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INTRODUCTION: This study describes the alcohol consumption in association with residence, gender and ethnicity among high school students from the coastal area of the Araucania Region in Chile. SUBJECTS AND METHOD: Cross-sectional study on a population of 2,763 high school students aged bet ween 14 to 18 years. STATISTICAL ANALYSIS: exploratory-descriptive analysis was used for all variables and inferential statistical analysis for associations among variables using 95% confidence interval for the estimates and 5% statistical significance for the statistical test. DATA COLLECTION: alcohol consumption reported by AUDIT test and sociodemographic records. RESULTS: 48.1% of students were Mapuche, mean age of 15.7 years (SD = 1.2), mostly from rural areas (50.9%). Alcohol consumption in the last month was 38.2%; 39.6% male 36.7% female (p < 0.001). 37.5% drank at least once in their life and 85% did so before age 15. 87% reported easy access to alcohol. According to AUDIT test, the levels of risk, harm and symptoms of dependence are 13.9% [95% CI: 12.6-15.2], 20.3% higher in men [95% CI: 18.2-22.5] than women 7.7% [6.4-9.3]. Mapuche students present risk consumption lower than non-Mapuche ones, 12.5% and 15.2% respectively. Urban-rural residence and risk consumption is 12.6% and 8.2% respectively (p < 0.001). CONCLUSIONS: The alcohol consumption was higher than that observed at the national level, and as age increases, the level of risk increases, especially in men. Alcohol risk consumption was associated with ethnicity, place of residence and gender. The fact of being non-Mapuche, urban resident and man are factors associated with the risk of alcohol con sumption among students.
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Conducta del Adolescente , Salud del Adolescente/estadística & datos numéricos , Consumo de Bebidas Alcohólicas/epidemiología , Adolescente , Chile/epidemiología , Estudios Transversales , Etnicidad , Femenino , Humanos , Indígenas Sudamericanos , Masculino , Características de la Residencia , Factores de Riesgo , Salud Rural/estadística & datos numéricos , Factores Sexuales , Salud Urbana/estadística & datos numéricosRESUMEN
BACKGROUND: University teachers prioritize acquiring knowledge about their disciplines over pedagogic training. However, the latter is becoming increasingly important in the present teaching scenario. AIM: To relate pedagogic practices with pedagogic training of teachers from health care careers of public and private universities. MATERIAL AND METHODS: Pedagogic practice and training activities participation questionnaires were answered by 296 teachers of undergraduate students from Chilean public and private universities. RESULTS: There was a direct correlation between discipline training and all pedagogic practice factors. However, pedagogic training correlated with all the factors with the exception of teacher centered learning. Teachers with a master degree had higher scores in factors related to teaching planning and process assessment. Having a doctor degree had no impact on these factors. A multiple regression analysis showed that both discipline and pedagogic training and having a master degree were associated with pedagogic practices of teachers. CONCLUSIONS: Both pedagogic and discipline training influence the quality of teaching provided by undergraduate teachers.
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Educación de Pregrado en Medicina , Docentes Médicos , Aprendizaje , Enseñanza , Adulto , Anciano , Chile , Femenino , Humanos , Masculino , Persona de Mediana Edad , Escuelas para Profesionales de Salud , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Biological nitrogen fixation (BNF) in soybeans is a complex process involving the interplay between the plant host and the symbiotic rhizobia. As nitrogen supply has a crucial role in growth and development, higher nitrogen fixation capacity would be important to achieve bigger plants and larger seeds, which were important selection criteria during plant domestication by humans. To test this hypothesis, we monitored the nitrogen fixation-related performance in 31 cultivated and 17 wild soybeans after inoculation with the slow-growing Bradyrhizobium diazoefficiens sp. nov. USDA110 and the fast-growing Sinorhizobium (Ensifer) fredii CCBAU45436. Our results showed that, in general, cultivated soybeans gave better performance in BNF. Electron microscopic studies indicated that there was an exceptionally high accumulation of poly-ß-hydroxybutyrate bodies in bacteroids in the nodules of all wild soybeans tested, suggesting that the C/N balance in wild soybeans may not be optimized for nitrogen fixation. Furthermore, we identified new quantitative trait loci (QTLs) for total ureides and total nodule fresh weight by employing a recombinant inbred population composed of descendants from a cross between a cultivated and a wild parent. Using nucleotide diversity (θπ), divergence index (Fst) and distribution of fixed single-nucleotide polymorphisms as parameters, we found that some regions in the total ureides QTL on chromosome 17 and the total nodule fresh weight QTL on chromosome 12 exhibited very low diversity among cultivated soybeans, suggesting that these were traits specially selected during the domestication and breeding process.
