Empirical approaches for rock burst prediction: A comprehensive review and application to the new level of El Teniente Mine, Chile.

Rockburst phenomena pose significant challenges in the mining industry, particularly with increased underground activities at greater depths. These sudden failures not only jeopardize personnel safety but also impact mining investments. Consequently, it becomes crucial to assess the reliability and effectiveness of empirical methods employed for predicting rock burst occurrences and their severity, an ongoing subject of debate within the scientific community. This research presents a comprehensive review of empirical approaches for rock burst prediction. Subsequently, these approaches are applied to predict rock burst occurrences and its intensity within sections of a tunnel at the new level of El Teniente mine in Chile. Most of these methods rely on single-factor criteria to predict the likelihood and severity of rock bursts. However, inconsistencies are observed in the results obtained from these approaches in numerous cases. This discrepancy highlights the influence of various input parameters on rock burst estimations and emphasizes that single-index criteria may not encompass all the pertinent factors that contribute to this phenomenon. Consequently, such criteria may inadequately estimate or reflect the probability of rock burst occurrences. Given the multifaceted nature of rock burst phenomena, which depend on multiple factors, it becomes imperative to explore new approaches that consider a broader range of influencing factors, thereby yielding more realistic results. Hence, continued research is essential to develop new methods that address this issue comprehensively and ensure the safety of the mining industry.

Effects of human mobility on the spread of Dengue in the region of Caldas, Colombia.

According to the World Health Organization (WHO), dengue is the most common acute arthropod-borne viral infection in the world. The spread of dengue and other infectious diseases is closely related to human activity and mobility. In this paper we analyze the effect of introducing mobility restrictions as a public health policy on the total number of dengue cases within a population. To perform the analysis, we use a complex metapopulation in which we implement a compartmental propagation model coupled with the mobility of individuals between the patches. This model is used to investigate the spread of dengue in the municipalities of Caldas (CO). Two scenarios corresponding to different types of mobility restrictions are applied. In the first scenario, the effect of restricting mobility is analyzed in three different ways: a) limiting the access to the endemic node but allowing the movement of its inhabitants, b) restricting the diaspora of the inhabitants of the endemic node but allowing the access of outsiders, and c) a total isolation of the inhabitants of the endemic node. In this scenario, the best simulation results are obtained when specific endemic nodes are isolated during a dengue outbreak, obtaining a reduction of up to 2.5% of dengue cases. Finally, the second scenario simulates a total isolation of the network, i.e., mobility between nodes is completely limited. We have found that this control measure increases the number of total dengue cases in the network by 2.36%.

Durable benefit after treatment of obstructive benign prostatic hyperplasia with a novel drug-device combination product: 2-year outcomes from the EVEREST-I study.

PURPOSE: To evaluate the safety and efficacy of the Optilume BPH Catheter System for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). METHODS: This open-label, single-arm study enrolled eighty subjects with LUTS secondary to BPH who were treated with the Optilume BPH Catheter System. Symptoms were recorded utilizing the International Prostate Symptom Score (IPSS) and Benign Prostatic Hyperplasia Impact Index (BPH-II). Functional improvement was measured utilizing peak urinary flow rate (Qmax) and post-void residual urine volume (PVR). Adverse events were systematically captured and reported at each follow-up visit. RESULTS: Subjects treated with the Optilume BPH Catheter System experienced a significant improvement in LUTS from baseline through 2 years of follow-up, as measured by IPSS (22.3 vs 8.2, p < 0.001) and BPH-II (6.9 vs 2.3, p < 0.001). Functional improvement was also significant, with Qmax improving from an average of 10.9 mL/s at baseline to 17.2 mL/s at the 2-year follow-up and PVR improving from 63.1 to 45.0 mL. Treatment-related adverse events were typically minor, with none occurring between 1- and 2-year post-treatment. CONCLUSIONS: The Optilume BPH Catheter System is a unique minimally invasive surgical therapy that combines mechanical and pharmaceutical aspects for the treatment of BPH. The functional and symptomatic improvements seen after treatment are significant and have been sustained through 2 years in this early feasibility study. REGISTRATION: NCT03423979, registered February 6, 2018.

