectively and safely during the COVID-9 pandemic, using a minimalist approach, early discharge, and by maintaining proper use of personal protective equipment.

Introducción: Se realizó una comparación del estado nutricional, hábitos alimentarios, actividad física y horas de sueño en estudiantes de 5° a 8° grado de educación primaria en una escuela pública de la ciudad Punta Arenas Chile, según las estaciones de invierno y verano considerando la variabilidad climática y de luz solar de un clima extremo.Material y métodos: Estudio observacional analítico de enfoque cuantitativo, longitudinal de cohorte. Se siguieron durante un período de 7 meses a 105 estudiantes de ambos sexos cuya edad promedio fue 11,5 años. Se realizaron dos mediciones de las cuatro variables en estudio (estado nutricional, hábitos alimentarios, actividad física y horas de sueño). Se efectuaron mediciones de peso y talla para la obtención del Índice de Masa Corporal (IMC) para clasificar el estado nutricional según IMC/edad con los patrones de crecimiento recomendados por la Organización Mundial de la Salud (OMS). Los hábitos alimentarios y sueño fueron evaluados con un cuestionario auto administrado y se categorizó las horas de sueño para la edad según National Sleep Foundation. Para la evaluación de la actividad física en los estudiantes se utilizó la Physical Activity Questionnaire for Children PAQ-C. El análisis de datos se realizó con el Software estadístico SPSSⓇ Versión 22 y la prueba estadística t-student para muestras relacionadas. Resultados: No se encontró diferencia significativa en el estado nutricional (p 0,57). Los hábitos alimentarios saludables y la actividad física disminuyen en la estación de verano (p> 0,05). Las horas de sueño no tuvieron diferencias significativas en ambas estaciones con un promedio de 8,3 horas. Conclusiones: Los hábitos alimentarios saludables y de actividad física disminuyen en la estación de verano posiblemente asociados al receso escolar, sin evidenciar un efecto directo de la estación de año sobre las variables estudiadas.

Background Recent advances using functional ultrasound (fUS) imaging have opened new avenues to evaluate brain activity through the regional monitoring of cerebral blood volume (CBV) dynamics. In particular, this technology paves the way for understanding physiological or pathological cerebral processes or exploring the pharmacological profiles of new drugs targeting brain disorders. One of the main difficulties of this technology is the lack of standardized and validated tools, in particular relevant brain atlases, to help improving the accuracy, automation and reproducibility of fUS data analysis. New method Here, we demonstrate the possibility to use the MRI-validated SIGMA brain atlas in rat to perform fast and precise analysis of CBV changes in numerous functionally relevant regions of interest using fUS imaging. We applied this atlas to a dataset obtained in anesthetized rats evaluating the cerebral effects of atomoxetine, a norepinephrine reuptake inhibitor currently marketed in attention-deficit/hyperactivity-disorder. Results This approach enabled to show the subregional effects of atomoxetine in the rat with very few inter-individual differences in some areas, such as the dentate gyrus. Conclusions We show the feasibility of inter-individual registration of 2D pharmaco-fUS data and subsequent detailed analysis using the SIGMA atlas.

The interruption of vector-borne transmission of Chagas disease was certified in Chile in 1999. Our goal was to determine the effects of the interruption of vector transmission on the age and spatial distributions of the risk of Chagas disease. We analyzed cases of Chagas disease by age and sex between 1989 and 2017, from notified disease reports of the Ministry of Health. Bayesian risk maps were constructed using the Besag-York-Mollie model. The reported cases of Chagas disease had a mean age of 45.9 ± 17.6 years. Small changes in the age distribution were found among different periods (χ

Resumen Objetivo: Demostrar la anatomía y aplicación de la vaina anterior de los rectos para la reparación de defectos herniarios gigantes de la línea media abdominal mediante la cirugía de separación de componentes más la aplicación de un colgajo aponeurótico tipo turn over. Materiales y Método: Disección anatómica con descripción vascular y dinámica de la vaina anterior de los rectos. Posterior aplicación de la técnica en pacientes con hernias gigantes de la línea media. Seguimiento clínico de recidiva y complicaciones locales como sistémicas. Resultados: 8 pacientes fueron seleccionados. La edad promedio fue de 58,6 años y el tamaño del defecto hemiario 19,6 cm. En todos los pacientes se pudo aplicar la técnica sin inconvenientes. Sólo 1 paciente presentó una complicación local (dehiscencia y necrosis parcial del colgajo cutáneo) que se manejó con resección y reavance sin incidentes. No se describen complicaciones sistémicas ni mortalidad. Discusión: Las hernias abdominales gigantes y con pérdida a derecho de domicilio son un desafío quirúrgico. Se han desarrollado importantes avances con abordajes quirúrgicos innovadores. Nuevos materiales biológicos y sintéticos se han convertido en una parte integral del arsenal quirúrgico, sin embargo, involucran muchas veces asumir grandes costos y complicaciones propias a los materiales utilizados, además, de no cumplir con la adaptación dinámica adecuada de la pared requerida. Conclusión: Esta modificación técnica es segura, útil y accesible para los pacientes con eventraciones gigantes. La tasa de complicaciones es baja y está dada principalmente por problemas relacionados al sufrimiento de los colgajos cutáneos.

