Influence of angiotensin receptor and converting enzyme blockers therapy in the respiratory outcome of COVID-19 hospitalized patients / Influencia de la terapia con bloqueadores del receptor de angiotensina y de la enzima convertidora en el resultado respiratorio de pacientes hospitalizados por COVID-19

Objectives: COVID-19, caused by SARS-CoV-2, has spread around the world since 2019. In severe cases, COVID-19 can lead to hospitalization and death. Systemic arterial hypertension and other comorbidities are associated with serious COVID-19 infection. Literature is unclear whether antihypertensive therapy with angiotensin receptor blockers (ARBs) and angiotensin converting enzyme (ACE) inhibitors affect COVID-19 outcomes. We aim to assess whether ACEI/ARB therapy is a risk factor for worse respiratory outcomes related to COVID-19 in hospitalized patients. Methods: Retrospective study enrolling admitted COVID-19-diagnosed patients by RT-PCR at the Hospital Geral de Fortaleza, Brazil, during 2021. Patient medical records, sociodemographic, and clinical data were analyzed. Chest CT images were analyzed using CAD4COVID-CT/Thirona™ software. Results: A total of 294 patients took part in the study. A cut-off point of 66% of pulmonary involvement was found by ROC curve, with patients having higher risk of death and intubation and lower 60-day survival. Advanced age (RR 1.025, P=0.001) and intubation (RR 16.747, P<0.001) were significantly associated with a higher risk of death. Advanced age (RR 1.023, P=0.001) and the use of noninvasive ventilation (RR 1.548, P=0.037) were associated with a higher risk of intubation. Lung involvement (>66%) increased the risk of death by almost 2.5-fold (RR 2.439, P<0.001) and by more than 2.3-fold the risk of intubation (RR 2.317, P<0.001). Conclusions: Altogether, our findings suggest that ACEI or ARB therapy does not affect the risk of death and disease course during hospitalization.(AU)

Objetivos: La COVID-19, causada por el SARS-CoV-2, se ha extendido por todo el mundo desde 2019. En casos graves, la COVID-19 puede provocar hospitalización y muerte. La hipertensión arterial sistémica y otras comorbilidades se asocian con una infección grave por COVID-19. La literatura no está clara si la terapia antihipertensiva con bloqueadores de los receptores de angiotensina (BRA) e inhibidores de la enzima convertidora de angiotensina (ECA) afecta los resultados de la COVID-19. Nuestro objetivo fue evaluar si la terapia BRA/ECA es un factor de riesgo de peores resultados respiratorios relacionados con COVID-19 en pacientes hospitalizados. Métodos: Estudio retrospectivo que incluyó pacientes ingresados con diagnóstico de COVID-19 mediante RT-PCR en el Hospital General de Fortaleza, Brasil, durante 2021. Se analizaron las historias clínicas de los pacientes, datos sociodemográficos y clínicos. Las imágenes de TC de tórax se analizaron utilizando el software CAD4COVID-CT/ThironaTM. Resultados: Participaron en el estudio un total de 294 pacientes. Mediante curva ROC se encontró un punto de corte del 66% de afectación pulmonar, teniendo los pacientes mayor riesgo de muerte e intubación y menor supervivencia a 60 días. La edad avanzada (RR 1,025; P=0,001) y la intubación (RR 16,747; P<0,001) se asociaron significativamente con un mayor riesgo de muerte. La edad avanzada (RR 1,023; P=0,001) y el uso de ventilación no invasiva (RR 1,548; P=0,037) se asociaron con un mayor riesgo de intubación. La afectación pulmonar (>66%) aumentó el riesgo de muerte casi 2,5 veces (RR 2,439; P<0,001) y más de 2,3 veces el riesgo de intubación (RR 2,317, P<0,001). Conclusiones: Se concluyó que el tratamiento con BRA o ECA no afecta el riesgo de muerte y el curso de la enfermedad durante la hospitalización.(AU)

Influence of angiotensin receptor and converting enzyme blockers therapy in the respiratory outcome of COVID-19 hospitalized patients.

OBJECTIVES: COVID-19, caused by SARS-CoV-2, has spread around the world since 2019. In severe cases, COVID-19 can lead to hospitalization and death. Systemic arterial hypertension and other comorbidities are associated with serious COVID-19 infection. Literature is unclear whether antihypertensive therapy with angiotensin receptor blockers (ARBs) and angiotensin converting enzyme (ACE) inhibitors affect COVID-19 outcomes. We aim to assess whether ACEI/ARB therapy is a risk factor for worse respiratory outcomes related to COVID-19 in hospitalized patients. METHODS: Retrospective study enrolling admitted COVID-19-diagnosed patients by RT-PCR at the Hospital Geral de Fortaleza, Brazil, during 2021. Patient medical records, sociodemographic, and clinical data were analyzed. Chest CT images were analyzed using CAD4COVID-CT/Thirona™ software. RESULTS: A total of 294 patients took part in the study. A cut-off point of 66% of pulmonary involvement was found by ROC curve, with patients having higher risk of death and intubation and lower 60-day survival. Advanced age (RR 1.025, P=0.001) and intubation (RR 16.747, P<0.001) were significantly associated with a higher risk of death. Advanced age (RR 1.023, P=0.001) and the use of noninvasive ventilation (RR 1.548, P=0.037) were associated with a higher risk of intubation. Lung involvement (>66%) increased the risk of death by almost 2.5-fold (RR 2.439, P<0.001) and by more than 2.3-fold the risk of intubation (RR 2.317, P<0.001). CONCLUSIONS: Altogether, our findings suggest that ACEI or ARB therapy does not affect the risk of death and disease course during hospitalization.