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Domesticación , Glycine max/genética , Fijación del Nitrógeno , Bradyrhizobium/metabolismo , Mapeo Cromosómico , Hidroxibutiratos/metabolismo , Nitrógeno/metabolismo , Fitomejoramiento , Poliésteres/metabolismo , Polimorfismo de Nucleótido Simple , Sitios de Carácter Cuantitativo , Nódulos de las Raíces de las Plantas/microbiología , Sinorhizobium/metabolismo , Glycine max/microbiología , SimbiosisRESUMEN
Restoration of neuronal functions by outgrowths regenerating at â¼1 mm/day from the proximal stumps of severed peripheral nerves takes many weeks or months, if it occurs at all, especially after ablation of nerve segments. Distal segments of severed axons typically degenerate in 1-3 days. This study shows that Wallerian degeneration can be prevented or retarded, and lost behavioral function can be restored, following ablation of 0.5-1-cm segments of rat sciatic nerves in host animals. This is achieved by using 0.8-1.1-cm microsutured donor allografts treated with bioengineered solutions varying in ionic and polyethylene glycol (PEG) concentrations (modified PEG-fusion procedure), being careful not to stretch any portion of donor or host sciatic nerves. The data show that PEG fusion permanently restores axonal continuity within minutes, as initially assessed by action potential conduction and intracellular diffusion of dye. Behavioral functions mediated by the sciatic nerve are largely restored within 2-4 weeks, as measured by the sciatic functional index. Increased restoration of sciatic behavioral functions after ablating 0.5-1-cm segments is associated with greater numbers of viable myelinated axons within and distal to PEG-fused allografts. Many such viable myelinated axons are almost certainly spared from Wallerian degeneration by PEG fusion. PEG fusion of donor allografts may produce a paradigm shift in the treatment of peripheral nerve injuries.
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Aloinjertos/fisiología , Trastornos Mentales/etiología , Trastornos Mentales/cirugía , Polietilenglicoles/uso terapéutico , Recuperación de la Función/fisiología , Neuropatía Ciática/complicaciones , Trasplante Homólogo/métodos , Potenciales de Acción/fisiología , Análisis de Varianza , Animales , Axones/patología , Modelos Animales de Enfermedad , Actividad Motora , Fibras Nerviosas Mielínicas/patología , Ratas , Ratas Sprague-Dawley , Estadística como Asunto , Factores de TiempoRESUMEN
In Chile the only requirement to study medicine is to obtain an academic achievement score over a certain cutoff value. However, the literature states that this type of selection is insufficient, since the medical profession requires cognitive and non-cognitive skills. These abilities are associated with better adaptation and academic success, as well as less dropping out. Therefore, those skills should be considered in the selection process to assure that the education goals are met. The aim of this study was to review the existing literature regarding the selection and evaluation criteria for students who are applying to medical schools. It was evident that Chilean medical schools need to establish appropriate criteria to ensure a more inclusive and fair admission. They need to design a system of admission with solid evidence of validity and reliability, complementary to the current form of student selection. This system should be considered common to all schools of medicine and, in turn, consider the sensibilities of the particular mission of each school, since academic, cognitive, inter- and intrapersonal aspects may vary among them.
