Prevalence of non-alcoholic fatty liver disease and liver fibrosis in a general population cohort from Argentina.

INTRODUCTION AND OBJECTIVES: South America is one of the regions with the highest rates of non-alcoholic fatty liver disease (NAFLD). This study aimed to assess the prevalence and severity of NAFLD in suburban Argentina. PATIENTS AND METHODS: The study involved a general community cohort of 993 subjects evaluated sequentially with a comprehensive lifestyle questionnaire, laboratory testing, abdominal ultrasound (US) and transient elastography with XL probe. NAFLD was diagnosed according to standard criteria. RESULTS: The prevalence of NAFLD by the US was 37.2% (326/875) overall, 50.3% in subjects with overweight/obesity, 58.6% with hypertriglyceridemia, 62.3% with diabetes/hyperglycemia and 72.1% with all three risk factors. Male gender (OR 1.42, 95% CI 1.03-1.47, p = 0.029), age (50-59 years: OR 1.98, 95 CI 1.16-3.39, p = 0.013 and ≥60 years: OR 1.86, 95% CI 1.13-3.09, p = 0.015), BMI (25-29: OR 2.87, 95% CI 1.86-4.51, p<0.001 and ≥30: OR 9.57, 95% CI 6.14-15.20, p<0.001), diabetes/hyperglycemia (OR 1.65, 95% CI 1.05-2.61, p = 0.029) and hypertriglyceridemia (OR 1.73, 95% CI 1.20-2.48, p = 0.002) were independent predictors of NAFLD. Among patients with steatosis, 22.2% (69/311) had ≥F2 fibrosis (overweight 25%, hypertriglyceridemia 32%, diabetes/hyperglycemia 34%). BMI (OR 5.22, 95% CI 2.64-11.74, p<0.001), diabetes/hyperglycemia (OR 2.12, 95% CI 1.05-4.29, p = 0.04) and hypertriglyceridemia (OR 1.94, 95% CI 1.03-3.68, p = 0.040) were independent predictors of liver fibrosis. CONCLUSIONS: This general population study from Argentina showed a high prevalence of NAFLD. Significant liver fibrosis was present in 22% of subjects with NAFLD. This information adds to the existing knowledge of NAFLD epidemiology in Latin America.

Subregional efforts to improve childhood cancer care in the Andean countries.

Cancer is one of the leading causes of death in children and adolescents younger than 19 years. An estimated 10 000 deaths are caused by this disease annually in this age group in Latin America and the Caribbean. In high-income countries, the survival of children and adolescents with neoplasms can reach 85%; however, in middle- and low-income countries, despite progress, survival rates are significantly lower (between 10% and 60%). Important inequities exist is survival from childhood cancer that need to be addressed through decisive actions from the health systems. This report describes the work of the ministries of health and the Secretariat of the Andean Health Organization (Organismo Andino de Salud - Convenio Hipólito Unánue (ORAS-CONHU)), to develop the Andean Cancer Prevention and Control Policy, with consideration given to childhood cancers. The policy was based on analysis of the cancer situation in the six Andean countries - Bolivia (Plurinational State of), Colombia, Chile, Ecuador, Peru and Venezuela (Bolivarian Republic of) - between 2015 and 2020, and it was approved in 2022. An in-depth study is currently being carried out on the situation of childhood cancer in the Andean countries.

El cáncer es una de las principales causas de muerte en la población infantil y adolescente menor de 19 años. Se estima que esta enfermedad ocasiona cada año 10 000 muertes en este grupo etario en América Latina y el Caribe. En los países de ingresos altos, la supervivencia de la población infantil y adolescente con neoplasias puede llegar al 85%; sin embargo, a pesar de los avances, en los países de ingresos bajos y medianos las tasas de supervivencia son significativamente más bajas (entre un 10% y un 60%). Existen desigualdades importantes en materia de supervivencia al cáncer infantil que es preciso abordar mediante medidas decisivas por parte de los sistemas de salud. En este informe se describe el trabajo realizado por los ministerios de salud y la Secretaría del Organismo Andino de Salud ­ Convenio Hipólito Unánue (ORAS-CONHU) para formular la Política Andina de Prevención y Control del Cáncer, con especial énfasis en el cáncer infantil. La política se basó en el análisis de la situación en materia oncológica de los seis países andinos ­Bolivia (Estado Plurinacional de), Chile, Colombia, Ecuador, Perú y Venezuela (República Bolivariana de)­ entre el 2015 y el 2020, y se aprobó en el 2022. En estos momentos, se está llevando a cabo un estudio pormenorizado sobre la situación del cáncer infantil en los países andinos.

