[Experience in COVID-19 in hospitalized patients in pediatric critical units during pandemic period]. / Experiencia en COVID-19 en pacientes hospitalizados en unidades de paciente crítico pediátrico durante el periodo pandémico.

OBJECTIVES: To characterize the COVID-19 disease profile in Chilean children hospitalized in pediatric intensive care units (PICU) and to evaluate risk factors associated with severe COVID-19. PATIENTS AND METHOD: A multicenter prospective cohort study with patients 0-18 years of age with confirmed SARS-CoV-2 hospitalized in PICU. Clinical, laboratory, imaging, and therapeutic variables were recorded. We compared "mild/moderate COVID-19" with ''severe COVID-19" using median with interquartile range (IQR), Mann-Whitney U test, two-tailed Fisher's test, and forward binary multivariate analysis to adjust variables for "severe COVID-19". A p < 0.05 was considered significant. RESULTS: From 16 PICUs, 219 patients were recruited, 55.3% were male, with a median age of 86 months (IQR: 13.5-156). The most frequent comorbidities were obesity and respiratory diseases. Overall mortality was 3.6%. "Severe COVID-19" (26.5%) showed more leukopenia, lymphopenia, increased inflammatory parameters, and altered organ function (p < 0.05). It also developed more sepsis/shock, ARDS, and organ dysfunction, requiring more hemodynamic, anti-inflammatory, anticoagulation, and antibiotic therapy, with a longer stay in the PICU/hospital (p < 0.05), and 13.8% of mortality. Risk factors associated with "severe COVID-19" were shock on admission to the PICU [aOR 28.44 (95%CI 10.45-77.4)], obesity [aOR 3.55 (95%CI 1.3-9.6)], consolidation [aOR 3.1 (95%CI 1.1 -8.7)], atelectasis [aOR: 8.7 (95%CI 1.17-64.3)], stress dose of corticosteroids [aOR 7.7 (95%CI 1.9-30.6)], early antibiotic therapy [aOR: 12.02 (95%CI 1.11-130.02)], acquired/congenital immunodeficiency [aOR: 19.2 (95%CI: 1.19-321)], and oncological pathology [aOR 10.7 (95%CI 2.14-47.8)]. CONCLUSION: In this Chilean pediatric cohort, most patients with COVID-19 admitted to de PICU were male, of school age, with associated comorbidity. Risk factors for developing severe COVID-19 were the presence of comorbidities such as acquired/congenital immunodeficiency, oncological pathology, and obesity, in addition to shock on admission and consolidations on X-rays.

Plasma A2AR Measurement Can Help Physicians Identify Patients Suspected of Coronary Chronic Syndrome: A Pilot Study.

The evaluation of suspected coronary artery disease (CAD) in the medical community is challenging. Patients with suspected coronary chronic syndrome (CCS) are referred by the medical community to be assessed by specialists for the performance of noninvasive tests that have high rates of false positives and false negatives. While troponins are the gold standard for evaluate myocardial injuries, there is no biomarker to assess myocardial ischemia in patient populations with negative electrocardiography or without an increase in troponin level. A2A adenosine receptors control the coronary blood flow through its vasodilating properties. It has been shown that patients with CAD have a lower A2AR expression on peripheral blood mononuclear cells, suggesting a link between A2AR production and the severity of CAD. Herein, we present a new and innovative method of inhibition ELISA for A2AR in the plasma of patients who permit the evaluation of the amount of soluble A2AR. For this analysis, the total study sample was 54, including 31 patients with CAD with stenosis > 50% and a significant fractional flow reserve (FFR < 0.8) (Group 1) and 23 patients with normal or non-obstructive coronary arteries (stenosis < 50% and nonsignificant FFR > 0.8) (Group 2). The % inhibition (which is linked to the presence of soluble receptors) with the plasma of patients with FFR < 0.8 was significantly lower than that of patients with FFR > 0.8 (median [range]: 68% [20.7−86.9] vs. 83% [67−88.4]; p < 0.001). The ROC curve indicated a good sensitivity/specificity ratio with a cut off of 72.5% and an area under the curve of 0.87. In conclusion, a rapid ELISA to assess soluble A2AR in the plasma shows promise to screen patients suspected of having CAD.

Implementation of a hospital-at-home (HAH) unit for hematological patients during the COVID-19 pandemic: safety and feasibility.

