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Copyright of Cuadernos de Investigación Geográfica is the property of Universidad de la Rioja, Servicio de Publicaciones and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A relevant problem in the construction sector is low productivity due to the high variability and uncertainty of projects, which makes it necessary to increase efficiency through better project planning and control. The last planner system (LPS) has proven to increase planning reliability; however, improving the management of commitments in weekly planning meetings is necessary. Therefore, the objective of this research is to develop a commitment management system (CMS) using the fundamental elements of the linguistic action perspective (LAP) in synergy with the LPS. Design science research (DSR) was used to develop the CMS through three iterations (artifacts) that were applied in construction projects in Chile and Colombia. To evaluate and validate the artifact, the following two approaches were used: (1) internal, conducted by the research team through reflections on each artifact and its consequences, and (2) external, through quantitative and qualitative results. The main results led to the development of a pioneering system of commitment management in construction projects, which proved to be a practical contribution when implemented, showing positive results in participants' statements, CMS indicators, LPS indicators, and performance (time deviation). Additionally, in terms of theoretical contributions, the CMS allows reinforcing the LPS with the incorporation of specific LAP fundamentals in construction projects through a (1) system containing indicators to measure and control the management of commitments, (2) flowchart of specific commitments for construction projects, and (3) six-phase implementation plan to be replicated. The main conclusions regarding the CMS are that it allows to: (1) manage commitments by focusing on the foreman (or supervisor), (2) implement a plan that allows replication of this system, (3) improve trust and teamwork based on participants' statements, and (4) improve performance in time deviation of construction projects. [ABSTRACT FROM AUTHOR]

Aim of the study was to analyse the Ministry of Health's (MINSAL) administrative database of the Universal Health Coverage (UHC) program for First Episode of Schizophrenia Spectrum Disorders (FEP-SSD). The database included every case registered in the program between 2004 and 2017. According to the timeframes established for permanence in the program, cases were defined as Suspected, FEP in diagnostic observation and FEP-SSD. Only first registers were analysed. We compared gender, age at entry, level of care and region where the case was registered. Denominator data for estimation of incidence rates were obtained from the last census. We adjusted incidence rate ratios by age, gender, and region. During the studied period, 33.207 suspected cases were registered. 27.006 (81%) were confirmed as FEP and after 6-month follow-up, 22.701 (68%) were confirmed as FEP-SSD. The median age at entry was 24 years, males entering at younger age. Male proportion was higher than female in all groups. 46.9% of all cases were detected in primary care. FEP-SSD cases were six years younger and had a higher proportion of males than discarded cases (62.6 vs 53.2%). During 169.4 million person-years at risk, crude incidence for suspected cases was 19.58 per 100.000 person-years; for FEP, 15.92 per 100.000 person-years and for FEP-SSD, 13.38 per 100.000 person-years. Chile has lower incidence of FEP-SSD compared to current world estimations but gender proportions are comparable. This UHC program has allowed early access through the integration of mental health to the health network at all levels of care. [ABSTRACT FROM AUTHOR]

The use of inhibitors is one of the most practical modern methods in preventing and protecting against metal and alloy pipe corrosion. Exploring such additional inhibitors, particularly of natural origins, has become a key area of research. The present work, thus, evaluates the extract of a desert plant fruit, endemic to northern Chile, called Chañar (Geoffroea decorticans), as an inhibitor for the corrosion of A36 steel under a saline environment. Extract inhibition efficiency was evaluated by mass loss, polarization curves, and electrochemical impedance spectroscopy, and surface morphology of the steel after assays was analyzed by scanning electron microscopy. Results showed the formation of a smooth surface on the steel in the presence of the extract and a rough surface in the absence of the extract; also, polarization curves indicated an inhibition efficiency of approximately 82% at a concentration of 200ppm extract, corroborated by electrochemical impedance spectroscopy. The adsorption of the extract on the steel surface follows Langmuir's isotherm model, for which thermodynamic parameters suggest a physisorption mechanism. [ABSTRACT FROM AUTHOR]