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Cognición , Criterios de Admisión Escolar , Estudiantes de Medicina/estadística & datos numéricos , Chile , Educación de Postgrado en Medicina/estadística & datos numéricos , Evaluación Educacional/estadística & datos numéricos , Humanos , Estudiantes de Medicina/psicologíaRESUMEN
BACKGROUND: Thyroid cancer (TC) detection is increasing steadily. AIM: To determine the incidence of TC based on pathological reports of thyroidectomies. MATERIAL AND METHODS: Fifty pathology laboratories performing thyroid gland pathological studies were identified. Those that accepted to participate were required to send trimestral reports of all thyroid pathological studies, from March 2011 to February 2012. RESULTS: In the study period, 1309 case of TC were confirmed in 2614 thyroidectomy surgical samples. Considering the susceptible population according to 2012 census, the estimated incidence of TC during 2011 should be higher than 7.86 cases per 100,000 persons/year. Papillary cancer was the most common pathological type in 92% of samples (95% confidence intervals 90-93%). The proportion of microtumors was significantly higher in women than in men and among papillary than in follicular or medullary tumors. Only one fourth of tumors came from thyroidectomies performed in the Ministry of Health network. CONCLUSIONS: The incidence and features of TC in Chile are similar to the figures reported abroad.
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Neoplasias de la Tiroides/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Chile/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias de la Tiroides/patología , Tiroidectomía , Adulto JovenRESUMEN
OBJECTIVE: To determine whether overweight is a risk factor for the development of early childhood caries (ECC) in preschoolers. PATIENTS AND METHOD: An observational retrospective cohort study was performed in 196 children under 2 years of age at Calbuco Hospital, Los Lagos Region, Chile, who were admitted between 2007 and 2009. Patients were grouped based on their nutritional status at admission in the two following categories: eutrophic and overweighed children as a result of excessive intake. Information regarding caries incidence and nutritional status were annually retrieved from records until the age of 5 years, according to medical and dental records. RESULTS: At the beginning of the study, 33.67% were overweight and 16.33% were obese, reaching 40% overweight and 20.56% obese at four years of age. The incidence of early childhood caries in overweighed children was 57.14% compared to 40.82% in normal weight children (p = 0.022), with 1.4 RR (95% CI, 1044-1.88). CONCLUSIONS: The increased risk of early childhood decay in overweighed patients makes necessary to create instances of timely mutual referral between the professional that diagnoses overweighed children and the pediatric dentist in order to develop preventive treatments for both diseases.
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Caries Dental/etiología , Obesidad/complicaciones , Sobrepeso/complicaciones , Preescolar , Chile/epidemiología , Estudios de Cohortes , Caries Dental/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Peso Corporal Ideal , Incidencia , Masculino , Estado Nutricional , Obesidad/epidemiología , Sobrepeso/epidemiología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Minimal residual disease (MRD) assessment is a known surrogate marker for survival in multiple myeloma (MM). Here, we present a single institution's experience assessing MRD by NGS of Ig genes and the long-term impact of depth of response as well as clonal diversity on the clinical outcome of a large population of MM patients; 482 MM patients at the University of California, San Francisco (UCSF) diagnosed from 2008 to 2020 were analyzed retrospectively. MRD assessment was performed by NGS. PFS curves were plotted by the Kaplan-Meier method. In the newly diagnosed group, 119 of 304, achieved MRD negativity at the level of 10-6 at least once. These patients had a prolonged PFS versus patients who were persistently MRD positive at different levels (p > 0.0001). In the relapsed disease group, 64 of 178 achieved MRD negativity at 10-6, and PFS was prolonged versus patients who remained MRD positive (p = 0.03). Three categories of MRD dynamics were defined by artificial intelligence: (A) patients with ≥3 consistently MRD negative samples, (B) patients with continuously declining but detectable clones, and (C) patients with either increasing or a stable number of clones. Groups A and B had a more prolonged PFS than group C (p < 10-7). Patients who were MRD positive and had not yet relapsed had a higher clonal diversity than those patients who were MRD positive and had relapsed. MRD dynamics can accurately predict disease evolution and drive clinical decision-making. Clonal Diversity could complement MRD assessment in the prediction of outcomes in MM.
