Antioxidant potential of coffee husks in fresh pork sausage.

Coffee husks, a by-product of dry coffee processing, present a disposal problem in coffee-producing countries. Valorization of this residue is necessary to reduce its environmental impact and improve benefits to the producer. This study evaluated the antioxidant effect of coffee husks on physicochemical properties and sensory liking of fresh sausages packaged in aerobic (AEP) or modified atmosphere packaging (MAP) (20% CO2 + 80%N2). Fresh sausages were prepared with different antioxidants: no addition (control C), sodium nitrite (T2), sodium nitrite + sodium erythorbate + BHA/BHT blend (T3), sodium nitrite + coffee husk 1% (T4), sodium nitrite + coffee husk 2% (T5). Physicochemical properties (TBARs, carbonyl content, pH and instrumental color) were analyzed to evaluate the effect of added synthetic and natural antioxidants on fresh sausages. A sensory test (n = 100) was conducted to assess consumer liking of fresh sausages stored in AEP and MAP. The addition of coffee husks reduced lipid oxidation in fresh sausages, especially under MAP packaging, but did not affect carbonyl content. Consumers reported lower liking scores for products packed in MAP. The addition of coffee husks did not affect the degree of liking. Valorization of coffee husks as an antioxidant in fresh meat products is a viable natural option for the meat industry.

Otto Engine: Classical and Quantum Approach.

In this paper, we analyze the total work extracted and the efficiency of the magnetic Otto cycle in its classic and quantum versions. As a general result, we found that the work and efficiency of the classical engine is always greater than or equal to its quantum counterpart, independent of the working substance. In the classical case, this is due to the fact that the working substance is always in thermodynamic equilibrium at each point of the cycle, maximizing the energy extracted in the adiabatic paths. We apply this analysis to the case of a two-level system, finding that the work and efficiency in both the Otto's quantum and classical cycles are identical, regardless of the working substance, and we obtain similar results for a multilevel system where a linear relationship between the spectrum of energies of the working substance and the external magnetic field is fulfilled. Finally, we show an example of a three-level system in which we compare two zones in the entropy diagram as a function of temperature and magnetic field to find which is the most efficient region when performing a thermodynamic cycle. This work provides a practical way to look for temperature and magnetic field zones in the entropy diagram that can maximize the power extracted from an Otto magnetic engine.

Tunable Spin-Polarized Edge Currents in Proximitized Transition Metal Dichalcogenides.

We explore proximity-induced ferromagnetism on transition metal dichalcogenides (TMDs), focusing on molybdenum ditelluride ribbons with zigzag edges, deposited on ferromagnetic europium oxide (EuO). A tight-binding model incorporates exchange and Rashba fields induced by proximity to EuO or similar substrates. For in-gap Fermi levels, electronic modes in the nanoribbon are localized along the edges, acting as one-dimensional (1D) conducting channels with tunable spin-polarized currents. TMDs on magnetic substrates can become very useful in spintronics, providing versatile platforms to study the proximity effects and electronic interactions in complex 1D systems.

Urological approach for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a clinical care center.

BACKGROUND: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is associated with significant manipulation of the urinary tract (UT). We aim to describe the urological events and their management in patients who underwent CRS-HIPEC. METHODS: Clinical records of patients who underwent treatment between 2007 and 2015 were reviewed. Urological events and their multidisciplinary management were analyzed. Descriptive statistics were calculated. RESULTS: A total of 103 patients were included. Mean age was 51 years (SD ± 11.8). Mean peritoneal cancer index (PCI) was 20.4 (SD ± 10.1). Primary tumors included appendicular (64%), gynecological (16%), colorectal (10%), and peritoneal mesotheliomas (9%). Ninety-three percent of patients had bilateral ureteral catheters inserted prior to surgery, without complications. Intraoperative UT injuries occurred in 7% of patients. In 5% of patients, tumor invasion of the bladder was evident at surgery and partial resection and primary repair of the bladder wall was performed. Urological complications included urinary tract infection (UTI) (21%) acute post-renal failure (4%), urinary fistulae (4%), and acute urinary retention (AUR) (1%). CONCLUSIONS: In our study, intraoperative UT events and postoperative complications, although not neglectable, were infrequent. Due to the high complexity of these cases, a multidisciplinary approach is mandatory. However, randomized clinical trials are necessary to clarify current data on the need and efficacy of prophylactic ureteral catheterization in patients undergoing CRS-HIPEC.