All decision-making processes are complex and include a high number of variables. Particularly, decisions related to disaster risk reduction despite having an inherent uncertainty, depend on many factors associated with the inhabitants in danger, risk disaster management authorities, previous experiences, among others. Although considerable research has been carried out to understand the evacuation processes undergoing among different types of natural hazards, few of them consider psychosocial variables under a dynamic approach. This research proposes a novel way of representing decision making using the risk homeostasis theory approach. We developed a multi-method simulation model to gain an understanding of how individuals react and what are the decision-making processes undergoing a volcanic eruption. For this, we developed a system dynamics (SD) model that captures the psychosocial decision-making process of individuals facing a volcanic eruption. This theory proposes that individuals will make decisions to balance their levels of perception and acceptance of risk and that, in addition, they depend on certain motivational and cognitive variables. Once the evacuation decision making was captured by the SD model, we represented the evacuation process through agent-based simulation based on the relationship between evacuation probability and the difference between risk perception and risk acceptance levels. For experimentation and validation methods, we worked with the 2008 Chaitén (southern Chile) volcanic eruption and further population evacuation as a use case scenario. [ABSTRACT FROM AUTHOR]

This paper presents the ordered weighted average weighted average inflation (OWAWAI) and some extensions using induced and heavy aggregation operators and presents the generalized operators and some of their families. The main advantage of these new formulations is that they can use two different sets of weighting vectors and generate new scenarios based on the reordering of the arguments with the weights. With this idea, it is possible to generate new approaches that under- or overestimate the results according to the knowledge and expertise of the decision-maker. The work presents an application of these new approaches in the analysis of the inflation in Chile, Colombia, and Argentina during 2017. [ABSTRACT FROM AUTHOR]

Broad-scale richness gradients are closely associated with temperature and water availability. However, historical and evolutionary processes have also contributed to shape current diversity patterns. In this paper we focus on the potential influences of Pleistocene glaciation and phylogenetic niche conservatism (the tendency for traits to be maintained during diversification) on the tree diversity gradient in Chile, and we quantify its primary climatic correlates. Tree species richness is greatest at mid latitudes, particularly in the Andes and Coastal ranges, and decreases abruptly to the south and north. Regression tree analysis identified annual precipitation and annual temperature as the primary probable drivers of this gradient. Ice cover during the Last Glacial Maximum was also identified as an 'important' variable, but the contemporary and historical predictors are strongly collinear. Geographically weighted regression indicated that the relationships between richness and environmental variables vary regionally: the relationship between tree richness and precipitation is stronger in north-central Chile, whereas tree richness and temperature are most strongly associated in south-central Chile. By assigning each species the age of the family to which it belongs and averaging all species in each geographical unit, we also found that species from the oldest families are distributed mainly in mid to high latitudes and species from younger families are distributed mainly at lower latitudes. This pattern is closely associated with annual precipitation. Thus, the ecological component of tree richness follows contemporary climatic gradients of both energy and water, but the aridification of the Atacama Desert was an important driver over evolutionary time. The influence of recent Pleistocene glaciation remains unresolved but it cannot be discounted. [ABSTRACT FROM AUTHOR]

Using panel data-sets from Mexico and Chile for the first years of the 21st century, the authors examine the determinants of middle-class intra-generational mobility. The middle class is defined by means of a latent index of economic well-being that is less sensitive to short-term fluctuation and measurement error than standard measures of income. The authors find high rates of both upward and downward mobility in Mexico and Chile, indicating that the middle class has opportunities to move to higher levels of well-being but is also vulnerable to falling into poverty. In both countries, labour-market resources (education and occupational status of the household head and number of members in the labour market) are much stronger determinants of mobility than demographic factors, suggesting the importance of policies that foster human capital and protect workers from shocks. Rural middle-class households are substantially more vulnerable to falling into poverty and have little chance of advancing to upper classes than their urban counterparts. [ABSTRACT FROM PUBLISHER]

Improvement of productivity in construction has been a major industry challenge, given its high impact on project results. It has received increased attention from construction researchers promoting different enhancement actions, since analyzing factors affecting labor productivity is an instrumental part in this process. This paper focuses on identifying and understanding the productivity factors affecting projects in a Chilean construction company on the basis of questionnaires administered to both direct workers and midlevel employees. Analysis of the questionnaire results helped to determine organizational and managerial weaknesses and facilitated comparison of the findings with previous productivity studies. The results proved to be useful in developing recommendations for productivity improvements. The main findings indicate that the critical areas affecting construction productivity were related to materials, tools, rework, equipment, truck availability, and the workers' motivational dynamics. These results are similar to those obtained in previous studies in the United States and in Chile. Salary expectations were found to be the main reason for turnover in the studied company, which was an aspect not mentioned in previous studies. Finally, additional analyses seem to show that some factors affecting productivity are common to construction projects across boundaries, therefore validating data aggregation and the possibility of learning from experiences in different locations and even separated in time of occurrence. [ABSTRACT FROM AUTHOR]

