Search

Background: Maternity care practices such as skin-to-skin care, rooming-in, and direct breastfeeding are recommended, but it is unclear if these practices increase the risk of clinically significant COVID-19 in newborns, and if disruption of these practices adversely affects breastfeeding. Methods: We performed a retrospective cohort study of 357 mothers and their infants 0.2 for each). Infants who did not directly breastfeed, experience skin-to-skin care, or who did not room-in within arms' reach, were significantly less likely to be exclusively breastfed in the first 3 months, adjusting for maternal symptoms (p

RESUMEN Introducción: En Chile, los efectos maternos y perinatales de la pandemia por SARS-CoV-2 son aún desconocidos. GESTACOVID es un estudio multicéntrico que incluye embarazadas y puérperas hasta el día 42 con COVID-19. El objetivo de este estudio es presentar un informe preliminar, describiendo el impacto de la enfermedad en las embarazadas, factores de riesgo asociados y resultados perinatales. Métodos: Estudio de cohorte descriptivo que incluye 661 pacientes enroladas entre el 7 de marzo y el 6 de julio de 2020, en 23 centros hospitalarios del país. Se analizaron variables demográficas, comorbilidades, características clínicas y del diagnóstico de COVID-19 y resultado materno y perinatal. Resultados: Las pacientes hospitalizadas por COVID-19 tuvieron mayor prevalencia de hipertensión arterial crónica [10% vs 3%; OR=3,1 (1,5–6,79); p=0,003] y de diabetes tipo 1 y 2 [7% vs 2%; OR=3,2 (1,3–7,7); p=0,009] que las pacientes manejadas ambulatoriamente. Un IMC >40 kg/mt2 se asoció con un riesgo dos veces mayor de requerir manejo hospitalizado [OR=2,4 (1,2 – 4,6); p=0,009]. Aproximadamente la mitad de las pacientes (54%) tuvo un parto por cesárea, y un 8% de las interrupciones del embarazo fueron por COVID-19. Hasta la fecha de esta publicación, 38% de las pacientes continuaban embarazadas. Hubo 21 PCR positivas en 316 neonatos (6,6%), la mayoría (17/21) en pacientes diagnosticadas por cribado universal. Conclusiones: Las embarazadas con COVID-19 y comorbilidades como diabetes, hipertensión crónica y obesidad mórbida deben ser manejadas atentamente y deberán ser objeto de mayor investigación. La tasa de transmisión vertical requiere una mayor evaluación para diferenciar el mecanismo y tipo de infección involucrada.

El surf es un deporte que ha incrementado su número de adeptos en Chile. Sin embargo, existen pocos estudios que describan las características antropométricas y físicas de estos deportistas en el medio nacional. Este estudio observacional descriptivo transversal, tuvo por objetivo describir las características antropométricas y físicas de surfistas experimentados chilenos. En 15 surfistas chilenos experimentados (edad: 27,1±5,2; talla: 1,77±0,04; peso: 74,1±6,3) se evaluó el somatotipo, control postural, los saltos Squat Jump (SJ) y Counter Movement Jump (CMJ), y el consumo máximo de oxígeno (VO2 Max.). El somatotipo promedio de la muestra fue endomorfo (2,7±0,5), mesomorfo (4,6±0,7) y ectomorfo (2,3±0,6). En la prueba de estabilidad postural se obtuvo un promedio de la velocidad y de área de desplazamiento del centro de presión de 7,2±1,3 mm/seg y 68,1±18,4 mm2 respectivamente. La altura promedio de los saltos SJ fue 33,2±5,3 cm y para el CMJ 35,8±5,1 cm. La media del VO2 Max. alcanzó los 47,2±5,6 (mL·min)/kg. Esta descripción reveló que el somatotipo de la muestra fue mesomórfico balanceado y que la capacidad aeróbica de estos deportistas fue alta en relación a la población general, pero intermedia en comparación a la de deportistas. Los surfistas de la muestra no presentan un gran desarrollo de la fuerza y fuerza-explosiva de los miembros inferiores, pero poseen un buen control postural.