Incidental appendectomy in surgical treatment of ileocolic intussusception in children. Is it safe to perform? / Apendicectomía incidental en el tratamiento quirúrgico de la intususcepción ileocólica en niños. ¿Es segura?

BACKGROUND: Surgical treatment of ileo-colic intussusception (ICI) has been reported as the second cause of emergency laparotomy in children. The performance of incidental appendectomy after surgical reduction is currently controversial. The aim is to analyse the outcomes of performing incidental appendectomy after surgical ICI reduction with or without associated bowel resection. MATERIALS AND METHODS: A retrospective study was performed in patients with ICI episodes, who underwent surgical treatment in our institution between 2005-2019. Patients were divided in two groups according to the performance of associated appendectomy (AA group) or not (NA group). Subsequently, a stratified analysis was performed according to the need for bowel resection in both groups. Demographic variables, intraoperative findings, surgical time, hospital stay, postoperative complications and recurrences were analysed. RESULTS: A total of 101 patients (77 AA group; 24 NA group) were included, without differences in demographics or intraoperative findings. A total of 36 bowel resections were performed (24 group AA; 10 group NA), with no differences in surgical time (55.7 min in group AA vs. 61.2 min in group NA; p = 0.587) or hospital stay (median 5 days in both groups). There were also no differences in postoperative complications or recurrences between the two groups. Stratified analysis showed that bowel resection increases operative time, hospital stay and postoperative complications, regardless of whether associated appendectomy was performed or not. CONCLUSIONS: Incidental appendectomy during surgical treatment of ICI in children is a safe procedure that does not increase operative time, hospital stay, postoperative complications or recurrence.

OBJETIVO: El tratamiento quirúrgico de la intususcepción ileocólica (IIC) es la segunda causa más frecuente de laparotomía de urgencia en niños. La realización de una apendicectomía incidental tras la reducción quirúrgica sigue siendo motivo de controversia. El objetivo de este trabajo es analizar los resultados obtenidos al llevar a cabo una apendicectomía incidental tras la reducción quirúrgica de una IIC con o sin resección intestinal asociada. MATERIAL Y METODO: Se realizó un estudio retrospectivo en pacientes con episodios de IIC sometidos a tratamiento quirúrgico en nuestro centro entre 2005 y 2019. Los pacientes se dividieron en dos grupos según se llevara a cabo apendicectomía asociada (grupo AA) o no (grupo NA). Posteriormente, se elaboró un análisis estratificado según la necesidad de practicar resección intestinal en ambos grupos. Se analizaron las variables demográficas, los hallazgos intraoperatorios, el tiempo quirúrgico, la estancia hospitalaria, las complicaciones posoperatorias y las recidivas. RESULTADOS: Se incluyeron un total de 101 pacientes (77 en el grupo AA, y 24 en el grupo NA), sin diferencias en las características demográficas ni en los hallazgos intraoperatorios. Se practicaron un total de 36 resecciones intestinales (24 en el grupo AA; 10 en el grupo NA), sin diferencias en el tiempo quirúrgico (55,7 min en el grupo AA frente a 61,2 min en el grupo NA; p = 0,587) ni en la estancia hospitalaria (mediana de 5 días en ambos grupos). Tampoco se registraron diferencias en términos de complicaciones posoperatorias o recidivas entre los dos grupos. El análisis estratificado mostró que la resección intestinal incrementa el tiempo quirúrgico, la estancia hospitalaria y las complicaciones posoperatorias, con independencia de si se lleva a cabo apendicectomía asociada o no. CONCLUSION: La apendicectomía incidental durante el tratamiento quirúrgico de la IIC en niños es un procedimiento seguro que no aumenta el tiempo quirúrgico, la estancia hospitalaria, las complicaciones posoperatorias ni las posibilidades de recidiva.

Apendicectomía incidental en el tratamiento quirúrgico de la intususcepción ileocólica en niños. ¿Es segura? / Incidental appendectomy in surgical treatment of ileocolic intussusception in children. Is it safe to perform?

Objetivo: El tratamiento quirúrgico de la intususcepción ileocólica(IIC) es la segunda causa más frecuente de laparotomía de urgencia enniños. La realización de una apendicectomía incidental tras la reduc-ción quirúrgica sigue siendo motivo de controversia. El objetivo deeste trabajo es analizar los resultados obtenidos al llevar a cabo unaapendicectomía incidental tras la reducción quirúrgica de una IIC cono sin resección intestinal asociada. Material y método: Se realizó un estudio retrospectivo en pacientescon episodios de IIC sometidos a tratamiento quirúrgico en nuestro centroentre 2005 y 2019. Los pacientes se dividieron en dos grupos según sellevara a cabo apendicectomía asociada (grupo AA) o no (grupo NA). Posteriormente, se elaboró un análisis estratificado según la necesidad depracticar resección intestinal en ambos grupos. Se analizaron las variablesdemográficas, los hallazgos intraoperatorios, el tiempo quirúrgico, laestancia hospitalaria, las complicaciones posoperatorias y las recidivas. Resultados: Se incluyeron un total de 101 pacientes (77 en el gru-po AA, y 24 en el grupo NA), sin diferencias en las características demográficas ni en los hallazgos intraoperatorios. Se practicaron untotal de 36 resecciones intestinales (24 en el grupo AA; 10 en el grupoNA), sin diferencias en el tiempo quirúrgico (55,7 min en el grupo AAfrente a 61,2 min en el grupo NA; p = 0,587) ni en la estancia hospi-talaria (mediana de 5 días en ambos grupos). Tampoco se registrarondiferencias en términos de complicaciones posoperatorias o recidivasentre los dos grupos. El análisis estratificado mostró que la resecciónintestinal incrementa el tiempo quirúrgico, la estancia hospitalaria y las complicaciones posoperatorias, con independencia de si se lleva a caboapendicectomía asociada o no.(AU)