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Inteligencia Artificial , Mieloma Múltiple , Neoplasia Residual , Humanos , Mieloma Múltiple/genética , Mieloma Múltiple/mortalidad , Mieloma Múltiple/diagnóstico , Mieloma Múltiple/patología , Masculino , Femenino , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Adulto , Anciano de 80 o más AñosRESUMEN
Survival in multiple myeloma has improved significantly in recent years, especially in young patients. We reviewed the evolution of the survival of patients with MM in three groups based on age at MM diagnosis over three time periods between 1999 and 2020 at our 12 de Octubre Hospital institution (H12O). Then, to confirm our results, we used data from TriNetx, a global health research platform that includes patients from Europe to US. Finally, we analysed differences in the patterns of treatment between networks across the world. KaplanâMeier analysis was used to estimate survival probabilities, and between-group differences were tested using the log-rank test and hazard ratio. For patients from H12O, the median OS was 35.61, 55.59 and 68.67 months for the 1999-2009, 2010-2014 and 2015-2020 cohorts, respectively (p = 0.0001). Among all patients included in the EMEA network, the median OS was 20.32 months versus 34.75 months from 1999-2009 versus 2010-2014. The median OS from the 2010-2014 versus 2015-2020 time cohorts was 34.75 months versus 54.43 months, respectively. In relation to the US cohort, the median OS from before 2010 versus 2010-2014 was not reached in either time cohort and neither when comparing the 2010-2014 versus 2015-2019 time cohorts. Bortezomib is the most commonly used drug in the EMEA cohort, while lenalidomide is the most commonly used drug in the US cohort. This large-scale study based on real-world data confirms the previous finding that MM patients have increased their survival in the last two decades.
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Mieloma Múltiple , Humanos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bortezomib/uso terapéutico , Dexametasona/uso terapéutico , Europa (Continente)/epidemiología , Lenalidomida/uso terapéutico , Mieloma Múltiple/tratamiento farmacológico , Mieloma Múltiple/diagnósticoRESUMEN
Benign colonic strictures and fistulas are a growing problem presenting most commonly after bowel resection. Standard treatment is with endoscopic bougies or, more usually, balloon dilation. When these approaches are not successful, other solutions are available and different endoscopic and surgical approaches have been used to treat fistulas. We present an additional option--biodegradable stents--for the treatment of colonic strictures and fistulas that have proven refractory to other endoscopic interventions. We analyzed the results from 10 patients with either a postsurgical colorectal stricture (n =7) or rectocutaneous fistula (n =3) treated with the biodegradable SX-ELLA esophageal stent (covered or uncovered). Stents were successfully placed in nine patients, although early migration subsequently occurred in one. Placement was impossible in one patient due to deformity of the area and the fact that the stricture was approximately 30cm from the anus. The fistulas were successfully closed in all patients, although symptoms reappeared in one patient. In the six patients who received stents for strictures, symptoms resolved in five; in the remaining patient, the stent migrated shortly after the endoscopy. Treatment of colonic strictures and rectocutaneous fistulas with biodegradable stents is an effective alternative in the short-to-medium term. The stent does not have to be removed and is subject to very few complications. The drawbacks of this approach are the need to repeat the procedure in some patients and the lack of published series on efficacy.