Resumen Introducción: El cáncer de células escamosas (CCE) es el segundo cáncer de piel más frecuente. Sin embargo, no hay publicaciones en Chile sobre el tema. Objetivo: Investigar características sociodemográficas y clínicas del CCE en la Región de Coquimbo, Chile. Material y Métodos: Serie de casos de pacientes con diagnóstico de CCE de piel tratados en el hospital de Coquimbo, entre enero de 2006 y diciembre de 2015. Criterios de inclusión: diagnóstico histológico definitivo de CCE de piel. Criterio de exclusión: 1.- seguimiento posoperatorio menor de 12 meses; 2.- operado en otro hospital; 3.- sometido a otro tratamiento previo a la cirugía; 4.- metástasis cutáneas de un CCE mucoso; 5.- CCE con metástasis a distancia. Variables independientes: edad, género, localización, tamaño, linfonodos comprometidos, residencia costera-interior. Variables dependientes: recurrencia, factores de recurrencia, letalidad. Análisis estadístico: descriptivo y analítico con el programa SSPS. Resultados: Se registraron 2.202 casos de cáncer de piel, 1.487 basocelular (67,5%), 181 melanomas (8,2%) y 534 CCE (24,2%). 236 pacientes tienen datos completos y constituyen el informe, 153 hombres (64,8%) y 83 mujeres (35,2%). Edad: 75,5 años ± 11,7 (extremos 46-94). La localización es: cabeza 158 casos (66,9%), otras áreas expuestas 47 (20%) y no expuestas 31 (14,1%). En cabeza la localización más frecuente es mejilla 40 casos (25%), frente 29 casos (12,3%). En 119 casos (50,4%) el cáncer se presenta ulcerado y en 117, no ulcerado (49,6%); diámetro del tumor 22 milímetros (rango 3-100 mm). En 10 casos hay linfonodos clínicos (4,2%). En 12 casos (5,9%) se extirpa LNC, 2 positivos. 201 casos presentan bordes histológicos libres (85,2%) y en 35 casos, borde comprometido (14,8%). Tasa de recurrencia local 8,5% (20 casos) y ganglionar 2,1% (5 casos). Recidiva del cáncer se asocia a borde histológico comprometido: P = 0,001, IC 95% 3,12-12,19 y ulceración p = 0,01, OR 4,63; IC 1,59-13,50. Seguimiento de 36 meses (rango 12-228). Letalidad 2,56%. Conclusión: El CCE de piel extirpado precozmente con confirmación histológica de erradicación tiene buen pronóstico. Introduction: Squamous skin cancer (SSC) is the second most frequent skin cáncer, nevertheless reports about this issue are not published in Chile. Objetive: To investigate social, demographics, and clinic characteristics of SSC in semidesertic Coquimbo Region, Chile. Material and Methods: serie of patients diagnosed and treated in Coquimbo hospital between January 2006 and December 2015. Inclussion criteria: 1.- histopathological confirmation of SSC. Exclusion criteria: 1.- follow up lesser than 12 months; 2.- operated in another hospital; 3.- submitted to another treatment prior to surgery; 4.- skin metastasis of mucous squamous carcinoma; 5.- patients with distant metástasis. Independent variables: age, gender, tumor site, tumor size, clinical lymph nodes, shore or valley residency. Dependent variable: recurrency frecuence, factors of recurrency, letality. Statistical analysis: descriptive and analytical by SSPS program. Results: 2.202 skin cancer cases were registered, 1.487 basal cells carcinoma (67.5%), 181 melanoma (8.2%) and 534 squamous cells carcinoma (24.2%). 236 patients with complete data are included in this report. There were 153 men (64.8%), and 83 women (35.2%). Mean age was 75.5 years old ± 11.7 (range 46-94). Primary site was: head 158 patients (66.9%), other sun exposed areas 47 patients (20%), and non exposed areas 31 patients. Cheek and front were the most frequents head site with 40 cases (25%) and 29 cases (12.3%), respectively. In 119 cases (50.4%) SCC was ulcerated, and 117 cases was not; primary tumor diameter was 22 millimeters (range 3-100). Clinical lymph nodes were primarily positives in 10 patients, (4.2%). In 12 cases with negative lymph nodes, sentinel limph node was resected. 2 were positives. Histological borders were tumor free in 201 patients (85.2%) and, 35 cases (14.8%) had positive histological borders. Local recurrence incidence was 8.5% (20 cases). Limph nodes recurrence was 2.1% (5 cases). Cancer recurrence was associated with histological positive borders P = 0.001, IC 95% 3.12-12.19, and ulcerated tumor p = 0.01, OR 4.63; IC 1.59-13.50. Letality was 2.56%. Mean follow up was 36 months (range 12-228 months). Conclusions: SSC has a good prognosis when primary tumor is resected early, with free histological borders resection.