O câncer é uma das principais causas de morte em crianças e adolescentes menores de 19 anos. Estima-se que, nessa faixa etária, a doença cause 10 mil mortes por ano na América Latina e no Caribe. Em países de renda alta, a sobrevida de crianças e adolescentes com neoplasias pode chegar a 85%; no entanto, em países de renda média e baixa, apesar de alguns avanços, as taxas de sobrevida são significativamente menores (entre 10% e 60%). Existem iniquidades importantes na sobrevivência ao câncer infantil que precisam ser abordadas por meio de ações decisivas dos sistemas de saúde. Este relatório descreve o trabalho dos ministérios da saúde e da Secretaria do Organismo Andino de Saúde ­ Convênio Hipólito Unanue (ORAS-CONHU) para desenvolver a Política Andina de Prevenção e Controle do Câncer, com atenção para os cânceres infantis. A política, baseada em uma análise da situação do câncer nos seis países andinos ­ Bolívia (Estado Plurinacional da), Colômbia, Chile, Equador, Peru e Venezuela (República Bolivariana da) ­ entre 2015 e 2020, foi aprovada em 2022. Um estudo aprofundado está sendo realizado atualmente para avaliar a situação do câncer infantil nos países andinos.

Argentina's National Program for Control of Breast Cancer: Time 1, Patient Navigation, and Patient Cancer Education Experience.

Argentina has the second highest mortality rate for breast cancer (BC) in South America. The age-standardized incidence of BC in Argentina is 73 per 100,000. Despite the availability of early detection services, 30% of BCs are diagnosed at advanced disease stages. The National Cancer Institute (NCI) of Argentina and the National Program for Control of Breast Cancer (NPCBC) focus on two main objectives: guaranteeing adequate and timely BC treatment and reducing BC mortality in Argentina. These objectives are addressed by maintaining three core concepts: quality control, disease monitoring, and wide coverage of available early detection and treatment services. The NPCBC is currently implementing the "Time 1 Survey Study." Time 1 is defined as the time from the first appearance of BC signs or symptoms to the first consult within the public healthcare system. This timeframe is important in Argentina because it is outside of the health timeframes and data parameters monitored by the national cancer data registry system. The Time 1 Survey study has the potential to serve as an informational tool for BC patient navigation efforts in Argentina because it can be used to identify and characterize the barriers and delays that women face during Time 1. Lessons and experiences included in this study could be translated to other Latin American and middle-income countries for developing cancer control programs that can lead to improving treatment and reducing mortality through patient navigation and cancer education efforts for the public, health professionals, and patients.

Ombitasvir/paritaprevir/ritonavir/dasabuvir ± ribavirin is safe and effective in HCV-infected patients in a real-life cohort from Latin America.

Information about the use of ombitasvir/paritaprevir/ritonavir/dasabuvir ± ribavirin (OBV/PTV/r/DSV ± RBV) in real-clinical practice in Latin America is scarce. We aimed to confirm safety and effectiveness of OBV/PTV/r/DSV ± RBV therapy in real-world setting. We analyzed a cohort of patients with genotype 1 infection treated with OBV/PTV/r/DSV ± RBV. Data on demographics, clinical features, safety, and virological response were retrospectively collected from 21 centers in Latin America. A total of 96 patients received OBV/PTV/r/DSV, associated with RBV in 68% of the cases. Most were genotype 1b (80%), 56 (58%) had cirrhosis, and 45 (47%) failed prior HCV treatment. Adverse events occurred in 62% of patients. The most common adverse events were pruritus (21%), hyperbilirubinemia (17%), and asthenia (17%). Five patients discontinued therapy prematurely due to hepatic decompensation, three of them were Child-Pugh B at baseline and one patient died due to multi-organ failure. Follow up HCV-RNA 12 weeks after completion of therapy was evaluated in all the patients and sustained virologic response rate was 97%. No virologic breakthrough was detected. Our study confirms that OBV/PTV/r/DSV treatment is highly effective in patients with chronic HCV without cirrhosis or with Child-Pugh A cirrhosis in non-European populations. Adverse events were often mild and rarely led to treatment discontinuation except for patients with Child-Pugh B cirrhosis or with previous history of hepatic decompensation. These results can support the development of public strategies to expand the access of OBV/PTV/r + DSV and other DAAs combinations in order to reduce the burden of HCV infection in our region.