BACKGROUND: "Hospital-at-home" (HAH) programs have been shown to optimize resource utilization, shorten hospitalization and prevent nosocomial infection. METHODS: We retrospectively analysed data regarding implementation of an HAH unit for caring patients with hematological malignancies in our center, during the COVID-19 pandemic. RESULTS: Between January and November 2020, 105 patients were treated in the HAH unit for a total of 204 episodes. Nine patients with multiple myeloma (MM) received autologous HSCT (auto-HSCT). Three patients with acute myeloid leukemia (AML) received consolidation therapy, 32 patients underwent clinical and analytical monitoring, 20 were transplant recipients early discharged (5 auto-HSCT and 15 allo-HSCT) and 2 had received CART cells therapy. Azacitidine, bortezomib and carfilzomib were administered at home to 54 patients with AML, myelodysplastic syndrome (MDS) or MM. A median of 17 (IQR 13-19) days of admission per patient and a total of 239 visits to the Hematology day-care hospital were avoided. Overall, 28 patients (14% of all episodes) needed admission to the hospital, 4 of them due to COVID-19. CONCLUSIONS: Implementation of a Hematology HAH unit was feasible and safe, and provided thorough advanced care to a high-risk population. Advanced care-at-home strategies can be crucial during times of COVID-19 to minimize treatment interruptions and reduce the risk of cross-infections.

Bienestar psicológico y social de funcionarios de centro de salud pública y su relación con personalidad y eficacia colectiva / Psycological and social well-being of public health center employees and their relationship with personality and collective effectiveness

Resumen Introducción: Los funcionarios de Salud Pública presentan el mayor número de patologías mentales asociadas a la esfera laboral, tornando urgente el adoptar medidas para prevenir los riesgos psicosociales y favorecer su bienestar psicológico y social. Objetivo: Establecer los rasgos de personalidad y categorías de eficacia colectiva que se relacionan con el bienestar psicológico y social de funcionarios de un centro de salud pública. Método: Estudio transeccional correlacional, con uso de metodología cuantitativa. Muestra no probabilística conformada por 51 participantes, entre 20 y 63 años; 30 % hombres, 70 % mujeres, 62,75 % profesionales, 25,5 % técnicos y 11,76 % otros. Resultados: Se encuentra una correlación positiva entre Apertura a la experiencia y Autoaceptación (rho = 0,391), al igual que entre Amabilidad y Propósito en la vida (rho =0,360). La misma tendencia se devela entre Competencias Grupales Positivas y Pertenencia Social (rho = 0,471) e Interacción Social en el trabajo (rho = 0,413). Al igual que entre Elementos Positivos influyentes en las tareas y Pertenencia Social en el trabajo (rho=0,395). Conclusiones: Los rasgos de personalidad establecidos por John, Donahue & Kentle (1991) de Apertura a la experiencia y Amabilidad, en conjunto con las dimensiones de eficacia colectiva de Competencias grupales positivas y Análisis de elementos positivos influyentes en las tareas, se relacionan positivamente con el bienestar psicológico y social en el trabajo, en funcionarios de salud pública.

Abstract Introduction: Public Health employees present the greatest number of mental pathologies associated with the workplace, making it urgent to adopt measures to prevent psychosocial risks and promote their psychological and social well-being. Objective: To establish the personality traits and categories of collective efficacy that are related to the psychological and social well-being of officials of the Public Health Center. Method: Cross-correlational study, using quantitative methodology. Non-probability sample made up of 51 participants, between 20 and 63 years old; 30% men, 70% women, 62,75% professionals, 25,5% technicians and 11,76% others. Results: positive correlation was found between Openness to experience and Self-acceptance (rho = 0,391), as well as between Kindness and Purpose in life (rho = 0,360). The same trend is revealed between Positive Group Competencies and Social Belonging (rho = 0,471) and Social Interaction at work (rho = 0,413). As between positive influencing elements in tasks and social belonging at work (rho = 0,395). Conclusions: The personality traits established by John, Donahue & Kentle (1991) of Openness to experience and Friendliness, together with the collective efficacy dimensions of Positive group competences and Analysis of positive influencing elements in tasks, are positively related to psychological and social well-being at work, in workers of public health center.

Enfrentamiento del paciente con poliartralgias y poliartritis / Patient's facing polyarthralgia and polyarthritis

El dolor articular es un motivo de consulta frecuente en la práctica clínica. La distinción del tipo de dolor, su distribución, los síntomas acompañantes, el examen físico y la evaluación de algunos exámenes de laboratorio ayudan a orientar acerca de las posibles causas y a pesquisar enfermedades graves que pueden causar destrucción articular o compromiso de otros órganos, con el fin de dar tratamiento oportuno y eficaz. En este artículo se dan algunas pautas que se pueden realizar en la consulta de Atención Primaria para distinguir cuadros de poliartralgias y poliartritis agudas y crónicas. Además, se dan nociones de algunas de las enfermedades reumatológicas más frecuentes.