Background: Surgical treatment of ileo-colic intussusception (ICI)has been reported as the second cause of emergency laparotomy inchildren. The performance of incidental appendectomy after surgicalreduction is currently controversial. The aim is to analyse the outcomesof performing incidental appendectomy after surgical ICI reduction withor without associated bowel resection. Materials and methods: A retrospective study was performed inpatients with ICI episodes, who underwent surgical treatment in ourinstitution between 2005-2019. Patients were divided in two groupsaccording to the performance of associated appendectomy (AA group)or not (NA group). Subsequently, a stratified analysis was performedaccording to the need for bowel resection in both groups. Demographicvariables, intraoperative findings, surgical time, hospital stay, postopera-tive complications and recurrences were analysed.Results. A total of 101 patients (77 AA group; 24 NA group) wereincluded, without differences in demographics or intraoperative findings. A total of 36 bowel resections were performed (24 group AA; 10 groupNA), with no differences in surgical time (55.7 min in group AA vs.61.2 min in group NA; p = 0.587) or hospital stay (median 5 days in bothgroups). There were also no differences in postoperative complicationsor recurrences between the two groups. Stratified analysis showed thatbowel resection increases operative time, hospital stay and postopera-tive complications, regardless of whether associated appendectomy wasperformed or not.(AU)

Trastornos de la salud mental en personas sometidas a cuarentena, estudio transversal durante pandemia por COVID-19 en población chilena / The effects of quarantine on anxiety and emotional symptoms. Results of an online survey

BACKGROUND: Quarantines may exacerbate the presence of emotional symptoms or anxiety. AIM: To explore the relation between time spent in lockdown and development of depressive and anxiety symptoms. MATERIAL AND METHODS: A survey including the GAD anxiety and PHQ-9 depression scores was answered online by 1,488 subjects aged 36 ± 14 years (74% women), invited to participate through social networks. Both scores are validated for the Chilean population. RESULTS: Most responders had a private health insurance system. Sixty seven percent had clinically significant depressive symptoms and 39% had anxiety symptoms. Spending four or more weeks of lockdown (quarantine) was associated with 1.6 times higher risk of developing depressive symptoms and 2.9 times higher risk of developing anxiety symptoms. Difficulties in access to health care increased 3.3 times the risk of developing depression. Suffering a respiratory disease increased 2.39 times the risk of developing anxiety. CONCLUSIONS: There was a direct association between depressive and anxious symptoms, and the time spent of quarantine.

[The effects of quarantine on anxiety and emotional symptoms. Results of an online survey]. / Trastornos de la salud mental en personas sometidas a cuarentena, estudio transversal durante pandemia por COVID-19 en población chilena.

BACKGROUND: Quarantines may exacerbate the presence of emotional symptoms or anxiety. AIM: To explore the relation between time spent in lockdown and development of depressive and anxiety symptoms. MATERIAL AND METHODS: A survey including the GAD anxiety and PHQ-9 depression scores was answered online by 1,488 subjects aged 36 ± 14 years (74% women), invited to participate through social networks. Both scores are validated for the Chilean population. RESULTS: Most responders had a private health insurance system. Sixty seven percent had clinically significant depressive symptoms and 39% had anxiety symptoms. Spending four or more weeks of lockdown (quarantine) was associated with 1.6 times higher risk of developing depressive symptoms and 2.9 times higher risk of developing anxiety symptoms. Difficulties in access to health care increased 3.3 times the risk of developing depression. Suffering a respiratory disease increased 2.39 times the risk of developing anxiety. CONCLUSIONS: There was a direct association between depressive and anxious symptoms, and the time spent of quarantine.

Síndrome de insensibilidad a andrógenos: revisión bibliográfica a propósito de 5 casos / Androgen insensitivity syndrome: literature review about 5 cases

El síndrome de insensibilidad a andrógenos (AIS en la sigla inglesa) es una entidad muy poco frecuente en endocrinología. Se caracteriza por la mutación del receptor de andrógenos de magnitud variable, por medio del cual individuos 46,XY no se virilizan normalmente, a pesar de conservar sus testículos y tener concentraciones de testosterona en rango masculino. El cuadro clínico es variable y depende la profundidad de la alteración del receptor. En un extremo, hay casos de insensibilidad androgénica completa (CAIS) con fenotipo femenino. En el otro extremo hay insensibilidad parcial (PAIS) que se extiende desde el fenotipo femenino, con o sin ambigüedad genital, hasta los casos de hombres infértiles o con subvirilización, que presentan insensibilidad androgénica más leve. En los fenotipos femeninos, los testículos suelen estar en posición ectópica y aquellos ubicados dentro del abdomen tienen riesgo de malignizarse, por lo que suelen extirparse. Estos son los casos de más difícil manejo, pues aparte de la necesidad de gonadectomía seguida de terapia hormonal femenina, existe una vagina estrecha y en fondo de saco ciego y que suele requerir corrección quirúrgica para permitir la actividad sexual. En este trabajo presentamos 5 casos de AIS vistos recientemente en 2 centros clínicos de Santiago y que ilustran la heterogeneidad de presentación. Además, hacemos una revisión actualizada de los criterios diagnósticos, los tratamientos más adecuados y el manejo global de esta condición.