Diferencias en los niveles de sexismo en estudiantes de educación física según variables sociodemográficas / Differences in the levels of sexism in physical education students according to sociodemographic variables / Diferenças nos níveis de sexismo em estudantes de educação física segundo variáveis sociodemográficas

El sexismo es el conjunto de creencias y características que son socialmente consideradas apropiadas para hombres y mujeres, en el caso de los varones, actividades asociadas a la fuerza, virilidad, entre otras características, mientras que a las damas se ligan actividades como la belleza, expresión corporal, entre otras. El objetivo de la presente investigación fue analizar las diferencias en el sexismo en los estudiantes en formación de pedagogía en educación física de una Universidad de Santiago de Chile según diversas variables sociodemográficas. Para ello se aplicó el Inventario de Sexismo Ambivalente (ISA) a 201 participantes. Los resultados evidenciaron bajos niveles de sexismo, los niveles de sexismo hostil y benevolente disminuyen conforme avanza la carrera y que los hombres puntúan más alto que las mujeres los dos tipos de sexismo. Se concluye que el sexo, año de carrera, orientación sexual y las creencias religiosas influyen en los niveles de sexismo de los estudiantes de Educación Física.

Sexism is the set of beliefs and characteristics that are socially considered appropriate for men and women, in the case of men, activities associated with strength, and virility, among other features, while the ladies are related to activities such as beauty and body expression, among others. The objective of the present research was to analyze the differences in sexism among the students in pedagogy training in physical education at the University of Santiago de Chile according to various sociodemographic variables. The Ambivalent Sexism Inventory (ASI) was applied to 201 participants. The results showed low levels of sexism, the levels of hostile and benevolent sexism decrease as the career progresses, and that men score higher than women in the two types of sexism. It is concluded that sex, career year, sexual orientation, and religious beliefs influence the sexism levels of physical education students.

Sexismo é o conjunto de crenças e características que são socialmente consideradas apropriadas para homens e mulheres, no caso dos homens, atividades associadas à força, virilidade, entre outras características, enquanto as mulheres estão ligadas a atividades como beleza, expressão corporal, entre outras. O objetivo da presente pesquisa foi analisar as diferenças no sexismo nos estudantes em formação de pedagogia em educação física de uma Universidade de Santiago do Chile segundo diversas variáveis sociodemográficas. Para este fim, o Inventário do Sexismo Ambivalente (ISA) foi aplicado a 201 participantes. Os resultados mostraram baixos níveis de sexismo, com níveis de sexismo hostil e benevolente diminuindo à medida que o curso avançava, e que os homens pontuavam mais alto que as mulheres em ambos os tipos de sexismo. Conclui-se que gênero, ano de estudo, orientação sexual e crenças religiosas influenciam os níveis de sexismo dos estudantes de Educação Física.

Natural infection of Chiromyzinae larvae (Diptera: Stratiomyidae) in southern Chile by Tolypocladium valdiviae sp. nov.

A new species from the fungal genus Tolypocladium (Hypocreales: Ophiocordycipitaceae) that infects Stratiomyidae larva from the genus Hylorops is described: Tolypocladium valdiviae Gallardo-Pillancari, Montalva & González. The description is based on both genomic data and morphological characteristics. The sexual stage of T. valdiviae presents fleshy and visible stromata; unlike Tolypocladium ophioglossoides, it is smaller and emerges directly from its host and resembles Tolypocladium longisegmentis and Tolypocladium capitatum, both of which are parasites of deer truffle fungi of the genus Elaphomyces (Ascomycota: Eurotiales). In the anamorphic state, T. valdiviae presents conidiogenous cells similar in shape and arrangement to those of Tolypocladium inflatum, however T. valdiviae produces larger conidiogenous cells and, occasionally, produces chlamydospores. Phylogenetic evidence suggested that T. valdiviae is in a clade close to T. longisegmentis, T. inflatum and T. ophioglossoides, species also recognized to be parasites of fungi of the genus Elaphomyces. The new species is known so far only from Valdivia, southern Chile.

Experiencia formadora con cuatro guías de buenas prácticas clínicas de la registered nurses' association of ontario

El presente artículo trata sobre la implementación de cuatro guías elaboradas por la Registered Nurses' Association of Ontario (Canadá) en la enseñanza de pregrado de la Carrera de Enfermería de la Universidad de Chile, proceso que se enmarca en el primer convenio establecido entre la Universidad de Chile y esta asociación. El acuerdo instaurado entre ambas instituciones promovió la incorporación de las guías: Valoración y Selección de Accesos Vasculares, Atención a las Familias, Establecimiento de Relación Terapéutica, y Valoración y Manejo del Dolor, al plan de formación de la Carrera de Enfermería, proceso liderado por docentes asesores de cada una de las guías a través de diversas estrategias pedagógicas y didácticas, demostrando un aporte significativo de este material al aprendizaje de los estudiantes de enfermería de la institución académica.