The procurement process is critical for construction companies. To improve it, many are resorting to e-marketplaces although they usually do not know exactly how much they can gain by doing so. This paper describes a study that measured the benefits of using an e-marketplace to support the procurement process of a construction company. The study included three marketplaces currently operating in Chile. However, in this paper, we focus on Iconstruye, the most important one. 70 executives and professionals from 25 construction companies randomly selected from the 89 that used this marketplace, were interviewed and asked to fill out a questionnaire. This data was validated using data from Iconstruye and from 33 suppliers. The results show that the adoption of an e-marketplace reduces turnaround time, errors, urgent orders, and irregular purchases. A more reliable procurement process directly contributes to a leaner construction process by reducing upstream variability, procurement cycle times, and the need for large inventories on site. Users also perceive an improvement in certain global indicators when using an e-marketplace. [ABSTRACT FROM AUTHOR]

This paper assesses the challenges that the lack of credibility poses for the implementation of inflation targeting, and for the design of inflation stabilization processes in emerging market economies. We also discuss the role that credibility has played in rationalizing the main elements of the disinflationary process in Chile during the 1990s and in explaining the grounds behind the monetary policy framework's changes in Chile at the end of the last decade. [ABSTRACT FROM AUTHOR]

Abstract: Background: Human respiratory syncytial virus (HRSV) is a major cause of severe lower respiratory tract infection (LRI) in children. Distinct variants of the viruses have been described. Objective: The objective was to compare the antigenic and genetic variability of HRSV strains recovered from infants admitted to two hospitals during one epidemic in a big city. Study design: We analyzed nasopharyngeal aspirates from 201 infants admitted for LRI to two hospitals during 2002 in Santiago, Chile. The analyses were carried out using a panel of monoclonal antibodies against G glycoprotein epitopes (EIA) and RFLP for N and G genes. Results: No differences in HRSV groups A/B and in N patterns distribution were observed among both hospitals. On the contrary, antigenic and genetic G patterns displayed a wide diversity of strains circulating during one epidemic, in one big city. Conclusions: RSV variability assessment depended rather on the tool used for analysis than on the geographical location. [Copyright &y& Elsevier]

The main objective of this study is to provide a review of the Tithonian succession of the Neuquén Basin and related Andean areas with an update from recent results on biostratigraphy and radio-isotopic geochronology. The studied successions include continental clastics and volcaniclastics of the Tordillo Formation and economically-important hydrocarbon source rocks such as the widespread black shales of the Vaca Muerta Formation, which has been ranked in recent studies as one of the most important recoverable shale oil and gas resources at global level. Significant recent data include the discovery of hyaline calpionellids associated with global nannofossil markers which are relevant to investigations of the definition of the Tithonian/Berriasian boundary. In addition, new high precision radio-isotopic data provide robust evidence to modify the absolute ages presently assigned to the base and top of the Tithonian Stage by the International Commission on Stratigraphy. • Updated review of the Tithonian of Andean Basins of Central Argentina and Chile. • Biostratigraphy combining ammonites, nannofossils, radiolarians and calpionellids. • High precision radio-isotopic CA-ID TIMS U-Pb zircon dating of ash fall tuffs. • Proposal for new absolute ages for the base and top of the Tithonian Stage. [ABSTRACT FROM AUTHOR]

Background: Filaggrin (FLG) loss-of-function variants are major genetic risk factors for atopic dermatitis (AD), but these have not been studied in Latin American populations with and without AD., Methods: FLG variants R501X and 2282del4 were genotyped in 275 Chilean adults with and without AD from the "Early origins of allergy and asthma" (ARIES) cohort and in 227 patients from an AD cohort based in Santiago, Chile., Results: Among adults in the ARIES cohort, 3.3% were carriers of R501X and 2.9% of 2282del4 variants, all heterozygotes. In this cohort, 6.2% were FLG variant carriers: 11.1% of subjects reporting AD were carriers of FLG variants vs. 5.2% in those without AD (P = 0.13). In this first cohort, FLG variants were not significantly associated with asthma, allergic rhinitis, or food allergy. In the AD cohort, the prevalence of FLG variants was 7% for R501X, 2.2% for the 2282del4 variant, and 9.3% for the combined genotype. In this cohort, FLG variants were present in 15.5% of severe AD vs. 7.1% of mild-to-moderate AD subjects (P = 0.056). Evaluation of Chilean population from both cohorts combined (n = 502) revealed that FLG variants were not significantly associated with AD (OR = 1.92 [95% CI 0.95-3.9], P = 0.067) but were associated with asthma (OR = 2.16 [95% CI 1.02-4.56], P = 0.039)., Conclusions: This is the first study to evaluate FLG loss-of-function variants R501X and 2282del4 in Latin American population, revealing a similar prevalence of these FLG variant carriers to that of European populations. Among Chileans, FLG variants were significantly associated with asthma but not AD., (© 2021 the International Society of Dermatology.)

