Multidimensional analysis of immune cells from COVID-19 patients identified cell subsets associated with the severity at hospital admission.

BACKGROUND: SARS-CoV-2 emerged as a new coronavirus causing COVID-19, and it has been responsible for more than 760 million cases and 6.8 million deaths worldwide until March 2023. Although infected individuals could be asymptomatic, other patients presented heterogeneity and a wide range of symptoms. Therefore, identifying those infected individuals and being able to classify them according to their expected severity could help target health efforts more effectively. METHODOLOGY/PRINCIPAL FINDINGS: Therefore, we wanted to develop a machine learning model to predict those who will develop severe disease at the moment of hospital admission. We recruited 75 individuals and analysed innate and adaptive immune system subsets by flow cytometry. Also, we collected clinical and biochemical information. The objective of the study was to leverage machine learning techniques to identify clinical features associated with disease severity progression. Additionally, the study sought to elucidate the specific cellular subsets involved in the disease following the onset of symptoms. Among the several machine learning models tested, we found that the Elastic Net model was the better to predict the severity score according to a modified WHO classification. This model was able to predict the severity score of 72 out of 75 individuals. Besides, all the machine learning models revealed that CD38+ Treg and CD16+ CD56neg HLA-DR+ NK cells were highly correlated with the severity. CONCLUSIONS/SIGNIFICANCE: The Elastic Net model could stratify the uninfected individuals and the COVID-19 patients from asymptomatic to severe COVID-19 patients. On the other hand, these cellular subsets presented here could help to understand better the induction and progression of the symptoms in COVID-19 individuals.

Pre and Post Pandemic Depressive and Anxious Symptoms in Children and Adolescents in Northern Chile.

The psychological effects of the COVID-19 pandemic still represent a focus of concern, especially in children and adolescents who are a group particularly vulnerable to the psychological consequences of the COVID-19 pandemic, mainly due to the loss of socialization and leisure spaces. The aim of the study is to determine the variation in the levels of depressive and anxious symptomatology in children and adolescents in the North of Chile. METHODS: A Repeated cross-sectional design (RCS) was used. The sample consisted of a total of 475 students aged 12 to 18 years (high school) from educational establishments in the city of Arica. To evaluate the changes in the mental health of students associated with the COVID-19 pandemic, the same mental health measures applied to students were compared in two waves (2018-2021). RESULTS: An increase in the symptomatology levels of depression, anxiety, social anxiety, and problems with the family, while a decrease in problems with school and peers was observed. CONCLUSIONS: The results show that there is an increase in mental health problems associated with the periods of time in which the COVID-19 pandemic transformed the social relation spaces and classrooms of secondary school students. The observed changes point to future challenges, which include that it may be important to improve the coordination and integration of mental health professionals in educational centers and schools.

Children's Mental Health: Discrepancy between Child Self-Reporting and Parental Reporting.

(1) Background: Discrepancies between children's self-reports and their parents' reports on mental health indicators are associated with measurement errors or informant bias. However, they are a valuable tool in understanding the course of child psychopathology. This study aims to determine the level of discrepancies between parents' perceptions and children's self-reports in mental health indicators in Northern Chile. (2) Methods: A System of Evaluation of Children and Adolescents self-report (Sistema de Evaluación de Niños y Adolescentes, SENA) was responded to by 408 students between 8 and 13 years old and their parents. (3) Results: Children reported a significantly higher frequency of emotional problems, defiant behavior, and executive functions as compared to their parents' responses. (4) Conclusions: There is a disjunction between the report of parents and children, which could originate in poor family communication.

The Mediating Role of Contextual Problems and Sensation Seeking in the Association between Substance Use and Mental Health in Adolescents from Northern Chile.