Pan-American mDNA haplogroups in Chilean patients with Leber's hereditary optic neuropathy.

PURPOSE: The clinical impact of mDNA mutations on the development of Leber hereditary optic neuropathy (LHON) may be modulated by mitochondrial haplogroups, which vary across populations. The aim of this research was to determine the clinical spectrum and molecular characteristics, including the haplogroup, of 15 South American families with LHON. METHODS: This study was a prospective, observational study conducted between March 2006 and August 2012. All patients were referred to the Clinical Hospital of the University of Chile, where the clinical study was conducted. Molecular studies were conducted at the Biomedical Sciences Institute (ICBM) of the University of Chile. Fifteen index cases were identified with molecular analysis after initial neuroophthalmic examination at different centers throughout Chile. Clinical features of patients with LHON and maternal relatives of the 15 families (75 individuals: 26 affected and 49 healthy carriers) were evaluated. The primary mDNA mutations (m.3460G>A, m.11778G>A, or m.14484T>C) were determined with restriction fragment length polymorphism analysis in all individuals. Mitochondrial haplogroups were determined with direct sequencing of two hypervariable regions (HV1 and HV2) and compared with reference sequences. RESULTS: The m.11778G>A mutation was found in 59 subjects (78.7%), the m.14484T>C mutation was found in 12 subjects (16.0%), and the m.3460G>A mutation was found in four (5.3%) subjects. The average age of onset of symptoms in affected subjects was 22.2 years old (range 3 to 53 years); 21 (80.7%) were male, and five (19.3%) were female. Twelve families (80%) had Amerindian haplogroups: One family had the A2 haplogroup, four families had the B2i2 haplogroup, six families had the C1b haplogroup, and one family had the D1g haplogroup. CONCLUSIONS: In this limited sample size, the Amerindian haplogroup A2 was associated with delayed onset of disease in this population. Patients with haplogroup C retained better vision than the patients with other haplogroups in this population. Disease in subjects with haplogroup D appeared to be underrepresented compared to the population at large.

Short-term effects of a revegetation program on the Orthopteran diversity in oak forests of the southern Iberian Peninsula.

Orthopterans are insects closely linked to vegetation as primary consumers as well as for other biological processes such as oviposition and development. This research aims to assess the effect of a revegetation program that began in 2007 in the compensation area linked to the construction of the Breña II dam on Orthopteran diversity within several different human-created and natural habitats (forest-islands, hedges, and river-copses). We assessed vegetation and orthopteran communities during monthly sampling performed during March through September 2011. For the Orthopterans, two replicates per habitat type were sampled in each of the eight selected sampling plots, providing 48 observations per environment per month. To characterize the structure of communities, diversity, dominance, and evenness were calculated, and posterior comparisons were made using bootstrapping analysis. Additionally, rarefaction curves were obtained. We found large between-habitat differences in plant abundance but smaller differences in diversity. The high degree of vegetational homogeneity likely explains the structural similarity among the Orthopteran communities in the different habitats. Although Caelifera were more abundant and diverse in unmanaged biotopes, Ensifera seem to be favored in revegetated areas. Because accurate management requires documenting diversity at the field scale, work like that presented here should increase the efficiency of future assessments of Orthopteran habitat suitability for diversity conservation.

Epidemiology and risk factors for histopathologic characteristics of non-alcoholic fatty liver disease in South America.

