Non-catalytic role of phosphoinositide 3-kinase in mesenchymal cell migration through non-canonical induction of p85ß/AP2-mediated endocytosis.

Class IA phosphoinositide 3-kinase (PI3K) galvanizes fundamental cellular processes such as migration, proliferation, and differentiation. To enable these multifaceted roles, the catalytic subunit p110 utilizes the multi-domain, regulatory subunit p85 through its inter SH2 domain (iSH2). In cell migration, its product PI(3,4,5)P3 generates locomotive activity. While non-catalytic roles are also implicated, underlying mechanisms and their relationship to PI(3,4,5)P3 signaling remain elusive. Here, we report that a disordered region of iSH2 contains AP2 binding motifs which can trigger clathrin and dynamin-mediated endocytosis independent of PI3K catalytic activity. The AP2 binding motif mutants of p85 aberrantly accumulate at focal adhesions and increase both velocity and persistency in fibroblast migration. We thus propose the dual functionality of PI3K in the control of cell motility, catalytic and non-catalytic, arising distinctly from juxtaposed regions within iSH2.

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

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

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

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

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

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

OnabotulinumtoxinA improves oral aperture in patients with scleroderma: A small clinical trial.

BACKGROUND: Reduced oral aperture (ROA), resulting from systemic sclerosis (SSc), is a debilitating condition with limited treatment options. Improvement in oral function has been reported with perioral administration of botulinum toxin type A. OBJECTIVE: To prospectively evaluate the efficacy of onabotulinumtoxinA (onabotA) injection in improving oral opening and quality of life in SSc patients with ROA. METHODS: Seventeen women with SSc and ROA were treated with 16 units of onabotA in 8 different sites around the cutaneous lips. Measurements of maximum mouth opening were taken before treatment, at 2 weeks posttreatment, and at 3 months posttreatment. Function and quality of life were also assessed via surveys. RESULTS: Interincisor and interlabial distances were significantly increased 2 weeks after treatment with onabotA (P < .001) but not 3 months after. Subjective improvement in quality of life was noted. LIMITATIONS: This single-institution study enrolled 17 patients and did not have a placebo control group. CONCLUSION: OnabotA appears to have a strong short-term symptomatic benefit in patients with ROA due to SSc, with possible benefit to quality of life.

Diferencias en los niveles de sexismo en estudiantes de Educación Física según variables sociodemográficas

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

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

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

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

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

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

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

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

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

A dual center and dual vendor comparison study of automated perfusion-weighted phase-resolved functional lung magnetic resonance imaging with dynamic contrast-enhanced magnetic resonance imaging in patients with cystic fibrosis.

For sensitive diagnosis and monitoring of pulmonary disease, ionizing radiation-free imaging methods are of great importance. A noncontrast and free-breathing proton magnetic resonance imaging (MRI) technique for assessment of pulmonary perfusion is phase-resolved functional lung (PREFUL) MRI. Since there is no validation of PREFUL MRI across different centers and scanners, the purpose of this study was to compare perfusion-weighted PREFUL MRI with the well-established dynamic contrast-enhanced (DCE) MRI across two centers on scanners from two different vendors. Sixteen patients with cystic fibrosis (CF) (Center 1: 10 patients; Center 2: 6 patients) underwent PREFUL and DCE MRI at 1.5T in the same imaging session. Normalized perfusion-weighted values and perfusion defect percentage (QDP) values were calculated for the whole lung and three central slices (dorsal, central, ventral of the carina). Obtained parameters were compared using Pearson correlation, Spearman correlation, Bland-Altman analysis, Wilcoxon signed-rank test, and Wilcoxon rank-sum test. Moderate-to-strong correlations between normalized perfusion-weighted PREFUL and DCE values were found (posterior slice: r = 0.69, p < 0.01). Spatial overlap of PREFUL and DCE QDP maps showed an agreement of 79.4% for the whole lung. Further, spatial overlap values of Center 1 were not significantly different to those of Center 2 for the three central slices (p > 0.07). The feasibility of PREFUL MRI across two different centers and two different vendors was shown in patients with CF and obtained results were in agreement with DCE MRI.

Beneficial Effects of Flavonoids on Skeletal Muscle Health: A Systematic Review and Meta-Analysis.

