Epidemiological and microbiological characteristics of S. aureus pediatric infections in Colombia 2018-2021, a national multicenter study (Staphylored Colombia).

Background: Staphylococcus aureus infections are a significant cause of morbidity and mortality in pediatric populations worldwide. The Staphylo Research Network conducted an extensive study on pediatric patients across Colombia from 2018 to 2021. The aim of this study was to describe the epidemiological and microbiological characteristics of S. aureus in this patient group. Methods: We analyzed S. aureus isolates from WHONET-reporting centers. An "event" was a positive culture isolation in a previously negative individual after 2 weeks. We studied center characteristics, age distribution, infection type, and antibiotic susceptibilities, comparing methicillin sensitive (MSSA) and resistant S. aureus (MRSA) isolates. Results: Isolates from 20 centers across 7 Colombian cities were included. Most centers (80%) served both adults and children, with 55% offering oncology services and 85% having a PICU. We registered 8,157 S. aureus culture isolations from 5,384 events (3,345 MSSA and 1,961 MRSA) in 4,821 patients, with a median age of 5 years. Blood (26.2%) and skin/soft tissue (18.6%) were the most common infection sources. Most isolates per event remained susceptible to oxacillin (63.2%), clindamycin (94.3%), and TMP-SMX (98.3%). MRSA prevalence varied by city (<0.001), with slightly higher rates observed in exclusively pediatric hospitals. In contrast, the MRSA rate was somewhat lower in centers with Antimicrobial Stewardship Program (ASP). MRSA was predominantly isolated from osteoarticular infections and multiple foci, while MSSA was more frequently associated with recurrent infections compared to MRSA. Conclusions: This is the largest study of pediatric S. aureus infections in Colombia. We found MSSA predominance, but resistance have important regional variations. S. aureus remains susceptible to other commonly used antibiotics such as TMP-SMX and clindamycin. Ongoing monitoring of S. aureus infections is vital for understanding their behavior in children. Prospective studies within the Staphylored LATAM are underway for a more comprehensive clinical and genetic characterization.

Experience of the use of lock therapy in pediatric patients with central venous catheter. / Experiencia del uso de terapia de sello en pacientes pediátricos con catéter venoso central.

Lock therapy is useful for preserving indwelling catheters. Few lock therapy studies have been published in Latin America. OBJECTIVE: To describe the clinical characteristics of pediatric patients using therapeutic and prophylactic lock therapy for six years in a high-complexity hospital in Colombia. PATIENTS AND METHOD: Cross-sectional descriptive study of patients aged < 18 years who received lock therapy. Collected variables included demographic data, clinical characteristics, blood test results, therapeutic interventions, frequency of admission to the pediatric critical care unit, and mortality. Descriptive analysis was performed. RESULTS: 54 patients were included in the study, most of them males, with 67 episodes of therapeutic lock therapy use. The most frequent diagnosis was hematological neoplasm (61%). Among these patients, 88% presented neutropenia while receiving lock therapy. Catheter preservation was achieved in 75% of the cases. Aminoglycosides were the most commonly used antibiotics (38%). Mortality due to catheter-related bacteremia was 6%. Catheter preservation using ethanol solution 70% was achieved in 62% of the patients with prophylactic lock therapy, all of whom had chronic gastrointestinal pathology. CONCLUSION: Catheter preservation rates were 75% and 62% in patients with therapeutic and prophylactic lock therapy, respectively, with a higher rate achieved among cancer patients with neutropenia (80%). Aminoglycosides and vancomycin were the most commonly used antibiotics.

Recommendations for modernizing infant vaccination schedules with combination vaccines in Colombia and Peru / Recomendaciones para modernizar los calendarios de vacunación infantil con vacunas combinadas en Colombia y Perú / Recomendações para modernizar os esquemas de vacinação infantil com vacinas combinadas na Colômbia e no Peru

ABSTRACT The objective of this article was to consider the vaccination challenges in Colombia and Peru and the role of pediatric combination vaccines in overcoming these challenges. Barriers to including new vaccines with more antigens remain apparent in parts of these countries, where vaccine-preventable diseases in infants continue to be a major problem. The challenges include the heterogeneity of vaccine coverage within each country and in neighboring countries, which can contribute to poor rates of vaccination coverage; the adverse impact of the inward migration of unvaccinated individuals, which has favored the re-emergence of vaccine-preventable diseases; vaccine shortages; and the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and the associated shifts in health care resources. To improve the coverage of pediatric vaccines in Colombia and Peru, it will be necessary to ensure the widespread integration into vaccine schedules of combination vaccines containing diphtheria, tetanus, acellular pertussis, inactivated poliovirus, Haemophilus influenzae type b and hepatitis B antigens with a three-dose primary series delivered at 2, 4 and 6 months of age followed by a booster at 18 months of age. Such vaccines play important roles in preventing diphtheria, tetanus and pertussis; eradicating polio; and providing boosting against H. influenzae type b.