Background: Andes orthohantavirus (ANDV) is the sole etiologic agent of Hantavirus Cardiopulmonary Syndrome in Chile and, until now, the only Hantavirus known to be transmitted by person-to-person route. The main risk of person-to-person transmission is to be a sexual partner of an index case, and deep kissing the main mechanism of infection. Experimental reports suggest that ANDV infection can be inhibited by some saliva components. Therefore, some host factors like saliva quality, could help to explain why some individuals do not become infected even though their exposure to the virus is high.Aim: To compare some saliva components, such cytokines and mucins, between ANDV-infected cases (exposed-sick), their close household contacts (exposed-not sick) and healthy control not exposed.Methods: Sixty-nine confirmed ANDV-infected cases, 76 close household contacts exposed to ANDV but not infected (CHC) and 39 healthy control not exposed (HCNE). The following components were measured in saliva: secretory immunoglobulin A (sIgA) by ELISA; cytokines (IL1β, IL12p70, TNFα, INFy, IL10, IL6, VEGF, IP10, and IL8) by Multiplex Assay and mucins MUC7 and MUC5B by Western Blotting.Results: Among infected cases, CHC and HCNE analyzed 74, 45, and 33% were men, respectively (p ≤ 0.05). The average age for cases, CHC and HCNE was 37.7, 28.7, and 32 years, respectively (p ≤ 0.05). The average concentration of sIgA in infected cases was 4.846 mg/mL, higher than for CHC group, 0.333 mg/mL (p ≤ 0.05). For cytokines, significant differences were found comparing all groups for IFNy, IL12p70, and IL8. Among CHC group, there was a higher frequency of detection of MUC7 isoform (62.6%; 31/49) compared to ANDV-infected cases (40.5%; 17/42) (p < 0.05). Similarly, presence of MUC5B was higher among CHC groups (62.16%; 46/74) than in ANDV-infected cases (44.4%; 28/63) (p < 0.05).Conclusions: Three salivary components showed differences between infected cases and close household contacts (sIgA, cytokines, and mucins). These differences can be explained by the acute state of the disease in the ANDV-infected cases group. However, the differences in MUC5B and isoforms of MUC7 are not entirely explainable by the infection itself. This work represents a novel description of salivary components in the context of ANDV infection.

Acute myocardial infarction caused by thrombosis of left main coronary artery generate acute cardiac failure, cardiogenic shock and death. Along with the clinical history, the electrocardiogram (EKG) is the most useful tool for its recognition and timely management. Classically the EKG shows ST elevation > 1 mm in aVR or V1 with ST depression in the other leads. Urgent coronary angiography with percutaneous coronary angioplasty using drug eluting stents is recommended when the diagnosis is made. We report two cases to exemplify the clinical presentation, EKG and angiographic findings and therapeutic approach.

BackgroundConvalescent plasma (CP), despite limited evidence on its efficacy, is being widely used as a compassionate therapy for hospitalized patients with COVID-19. We aimed to evaluate the efficacy and safety of early CP therapy in COVID-19 progression.MethodsOpen-label, single-center, randomized clinical trial performed in an academic center in Santiago, Chile from May 10, 2020, to July 18, 2020, with final follow-up August 17, 2020. The trial included patients hospitalized within the first 7 days of COVID-19 symptoms onset, presenting risk factors for illness progression and not on mechanical ventilation. The intervention consisted in immediate CP (early plasma group) versus no CP unless developing pre-specified criteria of deterioration (deferred plasma group). Additional standard treatment was allowed in both arms. The primary outcome was a composite of mechanical ventilation, hospitalization for >14 days or death. Key secondary outcomes included: time to respiratory failure, days of mechanical ventilation, hospital length-of-stay, mortality at 30 days, and SARS-CoV-2 RT-PCR clearance rate.ResultsOf 58 randomized patients (mean age, 65.8 years, 50% male), 57 (98.3%) completed the trial. A total of 13 (43.3%) participants from the deferred group received plasma based on clinical aggravation. We found no benefit in the primary outcome (32.1% vs 33.3%, OR 0.95, 95% CI 0.32-2.84, p>0.99) in the early versus deferred CP group. In-hospital mortality rate was 17.9% vs 6.7% (OR 3.04, 95% CI 0.54-17.2, p=0.25), mechanical ventilation 17.9% vs 6.7% (OR 3.04, 95% CI 0.54-17.2, p=0.25), and prolonged hospitalization 21.4% vs 30% (OR 0.64, 95%CI, 0.19-2.1, p=0.55) in early versus deferred CP group, respectively. Viral clearance rate on day 3 (26% vs 8%, p=0.20) and day 7 (38% vs 19%, p=0.37) did not differ between groups. Two patients experienced serious adverse events within 6 or less hours after plasma transfusion.ConclusionImmediate addition of CP therapy in early stages of COVID-19 -compared to its use only in case of patient deterioration-did not confer benefits in mortality, length of hospitalization or mechanical ventilation requirement.Clinical Trials RegistrationNCT04375098