Esta demostrada la relacion entre la alimentacion, la nutricion y la infeccion por VIH. La comunidad cientifi ca reconoce que los conocimientos y el cuidado nutricional pueden contribuir a mantener la salud y a disminuir los efectos de la infeccion. Objetivo: Evaluar el estado nutricional de las personas con VIH-sida atendidas en la consulta de descentralizacion del municipio Plaza. Sujetos y Metodos: Se realizo un estudio descriptivo transversal en 87 personas infectados con el VIH, 66 del sexo masculino y 21 femenino. 54 portadores asintomaticos del virus y 33 pacientes sida. La evaluacion nutricional consistio en mediciones antropometricas: peso, talla, pliegue tricipital, circunferencia braquial para calcular el indice de masa muscular, area grasa y muscular del brazo; evaluacion dietetica con encuestas de frecuencia de consumo de alimentos y por grupo de alimentos; medicion de parametros bioquimicos: hemoglobina, trigliceridos, glicemia y colesterol. Se comparo con la prueba t de Student asi como correlacion de Spearman entre indicadores. Resultados: Predominaron los asintomaticos masculinos entre 30-49 anos. Se detectaron pocos casos de anemia. Predomino la hipertrigliceridemia y disminuciones discretas de las reservas de grasas. La mitad de personas con sida presento comportamiento alimentario inadecuado. Mas de la mitad presento nivel de conocimientos y actitud sufi ciente. Conclusion: Es necesario incrementar la actitud de estos pacientes en relacion al cuidado de su nutricion

El surf es un deporte que ha incrementado su número de adeptos en Chile. Sin embargo, existen pocos estudios que describan las características antropométricas y físicas de estos deportistas en el medio nacional. Este estudio observacional descriptivo transversal, tuvo por objetivo describir las características antropométricas y físicas de surfistas experimentados chilenos. En 15 surfistas chilenos experimentados (edad: 27,1±5,2; talla: 1,77±0,04; peso: 74,1±6,3) se evaluó el somatotipo, control postural, los saltos Squat Jump (SJ) y Counter Movement Jump (CMJ), y el consumo máximo de oxígeno (VO2 Max.). El somatotipo promedio de la muestra fue endomorfo (2,7±0,5), mesomorfo (4,6±0,7) y ectomorfo (2,3±0,6). En la prueba de estabilidad postural se obtuvo un promedio de la velocidad y de área de desplazamiento del centro de presión de 7,2±1,3 mm/seg y 68,1±18,4 mm2 respectivamente. La altura promedio de los saltos SJ fue 33,2±5,3 cm y para el CMJ 35,8±5,1 cm. La media del VO2 Max. alcanzó los 47,2±5,6 (mL·min)/kg. Esta descripción reveló que el somatotipo de la muestra fue mesomórfico balanceado y que la capacidad aeróbica de estos deportistas fue alta en relación a la población general, pero intermedia en comparación a la de deportistas. Los surfistas de la muestra no presentan un gran desarrollo de la fuerza y fuerza-explosiva de los miembros inferiores, pero poseen un buen control postural. Surfing is a sport that has been growing rapidly in popularity throughout Chile. However, there are very few studies that describe the anthropometric and physical characteristics of these athletes in this country. The objective of this study was to describe anthropometric and physical characteristics in Chilean surfers. The study design is a descriptive observational cross study. Somatotype, postural stability, Squat Jump (SJ) and Counter Movement Jump (CMJ) and maximal oxygen uptake (VO2 max) were evaluated in 15 experienced, Chilean surfers (age: 27.1±5.2; height: 1.77±0.04; weight: 74.1±6.3). Somatotype sample average was: endomorphism: 2.7±0.5, mesomorphism: 4.6±0.7 and ectomorphism: 2.3±0.6. In postural stability test, the average of the center of pressure displacement of speed and area was 7.2±1.3 mm/sec and 68.1±18.4 mm2 respectively. The height average of the jumps was 33.2±5.3 cm for SJ and 35.8±5.1 cm for CMJ. The average of VO2 max reached 47.2±5.6 (mL·min)/kg. This description reflects the sample´s somatotype was balanced mesomorph, their aerobic capacity was high-level in relation to the general population, but is middle level in comparison to other athletes. Surfers of this sample didn´t show a large force development or explosive strength in their lower limbs and hold a good postural control.