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Implantes Absorbibles , Enfermedades del Colon/terapia , Fístula Cutánea/terapia , Fístula Rectal/terapia , Stents , Implantes Absorbibles/efectos adversos , Anciano , Anciano de 80 o más Años , Colectomía/efectos adversos , Enfermedades del Colon/etiología , Constricción Patológica/etiología , Constricción Patológica/terapia , Fístula Cutánea/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polidioxanona , Falla de Prótesis , Implantación de Prótesis , Fístula Rectal/etiología , Recurrencia , Stents/efectos adversosRESUMEN
BACKGROUND: Metabolic syndrome is becoming an important public health problem in affluent societies. AIM: To identify factors associated to metabolic syndrome in a Southern Chilean city. MATERIAL AND METHODS: Using a case control design, 200 participants, aged 35 to 70 years with at least three criteria for metabolic syndrome according to the National Cholesterol Education Program (NCEP_ATPIII) and 200 subjects with less than three criteria, were studied. Both groups were compared in terms of ethnic background, educational level, family history of diabetes and coronary artery disease, menopausal status, smoking, stress and depression, physical activity, changes in body mass index in the last five years and diet. RESULTS: Among subjects aged more than 54 years, among males and among overweight individuals, having a Mapuche origin was a risk factor with odds ratios (OR) of 7.2; 88 and 3.9 respectively. Among subjects aged more than 54 years, among women and among overweight individuals, a family history of diabetes was a risk factor with OR of 17.7; 3.2 and 3.9 respectively. Among subjects aged more than 54 years and among women a change in body mass index of more than three points was a risk factor with OR of 12.5 and 7.4, respectively. Depression also was a risk factor among subjects aged more than 54 years (OR 3.3). Regular consumption of wine was a protective factor among participants of more than 54 years, with an OR of 0.17. CONCLUSIONS: The risk factors for metabolic syndrome detected in this group of participants, were having a Mapuche origin, a family history of diabetes mellitus and depression. Wine consumption was associated with a lower risk.
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Síndrome Metabólico/epidemiología , Adulto , Factores de Edad , Anciano , Estudios de Casos y Controles , Chile/epidemiología , Chile/etnología , Depresión/psicología , Diabetes Mellitus , Femenino , Humanos , Masculino , Síndrome Metabólico/etnología , Síndrome Metabólico/etiología , Síndrome Metabólico/psicología , Persona de Mediana Edad , Factores de Riesgo , Factores Sexuales , Factores SocioeconómicosRESUMEN
INTRODUCTION: Disability in neuromyelitis optica spectrum disorder (NMOSD) is common and can be severe. AIM: To determine factors associated with increased disability in NMOSD. PATIENTS AND METHODS: Observational, analytical, ambispective study in a cohort of patients with NMOSD between January 2015 and July 2021, using a secondary source to review variables and the expanded disability status scale (EDSS) after onset and a primary source, with a telephone survey for the final EDSS and missing data. Major disability was defined as occurring when the EDSS score was = 6. The analysis was performed by means of logistic regression with SPSS 25®. RESULTS: A total of 125 patients were analysed. The average age at onset was 41 (standard deviation: 14) years, with a female-to-male ratio of 8:1. Of the total sample, 87% (109) were positive for anti-aquaporin antibodies. Optic neuritis (44.8%) and transverse myelitis (39.2%) were the most frequent clinical manifestations at onset. Altogether 71.2% of patients received acute treatment at their first relapse. Mean chronic treatment initiation was 12 months (interquartile range: 3-60) and 44% had difficulties with immunosuppression compliance. Of the total number of patients, 80.8% had relapses and 44% had a final EDSS score = 6. The median baseline-to-final EDSS score was 1 (interquartile range: 0-3), often towards disability accumulation. An association was found between a relapsing course (odds ratio = 3.73; p = 0.011) and a high baseline EDSS (odds ratio = 1.54; p = 0.0001) with increased disability. In the multivariate analysis, with a higher baseline EDSS and a relapsing course disability was 1.6 and 5.3 times more likely to occur, respectively. CONCLUSIONS: Disease relapses and high EDSS after the first episode are predictors of disability in NMOSD.