Design and Psychometric Evaluation of the Quality of Life in Patients With Anal Fistula Questionnaire.

BACKGROUND: Quality of life is often considered when deciding and evaluating the treatment strategy for patients diagnosed with anal fistula. OBJECTIVE: The purpose of this study was to develop and psychometrically test the Quality of Life in Patients with Anal Fistula Questionnaire. DESIGN: This was an observational cross-sectional study for the development and validation of a psychometric tool. SETTINGS: The study was conducted at a general hospital in the southeast of Spain. PATIENTS: A convenience sample included 54 patients diagnosed with anal fistula. MAIN OUTCOMES MEASURES: The reliability of the tool was assessed through its internal consistency (Cronbach α) and temporal stability (Spearman correlation coefficient (r) between test-retest). The content validity index of the items and the scale was calculated. Correlation analysis and an ordinal regression analysis between the developed tool and the Short Form 12 Health Survey examined its concurrent validity. Principal component analysis and known-group analysis using the Kruskal-Wallis test examined its construct validity. RESULTS: The reliability of the developed questionnaire was very high (α = 0.908; r = 0.861; p < 0.01). Its content validity was excellent (all-item content validity index = 0.79-1.00; scale validity index = 0.92). Evidence of its concurrent validity included strong correlation between the developed tool and Short Form 12 Health Survey (r = 0.734; p < 0.001), and participant scores on the developed tool explained ≈46.2% of the between-subject variation for the participant scores on Short Form 12 Health Survey (Nagelkerke R = 0.462). Confirming its construct validity, principal component analysis revealed that 2 factors explained 81.63% of the total variance found. Known-group analysis evidenced the ability of the questionnaire to detect expected differences in patients presenting with different symptomatology. LIMITATIONS: The major limitations of this study were the use of a small sample of Spanish-speaking patients, not including patients in the initial development of the questionnaire, and developing the scoring system using a summation method. CONCLUSIONS: The Quality of Life in Patients with Anal Fistula Questionnaire has proven to be a valid, reliable, and concise tool that could contribute to the evaluation of quality of life among patients with an anal fistula. See Video Abstract at http://links.lww.com/DCR/A368.

Safety and quality outcomes in peritoneal surface malignancy patients: developing a national center for excellence in Colombia.

BACKGROUND: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is being used more frequently for the treatment of peritoneal surface malignancies. There are a paucity of data regarding safety and quality outcomes in this group of patients. The aim of this study was to evaluate safety events and quality measures in a group of patients who underwent CRS + HIPEC. METHODS: All patients who underwent CRS + HIPEC procedures between December 2007 and March 2014 were included. All safety-related events and quality outcomes were reviewed. Major events were defined as occurrences in which there was harm to patient or healthcare personnel. Minor events were defined as quality or safety events in which there was potential for damage. RESULTS: A total of 72 patients were included. The mean Peritoneal Cancer Index for the study group was 20.5. One hundred percent compliance for informed consent, patient identification and surgical site marking, and antibiotic and venous thromboembolism prophylaxis guidelines was identified. The incidence of major safety events was 37.5 %. Minor events occurred in 47.2 % of patients. There was a 2.78 % 30-day mortality in the study group. CONCLUSIONS: One in three patients undergoing CRS + HIPEC procedures experienced a major safety or quality event before, during, or after surgery. Adequate surgical care alone is not sufficient to prevent these occurrences. Active surveillance of safety events and quality leads to early detection and development of improvement plans. New CRS + HIPEC centers need to adhere to strict safety and quality guidelines to ensure excellent patient outcomes.

Multilayer Graphene as an Endoreversible Otto Engine.

We examine the performance of a finite-time, endoreversible Otto heat engine with a working medium of monolayer or multilayered graphene subjected to an external magnetic field. As the energy spectrum of multilayer graphene under an external magnetic field depends strongly on the number of layers, so too does its thermodynamic behavior. We show that this leads to a simple relationship between the engine efficiency and the number of layers of graphene in the working medium. Furthermore, we find that the efficiency at maximum power for bilayer and trilayer working mediums can exceed that of a classical endoreversible Otto cycle. Conversely, a working medium of monolayer graphene displays identical efficiency at maximum power to a classical working medium. These results demonstrate that layered graphene can be a useful material for the construction of efficient thermal machines for diverse quantum device applications.