To cite this article: Riera-Mestre A, Jimenez D, Muriel A, Lobo JL, Moores L, Yusen RD, Casado I, Nauffal D, Oribe M, Monreal M, for the RIETE investigators. Thrombolytic therapy and outcome of patients with an acute symptomatic pulmonary embolism. J Thromb Haemost 2012; 10: 751-9. Summary. Background: While the primary therapy for most patients with a pulmonary embolism (PE) consists of antico- agulation, the efficacy of thrombolysis relative to standard therapy remains unclear. Methods: In this retrospective cohort study of 15 944 patients with an objectively confirmed symp- tomatic acute PE, identified from the multicenter, international, prospective, Registro Informatizado de la Enfermedad TromboEmbolica (RIETE registry), we aimed to assess the association between thrombolytic therapy and all-cause mor- tality during the first 3 months after the diagnosis of a PE. After creating two subgroups, stratified by systolic blood pressure (SBP) (< 100 mm Hg vs. other), we used propensity score- matching for a comparison of patients who received thrombol- ysis to those who did not in each subgroup. Results: Patients who received thrombolysis were younger, had fewer comorbid diseases and more signs of clinical severity compared with those who did not receive it. In the subgroup with systolic hypoten- sion, analysis of propensity score-matched pairs (n = 94 pairs) showed a non-statistically significant but clinically relevant lower risk of death for thrombolysis compared with no thrombolysis (odds ratio (OR) 0.72; 95% confidence interval (CI), 0.36-1.46; P = 0.37). In the normotensive subgroup, analysis of propensity score-matched pairs (n = 217 pairs) showed a statistically significant and clinically meaningful increased risk of death for thrombolysis compared with no thrombolysis (OR 2.32; 95% CI, 1.15-4.68; P = 0.018). When we imputed data for missing values for echocardiography and troponin tests in the group of normotensive patients, we no longer detected the increased risk of death associated with thrombolytic therapy. Conclusions: In normotensive patients with acute symptomatic PE, thrombolytic therapy is associated with a higher risk of death than no thrombolytic therapy. In hemodynamically unstable patients, thrombolytic therapy is possibly associated with a lower risk of death than no thrombolytic therapy. However, study design limitations do not imply a causal relationship between thrombolytics and outcome.

Background The natural history of unsuspected pulmonary embolism (PE) in patients with cancer has not been thoroughly studied. Methods We used the RIETE Registry data to compare the clinical characteristics, treatment strategies and outcome in cancer patients with unsuspected PE and in those presenting with symptomatic, acute PE. Results Up to December 2011, 78 cancer patients with unsuspected PE and 1,994 with symptomatic PE had been enrolled. Patients with unsuspected PE more likely had colorectal cancer than those with symptomatic PE (28% vs. 13%), and less likely had prostate (3.8% vs. 10%) or hematologic (1.3% vs. 6.4%) cancer, or prior venous thromboembolism (3.8% vs. 12%). While the patients were receiving anticoagulant therapy, the incidence of PE recurrences (0% vs. 1.9%) or major bleeding (2.6% vs. 4.8%) were similar. After completion of anticoagulation, recurrent PE developed in 2.6% vs. 1.4% of patients, and major bleeding in 0% vs. 0.4%, respectively. Conclusions Our findings suggest that the clinical characteristics and outcome in cancer patients with unsuspected PE are quite similar to those in patients with symptomatic PE.

