Development of a point-of-care colorimetric metabolomic sensor platform.

Metabolomics is the large-scale study of small molecule metabolites within a biological system. It has applications in measuring dietary intake, predicting heart disease risk, and diagnosing cancer. Metabolites are often measured using high-end analytical tools such as mass spectrometers or large spectrophotometers. However, due to their size, cost, and need for skilled operators, using such equipment at the bedside is not practical. To address this issue, we have developed a low-cost, portable, optical color sensor platform for metabolite detection. This platform includes LEDs, sensors, microcontrollers, a power source, and a Bluetooth chip enclosed within a 3D-printed light-tight case. We evaluated the color sensor's performance using both a range of dyed water samples as well as well-established colorimetric reactions for specific metabolite detection. The sensor accurately measured creatinine, L-carnitine, ascorbate, and succinate well within normal human urine levels with accuracy and sensitivity equal to or better than a standard laboratory spectrophotometer. Our color sensor offers a cost-effective, portable alternative for measuring metabolites via colorimetric assays, thereby enabling low-cost, point-of-care metabolite testing.

Consensus on pharmacological treatment of obesity in Latin America.

A panel of 10 experts in obesity from various Latin American countries held a Zoom meeting intending to reach a consensus on the use of anti-obesity medicines and make updated recommendations suitable for the Latin American population based on the available evidence. A questionnaire with 16 questions was developed using the Patient, Intervention, Comparison, Outcome (Result) methodology, which was iterated according to the modified Delphi methodology, and a consensus was reached with 80% or higher agreement. Failure to reach a consensus led to a second round of analysis with a rephrased question and the same rules for agreement. The recommendations were drafted based on the guidelines of the American College of Cardiology Foundation/American Heart Association Task Force on Practice. This panel of experts recommends drug therapy in patients with a body mass index of ≥30 or ≥27 kg/m2 plus at least one comorbidity, when lifestyle changes are not enough to achieve the weight loss objective; alternatively, lifestyle changes could be maintained while considering individual parameters. Algorithms for the use of long-term medications are suggested based on drugs that increase or decrease body weight, results, contraindications, and medications that are not recommended. The authors concluded that anti-obesity treatments should be individualized and multidisciplinary.

Pediatric heart surgery minimally invasive: experience of a Colombian center / Cirugía cardiaca pediátrica mínimamente invasiva: experiencia de un centro colombiano cardiovascular.

Objective: During the last decades, cardiac surgery has revolutionized, there is a growing interest in minimizing the physical aggression of surgical procedures, seeking a quick recovery, minimally invasive approaches have been a trend in recent years, with safety and efficacy equivalent to traditional techniques sternotomy. The objective of this study is to compare ­clinical results between pediatric patients with congenital heart disease undergoing minimally invasive surgery versus standard sternotomy. Methods: Case-control study, nested in a retrospective cohort. All pediatric patients over 10 kg in weight were included, between 2014 and 2019 who underwent surgical correction of simple congenital heart disease, in a cardiovascular center in Medellin. A case was defined as one that underwent a minimally invasive approach (MICS) and control patients who were approached in a conventional manner (CONV). 122 patients were admitted, with a mean age (MICS: 6, 4-12 vs. CONV: 5, 2-8 years). No differences were found in the baseline characteristics of both groups. No statistically significant difference was documented in infusion times (MICS: 67 min [50-90] vs. CONV: 53 min [42-90]; p = 0.54), nor differences in complications (MICS: 7.4 vs. CONV: 8.8%; p = 0.77). MICS patients had lactate on admission and a shorter ICU stay than controls. ­ Conclusion: The MICS approach turns out to be a novel, less invasive, safe and efficient technique compared to the conventional surgical approach for the repair of simple congenital heart disease in pediatric patients.