Pupillometric and behavioural evidence shows no differences between polyseme and homonym processing.

Ambiguous words can have related meanings (polysemes, e.g., newspaper) or unrelated meanings (homonyms, e.g., bat). Here we examined the processing of both types of ambiguous words (as well as unambiguous words) in tasks of increasing level of semantic engagement. Four experiments were conducted in which the degree of semantic engagement of the task was manipulated: lexical decision task (Experiments 1 and 2), semantic categorization task (Experiment 3) and number-of-meanings task (Experiment 4). RTs and pupillary response were recorded. To our knowledge, pupillary response had never been used before to study ambiguous words processing in isolation. Results showed faster RTs for ambiguous words with respect to unambiguous words in LDT, and larger pupil dilation was observed for ambiguous words in comparison to unambiguous ones in number-of-meanings task. However, differences between polysemes and homonyms were not observed in any task. These results provide no evidence that polysemes and homonyms are processed differently.

Efficient and easily scaled-up biosorbent based on natural and chemically modified macauba (Acrocomia aculeata) to remove Al3+, Mn2+ and Fe3+ from surface water contaminated with iron mining tailings.

The ruptures of tailings mine dams in the cities of Mariana and Brumadinho contaminated local Brazilian Rivers with toxic metals. Herein, we describe a scaled-up biosorbent based on natural macauba endocarp (NTE) and macauba endocarp chemically treated (TE) to remove Al3+, Mn2+ and Fe3+ from aqueous solutions. For the TE material: the variation of pH and temperature of water did not cause significant sorption interferences; the kinetics studies suggest a pseudo-second-order model; the adsorption isotherms revealed that the Langmuir equation was the best fit for Al3+ and Mn2+, while the Freundlich equation best described the Fe3+; and the maximum adsorption capacities were between 0.268 mg g-1 and 1.379 mg g-1. A scaled-up was carried out using an adsorption column to remove the metals from Rio Paraopeba River water samples and the results showed that both NTE and TE are potentially low cost biosorbents for removing Al3+, Mn2+ and Fe3+.

FunAndes - A functional trait database of Andean plants.

We introduce the FunAndes database, a compilation of functional trait data for the Andean flora spanning six countries. FunAndes contains data on 24 traits across 2,694 taxa, for a total of 105,466 entries. The database features plant-morphological attributes including growth form, and leaf, stem, and wood traits measured at the species or individual level, together with geographic metadata (i.e., coordinates and elevation). FunAndes follows the field names, trait descriptions and units of measurement of the TRY database. It is currently available in open access in the FIGSHARE data repository, and will be part of TRY's next release. Open access trait data from Andean plants will contribute to ecological research in the region, the most species rich terrestrial biodiversity hotspot.

Gate-tunable charge carrier electrocaloric effect in trilayer graphene.

The electrocaloric (EC) effect is the change in temperature and entropy of a material driven by the application of an electric field. Our tight-binding calculations linked to Fermi statistics, show that the EC effect can be produced in trilayer graphene (TLG) structures connected to a heat source, triggered by changes in the electronic density of states (DOS) at the Fermi level when external gate fields are applied on the outer graphene layers. We demonstrate that entropy changes are sensitive to the stacking arrangement in TLG systems. The AAA-stacked TLG presents an inverse EC response (cooling) regardless of the temperature value and gate field potential strength, whereas the EC effect in ABC-stacked TLG remains direct (heating) above room temperature. We reveal otherwise the TLG with Bernal-ABA stacking generates both the direct and inverse EC response within the same sample, associated with gate-dependent electronic transitions of thermally excited charge carriers from the valence band to the conduction band in the band structure. The novel charge carrier electrocaloric effect we propose in quantum layered systems may bring a wide variety of prototype van der Waals materials that could be used as versatile platforms to controlling the thermal response in nanodevices.

Stacking change in MoS2 bilayers induced by interstitial Mo impurities.

We use a theoretical approach to reveal the electronic and structural properties of molybdenum impurities between MoS2 bilayers. We find that interstitial Mo impurities are able to reverse the well-known stability order of the pristine bilayer, because the most stable form of stacking changes from AA' (undoped) into AB' (doped). The occurrence of Mo impurities in different positions shows their split electronic levels in the energy gap, following octahedral and tetrahedral crystal fields. The energy stability is related to the accommodation of Mo impurities compacted in hollow sites between layers. Other less stable configurations for Mo dopants have larger interlayer distances and band gaps than those for the most stable stacking. Our findings suggest possible applications such as exciton trapping in layers around impurities, and the control of bilayer stacking by Mo impurities in the growth process.