Information on thrombophilia risk factors for patients with upper extremity deep vein thrombosis (UEDVT) is limited. The genetic, acquired, and coagulation risk factors of an acute episode of lower EDVT (LEDVT) or UEDVT, either isolated or associated with pulmonary embolism (PE), were studied.A total of 4503 patients participated in a thrombophilia study. Odds ratio (OR) and 95% confidence intervals (CIs) were calculated.Mean age of the participants was 55 ± 19 years. The risk of LEDVT or UEDVT, isolated or associated with PE, was calculated according to thrombophilia factors. We found association between LEDVT and factor V Leiden ([FVL]; OR: 1.8; 95% CI 1.4-2.4) and resistance to activated protein C ([APC-R]; OR: 1.6; 95% CI 1.1-2.4). The LEDVT + PE presented an association with PTG20210A (OR: 1.5; 95% CI 1.1-2.1). No association was found between the thrombophilic defects studied and UEDVT or UEDVT + PE.Both FVL and APC-R carriers had the risk of developing LEDVT. The PTG20210A carriers had the risk of developing LEDVT + PE. No thrombophilic defects studied presented risk factors for UEDVT or UEDVT + PE.

SummaryLong-term therapy with low-molecular-weight heparin (LMWH) is the treatment of choice for cancer patients with venous thromboembolism (VTE). However, the ideal doses of LMWH have not been thoroughly studied. We used the RIETE Registry data to assess the influence of the daily LMWH dosage on outcome during the first three months after VTE. We used propensity score-matching to compare patients who received

Chronic obstructive pulmonary disease (COPD) is a moderate risk factor for venous thromboembolism (VTE), but neither the clinical presentation nor the outcome of VTE in COPD patients is well known. The clinical presentation of VTE, namely pulmonary embolism (PE) or deep venous thrombosis (DVT), and the outcome at 3 months (death, recurrent VTE or bleeding) were compared between 2,984 COPD patients and 25,936 non-COPD patients included in the RIETE (Registro Informatizado de la Enfermedad TromboEmbólica) registry. This ongoing international, multi-centre registry includes patients with proven symptomatic PE or DVT. PE was the more frequent VTE presentation in COPD patients (n = 1,761, 59%). PE presentation was more significantly associated with COPD patients than non-COPD patients (OR 1.64, 95% CI 1.49-1.80). During the 3-month follow-up, mortality (10.8% versus 7.6%), minor bleeding (4.5% versus 2.3%) or first VTE recurrences as PE (1.5% versus 1.1%) were significantly higher in COPD patients than in non-COPD patients. PE was the most common cause of death. COPD patients presented more frequently with PE than DVT. It may explain the worse prognosis of COPD patients, with a higher risk of death, bleeding or VTE recurrences as PE compared with non-COPD patients. Further therapeutic options are needed.

The influence of the site of cancer on outcome in cancer women with venous thromboembolism (VTE) is poorly understood. Reliable information on its influence might facilitate better use of prevention strategies. We assessed the 30-day outcome in all women with active cancer in the RIETE Registry, trying to identify if differences exist according to the tumor site. Up to May 2010, 2474 women with cancer and acute VTE had been enrolled. The most common sites were the breast (26%), colon (13%), uterus (9.3%), and haematologic (8.6%) cancers. During the 30-day study period, 329 (13%) patients died. Of them, 71 (2.9%) died of pulmonary embolism (PE), 22 (0.9%) died of bleeding. Fatal PE was more common in women with breast, colorectal, lung or pancreatic cancer (59% of the fatal PEs). Fatal bleeding was more frequent in women with colorectal, haematologic, ovarian cancer or carcinoma of unknown origin (55% of fatal bleedings).

This paper presents alternative models for forecasting the demand for bills and coins of different denominations. When compared to the models often used, the root mean squared forecasting error is substantially reduced. The paper also develops a new framework to formulate the printing and minting programs by using density forecasts along with information on technological constraints and preferences of the policy maker.