Objetivo: Durante las últimas décadas, la cirugía cardiaca ha evolucionado, existe un interés creciente en minimizar la agresión corporal de procedimientos quirúrgicos, buscando una rápida recuperación, los abordajes mínimamente invasivos han sido tendencia en los últimos años, con seguridad y eficacia equivalente a las técnicas tradicionales de esternotomía. El objetivo de este estudio es comparar resultados clínicos entre pacientes pediátricos con cardiopatías congénitas sometidos a cirugía mínimamente invasiva frente a esternotomía estándar. Métodos: Estudio de casos y controles, anidado en una cohorte retrospectiva. Se incluyeron todos los pacientes pediátricos mayores de 10 kg de peso, sometidos entre 2014 a 2019 a corrección quirúrgica de cardiopatías congénitas simples, en un centro cardiovascular en Medellín. Se definió caso aquel que fuera sometido a abordaje mínimamente invasivo (MICS) y control los pacientes que se abordaron de manera convencional (CONV). Un total de 122 pacientes fueron admitidos, con una media de edad (MICS: 6 [4-12] vs. CONV: 5 [2-8 años]). No se encontraron diferencias en las características basales de ambos grupos. No se documentó diferencia estadísticamente significativa en los tiempos de perfusión (MICS: 67 min [50-90] vs. CONV 53 min: [42­90]; p= 0,54), ni diferencias en las complicaciones (MICS; 7.4% vs. CONV: 8.8%; p = 0.77). Los pacientes MICS tuvieron un lactato al ingreso y una estadía en la UCI menor que los controles. Conclusión: El abordaje MICS resulta ser una técnica novedosa, menos invasiva, segura y eficiente, frente al abordaje quirúrgico CONV, para la reparación de cardiopatías congénitas simples en paciente pediátricos.

Hormesis-Inducing Essential Oil Nanodelivery System Protects Plants against Broad Host-Range Necrotrophs.

Botrytis cinerea, a broad host-range necrotrophic (BHN) phytopathogen, establishes compatible interactions with hosts by deploying multigene infection strategies, rendering simply inherited resistance ineffective to fight off this pathogen. Since essential oils (EOs) serve as intermediators during phytobiome communication, we hypothesize that they have the potential to enhance the quantitative disease resistance against BHN by eliciting the adaptive stress response (hormesis) in plants. However, using EOs is challenging due to their poor solubility in water. Nanoemulsification of EOs enhances not only the solubility of EOs but also their potency and stability. Here, we demonstrate the potential use of essential oil nanoemulsions (EONEs) to control infections caused by BHN. Using basic engineering principles of nanocarrier design, we demonstrate the efficacy of a robust EONEs design for controlling B. cinerea infection in a model plant, Arabidopsis thaliana. Our nanoemulsion delivery system significantly enhanced the disease resistance of the host by reducing the necrotic area by up to 50% compared to untreated plants. RNA-seq analysis indicated that successful treatments upregulated autophagy, ROS scavenging, and activation of the jasmonic acid signaling pathway.

Influence of gamma radiation on Amphotericin B incorporated in PVP hydrogel as an alternative treatment for cutaneous leishmaniosis.

Amphotericin B (Amph-B) is an antifungal drug used intravenously for the treatment of leishmaniasis. Side-effects from Amph-B treatment can arise such as cardiac arrhythmia and renal dysfunctions, which will lead to discontinuation of treatment. Unfortunately, patients in endemic countries do not have access to alternative therapies. The objective of this study was to analyze the effects of Cobalt-60 gamma irradiation on crosslinking polymeric hydrogels (Hydg) and the incorporation of Amph-B into the gel as a controlled-release drug delivery alternative. Polyvinylpyrrolidone (PVP)/Amph-B solutions were irradiated with 15 kGy at 0 °C and 25 °C. The drug's stability was ascertained by UV-visible spectrometry, liquid chromatography/mass spectrometry and proton nuclear magnetic resonance. Irradiated Hydg/Amph-B achieved similar stability to the standard Amph-B solution and was enough to promote hydrogel crosslinking. In vitro trials were carried out to ensure Amph-B was still biologically active after irradiation. The results from flow cytometry and MTT assay show that Amph-B had an IC50 = 16.7 nM. A combination of Hydg at 1.324 gmL-1 and Amph-B at 25.1 nM for 24 h lead to the greatest inhibition of L. amazonensis promastigotes, and could be used as an alternative treatment method for cutaneous leishmaniosis.