BACKGROUND: The burden of non-alcoholic fatty liver disease (NAFLD) in South America is among the highest in the world. However, the epidemiology and risk factors for NAFLD are insufficiently described in the region. AIM: To explore the associations between clinical characteristics and histopathological features of NAFLD METHODS: This was a descriptive study of 2722 patients with NAFLD from 8 medical centres across 5 South American countries. We collected clinical, biochemical and histopathological data using a templated chart. Fibrosis was assessed by elastography or fibrosis scores and confirmed with biopsy when available. We examined associations between histopathological features and clinical characteristics with logistic regression models. Models were adjusted for country, age and sex. RESULTS: The median age was 53 years (IQR: 41-62), and 63% were women. Subjects from Brazil had the highest body mass index at 42 kg/m2 . Sixty-seven percent had dyslipidemia, 46% had obesity, 30% had hypertension, 17% had type 2 diabetes mellitus (T2DM) and 34% had metabolic syndrome. Biopsy reports were available for 948 (35%), of which 58% showed fibrosis, 91% steatosis and 65% inflammation; 25% showed significant fibrosis and 27% severe steatosis. Metabolic syndrome, T2DM and hypertension were significantly associated with significant fibrosis (OR = 1.94, p < 0.001; OR = 2.93, p < 0.001 and OR = 1.60, p = 0.003, respectively), severe steatosis (OR = 2.05, p < 0.001; OR = 1.91, p = 0.001 and OR = 2.17, p < 0.001, respectively) and liver inflammation (OR = 1.66, p = 0.007; OR = 2.00, p = 0.002; OR = 1.62, p = 0.001, respectively). CONCLUSIONS: In the largest NAFLD cohort study to date from South America, metabolic syndrome, hypertension and T2DM were independently associated with significant fibrosis, severe steatosis, and inflammation. The prevalence of T2DM was lower than the reported global prevalence.

Comparative study of visits to Hospital Emergency Department for opioid overdose in two periods.

OBJECTIVE: The last few years have seen an increase in the use of opioid analgesics and in the incidence of opioid overdoses. The objective of this study was to evaluate the number of overdose-related visits to a  university hospital emergency department at two different periods of time  to analyze potential differences in terms of patient characteristics,  prescription profile, and treatment. METHOD: This is a retrospective observational study of opioid  verdoserelated visits in two periods of time: 2009-2014 and 2018-2020. RESULTS: The study included 47 cases of opioid overdoses: 20 during the first period (3.3 cases/year) and 27 during the second (9 cases/year).  A comparison between the two period showed a decrease in the patients' age (81.1 vs 74.0; p = 0.044) and an increase in the number of  acute trauma-derived pain treatments at the expense of chronic pain  treatments (p = 0.002). No differences were observed in the opioids  involved. As regards symptoms, there was a decrease in the incidence of  confusional syndromes (p = 0.026) and an increase in deaths. CONCLUSIONS: Emergency room visits for opioid overdoses have increased in recent years, as has the mortality associated to them. A  change has also been observed in the profile of affected patients, with a  higher number of cases where pain is derived from acute trauma.

Objetivo: El uso de fármacos opioides ha aumentado en las últimas  écadas, así como las intoxicaciones relacionadas con su uso. El objetivo de este estudio es evaluar el número de visitas a urgencias en un hospital  universitario por intoxicaciones por opiáceos entre dos periodos y analizar  las posibles diferencias de las características de los pacientes, perfil de  prescripción y el tratamiento de dicha intoxicación.Método: Estudio observacional, retrospectivo de las visitas debidas a intoxicaciones por fármacos opiáceos en dos periodos: 2009-2014 y 2018-2020.Resultados: Se incluyeron 47 casos de intoxicaciones, 20 en el primer periodo (3,3 casos/año) y 27 en el segundo (9 casos/año). Se observó una disminución en la edad de los pacientes (81,1 versus 74,0; p = 0,044) y un incremento de tratamientos debidos a dolor  raumatológico agudo a expensas de menos tratamientos de dolor crónico (p = 0,002). No hubo diferencias en el opiáceo implicado. Con  respecto a la clínica, se observó una disminución en los síndromes  confusionales (p = 0,026) y un incremento de fallecimientos.Conclusiones: Las visitas a urgencias por intoxicaciones a fármacos opiáceos han aumentado en los últimos años, así como la  mortalidad asociada. El perfil de los pacientes implicados ha variado,  incrementándose el tratamiento de dolor traumatológico agudo.