This article describes the implementation of four guidelines developed by the Registered Nurses' Association of Ontario for undergraduate nursing education at the Universidad de Chile, a process that is part of the first agreement reached between the University of Chile and the Registered Nurses' Association of Ontario. The agreement established between both institutions helped incorporate the following guidelines: Assessment and Selection of Vascular Accesses, Family Care, Establishment of Therapeutic Relationship, and Assessment and Management of Pain, into the training plan of the nursing program, a process led by the faculty advisors of each of the guidelines through various pedagogical and didactic strategies, demonstrating a significant contribution of this material to the learning process of the nursing students.

Este artigo trata da implementação de quatro guias desenvolvidas pela Associação de Enfermeiros Registrados de Ontário (Canadá) para a educação de enfermagem de graduação na Universidade do Chile, um processo que faz parte do primeiro acordo estabelecido entre Universidade do Chile e a Associação de Enfermeiros Registrados de Ontário. O acordo assinado entre as duas instituições promoveu a incorporação das seguintes guias: Avaliação e Seleção de Acessos Vasculares, Cuidado Familiar, Estabelecimento de Relacionamento Terapêutico e Avaliação e Gerenciamento da Dor, ao plano de treinamento do programa de enfermagem, um processo conduzido pelos orientadores de cada uma das guias através de várias estratégias pedagógicas e didáticas, demonstrando uma contribuição significativa deste material para o aprendizado dos estudantes de enfermagem.

Frequency of antibodies and seroconversion against Rickettsia spp in patients consulting health institutions in the department of Caldas, Colombia, 2016-2019 / [Frecuencia de anticuerpos y seroconversión frente a Rickettsia spp. en pacientes atendidos en instituciones de salud del departamento de Caldas, Colombia, 2016-2019].

Introduction: Rickettsioses are zoonotic diseases transmitted by arthropods acting as vectors and reservoirs. Disease symptoms are nonspecific and, therefore, their clinical diagnosis is difficult. Indirect immunofluorescence (IFA) is the gold standard assay for diagnosis. The interest for conducting studies on these pathologies has resurfaced in Colombia since 2001; besides, previous studies have evidenced cases of rickettsiosis in the north of the department of Caldas. Objective: To establish the frequency of antibodies and seroconversion against Rickettsia spp. In patients consulting health institutions in Caldas, Colombia, from 2016 to 2019. Materials and methods: We conducted a quantitative, observational, and descriptive study on a non-probabilistic sample of 175 patients with symptoms compatible with rickettsiosis who consulted in different municipalities of Caldas, Colombia; IFA was performed to detect antibodies in the acute and convalescent phases against Rickettsia rickettsii, Rickettsia typhi, and Rickettsia felis. Results: The average age of the patients was 31 years. The municipalities with the highest proportion of seropositive cases were Belalcázar, Chinchiná, Filadelfia, La Dorada, La Merced, and Manizales; 66% of patients owned pets and 12% reported arthropod bites. The most frequent signs and symptoms were headache (69.7%), arthromyalgia (60%), and fever (58.2%). IgG seroprevalence was 60% for R. rickettsii, 47.9% for R. typhi, and, and 24% for R. felis. Eight patients presented seroconversion. Conclusion: We found evidence of the circulation of Rickettsia species from the spotted fever group and the typhus group associated with human cases in Caldas.

Introducción. Las rickettsiosis son enfermedades zoonóticas transmitidas por artrópodos que cumplen el papel de vectores y reservorios, y cuyos síntomas son inespecíficos, por lo que su diagnóstico clínico es difícil. La inmunofluorescencia indirecta (IFI) es el método de referencia para el diagnóstico. En Colombia, ha resurgido el interés por su estudio por los casos de rickettsiosis detectados en el norte del departamento de Caldas a partir del 2001. Objetivo. Establecer la frecuencia de anticuerpos y la seroconversión contra Rickettsia spp. en pacientes atendidos en instituciones de salud del departamento de Caldas, Colombia, entre 2016 y 2019. Materiales y métodos. Se hizo un estudio de diseño cuantitativo, observacional y descriptivo, con una muestra no probabilística de 175 pacientes atendidos en diferentes municipios de Caldas, a quienes se les realizó IFI para la detección de anticuerpos en fase aguda y convaleciente contra Rickettsia rickettsii, R. typhi y R. felis. Resultados. El promedio de edad de los pacientes fue de 31 años. Los municipios con mayor proporción de seropositivos fueron Belalcázar, Chinchiná, Filadelfia, La Dorada, La Merced y Manizales. El 66 % tenía mascotas y el 12 % reportó picaduras por artrópodos. Los signos y síntomas más frecuentes fueron cefalea (69,7 %), artromialgia (60 %), y fiebre (58,2 %). La seroprevalencia por IgG fue de 60 % para R. rickettsii, 47,9 % para R. typhi y 24 % para R. felis. Ocho pacientes presentaron seroconversión. Conclusión. Se encontró evidencia de la circulación de rickettsias del grupo de las fiebres manchadas y del grupo del tifus asociada con casos humanos en el departamento de Caldas.