Objetivo: El objetivo de este artículo es determinar si la obesidad materna se asocia con un mayor riesgo de síndrome de Down en la descendencia y si las estimaciones de riesgo de trisomía 21, basado en el cribado combinado, se ven afectadas por el índice de masa corporal materno (IMC). Métodos: Grupo de estudio I, consistió en una cohorte de 1.568.604 mujeres; el resultado medido fue recién nacido con síndrome de Down. Se ajustó por edad materna. Grupo de estudio II consistió en 10.224 mujeres que se someten a cribado combinado en primer trimestre. El resultado medido fue la evaluación del riesgo para síndrome de Down. Todas las mujeres se dividieron en seis grupos de IMC, y se evaluaron los resultados sobre los estratos IMC con IMC 18,5 a 24,9 como referencia y corregidos por edad materna. Resultados: Las mujeres obesas tienen mayor riesgo de tener un recién nacido con síndrome de Down en comparación con mujeres de peso normal: IMC 30-34,9 OR 1,31; IC95%1,10 a 1,55, IMC 35-39,9 OR 1,12; IC95% 0,82-1,53, IMC ≥ 40 OR 1,56 (IC95% 1,00 a 2,43. Los números observados y esperados de las mujeres con un riesgo de síndrome de Down >1/300, basado en cribado combinado de primer trimestre y la edad materna, fueron similares en cada grupo de IMC. Conclusión: La obesidad materna parece aumentar el riesgo de síndrome de Down. La estimación del riesgo para el síndrome de Down con el cribado combinado de primer trimestre no se ve afectado por el IMC.

Objetivo: El objetivo de este artículo es determinar si la obesidad materna se asocia con un mayor riesgo de síndrome de Down en la descendencia y si las estimaciones de riesgo de trisomía 21, basado en el cribado combinado, se ven afectadas por el índice de masa corporal materno (IMC). Métodos: Grupo de estudio I, consistió en una cohorte de 1.568.604 mujeres; el resultado medido fue recién nacido con síndrome de Down. Se ajustó por edad materna. Grupo de estudio II consistió en 10.224 mujeres que se someten a cribado combinado en primer trimestre. El resultado medido fue la evaluación del riesgo para síndrome de Down. Todas las mujeres se dividieron en seis grupos de IMC, y se evaluaron los resultados sobre los estratos IMC con IMC 18,5 a 24,9 como referencia y corregidos por edad materna. Resultados: Las mujeres obesas tienen mayor riesgo de tener un recién nacido con síndrome de Down en comparación con mujeres de peso normal: IMC 30-34,9 OR 1,31; IC95%1,10 a 1,55, IMC 35-39,9 OR 1,12; IC95% 0,82-1,53, IMC ≥ 40 OR 1,56 (IC95% 1,00 a 2,43. Los números observados y esperados de las mujeres con un riesgo de síndrome de Down >1/300, basado en cribado combinado de primer trimestre y la edad materna, fueron similares en cada grupo de IMC. Conclusión: La obesidad materna parece aumentar el riesgo de síndrome de Down. La estimación del riesgo para el síndrome de Down con el cribado combinado de primer trimestre no se ve afectado por el IMC.