Manejo Multidisciplinario de la Cavidad Oral en Pacientes COVID-19 bajo Ventilación Mecánica Invasiva. Rol del Equipo Odontológico / Multidisciplinary Management of the Oral Cavity in COVID-19 Patients under Invasive Mechanical Ventilation. Role of the Dental Team

RESUMEN: El objetivo de este artículo es presentar algunas consideraciones odontológicas y un protocolo de mantención para el manejo y cuidado de cavidad oral en pacientes en ventilación mecánica invasiva (VMI) en unidades de cuidados intensivos hospitalarios. Además, presentar recomendaciones para la implementación de estas. Desde el desarrollo del COVID-19 en el mundo, los casos de VMI prolongada han aumentado y junto con ellos, se ha visibilizado las complicaciones propias de este tipo de terapia, dentro de las cuales encontramos aquellas que afectan la cavidad oral. Los centros hospitalarios normalmente cuentan con servicios dentales conformados por distintas especialidades, las cuales en un trabajo mancomunado pueden entregar herramientas y educar al personal encargado para el cuidado de la cavidad oral en estos pacientes si es que son requeridos, siendo el odontólogo el encargado de evaluar las distintas situaciones clínicas y entregar directrices para la prevención y tratamiento de patología de la cavidad oral. En este trabajo se describen los pasos a seguir para realizar una correcta higiene oral de estos pacientes y el manejo de las distintas complicaciones posibles de observar, junto con la experiencia local de cómo solucionarlos de la mejor manera. Consideramos importante que las unidades de cuidados intensivos (UCI) conozcan el rol del odontólogo y las acciones que este equipo puede aportar en el cuidado de los pacientes hospitalizados para disminuir los riesgos asociados a ventilación prolongada, basados principalmente en el manejo de la higiene oral y lesiones asociadas.

ABSTRACT: The aim of this sutudy dental considerations and an oral cavity maintenance and care protocol in patients on invasive mechanical ventilation (IMV) in hospital intensive care units. Since the development of COVID-19 in the world, cases of prolonged IMV have increased and together with them, the complications of this type of therapy have been made visible, among which we find those that affect the oral cavity. Hospital centers normally have dental services made up of different specialties, which in a joint effort can provide tools and educate the personnel in charge of the care of the oral cavity in these patients if they are required, being the dentist the one in charge of evaluating and deliver guidelines for the prevention and treatment of pathology of the oral cavity. This work describes the steps to be followed to carry out correct oral hygiene in these patients and the management of the different complications that may be observed, along with local experience on how to best solve them. We consider important that the intensive care units (ICU) get to know the role of the dentist in the hospital environment and that they become part of the care of hospitalized patients to reduce the risks associated with prolonged ventilation, based mainly on oral hygiene management and associated injuries.

The Good, the Bad, and Recovery: Adolescents Describe the Advantages and Disadvantages of Alternative Peer Groups.

In 2017, approximately 1.5 million American adolescents had a substance use disorder (SUD). Adolescents with SUD risk hindering their neurological development, which can result in problems with memory and self-regulation, and in turn disrupt their education, relationships, and life opportunities. Treating adolescents with SUD is challenging. Thus, effective models that help adolescents engage in long-term recovery are needed. The Alternative Peer Group (APG) is an adolescent recovery support model that incorporates pro-recovery peers and sober social activities into standard continuing care practices. In this qualitative study thematic content analysis methods were used to explore transcripts from in-depth interviews with adolescent APG participants collected in a prior study. The aim of this secondary analysis was to get a clear understanding of adolescents' perceptions of the advantages and disadvantages of APGs for supporting SUD recovery. Findings suggest that pro-recovery peer and adult role models, structured activities and a positive social climate that promotes fun, a sense of belonging, and accountability are continuing care elements that are likely to help adolescents resolve their ambivalence about SUD recovery and increase their motivation to engage in the hard work of recovery. These findings can inform the design of effective recovery support model services that promote long-term recovery for adolescents with SUD.