Frecuencia de anticuerpos y seroconversión frente a Rickettsia spp. en pacientes atendidos en instituciones de salud del departamento de Caldas, Colombia, 2016-2019 / Frequency of antibodies and seroconversion against Rickettsia spp in patients consulting health institutions in the department of Caldas, Colombia, 2016-2019

Resumen | Introducción. Las rickettsiosis son enfermedades zoonóticas transmitidas por artrópodos que cumplen el papel de vectores y reservorios, y cuyos síntomas son inespecíficos, por lo que su diagnóstico clínico es difícil. La inmunofluorescencia indirecta (IFI) es el método de referencia para el diagnóstico. En Colombia, ha resurgido el interés por su estudio por los casos de rickettsiosis detectados en el norte del departamento de Caldas a partir del 2001. Objetivo. Establecer la frecuencia de anticuerpos y la seroconversión contra Rickettsia spp. en pacientes atendidos en instituciones de salud del departamento de Caldas, Colombia, entre 2016 y 2019. Materiales y métodos. Se hizo un estudio de diseño cuantitativo, observacional y descriptivo, con una muestra no probabilística de 175 pacientes atendidos en diferentes municipios de Caldas, a quienes se les realizó IFI para la detección de anticuerpos en fase aguda y convaleciente contra Rickettsia rickettsii, R. typhi y R. felis. Resultados. El promedio de edad de los pacientes fue de 31 años. Los municipios con mayor proporción de seropositivos fueron Belalcázar, Chinchiná, Filadelfia, La Dorada, La Merced y Manizales. El 66 % tenía mascotas y el 12 % reportó picaduras por artrópodos. Los signos y síntomas más frecuentes fueron cefalea (69,7 %), artromialgia (60 %), y fiebre (58,2 %). La seroprevalencia por IgG fue de 60 % para R. rickettsii, 47,9 % para R. typhi y 24 % para R. felis. Ocho pacientes presentaron seroconversión. Conclusión. Se encontró evidencia de la circulación de rickettsias del grupo de las fiebres manchadas y del grupo del tifus asociada con casos humanos en el departamento de Caldas.

Abstract | Introduction: Rickettsioses are zoonotic diseases transmitted by arthropods acting as vectors and reservoirs. Disease symptoms are nonspecific and, therefore, their clinical diagnosis is difficult. Indirect immunofluorescence (IFA) is the gold standard assay for diagnosis. The interest for conducting studies on these pathologies has resurfaced in Colombia since 2001; besides, previous studies have evidenced cases of rickettsiosis in the north of the department of Caldas. Objective: To establish the frequency of antibodies and seroconversion against Rickettsia spp. In patients consulting health institutions in Caldas, Colombia, from 2016 to 2019. Materials and methods: We conducted a quantitative, observational, and descriptive study on a non-probabilistic sample of 175 patients with symptoms compatible with rickettsiosis who consulted in different municipalities of Caldas, Colombia; IFA was performed to detect antibodies in the acute and convalescent phases against Rickettsia rickettsii, Rickettsia typhi, and Rickettsia felis. Results: The average age of the patients was 31 years. The municipalities with the highest proportion of seropositive cases were Belalcázar, Chinchiná, Filadelfia, La Dorada, La Merced, and Manizales; 66% of patients owned pets and 12% reported arthropod bites. The most frequent signs and symptoms were headache (69.7%), arthromyalgia (60%), and fever (58.2%). IgG seroprevalence was 60% for R. rickettsii, 47.9% for R. typhi, and, and 24% for R. felis. Eight patients presented seroconversion. Conclusion: We found evidence of the circulation of Rickettsia species from the spotted fever group and the typhus group associated with human cases in Caldas.

[«Missing time¼: Experiences of demand management doctors in Chilean primary health care]. / «Falta tiempo¼: experiencias de médicos gestores de la demanda en la atención primaria de salud chilena.

OBJECTIVE: Characterize the current situation of the demand manager physician (DMP) in primary health care (PHC), from the perceptions of those who fulfill this role, their medical peers and the directors of the family health centers (CESFAMs). DESIGN: Qualitative cross-sectional study with a grounded theory approach. SITE: Four CESFAMs from the South East Metropolitan Health Service in Santiago, Chile. PARTICIPANTS: Demand manager physician, general practitioners and directors of CESFAM. METHOD: A semi-structured interview and discussion group were used as data collection technique. Open, axial, and selective coding was carried out with the support of the NVivo12 software. RESULTS: In practice, DMP performs more functions than those defined for the position by the Ministry of Health, generating the feeling of lack of time to carry out their work, what represents their main barrier at work and reflects the absence of institutional support they receive from their employees. Among these invisible functions are: providing feedback to the medical team, leading clinical meetings, and generating reference protocols. For the good performance of the DMP it is necessary to have technical skills and be recognized by their peers. It was estimated that the family doctor is the most suitable professional for the position. The work of the DMP is limited by institutional factors such as waiting lists, lack of specialists, and poor coordination between levels of care. CONCLUSIONS: Standardizing the functions of the DMP is a necessary element for its consolidation and achieving the objectives of maintaining continuity of care in the population.