Andes orthohantavirus (ANDV) is the etiologic agent of hantavirus cardiopulmonary syndrome (HCPS), which has a case fatality rate around 35%, with no effective treatment or vaccine available. ANDV neutralizing antibody (NAb) measurements are important for the evaluation of the immune response following infection, vaccination, or passive administration of investigational monoclonal or polyclonal antibodies. The standard assay for NAb measurement is a focus reduction neutralization test (FRNT) featuring live ANDV and must be completed under biosafety level (BSL)-3 conditions. In this study, we compared neutralization assays featuring infectious ANDV or vesicular stomatitis virus (VSV) pseudovirions decorated with ANDV glycoproteins for their ability to measure anti-ANDV NAbs from patient samples. Our studies demonstrate that VSV pseudovirions effectively measure NAb from clinical samples and have greater sensitivity compared to FRNT with live ANDV. Importantly, the pseudovirus assay requires less labor and sample materials and can be conducted at BSL-2.

International audience; Donepezil is a potent acetylcholinesterase inhibitor, largely used worldwide to alleviate cognitive symptoms in Alzheimer’s disease (AD). Beyond the widely described neuronal impact of donepezil, it was recently shown that targeting connexins, the proteins involved in astrocyte network organization, potentiates donepezil efficacy profile using behavioral tests in AD rodent models. We herein present data demonstrating the potential of functional ultrasound imaging to monitor cerebral activity changes after pharmacological challenge in mice. As an example, we showed that although administration of donepezil or mefloquine alone at low dose had only very limited effects on the signal compared to the baseline, their combination produced marked hemodynamic effects in the hippocampus, in line with previously published behavioral data demonstrating a synergic interaction between both drugs. Thus, the present study provides new perspectives, (i) through the use of pharmaco-fUS, a new non-clinical imaging modality, to move forward drug discovery in AD and (ii) by the profiling of two drug treatments on brain dynamics, one used in AD: donepezil, and the other in development: donepezil combined with mefloquine (THN201) as a modulator of astrocyte network.

International audience; Highlights• A first evaluation of the potential of fUS during a pharmacological challenge.• ATX modulates cerebral blood volume in areas associated with visual processing.• fUS as a new step to move forwards new drugs to development in neurological disorders.Functional ultrasound (fUS) is a new tool enabling the imaging of brain activity through the regional monitoring of cerebral blood volume (CBV) dynamics. This innovative technique has not yet demonstrated its full potential in pharmacological applications and drug development. In the current proof-of-concept study, the impact of atomoxetine (ATX), a potent norepinephrine reuptake inhibitor and non-stimulant treatment marketed in attention-deficit/hyperactivity-disorder, was evaluated in anesthetized rat using pharmacological functional ultrasound (pharmaco-fUS) at increasing doses (0.3, 1 and 3 mg/kg). Using regions of interest (acute changes of CBV and functional connectivity) or pixel-based (general linear modeling and independent component analysis) analysis, we here demonstrated that ATX consistently displayed a hemodynamic effect in the visual cortex, the dentate gyrus and thalamus, especially visual areas such as lateral posterior thalamic nuclei and lateral geniculate nuclei (LGN). The time profile of ATX effects was dose-dependent, with fastest CBV increases at the highest dose, and longer CBV increases at the intermediate dose. Standardizing the use of pharmaco-fUS could improve our understanding of the mechanism of action of drugs active in the brain and might constitute a new step to move forward in drug development for neurological disorders.