The Androgen insensitivity syndrome (AIS, in its English acronym) is a very rare entity in endocrinology. It is characterized by a variable magnitude androgen receptor mutation, whereby 46, XY individuals are not normally virilized, despite retaining their testicles and having testosterone concentrations in the male range. The clinical picture is variable and depends on the depth of the receptor alteration. At one extreme, there are cases of complete androgenic insensitivity (CAIS) with a female phenotype. At the other extreme, there is partial insensitivity (PAIS) that extends from the female phenotype, with or without genital ambiguity, to cases of infertile or undervirilized men, who have milder androgenic insensitivity. In female phenotypes, the testes are usually in an ectopic position and those located within the abdomen are at risk of malignancy, and therefore are usually removed. These are the most difficult cases to manage because apart from the need for gonadectomy followed by female hormonal therapy, there is a narrow vagina and a deep blind pouch that usually requires surgical correction to allow sexual activity. In this work, we present 5 cases of AIS recently seen in 2 clinical centers in Santiago and that illustrate the heterogeneity of presentation. In addition, we make an updated review of the diagnostic criteria, the most appropriate treatments, and the overall management of this condition.

Tendencia de la mortalidad por fibrosis quística en Chile, 1997-2017 / Cystic fibrosis mortality trend in chile, 1997-2017

Introducción. La Fibrosis Quística es la enfermedad hereditaria con pronóstico reducido más frecuente en raza blanca. Su incidencia varía según etnias. En Chile, la incidencia estimada es de 1/10.000 habitantes y la evidencia nacional acerca de la magnitud y caracterización de defunciones es escasa. El objetivo de este estudio es determinar la evolución de mortalidad por fibrosis quística en Chile durante 1997-2017. Materiales y Métodos. Estudio descriptivo retrospectivo sobre la tendencia de mortalidad por fibrosis quística en Chile. A partir de bases de datos secundarias del sistema de estadísticas de mortalidad del país, se analizó la cohorte de fallecidos registrado en el certificado de defunción como fibrosis quística. Se calcularon tasas de mortalidad crudas y ajustadas para todos los años observados. Se realizó un análisis para las defunciones en menores 40 años; según las variables sexo, edad y región. Se estimó el cambio porcentual anual utilizando el programa Joinpoint-Regression. Resultados. Se registraron 198 defunciones (49% mujeres). La edad media y mediana de defunción aumentaron progresivamente, desde 1997-2001 con media 8,5 y mediana 6 años a 2013-2017 con media 19,6 y mediana 20 años (p-valor<0,05). La tasa de mortalidad en los menores de 1 año presentó una tendencia decreciente con un cambio porcentual anual de - 32,5%, estadísticamente significativo. La región de Atacama presentó un riesgo de muerte 6,12 veces mayor que el promedio del país. Discusión. En Chile, la edad de defunción por fibrosis quística ha aumentado progresivamente y la mortalidad en los <1 año ha disminuido a lo largo de los últimos años.

Introduction. Cystic Fibrosis is the most frequent hereditary disease in whites, with a reduced prognosis. Its incidence varies by ethnicity. In Chile, the estimated incidence is 1/10,000 inha-bitants and national evidence regarding the magnitude and characterization of deaths is scarce.The aim of this study es to describe the evolution of cystic fibrosis mortality in Chile during 1997-2017. Materials and Methods. Retrospective descriptive study on the mortality trend due to cystic fibrosis in Chile. From secondary databases of the country's mortality statistics system, the cohort of deceased due to cystic fibrosis, as registered in the death certificate was analyzed. Crude and adjusted mortality rates were calculated for all observed years. An analysis was performed for deaths in persons younger 40 years; according to the variables of sex, age and region. The annual percentage change was estimated using the Joinpoint-Regression program.Results. 198 deaths were registered (49% women). For those younger than 40 years at the time of death, the mean and median age of death increased progressively, from mean 8.5 and median 6 years in 1997 to 2001 to a mean of 19.6 and median of 20 years in 2013-2017 (p-value <0.05). The mortality rate in under 1 year of ages presented a decreasing trend with an annual percentage change of -32.5%. The Atacama region presented a risk of death 6.12 times higher than the country's average.Discussion. In Chile, the age of death due to cystic fibrosis has progressively increased and mortality in <1 year has decreased in recent years

Genome-wide profiling of non-smoking-related lung cancer cells reveals common RB1 rearrangements associated with histopathologic transformation in EGFR-mutant tumors.

BACKGROUND: The etiology and the molecular basis of lung adenocarcinomas (LuADs) in nonsmokers are currently unknown. Furthermore, the scarcity of available primary cultures continues to hamper our biological understanding of non-smoking-related lung adenocarcinomas (NSK-LuADs). PATIENTS AND METHODS: We established patient-derived cancer cell (PDC) cultures from metastatic NSK-LuADs, including two pairs of matched EGFR-mutant PDCs before and after resistance to tyrosine kinase inhibitors (TKIs), and then performed whole-exome and RNA sequencing to delineate their genomic architecture. For validation, we analyzed independent cohorts of primary LuADs. RESULTS: In addition to known non-smoker-associated alterations (e.g. RET, ALK, EGFR, and ERBB2), we discovered novel fusions and recurrently mutated genes, including ATF7IP, a regulator of gene expression, that was inactivated in 5% of primary LuAD cases. We also found germline mutations at dominant familiar-cancer genes, highlighting the importance of genetic predisposition in the origin of a subset of NSK-LuADs. Furthermore, there was an over-representation of inactivating alterations at RB1, mostly through complex intragenic rearrangements, in treatment-naive EGFR-mutant LuADs. Three EGFR-mutant and one EGFR-wild-type tumors acquired resistance to EGFR-TKIs and chemotherapy, respectively, and histology on re-biopsies revealed the development of small-cell lung cancer/squamous cell carcinoma (SCLC/LuSCC) transformation. These features were consistent with RB1 inactivation and acquired EGFR-T790M mutation or FGFR3-TACC3 fusion in EGFR-mutant tumors. CONCLUSIONS: We found recurrent alterations in LuADs that deserve further exploration. Our work also demonstrates that a subset of NSK-LuADs arises within cancer-predisposition syndromes. The preferential occurrence of RB1 inactivation, via complex rearrangements, found in EGFR-mutant tumors appears to favor SCLC/LuSCC transformation under growth-inhibition pressures. Thus RB1 inactivation may predict the risk of LuAD transformation to a more aggressive type of lung cancer, and may need to be considered as a part of the clinical management of NSK-LuADs patients.