Beyond Atherothrombotic Disease in Acute Coronary Syndrome

Abstract Half of the global population over 20 years of age will be affected by cardiovascular disease. Cardiovascular events in young people is challenging. Spontaneous coronary artery dissection is a non-traumatic and non-iatrogenic separation of the coronary arterial wall and is an uncommon and underdiagnosed cause of acute myocardial infarction predominately found in young women. Medical management has been more widely accepted, with percutaneous and surgery treatment reserved for precise indications. Optimal control of individual risk factors is essential in order to avoid recurrences.

Advances and Applications of Water Phytoremediation: A Potential Biotechnological Approach for the Treatment of Heavy Metals from Contaminated Water.

Potable and good-quality drinking water availability is a serious global concern, since several pollution sources significantly contribute to low water quality. Amongst these pollution sources, several are releasing an array of hazardous agents into various environmental and water matrices. Unfortunately, there are not very many ecologically friendly systems available to treat the contaminated environment exclusively. Consequently, heavy metal water contamination leads to many diseases in humans, such as cardiopulmonary diseases and cytotoxicity, among others. To solve this problem, there are a plethora of emerging technologies that play an important role in defining treatment strategies. Phytoremediation, the usage of plants to remove contaminants, is a technology that has been widely used to remediate pollution in soils, with particular reference to toxic elements. Thus, hydroponic systems coupled with bioremediation for the removal of water contaminants have shown great relevance. In this review, we addressed several studies that support the development of phytoremediation systems in water. We cover the importance of applied science and environmental engineering to generate sustainable strategies to improve water quality. In this context, the phytoremediation capabilities of different plant species and possible obstacles that phytoremediation systems may encounter are discussed with suitable examples by comparing different mechanistic processes. According to the presented data, there are a wide range of plant species with water phytoremediation potential that need to be studied from a multidisciplinary perspective to make water phytoremediation a viable method.

Utilization of Marine Waste to Obtain ß-Chitin Nanofibers and Films from Giant Humboldt Squid Dosidicus gigas.

ß-chitin was isolated from marine waste, giant Humboldt squid Dosidicus gigas, and further converted to nanofibers by use of a collider machine under acidic conditions (pH 3). The FTIR, TGA, and NMR analysis confirmed the efficient extraction of ß-chitin. The SEM, TEM, and XRD characterization results verified that ß-chitin crystalline structure were maintained after mechanical treatment. The mean particle size of ß-chitin nanofibers was in the range between 10 and 15 nm, according to the TEM analysis. In addition, the ß-chitin nanofibers were converted into films by the simple solvent-casting and drying process at 60 °C. The obtained films had high lightness, which was evidenced by the CIELAB color test. Moreover, the films showed the medium swelling degree (250-290%) in aqueous solutions of different pH and good mechanical resistance in the range between 4 and 17 MPa, depending on film thickness. The results obtained in this work show that marine waste can be efficiently converted to biomaterial by use of mild extractive conditions and simple mechanical treatment, offering great potential for the future development of sustainable multifunctional materials for various industrial applications such as food packaging, agriculture, and/or wound dressing.

Design, Synthesis, and In Silico Multitarget Pharmacological Simulations of Acid Bioisosteres with a Validated In Vivo Antihyperglycemic Effect.

