Effect of intravenous pulses of methylprednisolone 250 mg versus dexamethasone 6 mg in hospitalised adults with severe COVID-19 pneumonia: An open-label randomised trial.

BACKGROUND: The efficacy and safety of high versus medium doses of glucocorticoids for the treatment of patients with COVID-19 has shown mixed outcomes in controlled trials and observational studies. We aimed to evaluate the effectiveness of methylprednisolone 250 mg bolus versus dexamethasone 6 mg in patients with severe COVID-19. METHODS: A randomised, open-label, controlled trial was conducted between February and August 2021 at four hospitals in Spain. The trial was suspended after the first interim analysis since the investigators considered that continuing the trial would be futile. Patients were randomly assigned in a 1:1 ratio to receive dexamethasone 6 mg once daily for up to 10 days or methylprednisolone 250 mg once daily for 3 days. RESULTS: Of the 128 randomised patients, 125 were analysed (mean age 60 ± 17 years; 82 males [66%]). Mortality at 28 days was 4.8% in the 250 mg methylprednisolone group versus 4.8% in the 6 mg dexamethasone group (absolute risk difference, 0.1% [95% CI, -8.8 to 9.1%]; p = 0.98). None of the secondary outcomes (admission to the intensive care unit, non-invasive respiratory or high-flow oxygen support, additional immunosuppressive drugs, or length of stay), or prespecified sensitivity analyses were statistically significant. Hyperglycaemia was more frequent in the methylprednisolone group at 27.0 versus 8.1% (absolute risk difference, -18.9% [95% CI, -31.8 to - 5.6%]; p = 0.007). CONCLUSIONS: Among severe but not critical patients with COVID-19, 250 mg/d for 3 days of methylprednisolone compared with 6 mg/d for 10 days of dexamethasone did not result in a decrease in mortality or intubation.

Derecho a la alimentación en la Constitución chilena: elementos jurídicos, sociales y nutricionales para una propuesta / Right to food in the Chilean constitution: legal, social and nutritional elements for a proposal

BACKGROUND: The Human Right to Food is not incorporated in the Chilean Constitution. Aim: To identify the legal, social, and nutritional elements for its incorporation into the new Constitution, and to draft a text proposal for the constituent discussion. MATERIAL AND METHODS: Descriptive and qualitative study on the perceptions of experts and key actors of the food chain in Chile. The sample was for convenience and included civil society, academia, international organizations, parliamentarians, food traders and producers, and national and local authorities (n = 26). The research team, previously trained and standardized, applied semi-structured online surveys, which were recorded and transcribed. Through an inductive approach, a thematic analysis was carried out using the Atlas.ti 9.0 software. RESULTS: Eighty-one percent of the interviewees were in favor of the Constitutional incorporation of the Right to Food. According to interviews, a constitutional text was proposed considering the characteristics of adequate, healthy, safe, and nutritious foods. Also, the food items must be available, physically and economically accessible, and culturally relevant. A guaranteed citizen participation, food sovereignty, food security, and environmental sustainability must be considered. Conclusions: The high prevalence of malnutrition due to excess, poor diet, and food insecurity during the COVID-19 pandemic, and a current Constitution that does not explicitly guarantee physical and economic access to food, establish a factual and normative background that justifies the incorporation of this right in a new Constitution.

Derecho a la alimentación: ¿Qué dicen las constituciones de América y el Caribe?

RESUMEN Introducción: Numerosos países de América y el Caribe cuentan con el derecho constitucional a la Alimentación. Chile no cuenta con este derecho constitucionalizado. Objetivo: Describir comparativamente cómo se encuentra explícito el derecho a la alimentación (DA) en la Constitución de los países de América y el Caribe, generando insumos para aquellos países que no cuentan con este derecho explícito, como en Chile. Fuentes de datos: Esta búsqueda se realizó en las plataformas: Seguridad Alimentaria y Nutricional (SAN-CELAC), Derecho a la Alimentación en el Mundo (FAO) y Constitute Project que presenta las constituciones del mundo. Método de revisión: Se realizó una revisión todas las constituciones disponibles de los países independientes de América y el Caribe y de países con territorios dependientes y departamentos de ultramar en la Región. Posteriormente, en aquellos países que presentan el DA de forma explícita en su texto constitucional, se realizó una revisión sobre las características generales del texto constitucional y de los conceptos asociados a la definición del DA, sugeridos por la FAO. La revisión se llevó a cabo entre los meses de junio y septiembre de 2020. Resultados: Del total de los países revisados (n= 42), solo el 40,5% presentó el DA explícito en su texto constitucional. La seguridad alimentaria es el concepto que aparece con mayor frecuencia. Conclusión: La mayor parte de las constituciones acompañan el DA con características de seguridad alimentaria, disponibilidad y accesibilidad, e incluyen alguna forma de judicialización, conceptos que deberían ser incorporadas la nueva Carta Magna de Chile.