[Sociodemographic risk factors of hantavirus cardiopulmonary syndrome]. / Factores de riesgo socio-demográficos del síndrome cardiopulmonar por hantavirus.

BACKGROUND: Hantavirus cardiopulmonary syndrome (HCPS) is caused by new world hantaviruses, among which Andes hantavirus (ANDV) is endemic to Chile and Southern Argentina. The disease caused by ANDV produces plasma leakage leading to enhanced vascular permeability and has a high case fatality rate (35%), mainly due to respiratory failure, pulmonary edema and myocardial dysfunction, hypoperfusion and shock. Host sociodemographic and genetic factors might influence the course and outcome of the disease. Yet, they have not been thoroughly characterized. AIM: To evaluate sociodemographic factors as risk factors in severity of HCPS. PATIENTS AND METHODS: Study period: 2004-20013, attending in eight collaborative centers, etiological diagnosis was performed by serology or molecular biology, mild and severe HCPS were compared.139 Chilean patients were analyzed, 64 (46%) with severe disease among which 12 (19 %) died. RESULTS: European ethnicity had 5,1 times higher risk than Amerindian ethnic group to develop a severe HCPS, greater seriousness that was also associated with an urban residence. CONCLUSION: It was observed that ethnicity and type of residence were significant risk factors for HCPS severity. Hypotheses explaining these findings are discussed.

Latent Class Analysis of School Refusal Behavior and Its Relationship With Cyberbullying During Adolescence.

Cyberbullying is a common relational problem having negative repercussions on the academic performance of adolescents. Numerous questions remain to be answered with regard to the relationship between cyberbullying and school refusal behavior. This study examines school refusal profiles (measured by School Refusal Assessment Scale-Revised) and assesses whether these profiles vary with respect to the level of victimization, aggression, aggression-victimization, and observation of cyberbullying (measured with the Screening of Harassment among Peers). The sample consisted of 1,102 Spanish high school students, aged 12-18 (M = 14.30, SD = 1.71). Latent class analysis revealed three school refusal behavior profiles: non-school refusal behavior, school refusal behavior by negative reinforcements (oriented to the avoidance of social evaluation and negative affectivity in school situations), and school refusal behavior by positive reinforcements (oriented to obtaining the attention of others with significant or tangible reinforcements). The ANOVA found statistically significant differences for all cyberbullying behaviors. Students with school refusal by negative reinforcements had significantly higher mean scores as compared to the other profiles in victimization, aggression, aggression-victimization, and observation behaviors, while the levels of cyberbullying were similar between students without school refusal and students with school refusal behavior by positive reinforcements. These findings underscore the need to consider priority interventions to prevent cyberbullying in children who refuse school for the purpose of avoiding situations of anxiety and negative emotions.

Factores de riesgo socio-demográficos del síndrome cardiopulmonar por hantavirus / Sociodemographic risk factors of hantavirus cardiopulmonary syndrome

Resumen Introducción: El síndrome cardiopulmonar por hantavirus (SCPH) es causado en Chile y en el sur de Argentina por el Andes hantavirus (ANDV), el que es endémico en esta zona. La enfermedad causada por ANDV produce un aumento de permeabilidad vascular y filtración de plasma con una alta tasa de letalidad (35%), debido principalmente a insuficiencia respiratoria por edema pulmonar y al desarrollo en los casos graves de compromiso miocárdico, hipoperfusión y shock. Aunque se sabe que los factores socio-demográficos del hospedero pueden influir en el curso y el resultado de la enfermedad, estos no se han caracterizado previamente en la población chilena. Objetivo: Evaluar la relación entre los factores socio-demográficos y la gravedad del SCPH. Pacientes y Métodos: Período de análisis 2004-20013, pacientes atendidos en ocho centros colaboradores, diagnóstico etiológico serológico o por biología molecular, se comparan SCPH leve y grave. Se analizaron 139 pacientes chilenos, 64 (46%) con enfermedad grave, entre los cuales 12 murieron (19%). Resultados: La etnia europea tuvo un riesgo 5,1 veces mayor de desarrollar un SCPH grave que la etnia amerindia, gravedad mayor que también se asoció a una residencia urbana. Conclusiones: Se observó una asociación estadísticamente significativa entre etnia, lugar de residencia y evolución de SCPH. Se discuten hipótesis que expliquen estos hallazgos.