Cycloviruses (CyV) (genus Cyclovirus, family Circoviridae) are nonenveloped DNA viruses. The first report in humans was in 2010 and research has focused only on disease-associated human sample detection. The only HuACyV (CyCV-ChileNPA1, HuACyV10) reported in the Chilean population was in children (3.3%) with an acute respiratory infection. Its detection in respiratory samples from adults, with/without respiratory disease remains unknown. The aim of this study was to detect HuACyV10 in adults with and without respiratory disease. HuACyV10 was studied in nasopharyngeal swabs from 105 hospitalized adults with community-acquired pneumonia (CAP) and 104 adults without respiratory symptoms. Total nucleic acids were extracted, and viral rep and cp gene fragments were amplified by real-time polymerase chain reaction. HuACyV10 was detected in 19.05% adults with CAP and in 0.96% asymptomatic adults, being significantly higher in adult CAP than asymptomatic (n = 1) ones (p = 0.0001). C t values were between 26.7 and 39.6, and the median was 34.1 for rep and 33.8 for the CAP in adults CAP (p = 0.68), and 35.7 and 36.0, respectively, in the asymptomatic case. HuACyV10 detection in CAP adults concentrated in the Autumn-Winter season of the Southern hemisphere. The only asymptomatic adult with HuACyV10 was detected in the Spring-Summer period. In this first report of HuACyV10 in respiratory samples from adults, detection was significantly higher in CAP than in asymptomatic adults. As the sensitivity of both rep and cp genes was similar, both can be applied for detecting HuACyV10. It would be advisable to investigate the pathogenic role of HuACyV10 in adult respiratory infections. ​., (© 2021 Wiley Periodicals LLC.)

Population-level sampling and whole-genome sequences of different individuals allow one to identify signatures of hybridization, gene flow and potential molecular mechanisms of environmental responses. Here, we report the isolation of 160 Saccharomyces eubayanus strains, the cryotolerant ancestor of lager yeast, from ten sampling sites in Patagonia along 2,000 km of Nothofagus forests. Frequency of S. eubayanus isolates was higher towards southern and colder regions, demonstrating the cryotolerant nature of the species. We sequenced the genome of 82 strains and, together with 23 available genomes, performed a comprehensive phylogenetic analysis. Our results revealed the presence of five different lineages together with dozens of admixed strains. Various analytical methods reveal evidence of gene flow and historical admixture between lineages from Patagonia and Holarctic regions, suggesting the co-occurrence of these ancestral populations. Analysis of the genetic contribution to the admixed genomes revealed a Patagonian genetic origin of the admixed strains, even for those located in the North Hemisphere. Overall, the Patagonian lineages, particularly the southern populations, showed a greater global genetic diversity compared to Holarctic and Chinese lineages, in agreement with a higher abundance in Patagonia. Thus, our results are consistent with a likely colonization of the species from peripheral glacial refugia from South Patagonia. Furthermore, fermentative capacity and maltose consumption resulted negatively correlated with latitude, indicating better fermentative performance in northern populations. Our genome analysis, together with previous reports in the sister species S. uvarum suggests that a S. eubayanus ancestor was adapted to the harsh environmental conditions of Patagonia, a region that provides the ecological conditions for the diversification of these ancestral lineages., Competing Interests: the authors have declared that no competing interests exist.