Analysis and description of disease-specific quality of life in patients with anal fistula. / Análisis y descripción de la calidad de vida específica en pacientes con fístula anal.

INTRODUCTION: In patients diagnosed with anal fistula, knowing the quality of life specifically related to the disease can help coloproctology specialists to choose the most appropriate therapeutic strategy for each case. The aim of our study is to analyzse and describe the factors related to the specific quality of life in a consecutive series of patients diagnosed with anal fistula. METHODS: Observational, cross-sectional study carried out from March 2015 to February 2017. All patients were assessed in the colorectal surgery unit of a hospital in southeast of Spain. After performing an initial anamnesis and a physical examination, patients diagnosed with anal fistula completed the Quality of Life in Ppatients with Anal Fistula Questionnaire (QoLAF-Q). This questionnaire specifically measures quality of life in people with anal fistula and its score range is the following: zero impact = 14 points, limited impact = 15 to 28 points, moderate impact = 29 to 42 points, high impact = 43 to 56 points, and very high impact = 57 to 70 points. RESULTS: A total of 80 patients were included. The median score obtained in the questionnaire for the sample studied was 34.00 (range=14-68). Statistically significant differences between patients with "primary anal fistula" (n=65) and "recurrent anal fistula" (n=15) were observed (mean rank=42.96 vs. mean rank=29.83, p=0.048). Furthermore, an inverse proportion (P=.016) between "time with clinical symptoms" and "impact on quality of life" was found (<6 months: mean rank = 45.55; 6-12 months: mean rank = 44.39; 1-2 years: mean rank = 37.83; 2-5 years: mean rank = 22; >5 years: mean rank = 19.00). There were no statistically significant differences (P=.149) between quality of life amongst patients diagnosed with complex (mean rank = 36.13) and simple fistulae (mean rank = 43.59). CONCLUSIONS: Anal fistulae exert moderate-high impact on patients' quality of life. "Shorter time experiencing clinical symptoms" and the "presence of primary fistula" are factors that can be associated with worse quality of life.

Enhancement of thermoelectric efficiency by quantum interference effects in trilayer silicene flakes.

In recent years, the enhancement of thermoelectric efficiencies has been accomplished in nanoscale systems by making use of quantum effects. We exploit the presence of quantum interference phenomena such as bound states in the continuum and Fano antiresonances in trilayer silicene flakes to produce sharp changes in the electronic transmission of the system. By applying symmetric gate voltages the thermoelectric properties can be tuned and, for particular flake lengths, a great enhancement of the figure of merit can be achieved. We show that the most favorable configurations are those in which the electronic transmission is dominated by the coupling of bound states to the continuum, tuned by an external gate.

The collateral impact of COVID19 among surgeonsand residents: Second cross-sectional survey about the Colombian perspective / El impacto colateral del COVID-19 entre cirujanos y residentes: Segunda encuesta transversal sobre la perspectiva colombiana

Introduction. The COVID-19 pandemic has led health services to adapt, surgical training has had to restructure, and personal life has had to thrive hardships. We aimed to describe the evolution of surgeons' and residents' per-ceptions about the impact COVID-19 has had on Colombia's surgical practice.Methods. Descriptive cross-sectional study using a structured electronic survey among general surgery residents, and graduated surgeons who have a clinical practice in Colombia.Results. 355 participants were included, with a median age of 37 years (IQR 30, 51), and 32.1% female. There were 28.7% residents, 43.3% general surgeons, and 27.8% subespecialist in surgery. Overall, 48.7% of respondents were from Bogotá, and 38.8% worked at academic private hospitals. Although almost all participants reported having used telemedicine platforms during the pandemic, 58% of the respondents did not view telemedicine as sufficient for follow-up consults. More than 80% of surgeons surveyed reported that their monthly incomes had been reduced. Discussion. The second survey showed a better-perceived adherence to safety protocols at their institutions than at the beginning of the pandemic. However, the toll on economic and academic domains are substantial among the surgical community. As the pandemic's effects are expected to last longer in our region, telemedicine services acceptance and healthcare providers' job stability need to be improved in Colombia