Skeletal muscle (SkM) is a highly dynamic tissue that responds to physiological adaptations or pathological conditions, and SkM mitochondria play a major role in bioenergetics, regulation of intracellular calcium homeostasis, pro-oxidant/antioxidant balance, and apoptosis. Flavonoids are polyphenolic compounds with the ability to modulate molecular pathways implicated in the development of mitochondrial myopathy. Therefore, it is pertinent to explore its potential application in conditions such as aging, disuse, denervation, diabetes, obesity, and cancer. To evaluate preclinical and clinical effects of flavonoids on SkM structure and function. We performed a systematic review of published studies, with no date restrictions applied, using PubMed and Scopus. The following search terms were used: "flavonoids" OR "flavanols" OR "flavones" OR "anthocyanidins" OR "flavanones" OR "flavan-3-ols" OR "catechins" OR "epicatechin" OR "(-)-epicatechin" AND "skeletal muscle." The studies included in this review were preclinical studies, clinical trials, controlled clinical trials, and randomized-controlled trials that investigated the influence of flavonoids on SkM health. Three authors, independently, assessed trials for the review. Any disagreement was resolved by consensus. The use of flavonoids could be a potential tool for the prevention of muscle loss. Their effects on metabolism and on mitochondria function suggest their use as muscle regulators.

The role of mediator subunit 12 in tumorigenesis and cancer therapeutics.

Mediator complex subunit 12 (MED12) is a subunit of Mediator, a large multi-subunit protein complex that acts an important regulator of transcription. Specifically, MED12 is an integral part of the kinase module of Mediator along with MED13, CyclinC (CycC) and CDK8. Structural studies have indicated that MED12 makes a direct connection to CycC through a specific interface and thereby functions to create a link between MED13 and CycC-CDK8. Disruption of the MED12-CycC interface often leads to dysregulated CDK8 kinase activity, which has important physiological implications. For example, a number of studies have indicated that mutations within MED12 can lead to the formation of benign or malignant tumors, either as a result of MED12-CycC disruption or through distinct independent mechanisms. Furthermore, recent studies have indicated that the N-terminal portion of MED12 forms a direct connection to CDK8. Mutations within MED12 do not appear to disrupt the physical connection to CDK8, but rather abrogate CDK8 kinase activity. Thus, mutations in MED12 can cause disruption of CDK8 kinase activity through two separate mechanisms. The aim of the present review article was to discuss the MED12 mutational landscape in a variety of benign and malignant tumors, as well as the mechanistic basis behind tumorigenesis. Furthermore, the link between MED12 and drug resistance has also been discussed, as well as potential cancer therapeutics related to MED12-altered tumors.

Validation of Phase-Resolved Functional Lung (PREFUL) Magnetic Resonance Imaging Pulse Wave Transit Time Compared to Echocardiography in Chronic Obstructive Pulmonary Disease.

BACKGROUND: Phase-resolved functional lung (PREFUL) magnetic resonance imaging (MRI) pulmonary pulse wave transit time (pPTT) is a contrast agent free, vascular imaging biomarker, but has not been validated in chronic obstructive pulmonary disease (COPD). PURPOSE: To validate PREFUL with echocardiographic pPTT as a reference standard and to compare arterial/venous pPTT mapping with spirometry and clinical parameters. STUDY TYPE: Prospective. POPULATION: Twenty-one patients (62% female) with COPD and 44 healthy participants (50% female). FIELD STRENGTH/SEQUENCE: 1.5 T; 2D-spoiled gradient-echo sequence. ASSESSMENT: Three coronal PREFUL MRI slices, echocardiography, and spirometry including forced expiratory volume in 1 second (FEV1, liter) and predicted defined as FEV1 in% divided by the population average FEV1%, were performed. Pulmonary pulse transit time from the main artery to the microvasculature (PREFUL pPTT), to the right upper lobe vein (PREFUL pPTTav , echo pPTTav ), from microvasculature to right upper lobe vein (PREFULvein ) and the ratio of PREFUL pPTT to PREFUL pPTTvein were calculated. Body mass index (BMI), Global Initiative for COPD (GOLD) stage 1-4, disease duration, and cigarette packs smoked per day multiplied by the smoked years (pack years) were computed. STATISTICAL TESTS: Shapiro-Wilk-test, paired-two-sided-t-tests, Bland-Altman-analysis, coefficient of variation, Pearson ρ were applied, pPTT data were compared between 21 subjects from the 44 healthy subjects who were age- and sex-matched to the COPD cohort, P < 0.05 was considered statistically significant. RESULTS: PREFUL pPTTav significantly correlated with echo pPTTav (ρ = 0.95) with 1.85 msec bias, 95% limits of agreement: 55.94 msec, -52.23 msec in all participants (P = 0.59). In the healthy participants, PREFUL and echo pPTTav significantly correlated with age (ρ = 0.81, ρ = 0.78), FEV1 (ρ = -0.47, ρ = -0.34) and BMI (ρ = 0.56, ρ = 0.51). In COPD patients, PREFUL pPTT significantly correlated with FEV1 predicted (ρ = -0.59), GOLD (ρ = 0.53), disease duration (ρ = 0.54), and pack years (ρ = 0.49). DATA CONCLUSION: Arteriovenous PTT measured by PREFUL MRI corresponds precisely to echocardiography and appears to be feasible even in severe COPD. EVIDENCE LEVEL: 1 TECHNICAL EFFICACY: Stage 2.