Joint pain is a frequent reason for consultation in clinical practice. The distinction of the type of pain, its distribution, the accompanying symptoms, the physical examination and the evaluation of some laboratory test help to guide about the possible causes and to investigate serious diseases that can cause joint destruction or involvement other organs, in order to provide timely and effective treatment. This article gives some guidelines that can be carried out in the Primary Care consultation to distinguish acute and chronic polyarthralgia and polyarthritis. In addition, notions of some of the most frequent rheumatological diseases are given.

Recomendaciones de manejo del paciente con pie diabético. Curso de instrucción / Management recommendations for diabetic foot patients. Instructional course

El ataque de pie diabético es uno de los desenlaces más fatídicos para el paciente con diabetes, lo que demuestra la importancia del control en una enfermedad que avanza hasta presentar cambios macroscópicos importantes en el miembro inferior. Durante la progresión de la Diabetes, la enfermedad puede derivar en un aumento de la morbilidad e intervenciones invasivas y limitantes para el paciente, de ahí la importancia de la detección e intervención temprana y oportuna de la patología por parte del equipo médico. Estas recomendaciones van dirigida a médicos generales y especialistas en diversas ramas médicas, con el objetivo de enfatizar el cómo se debe realizar el abordaje integral del paciente con pie diabético. Abarcando la prevención, diagnóstico inicial, evaluación de la progresión de la patología, estratificación con las clasificaciones propuestas, y por último el tratamiento según el estadio en el que se encuentre el paciente. Esto con el fin de minimizar desenlaces, intervenciones y complicaciones derivadas de la progresión del pie diabetico. Hablamos de recomendaciones y no de guías debido a la ausencia en un gran número de oportunidades de evidencia científica debidamente estructurada (I y II). Tal vez lo más importante por recalcar en todas estas recomendaciones es recordarle al lector que en los casos de afectación de un pie diabético, siempre se debe tener en cuenta que el pie contralateral también ha estado sometido a la misma enfermedad durante el mismo tiempo y por lo tanto aunque no tenga síntomas se debe considerar igualmente enfermo y se debe examinar también.

Diabetic foot is one of the most fatal outcomes for patients with diabetes; the importance of control in a disease that progresses until presenting important macroscopic changes in the lower limb is absolutely relevant. Along diabetes progression, the disease can lead to increased morbidity and invasive and limiting interventions for the patient, hence the importance of early and timely detection and intervention of the pathology by the medical team. These recommendations are addressed to general practitioners and specialized faculty in various medical branches, emphasizing how a comprehensive approach to the patient with diabetic foot should be carried out. Covering prevention, initial diagnosis, evaluation of the progression of the pathology, stratification with the proposed classifications, and finally the treatment according to the stage in which the patients are, is actually well described herein in order to minimize unsatisfactory outcomes, interventions and complications derived from the progression of diabetic foot. We are talking about recommendations and not guidelines due to the absence in a large number of opportunities of properly structured scientific evidence (I and II). Perhaps, the most important thing to emphasize in all these recommendations is to remind the reader that in cases of treating a diabetic foot, it should always be kept in mind that the contralateral foot is not healthy because it has also been subjected to the same disease, for the same period of time and stressed equally as well. Therefore, even if the contralateral foot does not have symptoms, it should be considered equally ill and should be examined and treated likewise.

Management recommendations for diabetic foot patients. Instructional course / Recomendaciones de manejo del paciente con pie diabético. Curso de instrucción

Diabetic foot is one of the most fatal outcomes for patients with diabetes; the importance of control in a disease that progresses until presenting important macroscopic changes in the lower limb is absolutely relevant. Along diabetes progression, the disease can lead to increased morbidity and invasive and limiting interventions for the patient, hence the importance of early and timely detection and intervention of the pathology by the medical team. These recommendations are addressed to general practitioners and specialized faculty in various medical branches, emphasizing how a comprehensive approach to the patient with diabetic foot should be carried out. Covering prevention, initial diagnosis, evaluation of the progression of the pathology, stratification with the proposed classifications, and finally the treatment according to the stage in which the patients are, is actually well described herein in order to minimize unsatisfactory outcomes, interventions and complications derived from the progression of diabetic foot. We are talking about recommendations and not guidelines due to the absence in a large number of opportunities of properly structured scientific evidence (I and II). Perhaps, the most important thing to emphasize in all these recommendations is to remind the reader that in cases of treating a diabetic foot, it should always be kept in mind that the contralateral foot is not healthy because it has also been subjected to the same disease, for the same period of time and stressed equally as well. Therefore, even if the contralateral foot does not have symptoms, it should be considered equally ill and should be examined and treated likewise.