RESUMEN El objetivo de este artículo es considerar los desafíos que se enfrentan en Colombia y Perú con respecto a la vacunación y el papel de las vacunas combinadas pediátricas para superar estos desafíos. Los obstáculos para incluir vacunas nuevas con más antígenos siguen siendo evidentes en algunos lugares de estos países, donde las enfermedades prevenibles por vacunación en menores de 1 año continúan siendo un grave problema. Entre los desafíos se incluye la heterogeneidad de la cobertura de vacunación en cada país y en los países vecinos, lo que puede contribuir con que se registren tasas bajas de cobertura de vacunación; el impacto adverso de la migración interna de personas no vacunadas, lo que ha favorecido la reaparición de enfermedades prevenibles por vacunación; la escasez de vacunas, y el impacto de la pandemia del coronavirus de tipo 2 causante del síndrome respiratorio agudo grave (SARS-CoV-2) y los consiguientes cambios en los recursos de atención médica. Para mejorar la cobertura de las vacunas pediátricas en Colombia y Perú será necesario integrar de manera generalizada en los calendarios de vacunación vacunas combinadas con antígenos de difteria, tétanos, tos ferina acelular, poliovirus inactivados, Haemophilus influenzae tipo b y hepatitis B con una serie primaria de tres dosis administradas a los 2, 4 y 6 meses de edad, seguida de un refuerzo a los 18 meses de edad. Esas vacunas desempeñan un papel esencial en la prevención de la difteria, el tétanos y la tos ferina; la erradicación de la polio; y el refuerzo contra H. influenzae tipo b.

RESUMO O objetivo deste artigo foi avaliar os desafios da vacinação na Colômbia e no Peru e o papel das vacinas pediátricas combinadas na superação de tais desafios. Os obstáculos para incluir novas vacinas com mais antígenos permanecem visíveis em partes desses países, onde doenças imunopreveníveis em lactentes continuam a ser um grande problema. Os desafios incluem a heterogeneidade da cobertura vacinal dentro de cada país e nos países vizinhos, o que pode contribuir para baixas taxas de cobertura vacinal; o impacto adverso da migração interna de pessoas não vacinadas, o que favoreceu o ressurgimento de doenças imunopreveníveis; a escassez de vacinas; e o impacto da pandemia de síndrome respiratória aguda grave do coronavírus 2 (SARS-CoV-2) e mudanças relacionadas nos recursos de atenção à saúde. Para melhorar a cobertura das vacinas pediátricas na Colômbia e no Peru, será necessário assegurar sua integração generalizada em esquemas de vacinas combinadas contendo antígenos de difteria, tétano, pertussis acelular, poliovírus inativado, Haemophilus influenzae tipo B e hepatite B, com uma série primária de três doses aplicadas aos 2, 4 e 6 meses de idade seguidas de um reforço aos 18 meses de idade. Tais vacinas desempenham papéis importantes na prevenção da difteria, tétano e coqueluche; na erradicação da poliomielite; e no reforço contra H. influenzae tipo b.

Etiology and the challenge of diagnostic testing of community-acquired pneumonia in children and adolescents.

