Effectiveness of COVID-19 vaccines in Ecuador: A test-negative design.

Background: The COVID-19 pandemic poses a significant global health threat, characterized by high morbidity, severity, and the emergence of concerning variants. Latin America has been greatly affected, with high infection and mortality rates. Vaccination plays a crucial role in mitigating severe disease and controlling the pandemic. This study aims to assess the effectiveness of COVID-19 vaccines in preventing SARS-CoV-2 severe acute respiratory infections (SARI) in hospitalized vaccination target groups in Ecuador. Methods: This is a test-negative design study. We used data reported through sentinel surveillance of SARI between May 2021 and March 2022 in Ecuador. Patients with case criteria of SARI and hospitalized for a minimum of 24 hours were included in the study. Cases were defined as patients with SARI with a positive RT-qPCR test for SARS-CoV-2 and controls were those with a negative result. Information on vaccination status was obtained from the national vaccination registry, a valid dose of vaccination was considered when it was administered at least 14 days prior to symptom onset. Vaccine effectiveness (VE) (1-OR/OR) was calculated using a logistic regression. Results: A total of 1,277 patients were included in the analysis of VE. The adjusted vaccine effectiveness (aVE) in preventing hospitalization, adjusted for sex, age group, presence of one or more comorbidities, and period of the predominance of the omicron variant, was 44.5% for the partial primary schedule, 74.7% for the complete primary schedule, and 79.9% for the complete primary schedule plus booster doses. The aVE in avoiding ICU admissions was close to 80% with both the complete primary schedule and the booster doses, and in avoiding deaths, the aVE was 89% and 98%, respectively. Conclusions: In Ecuador, COVID-19 vaccination prevents hospitalizations, ICU admissions, and deaths. The effectiveness of the vaccines improves with more doses, offering increased protection across all age groups.

[Parosteal osteosarcoma of the femur and salvage surgery with intercalary prosthesis. Experience in a third level unit and surgical technique]. / Osteosarcoma parostal de fémur y cirugía de salvamento con prótesis intercalar. Experiencia en una unidad de tercer nivel y técnica quirúrgica.

INTRODUCTION: parosteal osteosarcoma is an extramedullary malignant bone tumor in which cells produce osteoid, represents less than 5% of all osteosarcomas, it occurs predominantly in women between the second and fourth decade of life. It is often located in the distal region of the femur and proximal tibia. Clinically it presents with increased volume and thigh or knee pain. Due to its low incidence and clinical features, a clinical case of femoral parosteal osteosarcoma is presented, with description of the surgical technique performed. CASE REPORT: a 14-year-old female presented with a 6-month history of increased volume and right thigh pain. Radiological studies revealed a bone lesion with malignant characteristics, for which she was sent to third-level hospital where oncology study protocol was set up; consisting in two percutaneous biopsies of the lesion with Jamshidi needle, which were histopathology reported as negative for malignant cells. The pulmonary high-resolution computed tomography showed metastasis and a Tc-99m MDP bone scintigraphy showed increased osteoblastic activity in the right femoral shaft. Given the results, is confirmed the need of en-bloc resection and intercalary prosthesis implantation with adjuvant chemotherapy. CONCLUSION: the intercalary prosthesis is a suitable therapeutic option in limb-salvage surgery for patients with femoral parosteal osteosarcoma.

INTRODUCCIÓN: el osteosarcoma parostal es un tumor óseo maligno extramedular en el cual las células tumorales producen osteoide. Representa menos de 5% de los osteosarcomas. Se presenta predominantemente en la mujer, entre la segunda y cuarta década de la vida. Su localización más frecuente es la región distal del fémur y proximal de la tibia. Clínicamente, se manifiesta con aumento de volumen y dolor en muslo o rodilla. Debido a su baja incidencia y características clínicas, se presenta un caso clínico de osteosarcoma parostal femoral con descripción de la técnica quirúrgica realizada. CASO CLÍNICO: femenino de 14 años edad con cuadro clínico caracterizado por aumento de volumen y dolor en muslo derecho de seis meses de evolución. Se realizaron radiografías de fémur derecho, encontrando lesión ósea con características compatibles de malignidad, por lo que es enviada a unidad de tercer nivel para iniciar protocolo oncológico; se realizan dos biopsias percutáneas con aguja de Jamshidi, ambas con reporte histológico negativo para células malignas. En tomografía pulmonar de alta resolución se observó presencia de metástasis y la gammagrafía ósea con Tc99 reportó actividad osteoblástica en fémur derecho. Se decide tratamiento con resección en bloque y colocación de prótesis intercalar más quimioterapia adyuvante. CONCLUSIÓN: la prótesis intercalar resulta una opción terapéutica adecuada en la cirugía de salvamento de extremidad para pacientes con diagnóstico de osteosarcoma parostal femoral.