El ataque de pie diabético es uno de los desenlaces más fatídicos para el paciente con diabetes, lo que demuestra la importancia del control en una enfermedad que avanza hasta presentar cambios macroscópicos importantes en el miembro inferior. Durante la progresión de la Diabetes, la enfermedad puede derivar en un aumento de la morbilidad e intervenciones invasivas y limitantes para el paciente, de ahí la importancia de la detección e intervención temprana y oportuna de la patología por parte del equipo médico. Estas recomendaciones van dirigida a médicos generales y especialistas en diversas ramas médicas, con el objetivo de enfatizar el cómo se debe realizar el abordaje integral del paciente con pie diabético. Abarcando la prevención, diagnóstico inicial, evaluación de la progresión de la patología, estratificación con las clasificaciones propuestas, y por último el tratamiento según el estadio en el que se encuentre el paciente. Esto con el fin de minimizar desenlaces, intervenciones y complicaciones derivadas de la progresión del pie diabetico. Hablamos de recomendaciones y no de guías debido a la ausencia en un gran número de oportunidades de evidencia científica debidamente estructurada (I y II). Tal vez lo más importante por recalcar en todas estas recomendaciones es recordarle al lector que en los casos de afectación de un pie diabético, siempre se debe tener en cuenta que el pie contralateral también ha estado sometido a la misma enfermedad durante el mismo tiempo y por lo tanto aunque no tenga síntomas se debe considerar igualmente enfermo y se debe examinar también.

First international descriptive and interventional survey for cholesterol and non-cholesterol sterol determination by gas- and liquid-chromatography-Urgent need for harmonisation of analytical methods.

Serum concentrations of lathosterol, the plant sterols campesterol and sitosterol and the cholesterol metabolite 5α-cholestanol are widely used as surrogate markers of cholesterol synthesis and absorption, respectively. Increasing numbers of laboratories utilize a broad spectrum of well-established and recently developed methods for the determination of cholesterol and non-cholesterol sterols (NCS). In order to evaluate the quality of these measurements and to identify possible sources of analytical errors our group initiated the first international survey for cholesterol and NCS. The cholesterol and NCS survey was structured as a two-part survey which took place in the years 2013 and 2014. The first survey part was designed as descriptive, providing information about the variation of reported results from different laboratories. A set of two lyophilized pooled sera (A and B) was sent to twenty laboratories specialized in chromatographic lipid analysis. The different sterols were quantified either by gas chromatography-flame ionization detection, gas chromatography- or liquid chromatography-mass selective detection. The participants were requested to determine cholesterol and NCS concentrations in the provided samples as part of their normal laboratory routine. The second part was designed as interventional survey. Twenty-two laboratories agreed to participate and received again two different lyophilized pooled sera (C and D). In contrast to the first international survey, each participant received standard stock solutions with defined concentrations of cholesterol and NCS. The participants were requested to use diluted calibration solutions from the provided standard stock solutions for quantification of cholesterol and NCS. In both surveys, each laboratory used its own internal standard (5α-cholestane, epicoprostanol or deuterium labelled sterols). Main outcome of the survey was, that unacceptably high interlaboratory variations for cholesterol and NCS concentrations are reported, even when the individual laboratories used the same calibration material. We discuss different sources of errors and recommend all laboratories analysing cholesterol and NCS to participate in regular quality control programs.

Actualización en el estudio de granulomatosis con poliangeitis (granulomatosis de Wegener) / Update in study of granulomatosis with polyangiitis (Wegener's granulomatosis)