Sex differences and the influence of social factors in a Chilean urban psychiatric hospital population.

BACKGROUND: The epidemiological literature has reported differences by sex in the prevalence of psychiatric diagnoses. However, we know little about how other socio-demographic factors participate in these differences. AIM: To identify the socio-demographic factors that correlate with prevalent psychiatric diagnoses in women and men in a Chilean urban psychiatric hospital population. METHOD: Socio-demographic information (age, educational level, marital status, family group and work status), psychiatric diagnoses and sex of the population were collected for 3,920 patients of a tertiary care hospital during a period of 8 years (2007-2014). The data were subjected to bivariate and multivariate analyses comparing the results by sex. RESULTS: Among the most prevalent psychiatric diagnoses, those significantly correlated with sex were eating disorders and major depression (women) and schizophrenia (men). Socio-demographic factors behave differently in men and women regarding those diagnoses. Among the differences, working and being married correlated directly with the diagnosis of depression only among women. Living alone correlated directly with the diagnosis of schizophrenia among men, but correlated inversely among women. CONCLUSION: Dissimilar associations between sex, psychiatric diagnosis and socio-demographic factors found in this Latin American sample invite us to reflect on how social conditions crosscut the relation between sex and psychopathology and to include gender perspectives in psychiatric practices.

Subregional efforts to improve childhood cancer care in the Andean countries / Iniciativas subregionales para mejorar la atención oncológica prestada a los pacientes pediátricos en los países andinos / Iniciativas sub-regionais para melhorar o tratamento do câncer infantil nos países andinos

ABSTRACT Cancer is one of the leading causes of death in children and adolescents younger than 19 years. An estimated 10 000 deaths are caused by this disease annually in this age group in Latin America and the Caribbean. In high-income countries, the survival of children and adolescents with neoplasms can reach 85%; however, in middle- and low-income countries, despite progress, survival rates are significantly lower (between 10% and 60%). Important inequities exist is survival from childhood cancer that need to be addressed through decisive actions from the health systems. This report describes the work of the ministries of health and the Secretariat of the Andean Health Organization (Organismo Andino de Salud - Convenio Hipólito Unánue (ORAS-CONHU)), to develop the Andean Cancer Prevention and Control Policy, with consideration given to childhood cancers. The policy was based on analysis of the cancer situation in the six Andean countries - Bolivia (Plurinational State of), Colombia, Chile, Ecuador, Peru and Venezuela (Bolivarian Republic of) - between 2015 and 2020, and it was approved in 2022. An in-depth study is currently being carried out on the situation of childhood cancer in the Andean countries.

RESUMEN El cáncer es una de las principales causas de muerte en la población infantil y adolescente menor de 19 años. Se estima que esta enfermedad ocasiona cada año 10 000 muertes en este grupo etario en América Latina y el Caribe. En los países de ingresos altos, la supervivencia de la población infantil y adolescente con neoplasias puede llegar al 85%; sin embargo, a pesar de los avances, en los países de ingresos bajos y medianos las tasas de supervivencia son significativamente más bajas (entre un 10% y un 60%). Existen desigualdades importantes en materia de supervivencia al cáncer infantil que es preciso abordar mediante medidas decisivas por parte de los sistemas de salud. En este informe se describe el trabajo realizado por los ministerios de salud y la Secretaría del Organismo Andino de Salud - Convenio Hipólito Unánue (ORAS-CONHU) para formular la Política Andina de Prevención y Control del Cáncer, con especial énfasis en el cáncer infantil. La política se basó en el análisis de la situación en materia oncológica de los seis países andinos -Bolivia (Estado Plurinacional de), Chile, Colombia, Ecuador, Perú y Venezuela (República Bolivariana de)- entre el 2015 y el 2020, y se aprobó en el 2022. En estos momentos, se está llevando a cabo un estudio pormenorizado sobre la situación del cáncer infantil en los países andinos.