«Falta tiempo»: experiencias de médicos gestores de la demanda en la atención primaria de salud chilena / «Missing time»: Experiences of demand management doctors in Chilean primary health care

Objetivo: Caracterizar la situación actual del médico gestor de la demanda (MGD) en la atención primaria de salud (APS), desde las percepciones de aquellos que cumplen ese rol, sus pares médicos y los directivos de los centros de salud familiar (CESFAM). Diseño: Estudio transversal cualitativo con enfoque de teoría fundamentada. Emplazamiento: Cuatro CESFAM del Servicio de Salud Metropolitano Sur Oriente en Santiago, Chile. Participantes: Médico gestor de la demanda, médicos generales y directores de CESFAM. Método: Se utilizó la entrevista semiestructurada y el grupo de discusión como técnica de recolección de datos. Se realizó codificación abierta, axial y selectiva con el apoyo del software NVivo v.12. Resultados: El MGD realiza en la práctica más funciones que las definidas para el cargo por el Ministerio de Salud, generando una sensación de falta de tiempo para realizar su labor, lo que representa su principal barrera en el trabajo y refleja la falta de apoyo institucional que reciben de sus jefaturas. Entre estas funciones invisibles están: retroalimentar al equipo médico, liderar reuniones clínicas y generar protocolos de referencia. Para el buen desempeño del MGD es necesario contar con competencias técnicas y ser reconocido por sus pares. Se estimó que el médico de familia es el profesional más apto para el cargo. La labor del MGD está limitada por factores institucionales como las listas de espera, la falta de especialistas y la baja coordinación entre niveles asistenciales. Conclusiones: Estandarizar las funciones del MGD es un elemento necesario para su consolidación y lograr cumplir los objetivos de mantener la continuidad del cuidado en la población.(AU)

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

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

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

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

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

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

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

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

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

Novel use of poly-L-lactic acid filler for the treatment of facial cutaneous atrophy in patients with connective tissue disease.

BACKGROUND: Patients with connective tissue disease (CTD) often suffer from facial cutaneous defects and resultant facial asymmetry. Unfortunately, these issues have been known to be difficult-to-treat, and concern exists regarding the use of cosmetic procedures in this patient population due to the theoretical risk of disease flare-up or reactivation. Injectable poly-L-lactic acid (PLLA) is one type of filler that has been used to treat skin atrophy in patients with morphea and lupus erythematous panniculitis. However, overall, there is a dearth in literature regarding the safety and efficacy of PLLA filler in patients with CTDs. AIMS: This case series intends to evaluate the safety and efficacy of PLLA filler in treating facial atrophy in patients with CTDs. PATIENTS/METHODS: Three patients underwent various treatment courses involving the use of PLLA filler to treat facial atrophy. RESULTS: Two patients demonstrated significant improvement in facial atrophy following their treatment course. No patient experienced reactivation or exacerbation of their CTD following PLLA injection. CONCLUSION: PLLA filler appears to have good viability as a safe and potentially effective treatment for facial atrophy in patients with CTDs.

Beyond Atherothrombotic Disease in Acute Coronary Syndrome

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

Safety and Efficacy of Dermal Fillers in Patients With Connective Tissue Disease: A Review.

BACKGROUND: Dermal fillers such as hyaluronic acid, poly-l-lactic acid, and polymethyl-methacrylate are often used to treat cutaneous defects such as lipoatrophy. However, concern exists regarding their use in patients with a connective tissue disease (CTD) because of a theoretical risk of disease reactivation or exacerbation. Evidence regarding their use in patients with CTD also remains limited. OBJECTIVE: This review intends to summarize and evaluate the available literature regarding the use of dermal fillers in patients with CTD. MATERIALS AND METHODS: A literature search until May 2020 was conducted through PubMed, Ovid MEDLINE, and Ovid Embase to identify articles discussing the treatment of cutaneous defects secondary to CTD. Articles discussing the use of autologous fat transfer alone were excluded. RESULTS: Twenty-three articles were reviewed. The amount of available evidence varies between the type of CTD and type of filler with morphea having the most published evidence out of the CTDs discussed and hyaluronic acid having the most published evidence out of the fillers discussed. Most studies demonstrated positive results with no report of disease reactivation or exacerbation. CONCLUSION: Despite limited available evidence, dermal fillers seem to be safe as an adjunctive treatment for cutaneous defects in patients with CTD.