Resumen:La granulomatosis con poliangeítis (GPA) es una vasculitis sistémica de pequeño vaso, que afecta más frecuentemente el tracto respiratorio y el riñón. Sus criterios diagnósticos se basan en la clínica, exámenes de laboratorio, imágenes e histología. El 90% son ANCA (anticuerpos anticitoplasma de neutrófilos) positivos. La histología muestra inflamación granulomatosa, necrosis y vasculitis. Los exámenes de imagen son de vital importancia en su estudio inicial y seguimiento, correspondiendo principalmente a técnicas tomográficas. La tomografía Computada (TC) es el método de elección para la evaluación de vía aérea superior y pulmón, con alta sensibilidad en afectación de cavidades nasal/paranasales, árbol bronquial y pulmón. La Resonancia Magnética está indicada en compromiso del sistema nervioso central y corazón. El PET/CT presenta alta sensibilidad en enfermedad tóraco-abdominal, es de utilidad en detectar lesiones no visibles con otras técnicas, y en control de tratamiento. El compromiso renal, de alta ocurrencia en GPA, presenta escasa traducción en las imágenes y es frecuentemente indetectable con imágenes, aunque el PET/CT puede ser positivo en casos de glomerulonefritis acentuada. La radiología simple no debe ser utilizada en el estudio de GPA dado su bajo rendimiento diagnóstico. El tratamiento se basa en terapia corticoidea e inmunosupresora. Las recaídas son frecuentes, por lo que estos pacientes requieren seguimiento a largo plazo.

Abstract:Granulomatosis with polyangiitis (GPA) is a systemic type of vasculitis that affects small vessels, most commonly involving the respiratory tract and kidneys. Diagnosis is based on clinical criteria, laboratory tests, imaging and histology. Ninety percent are ANCA (anti-neutrophilic cytoplasmic antibodies) positive. Histology demonstrates granulomatous inflammation, necrosis and vasculitis. Imaging studies are vital for the initial work-up and follow-up. Computed Tomography (CT) is the method of choice for evaluation of the upper airway and lungs, because of its high sensitivity detecting anomalies of paranasal sinuses, bronchial tree and lungs. Magnetic Resonance is indicated for evaluation of the central nervous system and heart. PET/CT has high sensitivity for thoracic and abdominal disease, is useful at detecting lesions not seen with other imaging techniques, and for follow-up. Renal involvement, very frequent on GPA, is usually undetectable at imaging, but may be seen at PET/CT in cases of marked glomerulonephritis. Plain X-rays should not be used for evaluation of GPA because of their low diagnostic performance. Treatment is based on corticosteroid and immunosuppressive therapy. Relapses are frequent, so these patients require long-term follow-up.

Gestión del cuidado: valoración y conocimiento e enfermeros(as) de un hospital de la Región Metropolitana, Chile / Care management: nursing knowledge and assessment at a Metropolitan Region hospital, Chile

La unidad de gestión del cuidado (UGC) se enmarca en la reforma sanitaria chilena, adquiriendo importancia única para la profesión en el diseño, planificación, desarrollo y evaluación de los cuidados dentro de las instituciones sanitarias. El objetivo de este estudio fue describir la valoración y conocimiento que los(as) enferme-ros(as) le otorgan a la UGC. Método: Estudio descriptivo, de corte transversal, el universo correspondió a 52 sujetos, a quienes se les aplicó un cuestionario estructurado, cuyas variables respondieron a las concepciones más significativas de la reglamentación actual de la UGC. Resultados: Se valoró positivamente la unidad, específicamente la relación comunicacional entre ésta y la actividad clínica; como necesidad se distinguió el reconocimiento de la institución a la UGC, y la formación en gestión del cuidado como parte fundamental en las competencias de los profesionales. Por otro lado, se observó que los individuos con menor experiencia laboral y de cargos de atención clínica corresponden a sujetos menos empoderados con las concepciones de la reglamentación de las UGC; por último las UGC en Chile son consideradas en mayor proporción como un ámbito de desarrollo gerencial, sin embargo surgieron opiniones respecto a la ampliación de la visión de estas unidades, considerándolas de manera más global, otorgándole un sentido y valor propio en la atención de enfermería. Conclusiones: El estudio logró describir una valoración positiva de las UGC en enfermeros de una institución sanitaria chilena, sin embargo se abren nuevas líneas de investigación, que se hace necesario profundizar a través de metodologías de investigación mixtas.

The care management unit (CMU) in Chile is framed within the public health reform, getting a unique importance for the profession in designing, planning, development and evaluation care within the health institutions. Objective: To describe the knowledge and the assessment that nurses put on the CMU. Method: Descriptive, cross-sectional study, with universe of 52 that answered a structured questionnaire, whose variables responded to the most significant concepts of the current regulation of CMU. Results: The unit was positively considered, specifically the relationship between this unit and the clinical activity as need, the recognition of the institutional CMU and training in care management as a fundamental part in professional skills were recognized. Moreover, it was observed that individuals with less work experience and positions of clinical care, are less empowered subjects with conceptions of regulation of CMU; finally the CMU in Chile are considered in greater proportion as a field of management development, however emerged opinions on the extension of the vision of these units, considering them more globally, giving a sense and self-worth in nursing care. Conclusion: The study gets to describe a positive assessment of the CMU in health nurses in a Chilean institution, however new research lines are opened and, it is necessary to deepen through joint research methodologies.