Substance use is a risk behavior that has been associated with adverse mental health outcomes in adolescence. The aim of this study was to determine the relation between behavioral problems, emotional problems, and substance use as well as the mediating role of contextual problems and sensation seeking in this relation. A cross-sectional study of 2277 adolescents from Northern Chile was conducted. The System for the Evaluation of Children and Adolescents (SENA) was used to assess substance use, contextual problems, sensation seeking, and emotional and behavioral problems. Through a mediational model, it was observed that substance use has a positive indirect effect on emotional and behavioral problems when both contextual problems and sensation seeking act as mediating variables. An indirect effect of substance use on contextual problems with sensation seeking as a mediator was also observed. The results suggests that context and sensation seeking are a relevant source of information in understanding adolescents and their propensity to use drugs. Interventions based on addressing contextual problems (problems with school, peers, and family) and enhancing personal resources should be implemented in order to reduce substance use in adolescents as well as the consequences it can generate in the short, medium, and long term.

A Health Technician-delivered Brief Intervention linked to AUDIT for reduction of alcohol use in Chilean primary care: a randomized controlled trial.

BACKGROUND: Because of the shortage of health professionals in Chilean primary care, Health Technicians (HT) are providing Brief Interventions (BI) for risky alcohol consumption. We compared the efficacy of two AUDIT-linked interventions provided by HTs: an informative leaflet and a BI plus leaflet. METHODS: This is a parallel-group randomized controlled trial with 1:1 randomization. Participants were identified through screening with the Alcohol Use Disorders Identification Test (AUDIT) at five primary care centers between March 2016 and July 2017. People older than 18 years at intermediate-risk (AUDIT score 8 to 15, inclusive) were randomized to receive either an HT-delivered BI (n = 174) or an informative leaflet (n = 168). Only data from participants (n = 294) who completed the 6-month assessment were analyzed. The leaflet was delivered without further advice. It contains alcohol consumption limits, a change planner, and strategies to decrease drinking. The BI was a 5-min discussion on the leaflet´s content plus normative feedback, tailored information on alcohol and health, and a change plan. The change in the AUDIT risk category six months after randomization (primary outcome) was compared among groups with a Chi-squared test. Changes in the secondary outcomes, which were scores on the AUDIT and the AUDIT´s consumption items (AUDIT-C), were compared with T-tests. Mixed-effects linear models adjusted for potential confounders. Outcome adjudicators were blinded to group assignment. RESULTS: At 6-month follow-up, low-risk alcohol consumption was observed in 119 (80%) participants in the BI group, and in 103 (71%) in the leaflet group, with no difference among groups ([Formula: see text] [1, N = 294] = 2.6, p = 0.1; adjusted odds ratio 0.6; 95% confidence interval [CI] 0.34, 1.05). The mean AUDIT score decreased by 5.76 points in the BI group, and by 5.07 in the leaflet group, which represents a 0.86 AUDIT point reduction attributable to the BI (secondary outcome) (T = 2.03, p = 0.043; adjusted mean difference 0.86 CI 0.06, 1.66). CONCLUSIONS: The AUDIT-linked BI delivered by HTs was not associated with a greater reduction of risky alcohol consumption than an informative leaflet. Delivering a leaflet could be more efficient than a BI when provided by HTs; however, more research on the effectiveness of the leaflet is needed. Trial registration ClinicalTrials.gov NCT02642757 (December 30, 2015) https://clinicaltrials.gov/ct2/show/NCT02642757 .

Apoyo social percibido en pacientes con Hipertensión Arterial y Diabetes Mellitus tipo II en Atención Primaria y su relación con autopercepción de salud / Social support, self-rated health, treatment adherence and effectiveness in patients with type II diabetes and hypertension

Background: A high level of social support (SS) is associated with better health outcomes in many conditions, such as chronic diseases. Aim : To describe the level of SS in patients with Hypertension and type II Diabetes at Primary Health Care level in Chile and its association with self-rated health, adherence to treatment and better glycemic and blood pressure control. Material and Methods : SS was measured using a social support inventory previously validated in Chile. Self-Rated Health was assessed with a single non-comparative general question; adherence to medication was assessed using the four-item Morisky medication adherence scale. Blood glucose and blood pressure control were also assessed. A logistic regression was performed to estimate Prevalence Odds Ratio (POR) and Robust Poisson method to estimate the Prevalence Ratio (PR). Results : Eighty three percent of the 647 participants evaluated high for SS. There was a significant correlation between SS and Self-rated health (POR 2.32; 95% confidence intervals (CI) 1.19-11.23; PR 1.18; 95% CI 1.07-1.31). No statistically significant association was observed with medication adherence, glycemic or blood pressure control. Conclusions: High levels of SS were found. The association between self-rated health suggests that SS interventions targeting vulnerable subgroups would be worthwhile.