RESUMO O câncer é uma das principais causas de morte em crianças e adolescentes menores de 19 anos. Estima-se que, nessa faixa etária, a doença cause 10 mil mortes por ano na América Latina e no Caribe. Em países de renda alta, a sobrevida de crianças e adolescentes com neoplasias pode chegar a 85%; no entanto, em países de renda média e baixa, apesar de alguns avanços, as taxas de sobrevida são significativamente menores (entre 10% e 60%). Existem iniquidades importantes na sobrevivência ao câncer infantil que precisam ser abordadas por meio de ações decisivas dos sistemas de saúde. Este relatório descreve o trabalho dos ministérios da saúde e da Secretaria do Organismo Andino de Saúde - Convênio Hipólito Unanue (ORAS-CONHU) para desenvolver a Política Andina de Prevenção e Controle do Câncer, com atenção para os cânceres infantis. A política, baseada em uma análise da situação do câncer nos seis países andinos - Bolívia (Estado Plurinacional da), Colômbia, Chile, Equador, Peru e Venezuela (República Bolivariana da) - entre 2015 e 2020, foi aprovada em 2022. Um estudo aprofundado está sendo realizado atualmente para avaliar a situação do câncer infantil nos países andinos.

The crisis of subsidiarity in the National Service for Minors: Chile (1994-2021) / La crisis de la subsidiariedad en el Servicio Nacional de Menores: Chile (1994-2021) / A crise da subsidiariedade no Serviço Nacional de Menores: Chile (1994-2021)

Abstract In recent years, Chile has experienced an intense socio-legislative debate in which the State and society have taken responsibility for children who, for various reasons, cannot be cared for by their biological families. The crisis in the child protection system has become evident, highlighting the need for reform. This article proposes a critical analysis of the implementation of this policy based on a descriptive-interpretative study of the documents and evaluation reports produced by the National Service for Minors between 1994 and 2018. The study identifies structural deficiencies in the system that continued since this institution was founded. The authors identify that the cause of these deficiencies is the principle of subsidiarity of the State in this area.

Resumen En los últimos años en Chile se asiste a un intenso debate sociolegislativo respecto al modo en que el Estado y la sociedad se responsabilizan de la niñez que, por diferentes razones, no puede estar al cuidado de sus familias consanguíneas. El sistema de protección de la infancia ha hecho evidente su crisis provocando la instalación de una reforma al sistema. En este artículo se propone un análisis crítico a la implementación de esta política, a partir de un estudio descriptivo-interpretativo de los documentos e informes evaluativos realizados al Servicio Nacional de Menores entre 1994 y 2018. Se identifican deficiencias estructurales en el sistema que han permanecido a lo largo de toda la historia de la institución y cuya causa es el principio de subsidiariedad del Estado en la materia.

Resumo (analítico) Nos últimos anos, o Chile tem sido testemunha de um intenso debate sócio-legislativo sobre a forma em que o Estado e a sociedade assumem a responsabilidade pelas crianças que, por diversos motivos, não podem ser cuidadas por suas famílias. A crise do sistema de proteção à infância foi extremamente evidente, o que alavancou uma reforma no sistema. Este artigo propõe uma análise crítica da implementação desta política, baseada em um estudo descritivo-interpretativo dos documentos e relatórios de avaliação do Serviço Nacional de Menores entre 1994-2018. Ele identifica deficiências estruturais no sistema que permaneceram ao longo da história da instituição e cuja causa é o princípio de subsidiariedade do Estado na matéria.

Estudio comparativo de las visitas a urgencias por intoxicaciones por opiáceos en dos periodos / Comparative study of visits to Hospital Emergency Department for opioid overdose in two periods

Objetivo: El uso de fármacos opioides ha aumentado en las últimas décadas, así como las intoxicaciones relacionadas con su uso. El objetivo de esteestudio es evaluar el número de visitas a urgencias en un hospital universitariopor intoxicaciones por opiáceos entre dos periodos y analizar las posiblesdiferencias de las características de los pacientes, perfil de prescripción y eltratamiento de dicha intoxicación.Método: Estudio observacional, retrospectivo de las visitas debidas aintoxicaciones por fármacos opiáceos en dos periodos: 2009-2014 y2018-2020.Resultados: Se incluyeron 47 casos de intoxicaciones, 20 en el primer periodo (3,3 casos/año) y 27 en el segundo (9 casos/año). Seobservó una disminución en la edad de los pacientes (81,1 versus 74,0;p = 0,044) y un incremento de tratamientos debidos a dolor traumatológico agudo a expensas de menos tratamientos de dolor crónico(p = 0,002). No hubo diferencias en el opiáceo implicado. Con respectoa la clínica, se observó una disminución en los síndromes confusionales(p = 0,026) y un incremento de fallecimientos.Conclusiones: Las visitas a urgencias por intoxicaciones a fármacosopiáceos han aumentado en los últimos años, así como la mortalidadasociada. El perfil de los pacientes implicados ha variado, incrementándose el tratamiento de dolor traumatológico agudo. (AU)