Cavernoma-related epilepsy: review and recommendations for management--report of the Surgical Task Force of the ILAE Commission on Therapeutic Strategies.

Cerebral cavernous malformations (CCMs) are well-defined, mostly singular lesions present in 0.4-0.9% of the population. Epileptic seizures are the most frequent symptom in patients with CCMs and have a great impact on social function and quality of life. However, patients with CCM-related epilepsy (CRE) who undergo surgical resection achieve postoperative seizure freedom in only about 75% of cases. This is frequently because insufficient efforts are made to adequately define and resect the epileptogenic zone. The Surgical Task Force of the Commission on Therapeutics of the International League Against Epilepsy (ILAE) and invited experts reviewed the pertinent literature on CRE. Definitions of definitive and probable CRE are suggested, and recommendations regarding the diagnostic evaluation and etiology-specific management of patients with CRE are made. Prospective trials are needed to determine when and how surgery should be done and to define the relations of the hemosiderin rim to the epileptogenic zone.

Artritis por Parvovirus B19: Caso clínico / Parvovirus B19 arthritis: Report of three cases

Parvovirus B19 infection is highly prevalent in children and the most common manifestation is a facial rash. In adults, acute polyarthritis and skin rash are often the presenting features. We report three patients with the disease. A 40-year-old female presenting with fever, myalgias and painful swelling of elbows, knees, wrists and feet, with functional limitation, after having a respiratory infection. Additionally, an erythematous skin rash appeared in both extremities. IgM antibodies against Parvovirus B19 were positive. The skin biopsy disclosed a leukocytoclastic vasculitis. The patient was treated with anti-inflammatory drugs and antihistaminics. A 40-year-old female, presenting with skin rash and pain in wrists and hands. IgM antibodies against parvovirus were positive. The patient was treated successfully with acetaminophen. A 38-year-old male with psoriasis, presenting with generalized and progressive polyarthralgia. A Parvovirus viral load determination found 239000 copies of the virus and IgM antibodies were positive. He was successfully treated with non-steroidal anti-inflammatory drugs.

Development and validation of a comprehensive two-dimensional gas chromatography-mass spectrometry method for the analysis of phytosterol oxidation products in human plasma.

Phytosterol oxidation products (POPs) have been suggested to exert adverse biological effects similar to, although less severe than, their cholesterol counterparts. For that reason, their analysis in human plasma is highly relevant. Comprehensive two-dimensional gas chromatography (GC×GC) coupled with time-of-flight mass spectrometry (TOF-MS) has been proven to be an extremely powerful separation technique for the analysis of very low levels of target compounds in complex mixtures including human plasma. Thus, a GC×GC/TOF-MS method was developed and successfully validated for the simultaneous quantification of ten POPs in human plasma. The calibration curves for each compound showed correlation coefficients (R(2)) better than 0.99. The detection limits were below 0.1 ng mL(-1). The recovery data were between 71.0% and 98.6% (RSDs <10% for all compounds validated). Good results were obtained for within- and between-day repeatability, with most values being below 10%. In addition, non-targeted sterol metabolites were also identified with the method. The concentrations of POPs found in human plasma in the current study are between 0.3 and 4.5 ng mL(-1), i.e., 10-100 times lower than the typical values found for cholesterol oxidation products.

[Parvovirus B19 arthritis: Report of three cases]. / Artritis por Parvovirus B19: Caso clínico.

Parvovirus B19 infection is highly prevalent in children and the most common manifestation is a facial rash. In adults, acute polyarthritis and skin rash are often the presenting features. We report three patients with the disease. A 40-year-old female presenting with fever, myalgias and painful swelling of elbows, knees, wrists and feet, with functional limitation, after having a respiratory infection. Additionally, an erythematous skin rash appeared in both extremities. IgM antibodies against Parvovirus B19 were positive. The skin biopsy disclosed a leukocytoclastic vasculitis. The patient was treated with anti-inflammatory drugs and antihistaminics. A 40-year-old female, presenting with skin rash and pain in wrists and hands. IgM antibodies against parvovirus were positive. The patient was treated successfully with acetaminophen. A 38-year-old male with psoriasis, presenting with generalized and progressive polyarthralgia. A Parvovirus viral load determination found 239000 copies of the virus and IgM antibodies were positive. He was successfully treated with non-steroidal anti-inflammatory drugs.