Substituted phenylacetic (1-3), phenylpropanoic (4-6), and benzylidenethiazolidine-2,4-dione (7-9) derivatives were designed according to a multitarget unified pharmacophore pattern that has shown robust antidiabetic activity. This bioactivity is due to the simultaneous polypharmacological stimulation of receptors PPARα, PPARγ, and GPR40 and the enzyme inhibition of aldose reductase (AR) and protein tyrosine phosphatase 1B (PTP-1B). The nine compounds share the same four pharmacophore elements: an acid moiety, an aromatic ring, a bulky hydrophobic group, and a flexible linker between the latter two elements. Addition and substitution reactions were performed to obtain molecules at moderated yields. In silico pharmacological consensus analysis (PHACA) was conducted to determine their possible modes of action, protein affinities, toxicological activities, and drug-like properties. The results were combined with in vivo assays to evaluate the ability of these compounds to decrease glucose levels in diabetic mice at a 100 mg/kg single dose. Compounds 6 (a phenylpropanoic acid derivative) and 9 (a benzylidenethiazolidine-2,4-dione derivative) ameliorated the hyperglycemic peak in a statically significant manner in a mouse model of type 2 diabetes. Finally, molecular dynamics simulations were executed on the top performing compounds to shed light on their mechanism of action. The simulations showed the flexible nature of the binding pocket of AR, and showed that both compounds remained bound during the simulation time, although not sharing the same binding mode. In conclusion, we designed nine acid bioisosteres with robust in vivo antihyperglycemic activity that were predicted to have favorable pharmacokinetic and toxicological profiles. Together, these findings provide evidence that supports the molecular design we employed, where the unified pharmacophores possess a strong antidiabetic action due to their multitarget activation.

Prevención de enfermedad hemolítica perinatal severa con inmunoglobulina intravenosa en paciente altamente sensibilizada / Prevention of severe perinatal hemolytic disease with intravenous immunoglobulin in a highly sensitized patient

RESUMEN La enfermedad hemolítica perinatal es infrecuente hoy por la prevención que de ella se hace. Sin embargo, existen casos de madres altamente sensibilizadas que desean tener un hijo, lo que obliga a que ese embarazo deseado sea controlado de manera especial y sometido a procedimientos invasivos no exentos de morbimortalidad fetal. El uso prenatal de inmunoglobulina humana en la madre puede representar una alternativa terapéutica. Se presenta un caso en que su uso impidió el desarrollo de enfermedad intrauterina y favoreció la buena evolución neonatal a pesar de que el pronóstico inicial era muy adverso.

ABSTRACT Perinatal Hemolytic Disease is uncommon today due to its prevention. However, there are cases of highly sensitized mothers who wish to have a child, that forces this desired pregnancy to be controlled in a special way and be subjected to invasive procedures not exempt from fetal morbidity and mortality. Prenatal use of human inmunoglobulin in the mother may represent a therapeutic alternative. We present a case in which its use prevented the development of intrauterine disease and favored a good neonatal evolution despite the fact that the initial prognosis was very adverse.

Bladder squamous cell carcinoma in a pregnant woman: case report and review of the literature.

BACKGROUND: Bladder tumors in pregnancy are extremely rare. No more than 50 cases have been published to date, including all histologic variants, and only three cases of bladder squamous cell carcinoma have been described. CASE PRESENTATION: We present a clinical case of a 31-year-old woman with bladder squamous cell carcinoma in the second trimester of pregnancy. After a C-section at 30 weeks, we performed radical cystectomy with extended bilateral lymphadenectomy, hysterectomy and right oophorectomy. The Studer neobladder technique was performed for urinary tract reconstruction. Definitive pathology showed invasive bladder squamous cell carcinoma, Grade 2, with microscopic infiltration of the perivesical fat, negative margins, and 3/28 lymph nodes with carcinoma (pT3aN2M0). The patient underwent 18 months of surveillance after radical cystectomy, without recurrence by PET-CT. CONCLUSIONS: Bladder cancer in pregnant women is extremely rare but must be considered in those with recurrent gross hematuria and/or recurrent urinary tract infection. To our knowledge, this case involves the longest recurrence-free survival of a pregnant woman with squamous cell bladder cancer published thus far.

Caracterización de las consultas de la población migrante adulta en un servicio de urgencia público del área norte de Santiago de Chile durante 2018 / Characterization of the consultations of the adult migrant population in a public emergency service in the northern area of Santiago Chile in 2018

RESUMEN La migración internacional aumenta de forma sostenida a nivel mundial. En Chile los migrantes internacionales son un 4,4% de su población. A nivel mundial, los servicios de urgencia son elegidos por los migrantes para solucionar problemas de salud. Objetivo Caracterizar la población migrante adulta atendida en una urgencia pública del área metropolitana de Santiago durante 2018. Métodos Mediante estadística descriptiva simple, se analiza la base de datos del centro, teniendo en cuenta aspectos éticos. Resultados Del total de consultas, un 13,72% corresponde a migrantes. De ellos, el 95,3% reside en comunas asignadas al hospital. El rango de edad predominante es de 20 a 44 años y sus países de procedencia son, principalmente, Perú, Haití, Venezuela, Colombia y Bolivia. Un 10,67% declara no tener cobertura médica. La mayoría de las consultas (62,33%) tiene pronóstico leve. Los diagnósticos de chilenos y extranjeros dentro del grupo etario de 20 a 44 años coinciden en diferente orden, pero en migrantes las enfermedades respiratorias, digestivas e infecciosas/parasitarias se presentan con mayor frecuencia. Discusión Las consultas de migrantes reflejan condiciones leves a moderadas de salud propias de personas sanas; incluso, se puede hablar del "efecto migrante sano". Debido a la similitud de los diagnósticos entre chilenos y extranjeros en el grupo etario y nivel socioeconómico se infiere una condición de salud similar. Dado que la mayoría de las consultas de migrantes se categorizaron con menor gravedad, tienen pronóstico leve, menores tasas de hospitalización y su principal destino es el domicilio, se evidencia el uso del servicio de urgencia como primera opción ante problemas de salud.