Nanoscale Drug Delivery Systems: From Medicine to Agriculture.

The main challenges in drug delivery systems are to protect, transport and release biologically active compounds at the right time in a safe and reproducible manner, usually at a specific target site. In the past, drug nano-carriers have contributed to the development of precision medicine and to a lesser extent have focused on its inroads in agriculture. The concept of engineered nano-carriers may be a promising route to address confounding challenges in agriculture that could perhaps lead to an increase in crop production while reducing the environmental impact associated with crop protection and food production. The main objective of this review is to contrast the advantages and disadvantages of different types of nanoparticles and nano-carriers currently used in the biomedical field along with their fabrication methods to discuss the potential use of these technologies at a larger scale in agriculture. Here we explain what is the problem that nano-delivery systems intent to solve as a technological platform and describe the benefits this technology has brought to medicine. Also here we highlight the potential drawbacks that this technology may face during its translation to agricultural applications, based on the lessons learned so far from its use for biomedical purposes. We discuss not only the characteristics of an ideal nano-delivery system, but also the potential constraints regarding the fabrication including technical, environmental, and legal aspects. A key motivation is to evaluate the potential use of these systems in agriculture, especially in the area of plant breeding, growth promotion, disease control, and post-harvest quality control. Further, we highlight the importance of a rational design of nano-carriers and identify current research gaps to enable scale-up relevant to applications in the treatment of plant diseases, controlled release of fertilizers, and plant breeding.

[Head and neck cancer: validation of the QLQ-H&N35 quality of life questionnaire]. / Cáncer de cabeza y cuello: validación de cuestionario QLQ-H&N35.

BACKGROUND: Head and neck cancer affects esthetic and anatomical parameters, causing pain and functional impotence, affecting vital functions such as eating and breathing, hampering the quality of life of patients. EORTCQLQ-C30 questionnaire with its supplementary module QLQ-H & N35 evaluates the quality of life of these patients. AIM: To statistically validate the QLQ-H & N35 questionnaire in patients with head and neck cancer. MATERIAL AND METHODS: In a cross-sectional study, we studied patients with head and neck cancer who attended a rehabilitation unit. Reliability was measured using Cronbach's α and validity was determined by the diagnostic efficiency of the QLQ-H & N35 scale as compared with the SF-36 quality of life survey. A Receiver Operational Characteristic (ROC) curve was generated. RESULTS: The Cronbach's α global internal consistency of the questionnaire was > 0.70 and its discrimination capacity was 74.2%, which are considered acceptable. CONCLUSIONS: These results confirm the statistical validity of the QLQ-H & N35 questionnaire, specifically for patients with head and neck cancer in Chile.

Bronchopulmonary dysplasia predictor scale validation in preterm newborns in two neonatal units at 2600 m above sea level.

INTRODUCTION: Bronchopulmonary dysplasia (BPD) is common in premature babies. It is difficult to predict the risk of developing this disease and its definition is not well characterized in high altitude cities. OBJECTIVE: To determine the operating characteristics of a BPD predictive scale for in preterm infants based on a classical BPD definition and one adjusted for altitude. MATERIALS AND METHOD: Observational, analytical, longitudinal study with infants gestational age ≤32 weeks admitted at two University Hospital's in the city of Bogotá, Colombia between June 2010 and December 2016. The 2001 NIH consensus definition for BPD was used and a definition with an altitude adjustment. Perinatal data, and the Romagnoli scale variables for the 3rd and 5th days were described. Score operational characteristics in relation to BPD frequency are measured using the two definitions. RESULTS: 335 patients were included. The median birth weight was 1335 g and GA was 31 weeks. For the BPD classical definition, the incidence was 85%, whereas after adjusting for altitude it was 20%. The scale score showed good overall discrimination (ROC curve, AUC 0.81-0.86). The sensitivity for the classical definition with a high cut point of 4 was between 93-98% and the adjusted for altitude was 28-37%. The specificity for the same cut was 28-32% with the classical definition and 96% with the adjusted one. CONCLUSIONS: The scale using the classical definition has high sensitivity, but it is not specific; adjusting the definition for altitude decreases sensitivity but increases specificity. New cutoffs points are needed on the scale or a change in the weight for the variables included in the model in order to be used in our high-altitude population.