Efectividad de un modelo de manejo de pacientes con hipertensión y diabetes tipo II en atención primaria / Effectiveness of a case management intervention for high blood pressure and type II diabetes in primary health care

Background: Adequate management of high blood pressure (HBP) and Type 2 Diabetes (DM2) is a challenge to the healthcare system in Chile. Aim: To evaluate the effectiveness of a case management (CM) approach to manage HBP and DMII at Primary Healthcare (PHC) level, headed by healthcare technicians with the supervision of registered nurses. Material and Methods: Two primary health care centers were selected. In one the case management approach was used and the other continued with the usual care model. Patients with HBP or DM2 were selected to participate in both centers. The main outcomes were changes blood pressure and glycosylated hemoglobin levels. Results: Three hundred twenty-eight patients were allocated to the intervention group and 316 to control group. At the baseline evaluation, participants at the control health center had better systolic and diastolic BP levels (SBP and DBP), but no difference in glycosylated hemoglobin. After twelve months the adjusted mean difference in HBP patients for SBP was −0.93 (95% conficence intervals (CI) −5.49,3.63) and for DBP was 1.78 (95%CI −2.89,6.43). Among HBP+DMII patients, the mean difference for SBP was −0.51 (95% −0.52,0.49) and for DBP was −3.39 (95%CI −6.07, −0.7). No differences in glycosylated hemoglobin were observed. In a secondary analysis, the intervention group showed a statistically significant higher SBP and DBP reduction than the control group. Conclusions: The case management approach tested in this study had promissory results among patients with high blood pressure.

[Social support, self-rated health, treatment adherence and effectiveness in patients with type II diabetes and hypertension]. / Apoyo social percibido en pacientes con Hipertensión Arterial y Diabetes Mellitus tipo II en Atención Primaria y su relación con autopercepción de salud.

BACKGROUND: A high level of social support (SS) is associated with better health outcomes in many conditions, such as chronic diseases. AIM: To describe the level of SS in patients with Hypertension and type II Diabetes at Primary Health Care level in Chile and its association with self-rated health, adherence to treatment and better glycemic and blood pressure control. MATERIAL AND METHODS: SS was measured using a social support inventory previously validated in Chile. Self-Rated Health was assessed with a single non-comparative general question; adherence to medication was assessed using the four-item Morisky medication adherence scale. Blood glucose and blood pressure control were also assessed. A logistic regression was performed to estimate Prevalence Odds Ratio (POR) and Robust Poisson method to estimate the Prevalence Ratio (PR). RESULTS: Eighty three percent of the 647 participants evaluated high for SS. There was a significant correlation between SS and Self-rated health (POR 2.32; 95% confidence intervals (CI) 1.19-11.23; PR 1.18; 95% CI 1.07-1.31). No statistically significant association was observed with medication adherence, glycemic or blood pressure control. CONCLUSIONS: High levels of SS were found. The association between self-rated health suggests that SS interventions targeting vulnerable subgroups would be worthwhile.

[Effectiveness of a case management intervention for high blood pressure and type II diabetes in primary health care]. / Efectividad de un modelo de manejo de pacientes con hipertensión y diabetes tipo II en atención primaria.