ABSTRACT International migration is increasing steadily worldwide. In Chile 4.4% of its population are migrants. Worldwide, emergency rooms are chosen by migrants to solve health problems. Objective Characterize the adult migrant population treated in a public emergency service of the Santiago metropolitan region during 2018. Method Through simple descriptive statistics, the center's database is analyzed, keeping in mind ethical aspects. Results 13.72% of the total consultations were migrants. Of these 95.3% resided in localities assigned to the hospital; they are granted between the ages of 20 and 44 and came mainly from: Peru, Haiti, Venezuela, Colombia and Bolivia. 10.67% does not hold health coverage. Most consultations (62.33%) have a mild prognosis. The diagnoses of Chileans and foreigners within the age group of 20 to 44 years old coincide in a different order, however, migrants most frequently present respiratory, digestive and infectious / parasitic diseases. Discussion Migrant consultations reflect mild to moderate health conditions typical of healthy people, being able to talk about the "healthy migrant effect". As the diagnoses between Chileans and foreigners coincide in the age group and socioeconomic level, it can be said that they have a similar health condition. Due to most of the migrant consultations were categorized with less severity, have a mild prognosis, lower hospitalization rates and their main destination is domicile, there is evidence that they use the emergency service as the first option facing health problems.

[Characterization of the consultations of the adult migrant population in a public emergency service in the northern area of Santiago Chile in 2018]. / Caracterización de las consultas de la población migrante adulta en un servicio de urgencia público del área norte de Santiago de Chile durante 2018.

BACKGROUND: International migration is increasing steadily worldwide. In Chile 4.4% of its population are migrants. Worldwide, emergency rooms are chosen by migrants to solve health problems. OBJECTIVE: Characterize the adult migrant population treated in a public emergency service of the Santiago metropolitan region during 2018. METHOD: Through simple descriptive statistics, the center's database is analyzed, keeping in mind ethical aspects. RESULTS: 13.72% of the total consultations were migrants. Of these 95.3% resided in localities assigned to the hospital; they are granted between the ages of 20 and 44 and came mainly from: Peru, Haiti, Venezuela, Colombia and Bolivia. 10.67% does not hold health coverage. Most consultations (62.33%) have a mild prognosis. The diagnoses of Chileans and foreigners within the age group of 20 to 44 years old coincide in a different order, however, migrants most frequently present respiratory, digestive and infectious / parasitic diseases. DISCUSSION: Migrant consultations reflect mild to moderate health conditions typical of healthy people, being able to talk about the "healthy migrant effect". As the diagnoses between Chileans and foreigners coincide in the age group and socioeconomic level, it can be said that they have a similar health condition. Due to most of the migrant consultations were categorized with less severity, have a mild prognosis, lower hospitalization rates and their main destination is domicile, there is evidence that they use the emergency service as the first option facing health problems.

BACKGROUND: La migración internacional aumenta de forma sostenida a nivel mundial. En Chile los migrantes internacionales son un 4,4% de su población. A nivel mundial, los servicios de urgencia son elegidos por los migrantes para solucionar problemas de salud. OBJETIVO: Caracterizar la población migrante adulta atendida en una urgencia pública del área metropolitana de Santiago durante 2018. MÉTODOS: Mediante estadística descriptiva simple, se analiza la base de datos del centro, teniendo en cuenta aspectos éticos. RESULTADOS: Del total de consultas, un 13,72% corresponde a migrantes. De ellos, el 95,3% reside en comunas asignadas al hospital. El rango de edad predominante es de 20 a 44 años y sus países de procedencia son, principalmente, Perú, Haití, Venezuela, Colombia y Bolivia. Un 10,67% declara no tener cobertura médica. La mayoría de las consultas (62,33%) tiene pronóstico leve. Los diagnósticos de chilenos y extranjeros dentro del grupo etario de 20 a 44 años coinciden en diferente orden, pero en migrantes las enfermedades respiratorias, digestivas e infecciosas/parasitarias se presentan con mayor frecuencia. DISCUSIÓN: Las consultas de migrantes reflejan condiciones leves a moderadas de salud propias de personas sanas; incluso, se puede hablar del "efecto migrante sano". Debido a la similitud de los diagnósticos entre chilenos y extranjeros en el grupo etario y nivel socioeconómico se infiere una condición de salud similar. Dado que la mayoría de las consultas de migrantes se categorizaron con menor gravedad, tienen pronóstico leve, menores tasas de hospitalización y su principal destino es el domicilio, se evidencia el uso del servicio de urgencia como primera opción ante problemas de salud.