Impacto de la obesidad en pacientes con neumonía grave por virus influenza A/H1N1: estudio multicéntrico chileno / Impact of obesity with severe pneumonia by influenza A/H1N1 virus: a Chilean multicenter study

En la primera pandemia del siglo XXI por virus influenza A/H1N1, una importante proporción de paciente que desarrollaron neumonía y Falla Respiratoria Aguda (FRA) eran obesos. La obesidad ha sido propuesta como un factor de riesgo que aumenta la morbimortalidad; sin embargo, hay controversia al respecto. Objetivo: evaluar el impacto de la obesidad en complicaciones, estadía y/o mortalidad en pacientes adultos graves por virus influenza A/H1N1. Estudio observacional y multicéntrico realizado en 17 UCIs de Chile durante el periodo mayo-agosto 2009. Fueron incluidos en el estudio solo paciente con infección por virus Influenza A/H1N1 confirmada o probable. Los paciente obesos (IMC>30) fueron comparados con pacientes no obesos. Resultados: De un total de 136 pacientes incluidos en el estudio, 64 (47 por ciento) fueron obesos y de estos 13 obesos mórbidos (BMI >40). Los pacientes obesos tienen mayor frecuencia de: comorbilidades, ventilación mecánica y complicaciones. La estadía en UCI y en el hospital fue más prolongada en pacientes obesos (18,1+/-15 vs. 10,9+/-10,2, p=0,002 y 27,2+/-24,7 vs17,7 +/- 14,6, p=0,01 respectivamente). La mortalidad fue mayor en pacientes obesos (36 por ciento vs. 19,4 por ciento; OR 2,32; IC95 por ciento 1,07-5,05, p=0.035). El estudio de regresión logística encuentra que la FOM es un factor pronóstico independiente de mortalidad en pacientes obesos. Conclusiones: Los pacientes obesos con neumonía grave por virus influenza A/H1N1 tienen una mayor morbi-mortalidad y prolongación de su estadía en UCI y en el hospital. El desarrollo de FOM en pacientes obesos es un factor de mal pronóstico.

In the first pandemic of the 21st century due to influenza A/H1N1 virus, a significant proportion of patients who developed pneumonia and acute respiratory failure (ARF) were obese. Obesity has been proposed as a risk factor that increases morbidity and mortality, however, there is controversy about it. Objective: To determine the impact of obesity on complications, stay and / or mortality in adult patients with severe influenza A/H1N1 virus. Multicenter observational study conducted in 17 ICUs of Chile during the period May to August 2009. Were included only patients with influenza A/H1N1 virus infection confirmed or probable. Obese patients (BMI> 30) were compared with non obese patients. The results: Of a total of 136 patients included in the study, 64 (47 percent) were obese and of these 13 morbidly obese (BMI> 40). Obese patients have a higher frequency of: comorbidities, mechanical ventilation and complications. The stay in ICU and hospital was longer in obese patients (18.1 +/- 15 vs. 10.9 +/- 10.2, p = 0.002 and 27.2 +/- 24.7 vs17, 7 +/- 14.6, p = 0.01 respectively). Mortality was higher in obese patients (36 percent vs. 19.4 percent, OR 2.32, 95 percent CI 1.07 to 5.05, p = 0,035). The logistic regression analysis found that the MOF is an independent predictor of mortality in obese patients. Conclusions: Obese patients with severe pneumonia due to the influenza A/H1N1 virus have a high morbidity and mortality and prolonged stay in ICU and hospital. MOF development in obese patients is a poor prognostic factor.

Validation of a gas chromatography-mass spectrometry method for the analysis of sterol oxidation products in serum.

A validated gas chromatography-mass spectrometry (GC-MS) detection method for the quantitative analysis of sterol oxidation products (SOPs) in serum is described. After a lipid extraction procedure with chloroform-methanol, a cold saponification and purification by solid phase extraction, oxysterols were derivatized to form trimethyl-sylil-ethers which were subjected to GC-MS analysis. Calibration curves for cholesterol oxidation products showed determination coefficient (R(2)) of 1.0, with low values for the coefficient of variation of the response factors (< 1%). Detection and quantification limits were below 5 ng/mL and 10 ng/mL, respectively. Recovery data were between 77.65% and 110.29% (CV < 10% for all compounds). Good results were obtained for within- and between-day repeatability, with values below 10%. In conclusion, the method performed is suitable for the determination and quantification of SOPs in serum.