BACKGROUND: Pneumonia is the leading cause of mortality in pediatric population. The etiology of pneumonia in this population is variable and changes according to age and disease severity and where the study is conducted. Our aim was to determine the etiology of community-acquired pneumonia (CAP) in children aged 1 month to 17 years admitted to 13 Colombian hospitals. METHODS: Prospective cohort study. Hospitalized children with radiologically confirmed CAP and ≤ 15 days of symptoms were included and followed together with a control group. Induced sputum (IS) was submitted for stains and cultures for pyogenic bacteria and Mycobacterium tuberculosis, and multiplex PCR (mPCR) for bacteria and viruses; urinary antigens for pneumococcus and Legionella pneumophila; nasopharyngeal swabs for viruses, and paired serology for atypical bacteria and viruses. Additional cultures were taken at the discretion of primary care pediatricians. RESULTS: Among 525 children with CAP, 71.6% had non-severe pneumonia; 24.8% severe and 3.6% very severe pneumonia, and no fatal cases. At least one microorganism was identified in 84% of children and 61% were of mixed etiology; 72% had at least one respiratory virus, 28% pyogenic bacteria and 21% atypical bacteria. Respiratory syncytial virus, Parainfluenza, Rhinovirus, Influenza, Mycoplasma pneumoniae, Adenovirus and Streptococcus pneumoniae were the most common etiologies of CAP. Respiratory syncytial virus was more frequent in children under 2 years and in severe pneumonia. Tuberculosis was diagnosed in 2.3% of children. IS was the most useful specimen to identify the etiology (33.6%), and blood cultures were positive in 3.6%. The concordance between all available diagnostic tests was low. A high percentage of healthy children were colonized by S. pneumoniae and Haemophilus influenzae, or were infected by Parainfluenza, Rhinovirus, Influenza and Adenovirus. CONCLUSIONS: Respiratory viruses are the most frequent etiology of CAP in children and adolescents, in particular in those under 5 years. This study shows the challenges in making an etiologic diagnosis of CAP in pediatric population because of the poor concordance between tests and the high percentage of multiple microorganisms in healthy children. IS is useful for CAP diagnosis in pediatric population.

Manejo de los episodios de neutropenia febril en niños con cáncer: consenso de la Sociedad Latinoamericana de Infectología Pediátrica 2021 / Management of episodes of febrile neutropenia in children with cancer: consensus of the Latin American Society of Pediatric Infectious Diseases 2021

Resumen El Comité de Infecciones en el Niño Inmunocomprometido de la Sociedad Latinoamericana de Infectología Pediátrica, entrega este documento de Consenso, llamado "Manejo de los episodios de neutropenia febril en niños con cáncer. Consenso de la Sociedad Latinoamericana de Infectología Pediátrica 2021". El documento contiene recomendaciones sobre aspectos de prevención, predicción, diagnóstico, tratamiento y pronóstico de los episodios de fiebre y neutropenia, incluyendo recomendaciones específicas sobre: Análisis de ingreso; evaluación, ajustes y duración de terapias antimicrobianas; diagnóstico y manejo de infección fúngica invasora; análisis de los principales focos clínicos de infección; condiciones ambientales necesarias para hospitales que atienden niños con cáncer y quimioprofilaxis. Se ha puesto especial énfasis en entregar las mejores recomendaciones para optimizar el manejo de los episodios de fiebre y neutropenia en niños con cáncer, buscando la equidad y la excelencia a través de todos los centros que atienden estos pacientes en América Latina.

Abstract The Committee for Infections in Immunocompromised Children of Sociedad Latinoamericana de Infectología Pediátrica, presents this Consensus document, titled "Management of episodes of febrile neutropenia in children with cancer. Consensus of the Sociedad Latinoamericana de Infectología Pediátrica 2021". The document includes recommendations on prevention, prediction, diagnosis, treatment and prognosis of episodes of fever and neutropenia, including specific recommendations on: Analysis at admission; evaluation, adjustments and duration of antimicrobial therapies; diagnosis and management of invasive fungal infection; analysis of the main clinical source of infections; environmental conditions necessary for hospitals caring for children with cancer and chemoprophylaxis. Special emphasis has been placed on providing the best recommendations to optimize the management of episodes of fever and neutropenia in children with cancer, with equity and excellence through all the centers that treat these patients in Latin America.

Cáncer y acción preventiva en Chile: perfilando la abstención a la mamografía y papanicolaou / Abstention from pap smears and mammography among chilean women. Prevalence and causes

Background: Cancer is a public health problem among women, but preventive actions are effective. Aim: To outline the reasons and factors associated with abstention from pap smears and mammography examinations among women. Material and Methods: Using official databases of the WHO and the Ministry of Social Development of Chile, inferential statistical analyses and modeling of abstention through binomial logistic regression were carried out. Results: Breast and cervical cancer had the highest incidence and mortality among women over 35 years old in Chile, even when there are effective screening methods for their early detection. Abstention is conditioned by personal reasons such as low risk perception. There is a high concomitance of abstention for pap smears and mammography. Conclusions: Health promotion actions should encourage women to undergo preventive actions for breast and cervical cancer.

[Abstention from pap smears and mammography among chilean women. Prevalence and causes]. / Cáncer y acción preventiva en Chile: perfilando la abstención a la mamografía y papanicolaou.