Typical enteropathogenic Escherichia coli strains (tEPEC) cause attaching/effacing lesions in eukaryotic cells and produce the bundle-forming pilus (BFP), which interweaves and aggregates bacteria, resulting in the localized adherence (LA) pattern on eukaryotic cells. Previously, we identified tEPEC strains (serotype O119:H6) that exhibited LA simultaneously with an aggregative adherence (AA)-like pattern (LA/AA-like+). Remarkably, AA is characteristically produced by strains of enteroaggregative E. coli (EAEC), another diarrheagenic E. coli pathovar. In one LA/AA-like + strain (Ec404/03), we identified a conjugative plasmid containing the pil operon, which encodes the Pil fimbriae. Moreover, a pil operon associated with an AA pattern and plasmid transfer had been previously described in the EAEC C1096 strain. In this study, we investigated the occurrence of the two pilS alleles (pilS Ec404 and pilS C1096 ) in tEPEC strains of different serotypes, origins and years of isolation. We also examined the potential relationship of pilS with the AA-like phenotype, its ability to be transferred by conjugation, and occurrence among strains of the other E. coli pathovars. The pilS alleles were found in 90 (55.2%) of 163 tEPEC strains, with pilS Ec404 occurring more often (30.7%) than pilS C1096 (25.1%). About 21 tEPEC serotypes carried pilS. The pilS alleles were found in tEPEC strains from Chile, Peru and different Brazilian cities, with the oldest strain being isolated in 1966. No absolute correlation was found between the presence of pilS and the AA-like pattern. Conjugative pilS transfer was detected in 26.2% of pilS Ec404 + strains and in 65.1% of pilS C1096 + strains, but only pilS Ec404 + transconjugants were AA-like+, thus suggesting that the latter allele might need a different genetic background to express this phenotype. pilS was found in all other E. coli pathovars, where it was most prevalent in enterotoxigenic E. coli. More studies are needed to understand the mechanisms involved in the regulation of Pil expression and production., (Copyright © 2018 Elsevier GmbH. All rights reserved.)

Background: The nose deformity associated with cleft lip is difficult to solve in the primary and secondary surgery. In an adult patient, many techniques are used including mobilization, suspension, fixation and trimming the alar cartilages, septoplasty, nasal bones osteotomies, and dorsal bone and cartilage resection. Different types of cartilage grafts are commonly used., Methods: A septal cartilage graft was used in 75 adult patients with mild to severe cleft lip deformities. Based on the golden ratio proportions of the columella that can be observed in the lateral view, a septal cartilage graft with a number 1 shape was created and inserted between the medial cruras in 75 patients, with unilateral or bilateral cleft lip, between 2007 and 2014. Complementary surgery was done in the nose of all the patients. A retrospective, observational, and descriptive study was made with presurgical and postsurgical photographs, throughout a 6-month follow-up period., Results: Excellent cosmetic and functional results were seen, especially in the lateral view. There was 1 septal perforation reported. The patients were satisfied with the aesthetic results., Conclusion: The graft number 1 works in the reality; it has proven to be a stable support to the affected cartilage, projects a nice nasal tip, and is a lasting solution for adults.

Some respiratory tract infections remain unexplained despite extensive testing for common pathogens. Nasopharyngeal aspirates (NPAs) from 120 Chilean infants from Santiago with acute lower respiratory tract infections were analysed by viral metagenomics, revealing the presence of nucleic acids from anelloviruses, adenovirus-associated virus and 12 known respiratory viral pathogens. A single sequence read showed translated protein similarity to cycloviruses. We used inverse PCR to amplify the complete circular ssDNA genome of a novel cyclovirus we named CyCV-ChileNPA1. Closely related variants were detected using PCR in the NPAs of three other affected children that also contained anelloviruses. This report increases the current knowledge of the genetic diversity of cycloviruses whose detection in multiple NPAs may reflect a tropism for human respiratory tissues.

Background: Adult community-acquired pneumonia (CAP) is a relevant worldwide cause of morbidity and mortality, however the aetiology often remains uncertain and the therapy is empirical. We applied conventional and molecular diagnostics to identify viruses and atypical bacteria associated with CAP in Chile., Methods: We used sputum and blood cultures, IgG/IgM serology and molecular diagnostic techniques (PCR, reverse transcriptase PCR) for detection of classical and atypical bacteria (Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumoniae) and respiratory viruses (adenovirus, respiratory syncytial virus (RSV), human metapneumovirus, influenza virus, parainfluenzavirus, rhinovirus, coronavirus) in adults >18 years old presenting with CAP in Santiago from February 2005 to September 2007. Severity was qualified at admission by Fine's pneumonia severity index., Results: Overall detection in 356 enrolled adults were 92 (26%) cases of a single bacterial pathogen, 80 (22%) cases of a single viral pathogen, 60 (17%) cases with mixed bacterial and viral infection and 124 (35%) cases with no identified pathogen. Streptococcus pneumoniae and RSV were the most common bacterial and viral pathogens identified. Infectious agent detection by PCR provided greater sensitivity than conventional techniques. To our surprise, no relationship was observed between clinical severity and sole or coinfections., Conclusions: The use of molecular diagnostics expanded the detection of viruses and atypical bacteria in adults with CAP, as unique or coinfections. Clinical severity and outcome were independent of the aetiological agents detected.