TITLE: Predictores de discapacidad en una cohorte con espectro de neuromielitis óptica.Introducción. La discapacidad en el espectro de neuromielitis óptica (NMOSD) es frecuente y puede ser grave. Objetivo. Determinar factores asociados a mayor discapacidad en el NMOSD. Pacientes y métodos. Estudio observacional, analítico, ambispectivo, en una cohorte de pacientes con NMOSD entre enero de 2015 y julio de 2021, utilizando una fuente secundaria para la revisión de variables y la escala extendida de discapacidad (EDSS) después del inicio y una fuente primaria, con una encuesta telefónica para la EDSS final y los datos faltantes. Se definió la discapacidad mayor cuando la puntuación de la EDSS era = 6. El análisis se realizó por medio de regresión logística con SPSS 25®. Resultados. Se analizó a 125 pacientes. La edad promedio de inicio fue 41 (desviación estándar: 14) años, con una relación mujer:hombre de 8:1. El 87% (109) era positivo para anticuerpos antiacuaporinas. La neuritis óptica (44,8%) y la mielitis transversa (39,2%) fueron las manifestaciones clínicas más frecuentes en el inicio. El 71,2% de los pacientes recibió tratamiento agudo en la primera recaída. La mediana de inicio del tratamiento crónico fue de 12 meses (rango intercuartílico: 3-60) y el 44% tuvo dificultades en el cumplimiento de la inmunosupresión. El 80,8% presentó recaídas y el 44% tenía una puntuación en la EDSS final = 6. La mediana de EDSS basal-final fue de 1 (rango intercuartílico, 0-3), con frecuencia hacia la acumulación de discapacidad. Se encontró asociación entre el curso con recaídas (odds ratio = 3,73; p = 0,011) y la EDSS basal alta (odds ratio = 1,54; p = 0,001) con una mayor discapacidad. En el análisis multivariado, una mayor EDSS basal y un curso con recaídas presentaron una probabilidad de discapacidad 1,6 y 5,3 veces mayor, respectivamente. Conclusiones. Las recaídas de la enfermedad y la EDSS alta después del primer episodio son predictores de discapacidad en el NMOSD.
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Personas con Discapacidad , Neuromielitis Óptica , Estudios de Cohortes , Femenino , Humanos , Masculino , Neuromielitis Óptica/epidemiología , Recurrencia , Factores de RiesgoRESUMEN
Systematic review of published studies on the impact of social networks (SN) use on anorexia and bulimia in female adolescents. We selected articles published over the past 10 years, written in English, Spanish or Portu-guese found in The Cochrane Library Plus, PubMed, WOS, PsycINFO, and Scopus databases and with enough methodological quality. Nine studies were included in this review with a sample of 2,069 adolescents; 75.3% were female, mean age was 18 years, and mostly used Facebook and Instagram. Despite some positive aspects, SNs promote beauty standards in terms of thinness, allow comparisons between peers increasing concerns about weight, and create spaces that encourage anorexia and bulimia. Therefore, SN use plays a role in the development of eating disorders. The promotion of extreme thinness in girls makes this population more vulnerable.