Prosthetic knee joint function is important in the rehabilitation of individuals with transfemoral amputation.The objective of this study was to assess the gait patterns associated with two types of mechanical stance control prosthetic knee joints-weight-activated braking knee and automatic stance-phase lock knee. It was hypothesized that biomechanical differences exist between the two knee types, including a prolonged swing-phase duration and exaggerated pelvic movements for the weight-activated braking knee during gait.Prospective crossover study.Spatiotemporal, kinematic, and kinetic parameters were obtained via instrumented gait analysis for 10 young adults with a unilateral transfemoral amputation. Discrete gait parameters were extracted based on their magnitudes and timing.A 1.01% ± 1.14% longer swing-phase was found for the weight-activated braking knee (p 0.05). The prosthetic ankle push-off also occurred earlier in the gait cycle for the weight-activated braking knee. Anterior pelvic tilt was 3.3 ± 3.0 degrees greater for the weight-activated braking knee. This range of motion was also higher (p 0.05) and associated with greater hip flexion angles.Stance control affects biomechanics primarily in the early and late stance associated with prosthetic limb loading and unloading. The prolonged swing-phase time for the weight-activated braking knee may be associated with the need for knee unloading to initiate knee flexion during gait. The differences in pelvic tilt may be related to knee stability and possibly the different knee joint stance control mechanisms.Understanding the influence of knee function on gait biomechanics is important in selecting and improving treatments and outcomes for individuals with lower-limb amputations. Weight-activated knee joints may result in undesired gait deviations associated with stability in early stance-phase, and swing-phase initiation in the late stance-phase of gait.

Transcatheter aortic valve implantation (TAVI) has a lower perioperative risk than traditional surgery mostly when the transfemoral access is used. Some patients have anatomical conditions that contraindicate the use of this route. Lithoplasty is a novel technique that fractures calcium in coronary and peripheral arteries using pulsatile waves transmitted through an angioplasty balloon. We report an 83 year-old male with an aortic stenosis requiring TAVI, with severe calcification of his femoral and aortic arteries. A balloon lithoplasty of the right iliac-femoral tract was carried out, which allowed the use of the transfemoral route to install the aortic prosthesis. The patient had a good subsequent evolution.

Mumps virus usually produces a benign infection characterized by increased parotid volume which, prior to vaccination, mainly affected children and adolescents. After the introduction of measles, mumps and rubella (MMR) vaccine, mumps incidence decreased dramatically. This intervention also produced a change in its clinical presentation, moving to young adult patients, with an increased risk of complications. We report two clinical mumps cases in young adults with different clinical presentations. In both cases, serologic assays were assessed and, in one case, a polymerase chain reaction (PCR) was performed in order to confirm the diagnosis. The isolated virus was characterized and identifed as G genotype, the same genotype observed during outbreaks in United States and Europe, and different to the vaccinal strain. Mumps virus is currently circulating in Chile and it is important to be aware of possible outbreaks. Viral diagnosis can be difficult, particularly in populations with high vaccination coverage. Therefore, the access to etiologic study through PCR and serology becomes more relevant in order to optimize clinical management and secondary prevention measures.

This paper proposes a local financial access indicator which captures the accessibility of localities isolated from urban centers. As a case of study, we use Chilean data to show that higher level of local financial access reduces income inequality.

Resumen El tifus de los matorrales, causado por Orientia tsutsugamushi y transmitido por larvas de ácaros trombicúlideos de roedores silvestres es una rickettsiosis endémica en el Asia Pacífico. Luego del primer caso identificado en Chile en el año 2006, nuestro grupo ha identificado más de 30 casos a partir del año 2015. Los casos se han presentado con un marcado predominio en meses de verano, y su presentación clínica incluye fiebre, exantema y una mancha negra en el sitio de inoculación. Otros hallazgos frecuentes han sido cefalea intensa, sudoración nocturna, aumento de PCR, VHS y transaminasas hepáticas. La gran mayoría de los pacientes se han diagnosticado en el sur de Chile (principalmente la isla de Chiloé), pero recientemente también se han presentado casos en la Región Metropolitana, en personas volviendo de viajes al sur de Chile. Los médicos clínicos deben estar informados de esta enfermedad emergente en el país, de modo de sospecharla e iniciar terapia empírica con doxiciclina. La confirmación de estos casos con los métodos diagnósticos disponibles en Chile contribuirá a una mejor comprensión del rango epidemiológico y la relevancia clínica de esta infección nueva en el país.

The carbonization of Nannochloropsis gaditana microalgae biomass was found to produce bio-coal that is similar to bituminous coal used in thermal power plants. Currently, microalgae that capture CO2 while they are in the growth stage are considered a source for the production of biofuels. The carbonization of biomass for producing bio-coal has received attention for its ability to improve the biomass quality for producing solid biofuels. The research was focused on optimizing a fixed carbon index (FCindex), which allows finding operational conditions of carbonization to favor the fixed carbon content without significantly affecting the bio-coal yield. The optimization carried out by response surface methodology in a thermogravimetric analyzer allowed the prediction of optimal carbonization conditions to achieve an FCindex of 191% at 403 °C, 71 °C/min, and 60 min of residence time. The bio-coal produced under optimized conditions was characterized by 59% of fixed carbon and 41% of volatiles on a dry and ash-free basis, which is similar to bituminous coal. The promising results of dry carbonization producing bio-coal similar to bituminous coal could promote this technology, avoiding the necessity of hydrothermal carbonization. Because a high ash content was detected in the final product, further studies using the optimized conditions and a washing step should be conducted.