Introducción. La pandemia ha llevado a los servicios de salud a adaptarse, la formación quirúrgica ha tenido que reestructurarse y la vida personal ha tenido que prosperar en las dificultades. Nuestro objetivo fue describir la evolución de las percepciones de cirujanos y médicos residentes sobre el impacto que ha tenido el COVID-19 en la práctica quirúrgica de Colombia. Métodos. Estudio de corte transversal descriptivo mediante encuesta estructurada distribuida electrónica-mente a médicos residentes de cirugía general, cirujanos generales o sub-especialistas, con práctica clínica en Colombia. Resultados. Se incluyeron 355 participantes, con una mediana de edad de 37 años (RIC 30-51) y el 32,1 % fueron mujeres. El 28,7 % eran médicos residentes, el 43,3 % cirujanos generales y el 27,8 % subespecialistas en cirugía. El 48,7 % de los encuestados vivían en Bogotá y el 38,8 % trabajaba en hospitales académicos privados. Aunque la mayoría ha utilizado plataformas de telemedicina durante la pandemia, el 58 % de los encuestados no consideró que la telemedicina fuera suficiente para las consultas postoperatorias. Más del 80 % de los cirujanos encuestados informaron que sus ingresos mensuales se habían reducido. Discusión. La segunda encuesta mostró una mejor percepción de la adherencia a los protocolos de seguridad en sus instituciones que al comienzo de la pandemia. Sin embargo, el costo en los dominios económicos y académicos es considerable entre la comunidad quirúrgica. Dado que se espera que los efectos de la pandemia duren más en nuestra región, es necesario mejorar la aceptación de los servicios de telemedicina y la estabilidad laboral de los proveedores de atención médica en Colombia

Percepción de la pandemia COVID-19 en los servicios de cirugía en Colombia / Perception of the COVID-19 pandemic in the departments of surgery in Colombia

Introducción. La pandemia por COVID-19 ha llevado a modificar la estructura asistencial en los hospitales alrededor del mundo, buscando la mejor forma de adaptarse para responder al incremento de pacientes infectados por el virus, sin desatender las necesidades de los pacientes no afectados por el mismo. El objetivo de este trabajo es describir la percepción de la comunidad quirúrgica sobre el impacto que ha tenido la pandemia COVID-19 en los servicios de cirugía en Colombia.Métodos. Estudio de corte transversal descriptivo mediante encuesta estructurada compuesta por 10 preguntas de selección múltiple y 8 preguntas con ítems tipo Likert. Se distribuyó electrónicamente a residentes de cirugía general, cirujanos generales o sub-especialistas que tuvieran práctica clínica en Colombia. Resultados. Se incluyeron 464 participantes, 27.8 % fueron mujeres y 45.3 % cirujanos generales. Alrededor de la mitad residían en Bogotá (51.4 %) o trabajaban en un hospital universitario privado (48.3 %). El 78.8% de los encuestados consideraron que las recomendaciones de seguridad son efectivas y 76.6% se sienten seguros realizando procedimientos con ellas. Sin embargo, el 63% consideran que estas se cumplen parcialmente. Hasta el momento, 20% de los participantes reportó haber tenido contacto directo con pacientes COVID-19 positivos. Finalmente, la mayoría (93%) están de acuerdo con la cancelación de procedimientos electivos y están dispuestos a ser reubicados en otros servicios en caso de ser necesario. Conclusiones. Para el inicio de la fase de mitigación en Colombia existe consenso en la percepción del impacto de la pandemia COVID-19 en los servicios de cirugía. No se observó una variabilidad significativa respecto al nivel de entrenamiento ni al tipo de institución hospitalaria

Introduction: The COVID-19 pandemic has led to changes in the care structure in hospitals around the world, seeking the best way to adapt in response to the increase in patients infected with the virus, without neglecting the needs of patients not affected by it. The objective of this study is to describe the perception of the surgical community on the impact that the COVID-19 pandemic has had on the surgical services in Colombia.Methods: Descriptive cross-sectional study using a structured survey consisting of 10 multiple-choice questions and 8 questions with Likert-type items. It was distributed electronically to residents of general surgery, general surgeons, or sub-specialists who had clinical practice in Colombia.Results: 464 participants were included, 27.8% were women and 45.3% were general surgeons. About half resided in Bogotá (51.4%) or worked in a private university hospital (48.3%). 78.8% of the respondents considered that the safety recommendations are effective and 76.6% feel safe performing procedures with them. However, 63% con-sider that these are partially met. So far, 20% of participants reported having had direct contact with COVID-19 positive patients. Finally, the majority (93%) agree to the cancellation of elective procedures and are willing to be relocated to other services if necessary.Conclusions: There is a consensus in the perception of the COVID-19 pandemic impact in the surgery services without observing significant variability regarding the level of training or the type of hospital institution