Cáncer de cabeza y cuello: validación de cuestionario QLQ-H& N35 / Head and neck cancer: validation of the QLQ-H& N35 quality of life questionnaire

Background: Head and neck cancer affects esthetic and anatomical parameters, causing pain and functional impotence, affecting vital functions such as eating and breathing, hampering the quality of life of patients. EORTCQLQ-C30 questionnaire with its supplementary module QLQ-H & N35 evaluates the quality of life of these patients. Aim: To statistically validate the QLQ-H & N35 questionnaire in patients with head and neck cancer. Material and Methods: In a cross-sectional study, we studied patients with head and neck cancer who attended a rehabilitation unit. Reliability was measured using Cronbach's α and validity was determined by the diagnostic efficiency of the QLQ-H & N35 scale as compared with the SF-36 quality of life survey. A Receiver Operational Characteristic (ROC) curve was generated. Results: The Cronbach's α global internal consistency of the questionnaire was > 0.70 and its discrimination capacity was 74.2%, which are considered acceptable. Conclusions: These results confirm the statistical validity of the QLQ-H & N35 questionnaire, specifically for patients with head and neck cancer in Chile.

Porous micropillar structures for retaining low surface tension liquids.

The ability to manipulate fluid interfaces, e.g., to retain liquid behind or within porous structures, can be beneficial in multiple applications, including microfluidics, biochemical analysis, and the thermal management of electronic systems. While there are a variety of strategies for controlling the disposition of liquid water via capillarity, such as the use of chemically modified porous adhesive structures and capillary stop valves or surface geometric features, methods that work well for low surface tension liquids are far more difficult to implement. This study demonstrates the microfabrication of a silicon membrane that can retain exceptionally low surface tension fluorinated liquids against a significant pressure difference across the membrane via an array of porous micropillar structures. The membrane uses capillary forces along the triple phase contact line to maintain stable liquid menisci that yield positive working Laplace pressures. The micropillars have inner diameters and thicknesses of 1.5-3 µm and ∼1 µm, respectively, sustaining Laplace pressures up to 39 kPa for water and 9 kPa for Fluorinert™ (FC-40). A theoretical model for predicting the change in pressure as the liquid advances along the porous micropillar structure is derived based on a free energy analysis of the liquid meniscus with capped spherical geometry. The theoretical prediction was found to overestimate the burst pressure compared with the experimental measurements. To elucidate this deviation, transient numerical simulations based on the Volume of Fluid (VOF) were performed to explore the liquid pressure and evolution of meniscus shape under different flow rates (i.e., Capillary numbers). The results from VOF simulations reveal strong dynamic effects where the anisotropic expansion of liquid along the outer micropillar edge leads to an irregular meniscus shape before the liquid spills along the micropillar edge. These findings suggest that the analytical prediction of burst Laplace pressure obtained under quasi-static condition (i.e., equilibrium thermodynamic analysis under low capillary number) is not applicable to highly dynamic flow conditions, where the liquid meniscus shape deformation by flow perturbation cannot be restored by surface tension force instantaneously. Therefore, the critical burst pressure is dependent on the liquid velocity and viscosity under dynamic flow conditions. A numerical simulation using Surface Evolver also predicts that surface defects along the outer micropillar edge can yield up to 50% lower Laplace pressures than those predicted with ideal feature geometries. The liquid retention strategy developed here can facilitate the routing and phase management of dielectric working fluids for application in heat exchangers. Further improvements in the retention performance can be realized by optimizing the fabrication process to reduce surface defects.