La formación ciudadana: una estrategia para la construcción de justicia / Citizen education: A strategy for the construction of justice

Este artículo hace referencia a la relación que existe entre ciudadanía y justicia en Colombia, a partir de la configuración histórica de la primera, en cuyo recorrido se ha forjado el reconocimiento de los derechos individuales, políticos y sociales, hasta llegar a la época contemporánea, en la que se hace necesario el reconocimiento no sólo de estos derechos, sino también de los derechos culturales, dado que si la ciudadanía es el reconocimiento de derechos y deberes, se requiere de una justicia que los haga efectivos. Se argumenta el planteamiento acerca de que la formación ciudadana y el ejercicio de la ciudadanía constituyen una estrategia privilegiada para alcanzar procesos de justicia social, pero a su vez, que la garantía de justicia desde el Estado requiere el reconocimiento de deberes y derechos ciudadanos, con criterios de equidad social, que hagan posible mejorar las condiciones y calidad de vida de la población, con oportunidades en términos de acceso y distribución de recursos. El artículo se centra fundamentalmente en el reconocimiento de la ciudadanía desde una perspectiva de derechos, a la que sólo es posible llegar a través de procesos de formación y educación que la relacionen con un concepto de justicia, construido también desde la perspectiva de derechos. Palabras Clave: Ciudadanía, justicia, socialización política, educación en ciudadanía y perspectiva de derechos.

Identification of protective Lassa virus epitopes that are restricted by HLA-A2.

Recovery from Lassa virus (LASV) infection usually precedes the appearance of neutralizing antibodies, indicating that cellular immunity plays a primary role in viral clearance. To date, the role of LASV-specific CD8(+) T cells has not been evaluated in humans. To facilitate such studies, we utilized a predictive algorithm to identify candidate HLA-A2 supertype epitopes from the LASV nucleoprotein and glycoprotein precursor (GPC) genes. We identified three peptides (GPC(42-50), GLVGLVTFL; GPC(60-68), SLYKGVYEL; and GPC(441-449), YLISIFLHL) that displayed high-affinity binding (< or =98 nM) to HLA-A*0201, induced CD8(+) T-cell responses of high functional avidity in HLA-A*0201 transgenic mice, and were naturally processed from native LASV GPC in human HLA-A*0201-positive target cells. HLA-A*0201 mice immunized with either GPC(42-50) or GPC(60-68) were protected against challenge with a recombinant vaccinia virus that expressed LASV GPC. The epitopes identified in this study represent potential diagnostic reagents and candidates for inclusion in epitope-based vaccine constructs. Our approach is applicable to any pathogen with existing sequence data, does not require manipulation of the actual pathogen or access to immune human donors, and should therefore be generally applicable to category A through C agents and other emerging pathogens.

Immunoproteasome-deficient mice mount largely normal CD8+ T cell responses to lymphocytic choriomeningitis virus infection and DNA vaccination.

During viral infection, constitutive proteasomes are largely replaced by immunoproteasomes, which display distinct cleavage specificities, resulting in different populations of potential CD8(+) T cell epitope peptides. Immunoproteasomes are believed to be important for the generation of many viral CD8(+) T cell epitopes and have been implicated in shaping the immunodominance hierarchies of CD8(+) T cell responses to influenza virus infection. However, it remains unclear whether these conclusions are generally applicable. In this study we investigated the CD8(+) T cell responses to lymphocytic choriomeningitis virus infection and DNA immunization in wild-type mice and in mice lacking the immunoproteasome subunits LMP2 or LMP7. Although the total number of virus-specific cells was lower in LMP2 knockout mice, consistent with their having lower numbers of naive cells before infection, the kinetics of virus clearance were similar in all three mouse strains, and LMP-deficient mice mounted strong primary and secondary lymphocytic choriomeningitis virus-specific CD8(+) T cell responses. Furthermore, the immunodominance hierarchy of the four investigated epitopes (nuclear protein 396 (NP(396)) > gp33 > gp276 > NP(205)) was well maintained. We observed a slight reduction in the NP(205)-specific response in LMP2-deficient mice, but this had no demonstrable biological consequence. DNA vaccination of LMP2- and LMP7-deficient mice induced CD8(+) T cell responses that were slightly lower than, although not significantly different from, those induced in wild-type mice. Taken together, our results challenge the notion that immunoproteasomes are generally needed for effective antiviral CD8(+) T cell responses and for the shaping of immunodominance hierarchies. We conclude that the immunoproteasome may affect T cell responses to only a limited number of viral epitopes, and we propose that its main biological function may lie elsewhere.