Background: Hantavirus cardiopulmonary syndrome (HCPS) is caused by new world hantaviruses, among which Andes hantavirus (ANDV) is endemic to Chile and Southern Argentina. The disease caused by ANDV produces plasma leakage leading to enhanced vascular permeability and has a high case fatality rate (35%), mainly due to respiratory failure, pulmonary edema and myocardial dysfunction, hypoperfusion and shock. Host sociodemographic and genetic factors might influence the course and outcome of the disease. Yet, they have not been thoroughly characterized. Aim: To evaluate sociodemographic factors as risk factors in severity of HCPS. Patients and Methods: Study period: 2004-20013, attending in eight collaborative centers, etiological diagnosis was performed by serology or molecular biology, mild and severe HCPS were compared.139 Chilean patients were analyzed, 64 (46%) with severe disease among which 12 (19 %) died. Results: European ethnicity had 5,1 times higher risk than Amerindian ethnic group to develop a severe HCPS, greater seriousness that was also associated with an urban residence. Conclusion: It was observed that ethnicity and type of residence were significant risk factors for HCPS severity. Hypotheses explaining these findings are discussed.

Blood monocyte profiles in COPD patients with PiMM and PiZZ α1-antitrypsin.

Human blood monocytes are divided into populations based on the differential expression of CD14 and CD16 receptors: CD14 + CD16(classical), CD14 + CD16 + (intermediate), and CD14-CD16+ (non-classical). Given their functional differences and their role in pathogenesis of chronic obstructive pulmonary disease (COPD), monocyte profiling is of clinical interest. Here we investigated blood monocyte subsets in clinically stable COPD patients with alpha1-antitrypsin (AAT) deficiency (PiZZ, n = 7) and with normal AAT variant (PiMM, n = 7). Peripheral whole blood was collected in sodium heparin tubes and incubated with LPS (from E. coli; 1 µg/ml) or placebo for 6 h at 37 °C, 5% CO2. To profile monocyte subsets we performed flow cytometry analysis based on HLA-DR and CD14/CD16 staining. HLA-DR + subsets of cells did not differ between PiZZ and PiMM COPD, and healthy controls (n = 7), used as a reference. Monocyte profiling, which express the CD14 and CD16, but not the HLA-DR (HLA-DR-) showed that intermediate monocytes subset was lowest in PiZZ group, and almost totally disappeared from blood treated with LPS. The non-classical subset was almost absent in PiZZ patients independently of LPS treatment. Recent studies demonstrate that non-classical monocytes exhibit a unique ability to protect the vascular endothelium under both homeostatic and inflammatory conditions whereas intermediate monocytes are recruited at a later stage of inflammation, and are associated with secretion of cytokines/chemokines and wound healing. Evident alterations in blood monocyte subsets together with a partial reduction of AAT levels, an important anti-inflammatory protein, can be key factors for the early manifestation of emphysema in some PiZZ AATD carriers.

Pig cognitive bias affects the conversion of muscle into meat by antioxidant and autophagy mechanisms.

Slaughter is a crucial step in the meat production chain that could induce psychological stress on each animal, resulting in a physiological response that can differ among individuals. The aim of this study was to investigate the relationship between an animal's emotional state, the subsequent psychological stress at slaughter and the cellular damage as an effect. In all, 36 entire male pigs were reared at an experimental farm and a cognitive bias test was used to classify them into positive bias (PB) or negative bias (NB) groups depending on their decision-making capabilities. Half of the animals, slaughtered in the same batch, were used for a complete study of biomarkers of stress, including brain neurotransmitters and some muscle biomarkers of oxidative stress. After slaughter, specific brain areas were excised and the levels of catecholamines (noradrenaline (NA) and dopamine (DA)) and indoleamines (5-hydroxyindoleacetic acid and serotonin (5HT)) were analyzed. In addition, muscle proteasome activity (20S), antioxidant defence (total antioxidant activity (TAA)), oxidative damage (lipid peroxidation (LPO)) and autophagy biomarkers (Beclin-1, microtubule-associated protein I light chain 3 (LC3-I) and LC3-II) were monitored during early postmortem maturation (0 to 24 h). Compared with PB animals, NB pigs were more susceptible to stress, showing higher 5HT levels (P<0.01) in the hippocampus and lower DA (P<0.001) in the pre-frontal cortex. Furthermore, NB pigs had more intense proteolytic processes and triggered primary muscle cell survival mechanisms immediately after slaughter (0 h postmortem), thus showing higher TAA (P<0.001) and earlier proteasome activity (P<0.001) and autophagy (Beclin-1, P<0.05; LC3-II/LC3-I, P<0.001) than PB pigs, in order to counteract the induced increase in oxidative stress, that was significantly higher in the muscle of NB pigs at 0 h postmortem (LPO, P<0.001). Our study is the first to demonstrate that pig's cognitive bias influences the animal's susceptibility to stress and has important effects on the postmortem muscle metabolism, particularly on the cell antioxidant defences and the autophagy onset. These results expand the current knowledge regarding biomarkers of animal welfare and highlight the potential use of biomarkers of the proteasome, the autophagy (Beclin-1, LC3-II/LC3-I ratio) and the muscle antioxidant defence (TAA, LPO) for detection of peri-slaughter stress.

A study of torrefied cardboard characterization and applications: Composition, oxidation kinetics and methane adsorption.