BACKGROUND: Cancer is a public health problem among women, but preventive actions are effective. AIM: To outline the reasons and factors associated with abstention from pap smears and mammography examinations among women. MATERIAL AND METHODS: Using official databases of the WHO and the Ministry of Social Development of Chile, inferential statistical analyses and modeling of abstention through binomial logistic regression were carried out. RESULTS: Breast and cervical cancer had the highest incidence and mortality among women over 35 years old in Chile, even when there are effective screening methods for their early detection. Abstention is conditioned by personal reasons such as low risk perception. There is a high concomitance of abstention for pap smears and mammography. CONCLUSIONS: Health promotion actions should encourage women to undergo preventive actions for breast and cervical cancer.

[Management of episodes of febrile neutropenia in children with cancer. Consensus of the Latin American Society of Pediatric Infectious Diseases 2021]. / Manejo de los episodios de neutropenia febril en niños con cáncer. Consenso de la Sociedad Latinoamericana de Infectología Pediátrica 2021.

The Committee for Infections in Immunocompromised Children of Sociedad Latinoamericana de Infectología Pediátrica, presents this Consensus document, titled "Management of episodes of febrile neutropenia in children with cancer. Consensus of the Sociedad Latinoamericana de Infectología Pediátrica 2021". The document includes recommendations on prevention, prediction, diagnosis, treatment and prognosis of episodes of fever and neutropenia, including specific recommendations on: Analysis at admission; evaluation, adjustments and duration of antimicrobial therapies; diagnosis and management of invasive fungal infection; analysis of the main clinical source of infections; environmental conditions necessary for hospitals caring for children with cancer and chemoprophylaxis. Special emphasis has been placed on providing the best recommendations to optimize the management of episodes of fever and neutropenia in children with cancer, with equity and excellence through all the centers that treat these patients in Latin America.

Case Report: Rhinosporidiosis Literature Review.

Rhinosporidiosis is caused by Rhinosporidium seeberi, a pathogen currently considered a fungus-like parasite of the eukaryotic group Mesomycetozoea. It is usually a benign condition, with slow growth of polypoid lesions, with involvement of the nose, nasopharynx, or eyes. The clinical characteristics of a painless, friable, polypoid mass, usually unilateral, can guide the diagnosis, but the gold standard for diagnosis is histopathological findings. This article reviews the epidemiology, pathobiology, clinical manifestations, diagnostic strategies, and treatment approach for rhinosporidiosis.

Cáncer mamario y cervicouterino: el problema del absentismo femenino en la acción preventiva / Breast and cervical cancer: the problem of the lack of preventive actions in women

Introducción: La prevalencia del cáncer es un problema que vas más allá de la preocupación médica, por cuanto involucra aspectos subjetivos y sociales en la vida de quienes lo padecen o están en riesgo. Por esto, es de gran importancia detectarlo tempranamente, especialmente entre mujeres debido a su exposición a los factores de riesgo de cáncer de mama y cérvix. Objetivo: Analizar la abstención femenina en Chile a la Mamografía y Papanicolaou. Materiales y métodos: Se realizó un análisis multivariado de regresión logística binomial, de los datos disponibles en el Módulo de Salud de la Encuesta de Caracterización Socioeconómica Nacional (CASEN) en su edición del año 2015. Resultados: Se expone una generalizada abstención a la acción preventiva entre mujeres, aun cuando la prevalencia de ambos tipos de cáncer es alta. Los motivos personales aparecen como los más comunes para omitir Mamografía y/o Papanicolaou, especialmente la subvaloración de su importancia. Los factores que aumentan la probabilidad de abstención son la baja escolaridad, la ausencia de afiliación médica y la presencia de pareja. Conclusiones: Se plantea la necesidad de aumentar igualmente la cobertura del servicio preventivo, focalizar los recursos hacia la población vulnerable y mejorar las estrategias de incentivo hacia estos exámenes.

Introduction: The prevalence of cancer is a problem that goes beyond medical concern since it involves subjective and social aspects that affect the lives of those who either suffer from cancer or are at risk for it. Therefore, it is important to detect it early, especially among women due to their exposure to risk factors for breast and cervical cancer. Objective: To analyze women's abstention from mammography and Papanicolaou screening in Chile. Materials and methods: A multivariate binomial logistic regression analysis was conducted with available data from the Health Module of the National Socioeconomic Characterization Survey (NSCS) from 2015. Results: Even though there is a high prevalence of both types of cancer, there is a generalized female abstention from preventive actions. Personal reasons are the most common justifications given for avoidance of mammography and/or Papanicolaou test, especially undervaluing their importance. Factors that increase the probability of abstention include low education level, lack of medical affiliation, and presence of a partner. Conclusions: It is important to increase the coverage of preventive services, focus resources towards vulnerable populations, and create incentive strategies for women to take these exams.