Actualización en enfermedad de kawasaki: diagnóstico, estudio y tratamiento / Kawasaki disease update: diagnosis, study and treatment

La enfermedad de Kawasaki (EK) es una vasculitis aguda de vaso mediano que afecta principalmente a niños menores de 5 años, que de no ser tratada, se asocia al desarrollo de aneurismas de las arterias coronarias en aproximadamente el 25% de los casos. Típicamente la EK se presenta con fiebre, cambios mucocutáneos y linfadenopatía. Sin embargo, EK es una enfermedad excepcional en la que las formas incompletas de la enfermedad son muy comunes y a menudo asociación sintomatologías atípicas. Éstas pueden crear un desafío diagnóstico para los tratantes y retrasar el inicio de la terapia. No existe un gold standard para el diagnóstico de EK pero hay estudios de laboratorio y hallazgos ecocardiográficos que permiten apoyar el diagnóstico en casos incompletos. El estudio con ecocardiograma debe realizarse lo más pronto posible cuando se sospecha el diagnóstico, pero no debe retrasar el inicio de tratamiento. El objetivo de la terapia en EK es disminuir el riesgo de desarrollar aneurismas de las arterias coronarias y de esta forma, la morbimortalidad asociada a dicha condición. El propósito de esta revisión es conocer las características clínicas y las posibles formas de presentación de esta patología, además del tratamiento actual.

Kawasaki disease (KD) is an acute vasculitis of the medium vessel that mainly affects children under 5 years old, which if it's not treated, is associated with the development of coronary artery aneurysms in approximately 25% of all cases. Typically, KD presents with fever, mucocutaneous changes and lymphadenopathy. However, EK is an exceptional disease in which incomplete forms of the disease are very common and atypical presentations often occur. These presentations may create a diagnostic puzzle for pediatricians and may delay the start of therapy. There is no specific study for the diagnosis of KD but there are laboratory studies and findings in ECG that support the diagnosis in atypical cases. The echocardiogram study should be performed as soon as possible when the diagnosis is suspected, but should not delay the treatment. The goal of treatment in KD is to reduce the risk of developing aneurysms of the coronary arteries and thereby decrease the morbidity and mortality associated with this condition.

Brotes epidémicos de parotiditis, revisión de la literatura / Mumps outbreaks, literature review

La parotiditis es un infección viral producida por el virus parotídeo. Clínicamente se caracteriza por aumento de volumen de la glándula parótida generalmente bilateral. La estrategia que ha mostrado ser más eficaz para la prevención de esta infección ha sido la implementación de la vacuna tres vírica en los programas de inmunización. En países con población altamente inmunizada como Chile, se logró una importante disminución de la incidencia de esta enfermedad. Sin embargo, a pesar de la efectividad de la vacuna se siguen reportando brotes en todo el mundo, evidenciándose un cambio epidemiológico, trasladándose la edad de presentación clínica desde la niñez y adolescencia hacia los adultos jóvenes. Este aumento en el número de casos ha sido estudiado, determinando que el efecto protector inmunitario de la vacuna decaería con el transcurso del tiempo, contribuyendo a la propagación de los brotes. Con respecto a posibles estrategias para el manejo de los brotes la aplicación de una dosis adicional de la vacunas tres vírica en población expuesta sería una medida que mejoraría el control de los brotes.

Mumps is a viral infection caused by mumps virus. Clinically, it is characterized by increased parotid volume. The most effective strategy for preventing this infection, has been the implementation of measles-mumps-rubella (MMR) vaccine in the national immunization program. Among countries with a highly immunized population, like Chile, there has been an important reduction in the incidence of this disease. Nevertheless, despite the effectivity of the MMR, there are reports of outbreaks worldwide, with an epidemiological change, from clinical presentation in childhood, to adolescents and adults. This outbreaks have been studied, and it has been determined that they are due to the waning of vaccine-derived immunity. Regarding strategies for the management of new outbreaks, the administration of an additional dose of MMR, would be an alternative.