Background: Limited knowledge on the prevalence and distribution of risk factors impairs the planning and implementation of cardiovascular prevention programs in the Latin American and Caribbean (LAC) region., Methods and Findings: Prevalence of hypertension, diabetes mellitus, abnormal lipoprotein levels, obesity, and smoking were estimated from individual-level patient data pooled from population-based surveys (1998-2007, n=31,009) from eight LAC countries and from a national survey of the United States (US) population (1999-2004) Age and gender specific prevalence were estimated and age-gender adjusted comparisons between both populations were conducted. Prevalence of diabetes mellitus, hypertension, and low high-density lipoprotein (HDL)-cholesterol in LAC were 5% (95% confidence interval [95% CI]: 3.4, 7.9), 20.2% (95% CI: 12.5, 31), and 53.3% (95% CI: 47, 63.4), respectively. Compared to LAC region's average, the prevalence of each risk factor tended to be lower in Peru and higher in Chile. LAC women had higher prevalence of obesity and low HDL-cholesterol than men. Obesity, hypercholesterolemia, and hypertriglyceridemia were more prevalent in the US population than in LAC population (31 vs. 16.1%, 16.8 vs. 8.9%, and 36.2 vs. 26.5%, respectively). However, the prevalence of low HDL-cholesterol was higher in LAC than in the US (53.3 vs. 33.7%)., Conclusions: Major cardiovascular risk factors are highly prevalent in LAC region, in particular low HDL-cholesterol. In addition, marked differences do exist in this prevalence profile between LAC and the US. The observed patterns of obesity-related risk factors and their current and future impact on the burden of cardiovascular diseases remain to be explained.

Background: Respiratory syncytial virus (RSV) has been implicated in the etiology of adult community-acquired pneumonia (CAP). We investigated RSV infection in Chilean adults with CAP using direct viral detection, real-time reverse-transcription polymerase chain reaction (rtRT-PCR), and serology (microneutralization assay)., Methods: RSV, other respiratory viruses, and bacteria were studied by conventional and molecular techniques in adults aged ≥18 years presenting with CAP to the healthcare facilities in Santiago, Chile from February 2005 through December 2007., Results: All 356 adults with CAP enrolled had an acute blood sample collected at enrollment, and 184 had a convalescent blood sample. RSV was detected in 48 cases (13.4%). Immunofluorescence assay and viral isolation each detected only 1 infection (0.2%), whereas rtRT-PCR was positive in 32 (8.9%) cases and serology was positive in 20 (10.8%) cases. CAP clinical characteristics were similar in RSV-infected and non-RSV-infected cases. RSV-specific geometric mean serum-neutralizing antibody titer (GMST) was significantly lower at admission in the 48 RSV-infected cases compared with 308 non-RSV-infected adults (GMST in log(2): RSV/A 8.1 vs 8.9, and RSV/B 9.3 vs 10.4; P < .02)., Conclusions: RSV infection is frequent in Chilean adults with CAP. Microneutralization assay was as sensitive as rtRT-PCR in detecting RSV infection and is a good adjunct assay for diagnostic research. High RSV-specific serum-neutralizing antibody levels were associated with protection against common and severe infection. The development of a vaccine could prevent RSV-related CAP in adults.

This study was conducted to determine the types of M. pneumoniae prevalent in adults presenting with community-acquired pneumonia during an epidemic period, and to scrutinize a variable region of the RepMP4 element for the detection of P1 variants. All 23 clinical specimens PCR-positive for M. pneumoniae obtained in two hospitals in Santiago, Chile, from 2005 to 2006 were typed by a multiplex PCR directly and then the RepMP4 fragment of 18 specimens was sequenced. A predominance of M. pneumoniae type 2 was found, 18 (78.3 %) specimens being grouped as type 2 and 5 (21.7 %) as type 1. Co-infection of M. pneumoniae with other respiratory pathogens was found in 10/23 (43.4 %) patients, but their frequency was not related to the M. pneumoniae type. Sequence analysis revealed a single nucleotide polymorphism, a transition mutation, in 50 % of amplicons belonging to type 1 and in 71.4 % of amplicons of type 2. The nucleotide changes were synonymous in each P1 variant. In conclusion, during the 2005-2006 epidemic in Santiago, both types of M. pneumoniae circulated. Although the analysed area in the RepMP4 was small, we detected the existence of P1 variants in the two types of this organism.