Inherited p40phox deficiency differs from classic chronic granulomatous disease.

Biallelic loss-of-function (LOF) mutations of the NCF4 gene, encoding the p40phox subunit of the phagocyte NADPH oxidase, have been described in only 1 patient. We report on 24 p40phox-deficient patients from 12 additional families in 8 countries. These patients display 8 different in-frame or out-of-frame mutations of NCF4 that are homozygous in 11 of the families and compound heterozygous in another. When overexpressed in NB4 neutrophil-like cells and EBV-transformed B cells in vitro, the mutant alleles were found to be LOF, with the exception of the p.R58C and c.120_134del alleles, which were hypomorphic. Particle-induced NADPH oxidase activity was severely impaired in the patients' neutrophils, whereas PMA-induced dihydrorhodamine-1,2,3 (DHR) oxidation, which is widely used as a diagnostic test for chronic granulomatous disease (CGD), was normal or mildly impaired in the patients. Moreover, the NADPH oxidase activity of EBV-transformed B cells was also severely impaired, whereas that of mononuclear phagocytes was normal. Finally, the killing of Candida albicans and Aspergillus fumigatus hyphae by neutrophils was conserved in these patients, unlike in patients with CGD. The patients suffer from hyperinflammation and peripheral infections, but they do not have any of the invasive bacterial or fungal infections seen in CGD. Inherited p40phox deficiency underlies a distinctive condition, resembling a mild, atypical form of CGD.

[Cerebral tuberculosis without meningitis in a immunocompetent child]. / Tuberculosis cerebral sin meningitis en un niño inmunocompetente.

Cerebral tuberculosis TB (tuberculomas) without meningitis is an uncommon disease with a high morbidity and mortality. We report on a case that illustrates the complexity of this clinical presentation. An 11 month old, previously healthy male infant was brought to the clinic due to fever present during the last 1.5 months, associated with loss of neurodevelopmental goals and signs of endocranial hypertension. CT scan of the skull revealed dilatation of the ventricular system with transependimary edema; MRI showed multiple intra- and extra-axial micronodular images and hydrocephalus. Studies of CSF (cyto-chemical analysis, staining, culture for aerobes, fungi, mycobacteria, and molecular tests for TB were negative). Empirical management for subacute meningoencephalitis was prescribed complemented with tetraconjugated treatment for TB and steroids. As there was no microbiological isolation, biopsy of a cerebellar lesion was performed, which revealed chronic necrotizing granulomatous inflammation and acid-alcohol resistant bacilli. The diagnosis of cerebral TB without meningeal involvement was confirmed. The objective of the present report is to emphasize the importance of considering this presentation of TB in children, to remark the need of exhaustive search for the etiologic agent by obtaining samples of the different fluids and tissues even if it implies recurring to invasive methods.

Tuberculosis cerebral sin meningitis en un niño inmunocompetente / Cerebral tuberculosis without meningitis in a immunocompetent child

Resumen La tuberculosis (TBC) cerebral o tuberculoma(s) sin meningitis es una enfermedad poco frecuente y de alta morbimortalidad. Presentamos el caso clínico de un lactante de 11 meses, previamente sano, que consultó por fiebre prolongada y síntomas neurológicos. La RM de encéfalo mostró múltiples imágenes micronodulares e hidrocefalia. El estudio de LCR para bacterias, hongos y micobacterias fue negativo. Se prescribió terapia empírica como una meningoencefalitis subaguda y tratamiento antituberculoso tetraconjugado y corticoesteroides. La confirmación del diagnóstico de TBC cerebral se realizó por biopsia de la lesión, con presencia de inflamación granulomatosa crónica necrosante y bacilos ácido-alcohol resistentes. Se enfatiza la importancia de considerar esta presentación de TBC en niños, y la necesidad de la búsqueda exhaustiva del agente etiológico en diferentes líquidos y tejidos, aun por métodos invasores.

Cerebral tuberculosis TB (tuberculomas) without meningitis is an uncommon disease with a high morbidity and mortality. We report on a case that illustrates the complexity of this clinical presentation. An 11 month old, previously healthy male infant was brought to the clinic due to fever present during the last 1.5 months, associated with loss of neurodevelopmental goals and signs of endocranial hypertension. CT scan of the skull revealed dilatation of the ventricular system with transependimary edema; MRI showed multiple intra- and extra-axial micronodular images and hydrocephalus. Studies of CSF (cyto-chemical analysis, staining, culture for aerobes, fungi, mycobacteria, and molecular tests for TB were negative). Empirical management for subacute meningoencephalitis was prescribed complemented with tetraconjugated treatment for TB and steroids. As there was no microbiological isolation, biopsy of a cerebellar lesion was performed, which revealed chronic necrotizing granulomatous inflammation and acid-alcohol resistant bacilli. The diagnosis of cerebral TB without meningeal involvement was confirmed. The objective of the present report is to emphasize the importance of considering this presentation of TB in children, to remark the need of exhaustive search for the etiologic agent by obtaining samples of the different fluids and tissues even if it implies recurring to invasive methods.