Torrefaction is proposed as a valorization process for non recycled cardboard. Torrefied cardboard was physically and chemically characterized and it was proposed for energy production and methane adsorption. The surface area and pore volume obtained were among 3.0-6.0m2/g and 5.7·10-3-2.3·10-2cm3/g, respectively. The carbon content increased with temperature and residence time of torrefaction. Oxidation kinetics of torrefied cardboard at different temperatures (250-300°C) and at different plateaus (60-120min) were tested. Torrefied cardboard was chemically treated with KOH in order to study the effect of K on thermal oxidation kinetics. It was observed that high torrefaction temperatures and residence times lead to a more stable char. Furthermore, kinetic parameters were obtained by iso-conversional methods and Coats and Redfern method. Attending to iso-conversional method, a decrease of Ea was observed with both, temperature and residence time of torrefaction. Whereas chemically treated presented highest Ea values than torrefied cardboard. In addition, regarding Coats and Redfern method, the oxidation model was not highly modified by torrefaction temperature and residence time. However, for chemically treated samples the oxidation model was modified by K presence. Finally, CH4 adsorption capacity of torrefied cardboard was studied at 30°C and atmospheric pressure. CH4 partial pressures tested were lower than 0.45kPa. It was observed that CH4 adsorption capacity increased with torrefaction time and decreased with chemical treatment. Thus, for the tested samples, the highest adsorption capacity observed was 5.70mgCH4/g of sample.

Mastectomía profiláctica contralateral, con técnica ahorradora de piel y del complejo aréola-pezón, como tratamiento oncológico y estético / Contralateral prophylactic mastectomy with a skin-sparing, nipple-sparing technique as an oncological and esthetic procedure

La mastectomía profiláctica contralateral (MPC) en mujeres con diagnóstico de cáncer de mama es un procedimiento quirúrgico que permite obtener un mejor resultado estético y un pronóstico oncológico más favorable, al prevenir el desarrollo contralateral del cáncer. Presentamos nuestra experiencia en 38 casos de mujeres con diagnóstico de cáncer de mama que fueron operadas de mastectomía y reconstrucción inmediata en 2 tiempos mediante expansor tisular/implante. Estas pacientes optaron por una MPC en el segundo tiempo del proceso reconstructivo por motivos psicológicos u oncológicos. Realizamos una técnica ahorradora de piel y del complejo aréola-pezón, que ofrece un resultado natural de la mama una vez reconstruida y, por tanto, un alto nivel de satisfacción de la paciente

Contralateral prophylactic mastectomy (CPM) in women with a diagnosis of breast cancer improves the esthetic outcome and oncological prognosis because it reduces the risk of developing contralateral breast cancer. We report our experience of 38 women with a diagnosis of breast cancer who underwent mastectomy and immediate two-stage tissue expander / implant reconstruction. These patients opted for a CPM in the second stage of their reconstructive process due to psychological or oncological reasons. We performed a skin-sparing, nipple-sparing technique that offers a natural result and consequently a high level of patient satisfaction

[Mineral metabolism in patients on chronic peritoneal dialysis]. / Metabolismo mineral en niños en diálisis peritoneal crónica.

INTRODUCTION: Children with chronic kidney disease (CKD) and receiving peritoneal dialysis (PD) have disorders of mineral metabolism that impact their growth, survival and cardiovascular functions. New molecular markers offer a better understanding of the pathophysiology of this disease. OBJECTIVE: To characterize some components of mineral metabolism, with emphasis on FGF23/Klotho and cardiovascular functions (CV) of these patients. PATIENTS AND METHOD: Prospective observational cohort study. EXCLUSION CRITERIA: serum 25 (OH) vitamin D < 20 ng/ml, peritonitis within the last two months and active nephrotic syndrome. Calcemia, phosphemia, parathyroid hormone (PTH), 25 (OH) vitD3, 1.25 (OH) vitD3, FGF23 and Klotho in plasma were measured. FGF23 and Klotho were quantified in healthy children as a control group. Echocardiography was performed calculating the left ventricular mass index (LVMI). Descriptive statistics analysis, Pearson correlation coefficient for association among variables and multivariate analysis were conducted. RESULTS: 33 patients, 16 males, aged between 1.2 and 13.4 years were included. Age of onset for PD: 7.3 ± 5.0 years, time receiving PD: 13.5 ± 14.5 months. The plasma concentration of 25 (OH) vitD3 was 34.2 ± 6.3 pg/ml. Calcemia and phosphemia values were 9.8 ± 0.71 and 5.4 ± 1.0 mg/dl respectively. PTH was 333 ± 287 pg/ml. FGF23 in plasma was 225.7 ± 354.3 pg/ml and Klotho 131.6 ± 72 pg/ml, and in the controls ( n = 16 ), it was 11.9 ± 7.2 pg/ml and 320 ± 119 pg/ml, respectively. The residual and total dose of dialysis (KtV) was 1.6 ± 1.3 and 2.9 ± 1.6, respectively. FGF23 levels significantly correlated with calcium (p < 0.001, r = 0.85), and inversely with residual KtV, showing no relationship with phosphemia. Klotho level correlated negatively with residual KtV and also, it showed a negative association with chronological age and age at onset of PD. LVMI > 38 g/m² was confirmed in 20/28 patients. CONCLUSIONS: The values of FGF23, and PTH are elevated in children with CKD on PD. Klotho levels in CKD patients are lower than control children. A strong association of calcemia with FGF23 and PTH is reported. Residual renal function is inversely associated with FGF23 and Klotho. A high incidence of left ventricular hypertrophy was found evidencing a cardiovascular compromise in these patients.