Interventions to reduce the impact of dual practice in the public health sector. / Intervenciones para reducir el impacto de la práctica dual en el sector público de salud.

INTRODUCTION: Dual practice (i.e. workers who work in the public and private sector) has an impact on health services in terms of quality and costs. However, the effectiveness of regulatory policies has not been proven. METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified three systematic reviews that included 23 primary studies overall, of which all correspond to observational studies. We concluded it is not clear whether the interventions to reduce the negative consequences of dual practice in the health system are effective because the certainty of the available evidence is very low.

INTRODUCCIÓN: La práctica dual (trabajadores que se desempeñan en el sector público y privado) tiene impacto en los servicios de salud en términos de calidad y costos. Sin embargo, la efectividad de políticas de regulación no ha sido demostrada. MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos tres revisiones sistemáticas que en conjunto incluyeron 23 estudios primarios, de los cuales, todos corresponden a estudios observacionales. Concluimos que no está claro si las intervenciones para reducir las consecuencias negativas de la práctica dual en el sistema de salud son efectivas porque la certeza de la evidencia disponible es muy baja.

High Flavonoid Cocoa Supplement Ameliorates Plasma Oxidative Stress and Inflammation Levels While Improving Mobility and Quality of Life in Older Subjects: A Double-Blind Randomized Clinical Trial.

BACKGROUND: The age-related decline in mass, strength, and performance of skeletal muscle is associated with loss of independence, falls risk, disability, institutionalization, and death. METHODS: To determine whether a cocoa supplement enriched in flavonoids can improve plasma markers of oxidative stress and inflammation, physical performance and frailty in middle-aged and older subjects, we conducted a two-phase, randomized, double-blind, clinical trial. The initial study included 60 subjects (55- to 70-year-old) allocated into placebo (P), highly alkalinized (no-flavonoid; NF), or flavonoid-rich natural cocoa (F) beverage groups. The follow-up study included 74 older subjects (65- to 90-year-old) randomly distributed into NF or F groups. Subjects were instructed to consume the beverages once/day for up to 12-weeks. A comprehensive (aging relevant) set of end points were assessed, which included mean change in blood plasma metabolic and oxidative stress indicators, in physical performance tests and quality of life (QoL). RESULTS: In the initial study, the F group showed improved glycemia, triglyceridemia, High-density lipoprotein cholesterol, Low-density lipoprotein cholesterol, triglyceridemia/HDL index, and oxidative markers. Performance on the Up and Go test, skeletal muscle index, and quality of life also improved. In the follow-up study, F treatment was associated with significant improvements in metabolic, oxidative stress, and inflammatory endpoints and positive effects on physical performance, frailty indicators, and quality of life (F vs. NF group). CONCLUSIONS: Regular flavonoids consumption positively affects blood oxidative stress and inflammation end points, cardiometabolic risk markers, physical performance, and quality of life. The sum of such effects may help to mitigate the extent of frailty development in the elderly people. TRIAL REGISTRATION: NCT03585868.

Vólvulo de la vesícula biliar / Gallbladder volvulus

El vólvulo, o torsión de la vesícula biliar, es una enfermedad de la sexta a la octava décadas de la vida, condición excepcional por su poca frecuencia y síntomas atípicos. Dado que tiende a confundirse con la colecistitis de origen no litiásico, su diagnóstico suele ser intraoperatorio y puede llegar a causar complicaciones graves, como la gangrena y la sepsis biliar e incluso la muerte. Pese a que hace 120 años se hizo el primer reporte de caso, en la actualidad se notifican cada vez más casos en la población añosa. En este artículo se presentan dos casos clínicos de vólvulo de la vesícula biliar y se hace una revisión de la literatura

Volvulus, or torsion of the gallbladder, is a disease of the sixth to eighth decades of life, an exceptional condition due to its infrequent and atypical symptoms.Since it tends to be confused with non-lithiasic cholecystitis, its diagnosis is usually intraoperative and can lead to serious complications such as gangrene and biliary sepsis, even death.Although the first case was reported 120 years ago, more cases are reported in the elderly population.In this article, two clinical cases of gallbladder volvulus are presented and a review of the literature is made