Neonato con malformación de la vena de Galeno con diagnóstico oportuno: reporte de caso / Timely diagnosis of a Newborn wth Vein of Galen aneurysmal malformation: a case report

RESUMEN La malformación de la vena de Galeno a pesar de ser una patología poco frecuente representa un desafío clínico, por lo que debe ser detectada de forma temprana y manejada por un grupo multidisciplinario, iniciando desde los médicos generales quienes son los encargados de realizar el reconocimiento durante los controles prenatales, y así continuar el manejo de la mano de perinatólogos, pediatras, neonatólogos y radiólogos intervencionistas, todos ellos encargados de supervisar la evolución del paciente y dar tratamiento oportuno para mejorar el pronóstico de vida. A continuación, se presenta un caso clínico cuyo diagnóstico prenatal y manejo medico logró disminuir las complicaciones y comorbilidades resultantes, y así garantizar su preparación para una intervención endovascular posterior.

SUMMARY The vein of Galen malformation is a clinical challenge despite its low frequency, this disease must be detected early during the prenatal age and managed by a multidisciplinary group, beginning with the general physician in the antenatal medical appointment and later receiving treatment with perinatologists, pediatricians, neonatologists and interventional radiologists; all of this in order to ensure a better outcome and neurologic and systemic consequences. This report shows a female patient with an early and accurate antenatal diagnosis of vein of Galen malformation; during the postnatal period multidisciplinary approach and rationale medical management lowered the risk and possible complications, allowing the preparation for a late endovascular intervention.

About the Sterilization of Chitosan Hydrogel Nanoparticles.

In the last years, nanostructured biomaterials have raised a great interest as platforms for delivery of drugs, genes, imaging agents and for tissue engineering applications. In particular, hydrogel nanoparticles (HNP) associate the distinctive features of hydrogels (high water uptake capacity, biocompatibility) with the advantages of being possible to tailor its physicochemical properties at nano-scale to increase solubility, immunocompatibility and cellular uptake. In order to be safe, HNP for biomedical applications, such as injectable or ophthalmic formulations, must be sterile. Literature is very scarce with respect to sterilization effects on nanostructured systems, and even more in what concerns HNP. This work aims to evaluate the effect and effectiveness of different sterilization methods on chitosan (CS) hydrogel nanoparticles. In addition to conventional methods (steam autoclave and gamma irradiation), a recent ozone-based method of sterilization was also tested. A model chitosan-tripolyphosphate (TPP) hydrogel nanoparticles (CS-HNP), with a broad spectrum of possible applications was produced and sterilized in the absence and in the presence of protective sugars (glucose and mannitol). Properties like size, zeta potential, absorbance, morphology, chemical structure and cytotoxicity were evaluated. It was found that the CS-HNP degrade by autoclaving and that sugars have no protective effect. Concerning gamma irradiation, the formation of agglomerates was observed, compromising the suspension stability. However, the nanoparticles resistance increases considerably in the presence of the sugars. Ozone sterilization did not lead to significant physical adverse effects, however, slight toxicity signs were observed, contrarily to gamma irradiation where no detectable changes on cells were found. Ozonation in the presence of sugars avoided cytotoxicity. Nevertheless, some chemical alterations were observed in the nanoparticles.

[The Moral Deliberation: The Clinical Ethics Method. Presentation of a Paediatric Case]. / La deliberación moral: el método de la ética clínica. A propósito de un caso de paciente pediátrico.

Decision-making is one of the most difficult tasks of medical judgment, especially when cases involve paediatric patients with different cultural characteristics. It is the obligation of clinical ethics, taking the interdisciplinary approach as a tool to comprehensively analyse the clinical, social, cultural and legal aspects, among other topics, when choosing the treatment options that will be more beneficial for the patient. A clinical case, should enable this process of analysis and teamwork to be understood in practical way in order to address difficult medical problems.