Objective: The last few years have seen an increase in the use of opioidanalgesics and in the incidence of opioid overdoses. The objective of thisstudy was to evaluate the number of overdose-related visits to a universityhospital emergency department at two different periods of time to analyzepotential differences in terms of patient characteristics, prescription profile,and treatment.Method: This is a retrospective observational study of opioid overdoserelated visits in two periods of time: 2009-2014 and 2018-2020.Results: The study included 47 cases of opioid overdoses: 20 during thefirst period (3.3 cases/year) and 27 during the second (9 cases/year). Acomparison between the two period showed a decrease in the patients’age (81.1 vs 74.0; p = 0.044) and an increase in the number of acutetrauma-derived pain treatments at the expense of chronic pain treatments(p = 0.002). No differences were observed in the opioids involved. Asregards symptoms, there was a decrease in the incidence of confusionalsyndromes (p = 0.026) and an increase in deaths.Conclusions: Emergency room visits for opioid overdoses have increased in recent years, as has the mortality associated to them. A changehas also been observed in the profile of affected patients, with a highernumber of cases where pain is derived from acute trauma. (AU)

Intoxicación letal por piedras chinas con ideación suicida / Poisoning by Chinese rocks: fatal outcome of a suicide attempt

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Bleeding and venous thromboembolism arising in acutely ill hospitalized medical patients. Findings from the Spanish national discharge database.

BACKGROUND: There is scarce evidence to identify which acutely ill medical patients might benefit from prophylaxis against venous thromboembolism (VTE). METHODS: The Spanish National Discharge Database was used to identify predictors of bleeding and VTE during hospitalization for an acute medical illness. RESULTS: Of 1,148,301 patients, 3.10% bled, 1.21% were diagnosed with VTE, and 8.64% died. The case-fatality rate was: 20.8% for bleeding and 19.7% for VTE. Eight clinical variables were independently associated with an increased risk for VTE and bleeding, one with a decreased risk for both events, 4 with an increased risk for VTE and a decreased risk for bleeding, 2 with an increased risk for bleeding but a decreased risk for VTE, and 1 with a decreased risk for bleeding. When all these variables were considered, we composed a risk scoring system, in which we assigned points to each variable according to the ratio between the odds ratio for bleeding and for VTE. Overall, 21% of patients scored less than 0 points and had a bleeding vs. VTE ratio of 1.19; 55% scored 0 to 1.0 points and had a ratio of 2.13; and 24% scored over 1.0 points and had a ratio of 6.10. CONCLUSIONS: A risk score based on variables documented at admission can identify patients with different ratios (near 1.0; about 2.0; and >6.0) between the rate of bleeding and of VTE.

Desigualdad e infancia: lectura crítica de la Historia de la Infancia en Chile y en América Latina / Inequality and childhood: a critical reading of the history of childhood in Chile and Latin America / Desigualdade e infância: leitura crítica da história da infância no Chile e na América Latina

En este artículo hago una revisión crítica de la historia de la infancia en Chile y en América Latina desde la época prehispánica, para desde allí aportar a la comprensión de los mecanismos de legitimación de la desigualdad social presentes hasta nuestros días. La historia de la infancia chilena es similar a la de otros países en América latina, por lo que su conocimiento puede permitir comprender de mejor forma la construcción y legitimación cotidiana del orden social.

This article engages in a critical reading of the history of childhood in Chile and Latin America since the pre-hispanic age in order to help understand the mechanisms of legitimization of social inequality that have existed. The history of childhood in Chile is similar to other countries in Latin America and as a result this analysis can allow for a better understanding of the construction and legitimization of social order.