Está demostrada la relación entre la alimentación, la nutrición y la infección por VIH. La comunidad científica reconoce que los conocimientos y el cuidado nutricional pueden contribuir a mantener la salud y a disminuir los efectos de la infección. Objetivo: Evaluar el estado nutricional de las personas con VIH-sida atendidas en la consulta de descentralización del municipio Plaza. Sujetos y Métodos: Se realizó un estudio descriptivo transversal en 87 personas infectados con el VIH, 66 del sexo masculino y 21 femenino. 54 portadores asintomáticos del virus y 33 pacientes sida. La evaluación nutricional consistió en mediciones antropométricas: peso, talla, pliegue tricipital, circunferencia braquial para calcular el índice de masa muscular, área grasa y muscular del brazo; evaluación dietética con encuestas de frecuencia de consumo de alimentos y por grupo de alimentos; medición de parámetros bioquímicos: hemoglobina, triglicéridos, glicemia y colesterol. Se comparó con la prueba t de Student así como correlación de Spearman entre indicadores. Resultados: Predominaron los asintomáticos masculinos entre 30-49 años. Se detectaron pocos casos de anemia. Predominó la hipertrigliceridemia y disminuciones discretas de las reservas de grasas. La mitad de personas con sida presentó comportamiento alimentario inadecuado. Más de la mitad presentó nivel de conocimientos y actitud suficiente. Conclusión: Es necesario incrementar la actitud de estos pacientes en relación al cuidado de su nutrición. Introduction: At present, the relationship between diet, nutrition and HIV infection has been demonstrated. The scientific community recognizes that knowledge and nutritional care can help maintain health and reduce the effects of the infection. Objective: To assess the nutritional status of people living with HIV-AIDS treated in out-patient clinics of Plaza County. Subjects and Methods: A descriptive cross-sectional study in 87 people infected with HIV (66 males and 21 females). Fifty four asymptomatic infected people and 33 AIDS patients were studied. Nutritional assessment consisted of anthropometric measurements: weight, height, triceps skinfold and arm circumference to calculate the body mass index, and fat and arm muscle area; dietary assessment with frequency questionnaires and food consumption by food groups; measurement of biochemical parameters: hemoglobin, triglycerides, blood sugar and cholesterol. Values were compared with the Student t test and Spearman correlation. Results: The largest group was asymptomatic male between 30-49 years. Few cases of anemia were detected. Hypertriglyceridemia and discrete reductions in fat reserves were predominant. Half of people with AIDS presented bad eating habits. More than half presented sufficient level of knowledge and attitude. Conclusion: It is necessary to increase the attitude of these patients in relation to the care of their nutrition.

Los embarazos múltiples se consideran una entidad de alto riesgo obstétrico. Su incidencia ha ido en aumento debido a la utilización de técnicas de reproducción asistida y el aumento de la edad materna. Se presentan 2 casos de embarazos triples monocoriales triamnióticos, de sexo femenino y masculino. En ambos embarazos se manifestaron complicaciones, principalmente fetales y neonatales, atribuidas a embarazos múltiples descritas en la literatura. Multiple pregnancies are considered a high-risk obstetric entity. Their incidence has been increasing due to the use of assisted reproductive techniques and increased maternal age. Here, we describe two cases of triamniotic monochorionic triplet pregnancies, female and male respectively. Both pregnancies demonstrated complications, mainly fetal and neonatal, attributed to multiple pregnancies reported in the literature.

Este artículo presenta los resultados de un estudio experimental y su aplicación en una metodología que permite evaluar de una manera sencilla el comportamiento a fatiga de las mezclas asfálticas en estructuras de pavimentos. La metodología presentada y su aplicación se basan en la correlación obtenida de los parámetros de rigidez y deformación de un nuevo ensayo de fractura, el ensayo Fénix, y los parámetros de las leyes de fatiga entregados por el ensayo de fatiga a flexotracción en tres puntos especificados en la norma UNE-EN12697-24. Para el estudio experimental se utilizaron cuatro granulometrías especificadas en España para mezclas asfálticas: G-20, S-20, S-20R60 y S-12R40. Dos de las granulometrías contienen diferentes porcentajes de material reciclado de pavimentos (RAP) en su composición (S-20R60 y S-12R40 con 60% y 40% de RAP, respectivamente). Las mezclas G-20 y S-20 fueron fabricadas con los asfaltos de penetración B60/70 y B13/22, y las temperaturas de ensayo fueron 5 y 20 °C. Los ligantes utilizados para la fabricación de las mezclas S-20R60 y S-12R40 fueron de penetración 250 y 200 dmm, respectivamente. La temperatura de ensayo de las mezclas RAP fue de 20 °C. La principal conclusión obtenida de los resultados de esta investigación fue que la metodología propuesta basada en el ensayo Fénix permite evaluar la vida a fatiga de una estructura de pavimento por medio de un procedimiento sencillo. A su vez, entregar una solución a la problemática presentada por la complejidad y tiempo requerido de los ensayos de fatiga de las mezclas asfálticas. This article presents an experimental study and its application in a methodology to evaluate the fatigue behavior of asphalt mixtures in pavement structures. This methodology and its application are based on the correlations obtained between stiffness and deformation parameters of a simple new fracture test, named Fénix test, and those obtained by the fatigue laws determined by the three point bending beam fatigue test, which complies with the European standard UNE-EN 12697-24. Four different Spanish asphalt mixture gradations were used, named G-20, S-20, S-20R60 and S-12R40, respectively. Two were also based on standard gradations but had a different percentage of Recycled Asphalt Pavement, RAP (S-20R60 and S-12R40 with 60% and 40% of RAP, respectively). Two mixtures, G-20 and S-20, were manufactured with penetration binders B60/70 and B13/22. Test temperatures were 5 °C and 20 °C. The binders of S-20R60 and S-12R40 mixtures had penetrations of250 and 200 dmm, respectively. Mixtures test temperature was 20 °C. The main conclusion obtained from this research was that the proposed methodology allows evaluating the fatigue life of a pavement structure through a simple procedure. At the same time, this study attempts to solve the problems presented by the fatigue testing of asphalt mixtures due to their complexity and the time required.