Cáncer de cérvix y autorresponsabilidad: perfilando el riesgo de abstención al Papanicolaou entre las mujeres chilenas mediante Árboles de Decisión / Cervical cancer and self-responsibility: modeling the risk of refraining to undergo a papanicolaou test among Chilean women by decision trees

Objetivo: modelar estadísticamente los niveles de riesgo al absentismo preventivo de Papanicolaou que presentan las mujeres chilenas según variables sociodemográficas. Materiales y métodos: Encuesta de Caracterización Socioeconómica Nacional. Muestra de 73 324 casos según alcances CASEN. Modelamiento según Árboles de Decisión para establecer perfiles de la mujer que se abstiene y analizar luego los motivos que esgrimen para tal decisión. Resultados: el riesgo de abstención al examen varía considerablemente en razón de tomar otros exámenes de prevención de cáncer (no tomar mamografía), encontrarse en determinada etapa de la adultez (tardía) y tener algún tipo de vínculo conyugal; al tradicional déficit de información y acceso le sustituyen los motivos personales como excusa frecuente para no considerar el Papanicolaou como acción recurrente. Así, la percepción de poca utilidad y la falta de tiempo configuran el comportamiento de abstención como una decisión en lugar de una imposibilidad. Conclusiones: Tales resultados problematizan las características de la mujer contemporánea y sus comportamientos, además de plantear la necesidad de considerar la intervención socioeducativa como requisito para generar actitudes favorables hacia la prevención; factores que debiera considerar la política social de prevención del cáncer en general y de cérvix en particular

Objective: To model by statistical means the risk levels of refraining to undergo a papanicolaou test among Chilean women according to sociodemographic variables. Materials and methods: National Socioeconomic Characterization Survey (CASEN). Sample of 73,324 cases, according to CASEN's data. Modeling by decision trees to establish the profile of women who refrain from undergoing a papanicolaou test, and then analyze the reasons for that decision. Results: The risk of refraining to undergo a papanicolaou test varies considerably and depends on variables such as other cancer preventive tests (not undergoing a mammography), adulthood stage (late phase), and marital status. The traditional lack of information and access is replaced by personal reasons as the frequent excuse for not undergoing a papanicolaou test on a continuous basis. Perception of unusefulness and lack of time cause this refraining behavior as a decision and not as an impossibility. Conclusions: The results question contemporary women's characteristics and behaviors, and pose the need for considering a social-educational intervention as a requirement to generate favorable attitudes towards prevention. These factors should be considered by social policy on cancer prevention in general, and particularly in cervical cancer prevention

Formación profesional y empleabilidad: las tensiones del mercado en las carreras de la salud en Chile / Profesional training and employability: the market tensions regarding the health majors in Chile

Introducción: la formación profesional en Chile ha evidenciado un explosivo crecimiento aunque, con rezago en el área de la salud en razón de especificidades intrínsecas. Objetivos: explorar su repercusión en los procesos de formación, titulación y empleabilidad en carreras tradicionales como Medicina, Enfermería y Odontología, durante los años 2007-2015. Método: con el uso de bases de datos oficiales se construyen un conjunto de índices con el fin de caracterizar el comportamiento de la formación y el empleo en tres carreras tradicionales del ámbito de la salud. Resultados: entre los años 2007-2015 los datos reportan un fuerte crecimiento de la matrícula, en especial la de carácter privado, donde más de la mitad de los programas son impartidos por instituciones de esta naturaleza. Se observa una mayor mixtura social del alumnado, aunque persiste la tendencia a la sobre representación de segmentos de altos ingresos. Los programas exhiben adecuados niveles de eficiencia interna, con índices de deserción y reprobación acotados, una alta tasa de titulados y adecuados niveles de renta y empleo. Conclusiones: si bien se constatan adecuados índices de eficiencia interna y empleabilidad respecto a la generalidad del sistema, el aumento de la oferta y la masa de titulados tensionará los procesos de formación y de empleabilidad, desvalorizando las credenciales educativas, instalando en el mercado del trabajo una mayor capacidad para discriminar en razón de la institución y programa(AU)