Este artigo tem por objetivo revisar criticamente a história da infância no Chile e na América Latina desde o período pré-hispânica e a partir daí contribuir para a compreensão dos mecanismos de legitimação das desigualdades sociais presentes até hoje. A história de crianças chilenas é semelhante ao de outros países da América Latina, por isso o seu conhecimento pode ajudar a compreender a construção e legitimação da ordem social cotidiana.

Infancia, dictadura y resistencia: hijos e hijas de la izquierda chilena (1973-1989) / Children, dictatorship and resistance: sons and daughters of the Chilean left (1973-1989)

En este artículo de investigación recuperamos la voz de los hijos-niños e hijas-niñas de la gente militante de la izquierda de Chile, a partir del análisis de sus producciones simbólicas y registros de la vida cotidiana tales como cartas, dibujos, objetos realizados entre 1973 y 1989, y entrevistas registradas en documentales de la época que se encuentran actualmente en el Museo de la Memoria y los Derechos Humanos de Santiago de Chile, analizadas desde la perspectiva de los nuevos estudios de la infancia. Reflexionamos respecto al modo en que los niños y niñaselaboran su juicio y sentido de la realidad y construyen un sentido ético que dialoga con la herencia intergeneracional, pero la excede, reflejando su activa participación en la construcción de una comunidad afectiva que trasciende los vínculos consanguíneos...

Comparison of the clinical efficacy of two different immunosuppressive regimens in patients with chronic vogt-koyanagi-harada disease.

PURPOSE: To prospectively compare 2 immunosupressive regimens in patients with active Vogt-Koyanagi-Harada disease in spite of systemic glucocorticoid treatment. METHODS: Forty-four patients were diagnosed between 1998 and 2005. Twenty-one developed chronic intraocular inflammation in spite of glucocorticoid treatment and were randomized to receive either prednisone and azathioprine (AZA) (n = 12) or prednisone and cyclosporine (CyA) (n = 9). RESULTS: In the AZA group Tyndall score decreased from 1.21 +/- 1.10 to 0.29 +/- 0.62 (p < .01), and visual acuity (LogMAR) improved from 0.32 +/- 0.35 to 0.09 +/- 0.16 (p < .001). In the CyA group Tyndall score decreased from 1.67 +/- 1.08 to 0.16 +/- 0.51 (p < .001), and visual acuity improved from 0.41 +/- 0.40 to 0.25 +/- 0.42 (p < .001). Patients in the AZA group needed a significantly higher average prednisone dose and total cumulative dose than those in the CyA group, p < .01 for each comparison. CONCLUSIONS: Both regimens showed a good clinical efficacy, but CyA seems to be a better glucocorticoid-sparing agent than AZA.

Juego ampliado, juego restringido Producciones simbólicas tempranas en contextos de desigualdad / Play Elaborated, Play Restricted Early Symbolic Productions that Reproduce Inequality

La indagación de las consecuencias de la desigualdad ha sido un importante tema de investigación desde hace varios años. Sin embargo, pocos estudios han abordado este tema desde la perspectiva de comprender cuáles de las consecuencias encontradas inciden directamente en la reproducción y perpetuación de una determinada estratificación social. Esta investigación se desarrolló en Santiago de Chile y se propuso indagar en la infancia temprana las características del juego simbólico, con la finalidad de acceder a las formas tempranas de subjetivación y comprender desde ahí las diferencias en la identificación y en la transmision transgeneracional de contenidos que explicarían la reproducción de la desigualdad. Utilizando la metodología de observación clínica del juego infantil, se observaron niños de 3 a 5 años en el espacio educacional y familiar. Se identificaron siete dimensiones de diferenciación, con las cuales se describen las caracteristicas de dos modalidades de juego: ampliado y restringido.

The inquiry into consequences of inequality has been an important research topic for several years to date. However, few studies have addressed this issue from the perspective of understanding which consequences found affect directly the reproduction and maintenance of a certain social stratification. This research aimed to investigate the characteristics of symbolic play in early childhood (3-5 years) in Santiago de Chile, order to access the earliest forms of subjectivity and understand from their differences in identification and transmission transgenerational content which explain the reproduction of inequality. Using the methodology of clinical observation of children's play, children 3 to 5 years were observed in the educational and family space. Seven dimensions of differentiation with which the characteristics of two modes of play were identified.