Metabolismo mineral en niños en diálisis peritoneal crónica / Mineral metabolism in patients on chronic peritoneal dialysis

Introduction: Children with chronic kidney disease (CKD) and receiving peritoneal dialysis (PD) have disorders of mineral metabolism that impact their growth, survival and cardiovascular functions. New molecular markers offer a better understanding of the pathophysiology of this disease. Objective: To characterize some components of mineral metabolism, with emphasis on FGF23/Klotho and cardiovascular functions (CV) of these patients. Patients and Method: Prospective observational cohort study. Exclusion criteria: serum 25 (OH) vitamin D < 20 ng/ml, peritonitis within the last two months and active nephrotic syndrome. Calcemia, phosphemia, parathyroid hormone (PTH), 25 (OH) vitD3, 1.25 (OH) vitD3, FGF23 and Klotho in plasma were measured. FGF23 and Klotho were quantified in healthy children as a control group. Echocardiography was performed calculating the left ventricular mass index (LVMI). Descriptive statistics analysis, Pearson correlation coefficient for association among variables and multivariate analysis were conducted. Results: 33 patients, 16 males, aged between 1.2 and 13.4 years were included. Age of onset for PD: 7.3 +/- 5.0 years, time receiving PD: 13.5 +/- 14.5 months. The plasma concentration of 25 (OH) vitD3 was 34.2 +/- 6.3 pg/ml. Calcemia and phosphemia values were 9.8 ± 0.71 and 5.4 +/- 1.0 mg/dl respectively. PTH was 333 +/- 287 pg/ml. FGF23 in plasma was 225.7 +/- 354.3 pg/ml and Klotho 131.6 +/- 72 pg/ml, and in the controls ( n = 16 ), it was 11.9 +/- 7.2 pg/ml and 320 +/- 119 pg/ml, respectively. The residual and total dose of dialysis (KtV) was 1.6 +/- 1.3 and 2.9 +/- 1.6, respectively. FGF23 levels significantly correlated with calcium (p < 0.001, r = 0.85), and inversely with residual KtV, showing no relationship with phosphemia. Klotho level correlated negatively with residual KtV and also, it showed a negative association with chronological age and age at onset of PD. LVMI > 38 g/m² was confirmed in 20/28 patients...

Introducción: Los niños portadores de Enfermedad renal crónica (ERC) en diálisis peritoneal (DP) presentan alteraciones del metabolismo mineral que afectan su crecimiento, estado cardiovascular y sobrevida. Nuevos marcadores moleculares representan una mejor comprensión de la fisiopatología de esta enfermedad. Objetivo: Caracterizar componentes del metabolismo mineral, con énfasis en FGF23/Klotho, y estado cardiovascular (CV) en este grupo de pacientes. Pacientes y Método: Estudio prospectivo observacional. Criterios de exclusión: niveles de 25 (OH) vitamina D < 20 ng/ml, peritonitis hasta 2 meses previos y síndrome nefrótico activo. Se midió calcemia, fosfemia, paratohormona (PTH), 25 (OH) vitD3, 1,25 (OH) vitD3, FGF23 y Klotho en plasma. Se cuantificó FGF23 y Klotho en niños sanos como grupo control. Se efectuó ecocardiografía, calculándose el índice de masa ventricular izquierda (IMVI). Se realizó análisis estadístico descriptivo, coeficiente de correlación de Pearson para asociación entre variables y análisis multivariado. Resultados: Se incluyeron 33 pacientes, 16 varones, edad 1,2 a 13,4 años. Edad de inicio de DP: 7,3 +/- 5,0 años, tiempo en DP: 13,5 +/- 14,5 meses. El nivel plasmático de 25 (OH) vitD3 fue 34,2 +/- 6,3 pg/ml. Los valores de calcemia y fosfemia fueron 9,8 +/- 0,71 y 5,4 +/- 1,0 mg/dl respectivamente. La PTH fue de 333 +/- 287 pg/ml. El FGF23 en plasma fue de 225,7 +/- 354,3 pg/ml y Klotho 131,6 +/- 72 pg/ml, y en los controles (n = 16) fue de 11,9 +/- 7,2 pg/ ml y 320 +/- 119 pg/ml, respectivamente. La dosis de diálisis (KtV) residual y total fue de 1,6 +/- 1,3 y 2,9 +/- 1.6, respectivamente. El nivel de FGF23 se correlacionó significativamente con la calcemia (p < 0,001, r = 0,85), e inversamente con el KtV residual, sin mostrar relación con la fosfemia. El nivel de Klotho...

Autophagic and proteolytic processes in the Harderian gland are modulated during the estrous cycle.

The Syrian hamster Harderian gland (HG) is an organ that undergoes physiological autophagy in response to oxidative stress induced by porphyrin production. Porphyrin production in the HG has marked sex differences and is closely linked to reproductive function. In the present study, we observed that the estrous cycle and associated estrogen variations may affect oxidative-stress-induced proteolytic processes. In particular, significant changes in autophagic activity were detected during the estrous cycle. Notably, increased activation of macroautophagy as well as chaperone-mediated autophagy in the estrus phase coincided with a minimal antioxidant capability and the highest protein damage levels. By contrast, autophagic machinery was found to be blocked in the diestrus phase, likely due to mammalian target of rapamycin activation, which could be corroborated by the subsequent pS6K activation. Analogous results were observed regarding proteasome activity, which also showed maximal activity in the estrus phase. Interestingly, all these mechanisms were associated with important morphological changes in the HG during the estrous cycle. We observed statistically significant increases in Type II cells, which may be related to extensive autophagy in the estrus phase. Physiologically, this would result in a significant release of porphyrins specifically when females are more receptive. These data support the role of porphyrins as pheromones, as other authors have previously suggested, thus making the HG a scent organ. In addition, these results suggest a porphyrin-based approach to the treatment of porphyria during pregnancy, a condition for which no treatment is currently known.