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Bulimia Nerviosa , Bulimia , Adolescente , Anorexia , Bulimia/epidemiología , Femenino , Humanos , Masculino , Red Social , DelgadezRESUMEN
White and brown rot fungi efficiently deconstruct lignocellulose in wood, Earth's largest pool of aboveground biotic carbon and an important natural resource. Despite its vital importance, little is known about the metabolomic signatures among fungal species and nutritional modes (rot types). In this study, we used GC-MS metabolomics in solid wood substrates (in planta) to compare brown rot fungi (Rhodonia placenta and Gloeophylum trabeum) and white rot fungi (Trametes versicolor and Pleurotus ostreatus) at two decay stages (earlier and later), finding identifiable patterns for brown rot fungi at later decay stages. These patterns occurred in highly reducing environments that were not observed in white rot fungi. Metabolomes measured among the two white rot fungi were notably different, but we found a potential biomarker compound, galactitol, that was characteristic to white rot taxa. In addition, we found that white rot fungi were more efficient at catabolizing phenolic compounds that were originally present in wood. Collectively, white rot fungi were characterized by measured sugar release relative to higher carbohydrate solubilization by brown rot fungi, a distinction in soluble sugar availability that might shape success in the face of "cheater" competitors. This need to protect excess free sugars may explain the differentially high brown rot fungal production of pyranones and furanones, likely linked to an expansion of polyketide synthase genes. IMPORTANCE Despite the ecological and economic importance of wood-degrading fungi, little is known about the array of metabolites that fungi produce during wood decomposition. This study provides an in-depth insight into the wood decomposition process by analyzing and comparing the changes of >100 compounds produced by fungi with metabolic distinct nutritional modes (white and brown rot fungi) at different decay stages. We found a unique pattern of metabolites that correlated well with brown rot (carbohydrate selective mode) in later decay. These compounds were in line with some of the physiochemical and genetic features previously seen in these fungi such as a faster sugar release, lower pH, and the expansion of polyketide-synthase genes compared to white rot fungi (lignin-degrading mode). This study provides spatiotemporally resolved mechanism insights as well as critical groundwork that will be valuable for studies in basic biology and ecology, as well as applied biomass deconstruction and bioremediation.
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Rasgos de la Historia de Vida , Madera/química , Trametes , Carbohidratos , Azúcares/análisis , Azúcares/metabolismoRESUMEN
OBJECTIVE: The objective of the study is to identify the risk factors associated with mortality at six weeks, especially by analyzing the role of antivirals and munomodulators. DESIGN: Prospective descriptive multicenter cohort study. SETTING: 26 Intensive care units (ICU) from Andalusian region in Spain. PATIENTS OR PARTICIPANTS: Consecutive critically ill patients with confirmed SARS-CoV-2 infection were included from March 8 to May 30. INTERVENTIONS: None. VARIABLES: Variables analyzed were demographic, severity scores and clinical condition. Support therapy, drug and mortality were analyzed. An univariate followed by multivariate Cox regression with propensity score analysis was applied. RESULTS: 495 patients were enrolled, but 73 of them were excluded for incomplete data. Thus, 422 patients were included in the final analysis. Median age was 63 years and 305 (72.3%) were men. ICU mortality: 144/422 34%; 14 days mortality: 81/422 (19.2%); 28 days mortality: 121/422 (28.7%); 6-week mortality 152/422 36.5%. By multivariable Cox proportional analysis, factors independently associated with 42-day mortality were age, APACHE II score, SOFA score at ICU admission >6, Lactate dehydrogenase at ICU admission >470U/L, Use of vasopressors, extrarenal depuration, %lymphocytes 72h post-ICU admission <6.5%, and thrombocytopenia whereas the use of lopinavir/ritonavir was a protective factor. CONCLUSION: Age, APACHE II, SOFA>value of 6 points, along with vasopressor requirements or renal replacement therapy have been identified as predictor factors of mortality at six weeks. Administration of corticosteroids showed no benefits in mortality, as did treatment with tocilizumab. Lopinavir/ritonavir administration is identified as a protective factor.