Diagnosis of cardiac pathology, valvular stenosis, cardiac dilation, and/or cardiac hypertrophy is underestimated if measures of weight, wall thickness, and valve circumference are not obtained. Routine study methodology protocols allow us to obtain values of these measurements for a correct diagnosis of these cardiopathies. The aim of the study is to establish reference values for cardiac measurements in fetuses and to compare them with an international curve of reference. One hundred seventy-one autopsies from week 17 through 41 of gestation were performed on fetuses from the Pathology Unit at the Hospital Barros Luco in Santiago de Chile. Cases with malformations were not considered. Anthropometric and cardiac measurements for each gestational week were taken. A tabulation of data with values (in percentiles) of cardiac weight, valve circumference, and ventricular wall thickness was obtained. Values were similar to an international reference. The curves of values obtained allow for identification of normal parameters of heart weight, valve circumference, and ventricular wall thickness, thereby providing easily accessible data for each gestational week. Abnormal values that fall outside of the curve must be attributed to cardiac fetal pathology.

Human metapneumovirus (hMPV) is a significant cause of acute lower respiratory tract infection in all age groups, particularly in children. Two genetic groups and four subgroups of hMPV have been described. They co-circulate during an epidemic in variable proportions. The aims were to characterize the genotypes of hMPV recovered from children hospitalized for acute lower respiratory tract infection and to establish the molecular epidemiology of strains circulating in Santiago of Chile during a 2-year period. The detection of the N gene by reverse-transcription polymerase chain reaction was carried out for screening 545 infants hospitalized for acute lower respiratory tract infection in Santiago during 2003-2004. The genetic typing of hMPV was performed by analyzing the fusion gene sequences. hMPV was detected in 10.2% (56/545 cases). Phylogenetic analysis of F gene sequences from 39 Chilean hMPV strains identified the two groups and four subgroups previously described. Strains clustered into group A were split further into the sub lineages A1, A2, and A3. Most Chilean strains clustered into the proposed novel A3 sub lineage (59%). A3 viruses were present in both years, while A1 and A2 circulated just in 1 year. In conclusion, hMPV is a relevant cause of acute lower respiratory infection in Chilean children and the potential novel cluster of group A emphasize the need for further regional genetic variability studies., ((c) 2008 Wiley-Liss, Inc.)

Diagnosis of pneumonia caused by Mycoplasma pneumoniae in adults is hampered by a lack of rapid and standardized tests for detection. This prospective study was conducted to compare the diagnostic values of an indirect immunofluorescence assay and a 16S rRNA gene PCR for the diagnosis of M. pneumoniae pneumonia in adults. From February 2005 to January 2008, 357 patients (53.8 % males, median age 63 years, range 18-94) admitted for community-acquired pneumonia (CAP) to two hospitals in Santiago, Chile, were enrolled in the study. Thirty-two patients (9.0 %) met the criteria of current or recent M. pneumoniae infection, and laboratory diagnosis was definitive in 26 cases (81.2 %) and presumptive in six cases (18.8 %). Among the 32 M. pneumoniae infections, the PCR assay was positive in 23 (71.9 %) and the serology in 27 (84.4 %) of the cases. IgM was positive in acute-phase serum specimens in 13 cases (40.6 %) of M. pneumoniae infections. Using serology as the gold standard, the sensitivity, specificity, and positive and negative predictive values of the PCR were 66.7, 98.5, 78.3 and 97.3 %, respectively, whereas the global agreement of the methods was 343/357 (96.1 %). The frequency of M. pneumoniae CAP cases declined significantly during the second year of study, suggesting the end of an epidemic period. In conclusion, although good global agreement was found between PCR and serology, the lower sensitivity of the PCR leads us to recommend the use of both procedures in parallel to confirm M. pneumoniae in CAP in adults.