ABSTRACT Introduction: Many American and Caribbean countries consider the right to food as constitutional right. Chile does not have this explicit right in the Constitution. Objective: To describe comparatively how the right to food is explicit in the constitutions of American and Caribbean countries, generating inputs for those countries that do not have this constitutional right, such as the case of Chile. Data sources: This research was carried out on platforms: Food and Nutritional Security (SAN-CELAC), Right to Food in the World (FAO) and Constitute Project which presents constitutions of the world. Revision method: A revision was made of all available constitutions of American and independent Caribbean countries, dependent territories and overseas departments in the Region. Subsequently, in those countries which explicitly consider the right to food in constitutional texts, a review of general characteristics and right to food-associated concepts, suggested by FAO, was carried out. The review was carried out between June and September 2020. Results: Of the total of countries reviewed (n= 42), 40.5% presented the right to food in constitutional text. The most frequently associated concept was food security. Conclusion: Most of the revised constitutions accompany the right to food with food safety, availability and accessibility characteristics, and include kinds of judicialization, concepts that should be incorporated into the new Magna Carta of Chile.

[Right to food in the Chilean constitution: legal, social and nutritional elements for a proposal]. / Derecho a la alimentación en la Constitución chilena: elementos jurídicos, sociales y nutricionales para una propuesta.

BACKGROUND: The Human Right to Food is not incorporated in the Chilean Constitution. AIM: To identify the legal, social, and nutritional elements for its incorporation into the new Constitution, and to draft a text proposal for the constituent discussion. MATERIAL AND METHODS: Descriptive and qualitative study on the perceptions of experts and key actors of the food chain in Chile. The sample was for convenience and included civil society, academia, international organizations, parliamentarians, food traders and producers, and national and local authorities (n = 26). The research team, previously trained and standardized, applied semi-structured online surveys, which were recorded and transcribed. Through an inductive approach, a thematic analysis was carried out using the Atlas.ti 9.0 software. RESULTS: Eighty-one percent of the interviewees were in favor of the Constitutional incorporation of the Right to Food. According to interviews, a constitutional text was proposed considering the characteristics of adequate, healthy, safe, and nutritious foods. Also, the food items must be available, physically and economically accessible, and culturally relevant. A guaranteed citizen participation, food sovereignty, food security, and environmental sustainability must be considered. CONCLUSIONS: The high prevalence of malnutrition due to excess, poor diet, and food insecurity during the COVID-19 pandemic, and a current Constitution that does not explicitly guarantee physical and economic access to food, establish a factual and normative background that justifies the incorporation of this right in a new Constitution.

Determination of sulfachloropyridazine residue levels in feathers from broiler chickens after oral administration using liquid chromatography coupled to tandem mass spectrometry.

Several antimicrobials are routinely used by the poultry farming industry on their daily operations, however, researchers have found for some antimicrobials that their residues persist for longer periods in feathers than they do in edible tissues, and at higher concentrations, as well. But this information is not known for other classes of antimicrobials, such as the sulfonamides. Therefore, this work presents an accurate and reliable analytical method for the detection of sulfachloropyridazine (SCP) in feathers and edible tissues from broiler chickens. This method was also validated in-house and then used to study the depletion of sulfachloropyridazine in those matrices. The experimental group comprised 54 broiler chickens, who were raised under controlled conditions and then treated with a commercial formulation of 10% sulfachloropyridazine for 5 days. Samples were analyzed via LC-MS/MS, using 13C6-sulfamethazine (SMZ-13C6) as an internal standard. Aromatic sulfonic acid solid phase extraction (SPE) cartridges were used to clean up the samples. The Limit of Detection (LOD) for this method was set at 10 µg kg-1 on feathers and liver; and at 5 µg kg-1 on muscle. Within the range of 10-100 µg kg-1, the calibration curves for all matrices presented a determination coefficient greater than 0.96. Our results show, with a 95% confidence level, that sulfachloropyridazine persisted in feathers for up to 55 days after ceasing treatment, and its concentrations were higher than in edible tissues. In consequence, to avoid re-entry of antimicrobial residues into the food-chain, we recommend monitoring and inspecting animal diets that contain feather derivatives, such as feathers meals, because they could be sourced from birds that might have been medicated with sulfachloropyridazine.