Introduction: Professional training in Chile has shown an explosive growth, although with lag in the health area due to intrinsic specificities. Objectives: To explore the phenomenon's impact on the processes of training, qualification and employability in traditional majors such as Medicine, Nursing and Dentistry, during the years 2007-2015. Methods: With the use of official databases, a set of indexes were constructed in order to characterize the actual state of training and employment in three traditional health majors. Results: Data between the years 2007 and 2015 reported a strong growth in enrollment, especially private enrollment, where more than half of the programs are taught by institutions of this nature. A greater social mix of the students is observed, although the tendency to over-representation of high-income segments persists. The programs exhibit adequate levels of internal efficiency, with limited quitting and failure rates, a high rate of graduates and adequate levels of income and employment. Conclusions: Although adequate indexes of internal efficiency and employability are observed with respect to the generality of the system, the increase of the offer and the mass of graduates will stress the training and employability processes, devaluing the educational credentials, installing in the labor market a greater ability to discriminate on the basis of the institution and program(AU)

Bilateral Continuous Erector Spinae Plane Block Contributes to Effective Postoperative Analgesia After Major Open Abdominal Surgery: A Case Report.

The erector spinae plane (ESP) block is a regional anesthetic technique involving local anesthetic injection in a paraspinal plane deep to the erector spinae muscle. Originally described for thoracic analgesia when performed at the T5 transverse process, the ESP block can provide abdominal analgesia if performed at lower thoracic levels because the erector spinae muscles extend to the lumbar spine. A catheter inserted into this plane can extend analgesic duration and can be an alternative to epidural analgesia. In this report, we describe using bilateral ESP catheters inserted at the T8 level to provide effective perioperative analgesia for major open lower abdominal surgery.

Segmentación y exclusión en Chile: el caso de los jóvenes primera generación en educación superior / Segmentation and exclusion in Chile: the case of first generation young people in higher education / Segmentation and exclusion in Chile: the case of first generation young people in higher

Haciendo uso de bases de datos históricas del Proceso de Admisión a la Educación Superior en Chile, mediante un análisis estadístico inferencial y comparativo, este artículo tiene como objetivo analizar a estudiantes “Primera Generación” y sus elecciones profesionales, contrastándolo con el estudiante “Continuista”. Los principales hallazgos informan sobre la existencia de atributos y comportamientos diferenciales del estudiante “Primera Generación” respecto del alumno “Continuista”, dando cuenta de la persistencia de procesos de exclusión y segregación que se manifiestan en una elección profesional fuertemente condicionada por el habitus que reproduce desigualdades y limita las aspiraciones a un conjunto restringido de opciones. Este escenario pone en cuestión el real ejercicio de la opción vocacional así como la mayor democratización e inclusión de un sistema de educación superior masificado y diversificado.

Using historical databases that contain statistics on higher educationadmissions in Chile, this article uses an inferential and comparative statistical analysis to analyze“first generation” university students” and their career choices, contrasting with “continuousgeneration” students, whose parents and/or grandparents also went to university. The main findingsof this report the existence of differential attributes and behaviors of “first generation” studentscompared to the “continuous generation” students, demonstrating the persistence of exclusion andsegregation processes that manifest themselves in professional choices that are highly conditioned by the habitus that reproduces inequalities and limits aspirations to a restricted set of options. Thisscenario calls into question the actual exercise of making vocational choices and the increaseddemocratization and inclusion of a mass and diversified higher education system.

Usando bases de dados históricos de admissão ao ensino superior noChile por meio de uma análise estatística inferencial e comparativa, este artigo tem por objetivoanalisar os alunos de primeira geração e suas escolhas de carreira, contrastando com os alunosveteranos.As principais conclusões do relatório informam a existência de atributos e comportamentosdiferentes do estudante “Primeira Geração” em relação ao aluno veterano, percebendo a persistênciade processos de exclusão e segregação que se manifestam em uma escolha de profissionais altamentecondicionada pelo habitus que reproduz as desigualdades e aspirações limitadas a um conjuntorestrito de opções. Este cenário põe em questão o real exercício da escolha profissional assim comoda maior democratização e inclusão de um sistema de ensino superior massificado e diversificado.

Osterix and RUNX2 are Transcriptional Regulators of Sclerostin in Human Bone.

