High Burden of Intestinal Colonization With Antimicrobial-Resistant Bacteria in Chile: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study.

BACKGROUND: Antimicrobial resistance is a global threat, heavily impacting low- and middle-income countries. This study estimated antimicrobial-resistant gram-negative bacteria (GNB) fecal colonization prevalence in hospitalized and community-dwelling adults in Chile before the coronavirus disease 2019 pandemic. METHODS: From December 2018 to May 2019, we enrolled hospitalized adults in 4 public hospitals and community dwellers from central Chile, who provided fecal specimens and epidemiological information. Samples were plated onto MacConkey agar with ciprofloxacin or ceftazidime added. All recovered morphotypes were identified and characterized according to the following phenotypes: fluoroquinolone-resistant (FQR), extended-spectrum cephalosporin-resistant (ESCR), carbapenem-resistant (CR), or multidrug-resistant (MDR; as per Centers for Disease Control and Prevention criteria) GNB. Categories were not mutually exclusive. RESULTS: A total of 775 hospitalized adults and 357 community dwellers were enrolled. Among hospitalized subjects, the prevalence of colonization with FQR, ESCR, CR, or MDR-GNB was 46.4% (95% confidence interval [CI], 42.9-50.0), 41.2% (95% CI, 37.7-44.6), 14.5% (95% CI, 12.0-16.9), and 26.3% (95% CI, 23.2-29.4). In the community, the prevalence of FQR, ESCR, CR, and MDR-GNB colonization was 39.5% (95% CI, 34.4-44.6), 28.9% (95% CI, 24.2-33.6), 5.6% (95% CI, 3.2-8.0), and 4.8% (95% CI, 2.6-7.0), respectively. CONCLUSIONS: A high burden of antimicrobial-resistant GNB colonization was observed in this sample of hospitalized and community-dwelling adults, suggesting that the community is a relevant source of antibiotic resistance. Efforts are needed to understand the relatedness between resistant strains circulating in the community and hospitals.

Clinical, esthetic, and quality of life outcomes after telegnathic surgery in Caucasian OSAS patients.

Objective: To carry out both an objective and subjective assessment of the facial esthetics, clinical outcome, and quality of life evaluation in 25 OSAS patients treated with telegnathic surgery.Methods: Patients were analyzed using AHI, Legan and Burstone and airway cephalometric analysis for the objective study together with youthful and esthetic perception and SF-36 health surveys for the subjective part.Results: Facial convexity, nasolabial and lower face-throat angle, upper lip protrusion, and vertical height-depth ratio improved the facial and neck esthetics, while the maxillary and mandibular prognathism increased. Eighty-eight percent considered an esthetic change on their facial profile and 52% a more youthful profile. FS-36 survey (pre- 48.86 and post-surgery 71.74) and AHI (pre- 41.32 and post-surgery 7.80) scores improved significantly.Discussion: Results after telegnathic surgery were both esthetically and clinically satisfactory. The FS-36 survey should be considered for monitoring treatment in OSAS patients.

Embedded Vision Intelligence for the Safety of Smart Cities.

Advances in Artificial intelligence (AI) and embedded systems have resulted on a recent increase in use of image processing applications for smart cities' safety. This enables a cost-adequate scale of automated video surveillance, increasing the data available and releasing human intervention. At the same time, although deep learning is a very intensive task in terms of computing resources, hardware and software improvements have emerged, allowing embedded systems to implement sophisticated machine learning algorithms at the edge. Additionally, new lightweight open-source middleware for constrained resource devices, such as EdgeX Foundry, have appeared to facilitate the collection and processing of data at sensor level, with communication capabilities to exchange data with a cloud enterprise application. The objective of this work is to show and describe the development of two Edge Smart Camera Systems for safety of Smart cities within S4AllCities H2020 project. Hence, the work presents hardware and software modules developed within the project, including a custom hardware platform specifically developed for the deployment of deep learning models based on the I.MX8 Plus from NXP, which considerably reduces processing and inference times; a custom Video Analytics Edge Computing (VAEC) system deployed on a commercial NVIDIA Jetson TX2 platform, which provides high level results on person detection processes; and an edge computing framework for the management of those two edge devices, namely Distributed Edge Computing framework, DECIoT. To verify the utility and functionality of the systems, extended experiments were performed. The results highlight their potential to provide enhanced situational awareness and demonstrate the suitability for edge machine vision applications for safety in smart cities.