Evaluación de la autopercepción de la aptitud física y propuesta de normativas en adolescentes escolares chilenos: estudio EAPAF / Assessment of self-perception of physical fitness and proposal for standards among Chilean adolescent students: the EAPAF study

Introducción: La aptitud física en niños y adolescentes puede ser evaluada cuantitativa y cualitativamente. En la actualidad, en Chile, no existen herramientas que permitan evaluar la autopercepción de la aptitud física, por lo que el propósito de este estudio fue construir un instrumento válido y confiable que permitiera evaluar la autopercepción de la aptitud física de adolescentes y proponer valores normativos según edad y sexo. Material y métodos: Se encuestaron a adolescentes escolares de 6 escuelas públicas de la región del Maule, Chile, seleccionadas de forma probabilística (estratificada). Para medir la autopercepción de la aptitud física, se construyó un instrumento cualitativo, la escala de autopercepción de la aptitud física(EAPAF) con 4 dimensiones y 18 preguntas. Se utilizó el método LMS (L= coeficiente Box-Cox; M= mediana; S= coeficiente de variación) para desarrollar percentilos y proponer las referencias según dimensión, edad y sexo. Resultados: Se estudió a 3060 adolescentes (1702 hombres y 1358 mujeres) entre 11,0 y 18,9 años. El análisis factorial evidenció cuatro factores. Los valores de saturación fueron superiores a 0,40. El % de explicación del instrumento ascendió a 54,24%. En relación con la confiabilidad, las 18 preguntas reflejaron un alfa de Cronbach entre 0,82 y 0,85. Se construyeron percentilos (p 15, p 50 y p 85) para clasificar la autopercepción de la aptitud física según dimensión, edad y sexo. Los hombres evidenciaron puntuaciones superiores en la escala de autopercepción de la aptitud física, en comparación con las mujeres (p < 0,001). Conclusión: El instrumento construido fue válido y confiable. Además, la propuesta de normativas puede ser una herramienta útil para clasificar a los adolescentes en relación con la autopercepción de la aptitud física.

Introduction: Physical fitness may be assessed among children and adolescents in a quantitative and qualitative manner. At present, in Chile, there are no tools available to assess self-perception of physical fitness. Therefore, the purpose of this study was to develop a valid and reliable instrument that would allow to assess selfperception of physical fitness among adolescents and propose standards for age and sex. Material and methods: A survey was administered among adolescent students from six public schools in the Maule Region, Chile, selected in a probabilistic (stratified) fashion. To measure self-perception of physical fitness, a qualitative instrument was developed: the Self-Perception of Physical Fitness Scale (EAPAF, escala de autopercepcion de la aptitud fisica), which is made up of four dimensions and 18 questions. The LMS method (L: Box-Cox coefficient, M: median curve, and S: variation coefficient) was used to establish percentiles and propose references by dimension, age and sex. Results: A total of 3060 adolescents (1702 boys and 1358 girls) aged 11.0 to 18.9 years old were included. The factor analysis evidenced four factors. Saturation values were above 0.40. The percentage of instrument explanation reached 54.24%. In terms of reliability, the 18 questions reflected that Cronbach's alpha was between 0.82 and 0.85. Percentiles (p15, p50 and p85) were developed to classify self-perception of physical fitness by dimension, age and sex. Boys showed higher scores in the self-perception of physical fitness scale when compared to girls (p < 0.001). Conclusion: The instrument developed in this study was valid and reliable. In addition, the standards proposed may become a useful tool to classify adolescents in relation to their selfperception of physical fitness.

Assessment of self-perception of physical fitness and proposal for standards among Chilean adolescent students: the EAPAF study. / Evaluación de la autopercepción de la aptitud física y propuesta de normativas en adolescentes escolares chilenos: estudio EAPAF.