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COVID-19 , SARS-CoV-2 , Estudios de Cohortes , Enfermedad Crítica , Femenino , Mortalidad Hospitalaria , Humanos , Lactante , Lopinavir/uso terapéutico , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Ritonavir/uso terapéuticoRESUMEN
BACKGROUND: Previous analyses from a randomised trial in women aged 24-45 years have shown the quadrivalent human papillomavirus (qHPV) vaccine to be efficacious in the prevention of infection, cervical intraepithelial neoplasia (CIN), and external genital lesions (EGLs) related to HPV 6/11/16/18. In this report, we present end-of-study efficacy, safety, and immunogenicity data with a median follow-up time of 4.0 years. METHODS: We enrolled 3819 24-45-year-old women with no history of cervical disease or genital warts in the past 5 years. Women received quadrivalent vaccine or placebo at day 1, and at months 2 and 6. Ascertainment of CIN/EGL was accomplished through Pap testing, genital inspection, and cervicovaginal sampling (every 6 months). The main analysis was conducted in a per-protocol efficacy population (that received three doses, was naive to the relevant HPV types at day 1, and remained free of infection through month 7). Efficacy was also estimated in other naive and non-naive populations. RESULTS: Vaccine efficacy against the combined incidence of persistent infection, CIN/EGL related to HPV6/11/16/18 in the per-protocol population was 88.7% (95% CI: 78.1, 94.8). Efficacy for women who were seropositive and DNA negative for the relevant vaccine HPV type at the time of enrolment who received at least 1 dose was 66.9% (95% CI: 4.3, 90.6). At month 48, 91.5, 92.0, 97.4, and 47.9% of vaccinated women were seropositive to HPV 6/11/16/18, respectively. No serious vaccine-related adverse experiences were reported. CONCLUSIONS: The qHPV vaccine demonstrated high efficacy, immunogenicity, and acceptable safety in women aged 24-45 years, regardless of previous exposure to HPV vaccine type.
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Neoplasias Ováricas/inmunología , Neoplasias Ováricas/prevención & control , Papillomaviridae/inmunología , Vacunas contra Papillomavirus/uso terapéutico , Vacunas Sintéticas/uso terapéutico , Adulto , Ensayos Clínicos como Asunto , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Agencias Internacionales , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Neoplasias Ováricas/virología , Infecciones por Papillomavirus/inmunología , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/virología , Vacunas contra Papillomavirus/inmunología , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento , Vacunación , Vacunas Sintéticas/inmunología , Adulto Joven , Displasia del Cuello del Útero/inmunología , Displasia del Cuello del Útero/prevención & control , Displasia del Cuello del Útero/virologíaRESUMEN
A 53-year old male admitted for episodes of sustained ventricular tachycardia subjected to electrical cardioversion, carrier of a right femoral central venous catheter, began with febrile peaks, and Staphylococcus epidermidis was isolated in the blood cultures. What is the value of isolation in the blood cultures of S. epidermidis, a microorganism that forms a part of the usual flora of the skin and mucous of the patient? How should this situation be managed? Should an antimicrobial agent be administered? Which one? For how long?
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Bacteriemia/sangre , Bacteriemia/microbiología , Staphylococcus epidermidis/aislamiento & purificación , Coagulasa , Humanos , Masculino , Persona de Mediana Edad , Staphylococcus epidermidis/enzimologíaRESUMEN
OBJECTIVE: To evaluate the association between hospital stay, functional status and physical therapy delay (PT delay) in patients admitted to a surgery unit of a high complexity hospital. MATERIALS AND METHODS: Observational, analytic and cross-sectional study. We included 279 patients (124 women). Days of PT delay (calculated as the difference between hospital admission and start of PT), days of bed rest, prolonged hospital stay (75th percentile of bed rest days), and functional status were registered to investigate the influence of PT delay on these variables. RESULTS: The number of days of PT delay was strongly associated with the number of bed rest days (r2 = 0.74, p < 0.05). Moreover, a PT delay of five days or more was associated with extended lengths of stay in our sample (p < 0.05). However, physical therapy had similar effects on functional status, even when there were PT delays (p > 0.05). CONCLUSIONS: PT delay is associated with extended length of stay in patients admitted to a surgery unit of a high complexity hospital. Future studies should investigate the associated factors that could explain the occurrence of PT delays in surgical patients.
Asunto(s)
Estado Funcional , Modalidades de Fisioterapia , Estudios Transversales , Femenino , Hospitalización , Humanos , Tiempo de Internación , MasculinoRESUMEN
Part 2 of this series on granulomatous diseases focuses on skin biopsy findings. Whereas the first part treated noninfectious conditions (metabolic disorders and tumors, among other conditions), this part mainly deals with various types of infectious disease along with other conditions seen fairly often by clinical dermatologists.