Schoolteachers as candidates to be basic life support trainers: A simulation trial.

BACKGROUND: The aim was to assess future schoolteachers' basic life support (BLS) knowledge and willingness to include this content in school lessons. The aim was also to determine the learning effect of a brief BLS hands-on training session, supported by real-time feedback. METHODS: A convenience sample of 98 University students of Educational Sciences and Sports were recruited. The training program consisted of brief theoretical and hands-on interactive sessions with a 2/10 instructor/participants ratio. Knowledge and willingness was assessed by means of a survey. Chest compressions (CC) and ventilation quality were registered in 47 cases during 1 min cardiopulmonary resuscitation (CPR) tests. RESULTS: Fifty-eight percent of subjects declared to know how to perform CPR, 62% knew the correct chest compression/ventilation ratio but only one in four knew the CC quality standards. Eighty-eight percent knew what an automated external defibrillator (AED) was; willingness to use the device improved from 70% to 98% after training. Almost half of CCs were performed atan adequate rate. Men performed deeper compressions than women (56.1 ± 4.03 mm vs. 52.17 ± 5.51 mm, p = 0.007), but in both cases the mean value was within recommendations. Full chest recoil was better in women (72.2 ± 32.8% vs. 45.4 ± 32.9%, p = 0.009). All CCs were delivered with correct hand positions. CONCLUSIONS: Brief hands-on training supported by real-time feedback of CPR quality helps future schoolteachers improve their knowledge, self-confidence and CPR skills. BLS training should be implemented in University curricula for schoolteachers in order to promote their engagement in effective BLS training of schoolchildren.

[The medical community's perceptions of management of the layoff process]. / La percepción del colectivo médico sobre la gestión del proceso de desvinculación.

The definition and process of layoff are evolving rapidly. This study focuses on the perceptions of physicians in Catalonia, Spain, concerning layoff and the identification of strategies and proposals that allow more satisfactory adjustment to the process. A qualitative approach was used with 16 in-depth interviews with key persons in the healthcare setting (phase 1) and 6 focus groups with 72 persons, according to sampling criteria (phase 2). The analysis was interpretative, based on Grounded Theory. Comparison and triangulation of the results generated by the different techniques and researchers revealed the social representation of the current healthcare organization (immersed in a new public management model) on the medical community and the layoff process. In this sense, retirement is seen as a personal issue, separate from human resources policies, which are more interested in staff turnover at a lower "cost". Given this situation, the article proposes alternatives that value physicians' experience and expertise before they leave the healthcare organization.

[End-of-life dilemmas]. / Dilemas al final de la vida.

Cancer patients need continuous care from the time of diagnosis until the final phase of life. Comfort for the patients becomes the predominant goal as the disease progresses. Cancer patients often die with serious, unrelieved, symptoms that cause a distressing death and tremendous suffering for their families. Many physicians have not been trained to care for the dying patient. The symptoms associated with the dying process are so characteristic that all physicians should be able to recognise them, be skilled in providing appropriate care, and be prepared for problems that may arise. As the disease progresses, it may become necessary in some cases for the patient and his/ her family to consider sedation as an alternative to alertness accompanied by intolerable physical and existential disease. This article reviews the common symptoms in the final phase of life and describes the methods to manage the symptoms while supporting the patient and family through this difficult period.

[Qualitative evaluation of the blood collection process in Catalonia]. / Evaluación cualitativa del sistema de recogida de sangre en Cataluña.

Blood donation is indispensable for quality health service provision. The stagnation of the number of donations in Catalonia prompted up an external evaluation of the system of blood collection that could orient the future policies. An evaluation of blood-donor services in Catalonia was designed adopting a qualitative methodology. The evaluation design included the use of a variety of techniques namely participant observation, individual interviews, group interviews and documentary techniques. The field work was carried out in all blood-donation sectors of Catalonia from the 23th November to the 4th December, 1998. Using Atlas/ti, a computer science tool for the qualitative analysis of textual data, the information analysis partially followed the prescriptions of "grounded theory" and of some modalities of thematic content analysis. The results show the basic characteristics and deficiencies of the process and its organization, describing their strong and weak points. The findings also detail arguments on blood donation that the agents implied in the process, donors an professionals, use. We also report what reasons the blood-donor service managers/providers gave for donating blood, and what perceptions they had of blood donors.