INTRODUCTION: Physical fitness may be assessed among children and adolescents in a quantitative and qualitative manner. At present, in Chile, there are no tools available to assess self-perception of physical fitness. Therefore, the purpose of this study was to develop a valid and reliable instrument that would allow to assess selfperception of physical fitness among adolescents and propose standards for age and sex. MATERIALS AND METHODS: A survey was administered among adolescent students from six public schools in the Maule Region, Chile, selected in a probabilistic (stratified) fashion. To measure self-perception of physical fitness, a qualitative instrument was developed: the Self-Perception of Physical Fitness Scale (EAPAF, escala de autopercepcion de la aptitud fisica), which is made up of four dimensions and 18 questions. The LMS method (L: Box-Cox coefficient, M: median curve, and S: variation coefficient) was used to establish percentiles and propose references by dimension, age and sex. RESULTS: A total of 3060 adolescents (1702 boys and 1358 girls) aged 11.0 to 18.9 years old were included. The factor analysis evidenced four factors. Saturation values were above 0.40. The percentage of instrument explanation reached 54.24%. In terms of reliability, the 18 questions reflected that Cronbach's alpha was between 0.82 and 0.85. Percentiles (p15, p50 and p85) were developed to classify self-perception of physical fitness by dimension, age and sex. Boys showed higher scores in the self-perception of physical fitness scale when compared to girls (p 〈 0.001). CONCLUSION: The instrument developed in this study was valid and reliable. In addition, the standards proposed may become a useful tool to classify adolescents in relation to their selfperception of physical fitness.

INTRODUCCIÓN: La aptitud física en niños y adolescentes puede ser evaluada cuantitativa y cualitativamente. En la actualidad, en Chile, no existen herramientas que permitan evaluar la autopercepción de la aptitud física, por lo que el propósito de este estudio fue construir un instrumento válido y confiable que permitiera evaluar la autopercepción de la aptitud física de adolescentes y proponer valores normativos según edad y sexo. MATERIAL Y MÉTODOS: Se encuestaron a adolescentes escolares de 6 escuelas públicas de la región del Maule, Chile, seleccionadas de forma probabilística (estratificada). Para medir la autopercepción de la aptitud física, se construyó un instrumento cualitativo, la escala de autopercepción de la aptitud física(EAPAF) con 4 dimensiones y 18 preguntas. Se utilizó el método LMS (L= coeficiente Box-Cox; M= mediana; S= coeficiente de variación) para desarrollar percentilos y proponer las referencias según dimensión, edad y sexo. RESULTADOS: Se estudió a 3060 adolescentes (1702 hombres y 1358 mujeres) entre 11,0 y 18,9 años. El análisis factorial evidenció cuatro factores. Los valores de saturación fueron superiores a 0,40. El % de explicación del instrumento ascendió a 54,24%. En relación con la confiabilidad, las 18 preguntas reflejaron un alfa de Cronbach entre 0,82 y 0,85. Se construyeron percentilos (p 15, p 50 y p 85) para clasificar la autopercepción de la aptitud física según dimensión, edad y sexo. Los hombres evidenciaron puntuaciones superiores en la escala de autopercepción de la aptitud física, en comparación con las mujeres (p 〈 0,001). CONCLUSIÓN: El instrumento construido fue válido y confiable. Además, la propuesta de normativas puede ser una herramienta útil para clasificar a los adolescentes en relación con la autopercepción de la aptitud física.

La deliberación moral: el método de la ética clínica. A propósito de un caso de paciente pediátrico / The Moral Deliberation: The Clinical Ethics Method. Presentation of a Paediatric Case

La toma de decisiones es una de las tareas más complejas del quehacer médico, y más cuando los casos afectan a pacientes pediátricos y con características socioculturales especiales. Es deber de la ética clínica, teniendo la interdisciplinaridad como herramienta, analizar de manera integral los aspectos clínicos, sociales, culturales y legales, entre otros, que se debe tener en cuenta a la hora de escoger la mejor opción terapéutica que beneficie al paciente. Un caso clínico permitirá entender de manera práctica este proceso de análisis y trabajo en equipo, para abordar problemas médicos difíciles.

Decision-making is one of the most difficult tasks of medical judgment, especially when cases involve paediatric patients with different cultural characteristics. It is the obligation of clinical ethics, taking the interdisciplinary approach as a tool to comprehensively analyse the clinical, social, cultural and legal aspects, among other topics, when choosing the treatment options that will be more beneficial for the patient. A clinical case, should enable this process of analysis and teamwork to be understood in practical way in order to address difficult medical problems.