Sclerostin, encoded by the SOST gene, works as an inhibitor of the Wnt pathway and therefore is an important regulator of bone homeostasis. Due to its potent action as an inhibitor of bone formation, blocking sclerostin activity is the purpose of recently developed anti-osteoporotic treatments. Two bone-specific transcription factors, RUNX2 and OSX, have been shown to interact and co-ordinately regulate the expression of bone-specific genes. Although it has been recently shown that sclerostin is targeted by OSX in mice, there is currently no information of whether this is also the case in human cells. We have identified SP-protein family and AML1 consensus binding sequences at the human SOST promoter and have shown that OSX, together with RUNX2, binds to a specific region close to the transcription start site. Furthermore, we show that OSX and RUNX2 activate SOST expression in a co-ordinated manner in vitro and that SOST expression levels show a significant positive correlation with OSX/RUNX2 expression levels in human bone. We also confirmed previous results showing an association of several SOST/RUNX2 polymorphisms with bone mineral density.

Bloqueo axilar guiado por ultrasonido y neuroestimulador / Ultrasound and nerve stimulation-guided axillary

Introduction: The axillary block of the brachial plexus is widely used as an anaesthesia and analgesia technique in upper limb surgery, specifically for hand, wrist and forearm procedures. The use of nerve stimulation and ultrasound guidance has increased the rate of success with this block. Objective: This article presents a non-systematic review of the most recent literature on axillary block of the brachial plexus using ultrasound and peripheral nerve stimulation. Materials and methods: A search for a non-systematic review was conducted in the Cochrane, Pubmed/Medline, Embase and OVID databases. Conclusion: The axillary block of the brachial plexus is an anaesthetic and analgesic technique for upper limb surgery that has a high percentage of success, with a low degree of difficulty for the procedure.

Introducción: El bloqueo axilar del plexo braquial es un bloqueo anestésico ampliamente utilizado como técnica anestésica y analgésica en cirugía de miembro superior, específicamente para mano, muñeca y antebrazo. El uso de neuroestimulador y ultrasonido ha aumentado la tasa de éxito de éste bloqueo. Objetivo: El presente artículo hace una revisión no sistemática de la literatura más reciente relacionada con el bloqueo axilar del plexo braquial utilizando ultrasonido y estimulación de nervio periférico. Métodos y Materiales: Se hizo una búsqueda en las bases de datos de Cochrane, Pubmed/Medline, Embase y OVID para la realización de una revisión no sistemática. Conclusión: El bloqueo del plexo braquial a nivel axilar es una técnica anestésica y analgésica para cirugía de miembro superior con alto porcentaje de éxito y bajo grado de dificultad en cuanto a realización del procedimiento.

Procesamiento emocional en maltratadores de género mediante el Test de Expresiones Faciales de Ekman y la Tarea Stroop Emocional / Emotional processing in batterers as assessed by Test Ekman Facial Expressions and Emotional Stroop Task in intimate partner violence situations

La investigación actual en el campo de la violencia de pareja es escasa en lo que se refiere al papel del procesamiento emocional de los maltratadores. Sin embargo, ningún estudio ha investigado en la misma muestra la capacidad de reconocer las emociones y la influencia de las emociones en los aspectos atencionales. El objetivo de este estudio es investigar en una muestra de maltratadores la capacidad de reconocer las emociones de fotografías estandarizadas y analizar la interferencia de las palabras con contenido emocional en una tarea atencional. La muestra consistió en 90 hombres condenados por violencia de pareja y 77 hombres condenados por otros delitos. Se evaluaron las características sociodemográficas asociadas a nuestra muestra y el procesamiento emocional de las expresiones faciales con la prueba de Ekman y la Tarea Stroop Emocional, diseñada específicamente para evaluar el procesamiento emocional en situaciones de violencia contra la pareja. Los resultados mostraron un mejor reconocimiento emocional de los maltratadores en las emociones faciales de enfado y sorpresa. Para el procesamiento de palabras con contenido emocional, las diferencias no fueron estadísticamente significativas.

Current research in the field of intimate partner violence has been scarce as regards the role of emotional processing in abusers. Nevertheless, no study has investigated the ability to recognize emotions and the influence of emotions on attention-related aspects among the same sample. The aim of this study is to investigate the ability to recognize emotions in standardized photographs, and to analyze the interference that words with emotional content exert on an attention task in a sample of abusers. The sample consisted of 90 men convicted of intimate partner violence and 77 men convicted of other crimes. Demographic characteristics associated to the sample were evaluated, as were emotional processing of facial expressions with the Ekman Test and the Emotional Stroop task, specifically designed to assess emotional processing in situations of intimate partner violence. The results showed better emotional recognition among abusers in the recognition of facial emotions of anger and surprise. As for the processing of words with emotional content, differences were not statistically significant.