Ozone-Oxidative Preconditioning Prevents Doxorubicin-induced Cardiotoxicity in Sprague-Dawley Rats.

OBJECTIVES: Induced dilated cardiomyopathy is the main limitation of the anti-cancer drug doxorubicin, which causes oxidative stress and cardiomyocyte death. As ozone therapy can activate the antioxidant systems, this study aimed to investigate the therapeutic efficacy of ozone-oxidative preconditioning against doxorubicin-induced cardiotoxicity. METHODS: The study was carried out from September 2013 to January 2014. Sprague-Dawley rats were randomly distributed in the following treatment groups: Group 1 were treated with 2 mg/kg intraperitoneal (i.p.) of doxorubicin twice a week for 50 days; Group 2 were treated with 0.3 mg of ozone/oxygen mixture at 50 µg/mL of ozone per 6 mL of oxygen by rectal insufflation and then treated with doxorubicin; Group 3 were treated as Group 2 but only with the oxygen, and Group 4 were treated with oxygen first, and then with sodium chloride i.p. as the control group. RESULTS: The results showed that ozone therapy preserved left ventricle morphology which was accompanied by a reduction of serum pro-brain natriuretic peptide levels. The cardioprotective effects of ozone-oxidative preconditioning were associated with a significant increase (P <0.05) of antioxidant enzymes activities and a reduction of lipid and protein oxidation (P <0.05). CONCLUSION: Ozone-oxidative preconditioning prevents doxorubicin-induced dilated cardiomyopathy through an increase of antioxidant enzymes and a reduction of oxidised macromolecules. This establishes the background for future studies to determine if ozone therapy can be used as a complementary treatment for attenuating doxorubicin-induced cardiotoxicity in cancer patients.

La percepción del colectivo médico sobre la gestión del proceso de desvinculación / The medical community's perceptions of management of the layoff process / A percepção da comunidade médica sobre a gestão do processo de desvinculação

Resumen: El concepto y el proceso de desvinculación están evolucionando rápidamente. El objetivo del artículo es conocer las percepciones de los profesionales de la medicina de Cataluña (España) sobre el proceso de desvinculación e identificar estrategias y configurar propuestas que permitan un ajuste más satisfactorio. Mediante una aproximación cualitativa, se han realizado 16 entrevistas en profundidad a personas clave del contexto sanitario (fase 1) y 6 grupos focales a 72 personas, atendiendo a criterios muestrales (fase 2). El análisis es interpretacional, siguiendo los supuestos de la Grounded Theory. La comparación y triangulación constante de los resultados generados por las diferentes técnicas e investigadores muestra la representación social que tiene la organización sanitaria actual, inmersa en el nuevo modelo de gestión pública, sobre el colectivo médico y su proceso de desvinculación. En este sentido, la jubilación es vista como un tema personal y ajeno a las políticas de recursos humanos, más interesadas en rejuvenecer plantillas con un "coste" menor. Ante esta situación se proponen alternativas que valoren la pericia y experiencia del médico antes de desvincularse de la organización sanitaria.

Abstract: The definition and process of layoff are evolving rapidly. This study focuses on the perceptions of physicians in Catalonia, Spain, concerning layoff and the identification of strategies and proposals that allow more satisfactory adjustment to the process. A qualitative approach was used with 16 in-depth interviews with key persons in the healthcare setting (phase 1) and 6 focus groups with 72 persons, according to sampling criteria (phase 2). The analysis was interpretative, based on Grounded Theory. Comparison and triangulation of the results generated by the different techniques and researchers revealed the social representation of the current healthcare organization (immersed in a new public management model) on the medical community and the layoff process. In this sense, retirement is seen as a personal issue, separate from human resources policies, which are more interested in staff turnover at a lower "cost". Given this situation, the article proposes alternatives that value physicians' experience and expertise before they leave the healthcare organization.