Background: The knowledge of variables influencing hospital efficiency is of paramount importance to carry out initiatives of management improvement and optimization. Aim: To explore on the hospital technical efficiency factors. Material and Methods: Data from 255,439 hospital discharges from 28 hospitals from May to October 2011 were analyzed. The efficiency index developed by Santelices et al was calculated. Proxy variables of hospital practices, human resource productivity, strategic performance, financing mechanisms, geographical territory and specialization, were considered. The analysis was carried out estimating econometric models. Results: The most significant variables to explain efficiency are the length of stay adjusted by complexity, the discharges per nurse and midwife and the performance of the Hospital Balancea Score Card. Conclusions: The suggested analysis contributes to identify hospital efficiency causes. The results suggest ways to improve performance of hospitals.

Background: Efficiency in the use ofresources in health systems and hospitals has been a matter ofinterestfor administrators as well asforpolicy makers. The growing costs due to higher levéis of demand from the population require a better use and allocation ofsuch costs. Aim: To assess the technical efficiency in 28 hospitals in Chile, considering the period from May to October, 2011. Material and Methods: The average number ofavailable beds, the number ofstaffand the expenses on consumer and service goods were used as production inputs and, on the other hand, the expenditures adjusted by the Diagnosis-Related Groups (IR-DRG) were used as producís. To assess the technical efficiency, the Data Envelopment Analysis technique was used. Results: The levéis of inefficiency fluctuóte from 20 to 23.3%. In other words, with a 20% increase in hospital discharges and maintainingfixed inputs, hospitals could become efficient. Conclusions: The incorporation of methodologies to determine efficiency allows gathering new knowledge for people who manage resources as well asforpolicy makers by optimizing practices and having better allocation criteria.

Efficiency in the use of resources in health systems and hospitals has been a matter of interest for administrators as well as for policy makers. The growing costs due to higher levels of demand from the population require a better use and allocation of such costs.To assess the technical efficiency in 28 hospitals in Chile, considering the period from May to October, 2011.The average number of available beds, the number of staff and the expenses on consumer and service goods were used as production inputs and, on the other hand, the expenditures adjusted by the Diagnosis-Related Groups (IR-DRG) were used as producís. To assess the technical efficiency, the Data Envelopment Analysis technique was used.The levéis of inefficiency fluctuóte from 20 to 23.3%. In other words, with a 20% increase in hospital discharges and maintaining fixed inputs, hospitals could become efficient.The incorporation of methodologies to determine efficiency allows gathering new knowledge for people who manage resources as well as for policy makers by optimizing practices and having better allocation criteria.

The knowledge of variables influencing hospital efficiency is of paramount importance to carry out initiatives of management improvement and optimization.To explore on the hospital technical efficiency factors.Data from 255,439 hospital discharges from 28 hospitals from May to October 2011 were analyzed. The efficiency index developed by Santelices et al was calculated. Proxy variables of hospital practices, human resource productivity, strategic performance, financing mechanisms, geographical territory and specialization, were considered. The analysis was carried out estimating econometric models.The most significant variables to explain efficiency are the length of stay adjusted by complexity, the discharges per nurse and midwife and the performance of the Hospital Balancea Score Card.The suggested analysis contributes to identify hospital efficiency causes. The results suggest ways to improve performance of hospitals.