BACKGROUND: Adequate management of high blood pressure (HBP) and Type 2 Diabetes (DM2) is a challenge to the healthcare system in Chile. AIM: To evaluate the effectiveness of a case management (CM) approach to manage HBP and DMII at Primary Healthcare (PHC) level, headed by healthcare technicians with the supervision of registered nurses. MATERIAL AND METHODS: Two primary health care centers were selected. In one the case management approach was used and the other continued with the usual care model. Patients with HBP or DM2 were selected to participate in both centers. The main outcomes were changes blood pressure and glycosylated hemoglobin levels. RESULTS: Three hundred twenty-eight patients were allocated to the intervention group and 316 to control group. At the baseline evaluation, participants at the control health center had better systolic and diastolic BP levels (SBP and DBP), but no difference in glycosylated hemoglobin. After twelve months the adjusted mean difference in HBP patients for SBP was -0.93 (95% conficence intervals (CI) -5.49,3.63) and for DBP was 1.78 (95%CI -2.89,6.43). Among HBP+DMII patients, the mean difference for SBP was -0.51 (95% -0.52,0.49) and for DBP was -3.39 (95%CI -6.07, -0.7). No differences in glycosylated hemoglobin were observed. In a secondary analysis, the intervention group showed a statistically significant higher SBP and DBP reduction than the control group. CONCLUSIONS: The case management approach tested in this study had promissory results among patients with high blood pressure.

Hemoperitoneo en el puerperio debido a ruptura de vasos venosos uterinos asociado a endometriosis. Presentación de un caso y revisión de la literatura / Post-partum hemoperitoneum following uterine vessel rupture associated with endometriosis. Case report and review of the literature

Objetivo: realizar una revisión de la literatura sobre la epidemiología, etiología, diagnóstico y manejo de la ruptura de vasos uterinos en el embarazo.Materiales y métodos: Se presenta el caso de una mujer de 32 años quien desarrolla un hemoperitoneo espontáneo en el puerperio inmediato, secundario a la ruptura de los vasos uterinos superficiales en el Hospital Universitario Fundación Santa Fe de Bogotá, instituto de cuarto nivel, que atiende pacientes del aseguramiento contributivo privado. Se realizó una laparotomía e histerectomía de urgencia en la que se encontró tejido endometrial en cara posterior del útero y en fondo de saco posterior con sangrado venoso activo. Se realizó una búsqueda bibliográfica en las bases de datos electrónicas Medline/Pubmed, Ebsco, Ovid y ProQuest a partir de los términos hemoperitoneum, pregnancy, uterine vessel rupture y endometriosis sin limitación de idioma y diseño epidemiológico, publicados desde 1966 hasta la fecha.Resultados: se encontraron 34 artículos de interés, de estos se seleccionaron un total de 13: una guía de práctica clínica, 2 artículos de revisión y 10 reportes de casos. Conclusión: el hemoperitoneo durante el embarazo, como resultado de ruptura de los vasos uterinos, es una complicación rara, de etiología no clara y cuadro clínico poco específico. Para el manejo es necesario realizar un enfoque multidisciplinario, intervención quirúrgica temprana y correcta reposición del volumen intravascular.

Objective: To undertake a review of the literature on the epidemiology, etiology, diagnosis and management of uterine vessel ruptures in pregnancy.Materials and methods: A case of a 32 year old woman with spontaneous hemoperitoneum in the immediate post-partum period secondary to a rupture of superficial uterine vessels at Hospital Universitario Fundación Santa Fe, a high complexity institution that provides care to patients with private contributive health insurance coverage. Emergency laparotomy and hysterectomy were performed with a finding of endometrial tissue in the posterior aspect of the uterus and the posterior cul-de-sac, and active venous bleeding. A search of the literature was done in Medline/Pubmed, Ebsco, Ovid and ProQuest, using the terms "hemoperitoneum", "pregnancy", "uterine vessel rupture" and "endometriosis" with no language limitation and epidemiologic design, published since 1966 to this date. Results: Out of 34 articles of interest, 13 were selected: 1 clinical practice guideline, 2 review articles and 10 case reports. Conclusion: Hemoperitoneum in pregnancy, secondary to uterine vessel rupture is a rare complication of unclear etiology and non-specific clinical presentation. Management requires a multidisciplinary approach with early surgical intervention and correct intravascular volume replacement.