Background: Severe sepsis (SS) is the leading cause of death in the Intensive Care Units (ICU)., Aim: To study the prevalence of SS in Chilean ICUs., Material and Methods: An observational, cross-sectional study using a predesigned written survey was done in all ICUs of Chile on April 21st, 2004. General hospital and ICU data and the number of hospitalized patients in the hospital and in the ICU at the survey day, were recorded. Patients were followed for 28 days., Results: Ninety four percent of ICUs participated in the survey. The ICU occupation index was 66%. Mean age of patients was 57.7+/-18 years and 59% were male, APACHE II score was 15+/-7.5 and SOFA score was 6+/-4. SS was the admission diagnosis of 94 of the 283 patients (33%) and 38 patients presented SS after admission. On the survey day, 112 patients fulfilled SS criteria (40%). APACHE II and SOFA scores were significantly higher in SS patients than in non SS patients. Global case-fatality ratio at 28 days was 15.9% (45/283). Case-fatality ratio in patients with or without SS at the moment of the survey was 26.7% (30/112) and 8.7% (17/171), respectively p <0.05. Thirteen percent of patients who developed SS after admission, died. Case-fatality ratios for patients with SS from Santiago and the other cities were similar, but APACHE II score was significantly higher in patients from Santiago. In SS patients, the independent predictors of mortality were SS as cause of hospital admission, APACHE II and SOFA scores. Ninety nine percent of SS patients had a known sepsis focus (48% respiratory and 30% abdominal). Eighty five patients that presented SS after admission, had a respiratory focus., Conclusions: SS is highly prevalent in Chilean ICUs and represents the leading diagnosis at admission. SS as cause of hospitalization, APACHE II and SOFA scores were independent predictors of mortality.

Background: In Chile respiratory syncytial virus (RSV) and adenovirus (AD) are the principal viruses detected in acute lower respiratory infections (ALRI) in infants. An overview of AD pneumonia in Chile to detect annual trends and to compare the severity of single AD or mixed RSV-AD infections is presented., Methods: Surveillance in 4927 infants hospitalized for ALRI has been performed from 1989 to 2001 using immunofluorescence assay (IFA) and viral isolation. Clinical features in 117 infants with single genotyped AD and 81 infants with mixed RSV-AD infections were analyzed., Results: Adenovirus cases declined from 20% annually in the early 1990s to approximately 5% in the 2000 decade. Genotype 7h showed increasing prevalence in hospitalized cases. The mean annual burden of hospitalizations caused by AD in Santiago was estimated to be 0.6%. No difference was observed in duration of fever, oxygen requirement and hospital stay between groups. Lung consolidation was more frequent in AD cases than mixed cases (P < 0.01); interstitial pattern and hyperinflation prevailed in the mixed cases (P < 0.01). No child died. AD diagnosis was confirmed on admission by IFA in 17% of cases of RSV-AD and in 43% of cases of single AD ALRI. AD cases diagnosed early by IFA had worse clinical outcome than those diagnosed later by virus isolation (P < 0.05)., Conclusions: AD cases declined since 1989. Mixed RSV-AD infections were not more severe than single AD etiology. AD cases admitted with positive IFA had worse prognoses than AD infections diagnosed later by virus isolation.

Hospitalized infants (4,618) were studied for lower respiratory infections from 1989 through 2000 by routine immunofluorescence assay and viral isolation. The hospitalization rate for respiratory syncytial virus (RSV) averaged 2% per year. The fatality rate was 0.1%. Monthly RSV detection varied from 14 to 88%, and epidemics lasted 3.5 to 6 months. From 1994 high-early versus low-late epidemic patterns alternately were observed, the first influenced by a group B strain.

Background: The increase in winter related health pediatric demand is associated with three factors: cold and rainy weather, air pollution and respiratory viral epidemics. During the winter of 2002 there was, successively, heavy rain, air pollution, cold weather and a respiratory syncytial virus (RSV) epidemic in Santiago., Aim: To study the influence of environmental factors and RSV epidemic on pediatric health care demand., Patients and Methods: The number of hospital admissions and outpatient consultations for acute lower respiratory infections (ALRI) from April to October 2002 (Autumn to Spring in Chile), were registered in a public pediatric hospital of Santiago. A respiratory virus surveillance (RSV, adenovirus influenza and parainfluenza virus) was carried out among children admitted for ALRI. Climate conditions and air pollution (number of particles of more than 10 microns/mm3) values were provided by local environmental health services., Results: As expected, a rise in winter hospital admissions and outpatient consultations was detected, that peaked in week 29. This rise coincided with the higher RSV detection week. There was heavy rain in weeks 22, 23 and 30, as well as cold weather in June-July (weeks 23, 24, 26, 27 and 30; mid Winter), that did not increase health care demand. Likewise, high air pollution, registered from weeks 24 to 26, did not increase health care demand., Conclusions: RSV epidemic is the principal factor associated to the increase in health burden during winter in Santiago.