Relationship among angiotensin-converting enzyme polymorphism, cardiovascular risk, and osteoporotic fractures.

OBJECTIVE: Angiotensin-converting enzyme (ACE) has been related to cardiovascular physiology and bone remodeling. Our aim was to assess the relationship among ACE polymorphisms, cardiovascular risk, and osteoporotic fractures. MATERIAL AND METHODS: We prospectively enrolled 71 patients with hypertension from 2001 to 2014. Sociodemographic and medical data were collected. Comorbidity was evaluated with Charlson index. Densitometric studies on lumbar spine were performed. ACE polymorphism was analyzed by polymerase chain reaction. Data were analyzed using SPSS 15.0 (p value <0.05). RESULTS: Homozygous deletion (DD) genotype was described in 32.4% of patients, homozygous insertion (II) in 19.7%, and heterozygous insertion/deletion (ID) in 47.9%. On stratifying data by ACE polymorphism, we observed that DD carriers demonstrated neither greater cardiovascular risk factors (30.4% vs. 33.3%, p=0.4) and higher comorbidity (34.8% vs. 22.9%, p=0.3) nor higher osteoporotic fracture incidence (17.4% vs. 16.8%, p=0.9). In women, no significant differences were observed between DD homozygous individuals and ID+II subjects. CONCLUSION: It is unclear whether DD genotype is an independent risk factor for cardiovascular disease. In contrast to our expectations, we found no relationship among the DD genotype, cardiovascular risk, and osteoporotic fracture incidence.

[Neddle-guided biopsy in the diagnosis of non-palpable breast cancer]. / Biopsia guiada con arpón en el diagnóstico de cáncer de mama no palpable.

OBJECTIVE: To estimate the diagnostic accuracy of the spearfishing or neddle-guided biopsy to breast cancer and no palpable mammography and ultrasound findings suspicious for malignancy. MATERIAL AND METHODS: Observational, transversal, prolective, and descriptive study was made. A histopathological diagnosis were conducted from August 2004 to December 2011 in the Radiology and Image Departmen of Centro Médico La Raza to patients sent by the service of Surgical Oncology-with non-palpable breast findings identified by mammography and/or ultrasound with any suspicion of malignancy. Radiographic and ultrasonographic images of the specimen were obtained after the surgical procedure. RESULTS: Harpoon 532 placements with histopathological report. Malignancies were 4.0% of the biopsies were performed in negative mammograms (ACR BI-RADS® 3) and 34.3% (p ≤ 0.05) of which were performed in positive mammography: 19.5% of mammograms ACR BI-4 and RADS® 89.7% (p < 0.0001) of mammograms ACR BI-RADS® 5. The negative mammography (ACR BI-RADS® 3) which resulted in cancer occurred in a patient with a personal history of breast cancer who had a solid nodule in one breast. In the evaluation of mammography studies and placing seven harpoons participated certified radiologists and additional qualification in breast imaging, and five radiology technicians trained in mammography. CONCLUSIONS: The positive cases in the evaluation of mammography studies and placing seven harpoons participated certified radiologists and additional qualification in breast imaging, and five radiology technicians trained in mammography. (sum of the ACR BI-RADS® cases 4 and ACR BI-RADS® 5) and individual cases ACR BI-RADS® 4 had a PPV within recommended ranges ACR BI-RADS®; PPV ACR BI-RADS® may was lower than recommended by the literature, although most recommended by other series, which forces us to emphasize adherence to the semiotics suggested by ACR BI-RADS® and avoid unnecessary surgery. Patients with a personal history of breast cancer and finding a new ACR BI-RADS® 3 should have an individual assessment and consider biopsy before the short-term monitoring.