Resumo: O conceito e processo de desvinculação estão evoluindo rapidamente. O objetivo do trabalho é conhecer as percepções de profissionais médicos na Catalunha (Espanha) sobre o processo de desvinculação e identificar estratégias e propostas de criação de um ajuste mais satisfatório. Através de uma abordagem qualitativa, houve 16 entrevistas em profundidade com pessoas-chave do contexto de saúde (fase 1) e 6 grupos focais com 72 pessoas, com base em critérios de amostragem (fase 2). A análise é interpretativa, seguindo os pressupostos da Grounded Theory. A comparação constante e triangulação dos resultados gerados por diferentes técnicas e pesquisadores mostram a representação social da atual organização da saúde, imersa no novo modelo de gestão, na comunidade médica e o processo de desvinculação. Nesse sentido, a aposentadoria é vista como uma questão pessoal, separada das políticas de recursos humanos, que estão mais interessadas em modelos de rejuvenescimento de pessoal com um "custo" menor. Diante desta situação, o artigo propõe alternativas que valorizam a experiência e os conhecimentos dos médicos antes da desvinculação à organização de saúde.

Patterns of left ventricular hypertrophy in essential hypertension: should echocardiography guide the pharmacological treatment?

The experimental design of clinical studies, on the pharmacological treatment of essential hypertension, has ignored a fundamental issue: Hypertensive patients are not a homogenous population. The adaptation of the cardiovascular system to hypertension is structurally and functionally heterogeneous. Recent clinical investigations suggest that this heterogeneity can be minimized by echocardiography. Thus, when the hemodynamic and neurohormonal profiles of untreated hypertensive patients are considered, in the particular context of the cardiac morphologic adaptation to high blood pressure, distinct common denominators emerge. Concentric and eccentric hypertrophy, the two most common patterns of ventricular hypertrophy, are at the extremes of the geometric spectrum. Concentric hypertrophy is characterized by an elliptic left ventricle, normal stroke volume and high peripheral vascular resistance. Its predominant neurohormonal profile includes elevated plasma renin and natriuretic peptide levels. Conversely, most patients with eccentric hypertrophy have a spheric left ventricle, increased stroke volume and low peripheral vascular resistance. Its corresponding neurohormonal profile shows low serum renin and enhanced sympathetic nervous activity. The therapeutic response, to angiotensin II antagonists and to beta-adrenergic blockers, of these two geometric patterns is also different. Concentric hypertrophy is substantially reversed by losartan, whereas, eccentric hypertrophy is refractory to both, losartan and atenolol. These facts raise a relevant question: Should ventricular geometry be considered when deciding which antihypertensive drug is to be prescribed?

Fisiopatología, diagnóstico y tratamiento médico de la insuficiencia cardiaca congestiva

El síndrome de insuficiencia cardíaca crónica se caracteriza por una limitación progresiva de la actividad física, retención de sal y agua, activación neurohormonal y alteraciones estructurales y funcionales cardiacas. Estas últimas pueden afectar la función sistólica, diastólica o ambas. En relación con la insuficiencia cardiaca predominantemente sistólica, los mecanismos responsables de la remodelación cardiaca y de la activación neurohormonal no están relacionados con la etiología de la enfermedad cardiaca subyacente. Aún cuando, el tratamiento farmacológico mejora la sobreviva y la calidad de vida de los pacientes con insuficiencia cardiaca congestiva, la mortalidad sigue siendo alta.

Congestive heart failure is a progressive syndrome characterized by abnormalities of cardiac structure and function, limitation of exercise capacity, neurohormonal activation and salt and water retention. Cardiac systolic or diastolic function may be predominantly impaired. Concerning systolic heart failure, the mechanisms responsible for cardiac remodeling and neurohormonal activation are not related to a specific etiology. Although, pharmacological treatment improves quality of life and survival, mortality is still high.

Adaptación morfológica del corazón a la hipertensión arterial esencial: fisiopatología e implicaciones terapéuticas / Morphologic adaptation of the heart to high blood pressure: pathophysiology and therapeutic implications

El diseño experimental de los estudios prospectivos sobre el tratamiento de la hipertensión arterial esencial, ha ignorado un aspecto fundamental de la fisiopatología del paciente hipertenso: Los pacientes hipertensos no son homogéneos, en lo que respecta a los mecanismos responsables del aumento de la presión arterial. La adptación cardiovascular a la hipertensión arterial es anatómica y funcionalmente heterogénea. Investigaciones clínicas recientes indican que, esta heterogeneidad, puede ser minimizada con el uso de la eco-cardiografía. El análisis de los perfiles hemodinámicos y neurohormonales de los pacientes hipertensos permite distinguir la presencia de denominadores comunes: La hipertrofia ventricular concéntrica y la hipertrofia ventricular excéntrica representan los extremos opuestos de adaptación del corazón a la hipertensión arterial. El primero se caracteriza por tener una forma geométrica elíptica, con un perfil hemodinámico de gasto cardíaco normal y resistencias vasculares periféricas elevadas. Los niveles plasmáticos de renina y de los péptidos natriuréticos están elevados.

The experimental design of clinical studies, on the pharmacological treatment of essencial hypertension, has ignored a fundamental issue: Hypertensive patiens are not a homogenous population. The adaptation of the cardiovascular system to hypertension is structurally and funtionally heterogeneous. Recent clinical investigations suggest that this heterogeneity can be minimized by echocardiography. Thus, when the hemodynamic and neurohormonal profiles of untreated hypertensive patients are considered, in the particular context of the cardiac morphologic adaptation to high blood pressure, distinct common denominator emerge. Concentric Hypertrophy is characterized by an elliptic left ventricle, normal stroke volume and high peripheral vascular resistance. Its predominant neurohormonal profile includes elevated plasma renin and natriuretic peptide levels. Conversely, most patients with eccentric hypertrophy have a spheric left ventricle, increased stroke volume and low peripheral vascular resistance. Its corresponding neurohormonal profile shows low serum renin and anhanced sympathetic nervous activity. The therapeutic response, to angiotensin II antagonists and to beta-adrenergic blockers, of these two geometric patterns is also different. Concentric hypertrophy is substantially reversed by angiotensin II blockers, where as, eccentric hypertrophy is refractory to both, angiotensin II blockerds and atenol. These facts raise a relevant question: Should ventricular geometry be considered when deciding which antihypertensive drug is to be prescribed?.

Efectos térmicos centrales y cutáneos en el miembro superior de la inducción anestésica con tiopental / Core and cutaneous thermal effects on the upper limb after induction of general anaesthesia with thiopental

Objetivos: Describir y comparar los efectos térmicos (centrales y cutáneos en el miembro superior) y fotopletismográficos inmediatos a la inducción anestésica con fentanilo, tiopental sódico y vecuronio. Pacientes y métodos: Hemos estudiado las variaciones de las temperaturas central y cutáneas (del miembro superior: dedo, antebrazo y brazo), así como las variaciones del flujo sanguíneo digital, en 20 pacientes adultos, ASA-I (12 hombres y 8 mujeres), cada 5 minutos durante los 20 minutos iniciales de la anestesia general. La temperatura se midió con termosondas desechables (esofágicas y cutáneas) conectadas a un termómetro digital y el flujo sanguíneo digital mediante fotopletismografía digital. La anestesia se realizó sin premedicación con: tiopental sódico (5 mg x kg), fentanilo 0,1 mg y vecuronio 0,1 mg x kg. El mantenimiento anestésico se realizó con N2O-O2 (75/35 por ciento) y fentanilo 0,1 mg a los 10 minutos, sin anestésicos inhalatorios. Resultados: La inducción anestésica se asoció con vasodilatación digital intensa y rápida, con un incremento marcado de la amplitud de la onda fotopletismográfica (AOFP) (AOFP = 6,9 ñ 3,9 mV/V, a los 5 min, P<0,001) y de la temperatura cutánea del dedo (Ta Dedo = 6,3 ñ 2,8ºC, a los 10 min, P<0,001). Sin embargo, los cambios de la temperatura cutánea en el brazo y antebrazo fueron muy inferiores y más lentos (menores de 1ºC en los 20 min, en ambos casos). Solamente encontramos una correlación significativa entre la AOFP y la Ta Dedo: r=0,54 (P<0,001). Conclusiones: Tras inducción anestésica con tiopental sódico, fentanilo y vecuronio sucede un calentamiento cutáneo en el miembro superior, distribuido de forma desigual. El calentamiento es marcado en los dedos mientras que en el brazo y en el antebrazo las variaciones térmicas son menores. La apertura de las fístulas arterio-venosas termorreguladoras de las manos, consecuente con la inhibición simpática de la inducción anestésica, puede tener un papel destacado en la génesis de la hipotermia de redistribución de la inducción de la anestesia general.