Actualización del consenso chileno SOCHINEP-SER para el manejo de las sibilancias recurrentes del preescolar / Update of the chilean consensus SOCHINEP-SER for the management of recurrent wheezing in preschool children

Las sibilancias recurrentes del preescolar son un problema prevalente. 50% de todos los niños tiene al menos un episodio de sibilancias en los primeros 6 años. Sin embargo, solo 4 % de los menores de 4 años tiene diagnóstico de asma. Por este motivo es fundamental realizar una adecuada anamnesis y examen físico tendientes a descartar causas secundarias, lo que debe ser complementado con exámenes de laboratorio de acuerdo con la orientación clínica. En la actualidad se recomienda indicar tratamiento de mantención con corticoides inhalados en aquellos niños que tengan episodios repetidos de obstrucción bronquial y que tengan una alta probabilidad de respuesta favorable a esta terapia. Se ha demostrado que aquellos pacientes que tienen un recuento de eosinófilos en sangre > 300 células por mm3 o aquellos que presentan una prueba cutánea positiva o IgE específicas positivas para alérgenos inhalados, responderán adecuadamente al tratamiento con esteroides inhalados.

Recurrent wheezing in preschoolers has a high prevalence. 50% of all children have at least one wheezing episode in the first six years of life. However, only 4% of children under four years of age are diagnosed with asthma. Therefore, it is essential to carry out an adequate medical history and physical examination to rule out secondary causes, which must be complemented with laboratory tests in accordance with clinical guidance. It is recommended to indicate maintenance treatment with inhaled corticosteroids to those children who have repeated episodes of wheezing and who have a high probability of a good response to this therapy. It has been demonstrated that those patients who have blood eosinophil count > 300 cells per mm3 or those who have a positive skin test or positive specific IgE for inhaled allergens will have a good response to inhaled corticosteroids.

Actualización del consenso chileno SOCHINEP-SER para el manejo de las sibilancias recurrentes del preescolar / Update of the chilean consensus SOCHINEP-SER for the management of recurrent wheezing in preschool children

Las sibilancias recurrentes del preescolar son un problema prevalente. 50% de todos los niños tiene al menos un episodio de sibilancias en los primeros 6 años. Sin embargo, solo 4% de los menores de 4 años tiene diagnóstico de asma. Por este motivo es fundamental realizar una adecuada anamnesis y examen físico tendientes a descartar causas secundarias, lo que debe ser complementado con exámenes de laboratorio de acuerdo con la orientación clínica. En la actualidad se recomienda indicar tratamiento de mantención con corticoides inhalados en aquellos niños que tengan episodios repetidos de obstrucción bronquial y que tengan una alta probabilidad de respuesta favorable a esta terapia. Se ha demostrado que aquellos pacientes que tienen un recuento de eosinófilos en sangre > 300 células por mm3 o aquellos que presentan una prueba cutánea positiva o IgE específicas positivas para alergenos inhalados responderán adecuadamente al tratamiento con esteroides inhalados.

Recurrent wheezing in preschoolers has a high prevalence. 50% of all children have at least one wheezing episode in the first six years of life. However, only 4% of children under four years of age are diagnosed with asthma. Therefore it is essential to carry out an adequate medical history and physical examination to rule out secondary causes, which must be complemented with laboratory tests in accordance with clinical guidance. It is recommended to indicate maintenance treatment with inhaled corticosteroids to those children who have repeated episodes of wheezing and who have a high probability of a good response to this therapy. It has been demonstrated that those patients who have blood eosinophil count > 300 cells per mm3 or those who have a positive skin test or positive specific IgE for inhaled allergens will have a good response to inhaled corticosteroids.

Historia de la Enfermería Pediátrica en el Hospital Infantil de México Federico Gómez / History of Pediatric Nursing at the Children´s Hospital of Mexico Federico Gomez

El cuidado otorgado a los niños tiene un lugar importante para la historia de la enfermería en México; desde la cultura azteca, se les preparaba para sus actividades futuras en el calmecac, telpuchcalli y culcalli, mientras que durante la época precortesiana la principal figura era la tlamatqui-ticitl (partera), responsable de atender a las embarazadas y a sus niños durante los primeros meses.Posteriormente se funda el Hospital de la Inmaculada Concepción (hoy Hospital de Jesús), así como centros de protección para niños indígenas, mestizos y criollos a cargo de monjes agustinos, franciscanos, dominicos y jesuitas. Vasco de Quiroga fundó una casa cuna, motivo por el cual fue llamado "protector del niño indio de América", y el arzobispo Francisco de Lorenzana y Butrón fundó la Casa de Niños Expósitos de la ciudad de México. Durante el Imperio de Maximiliano de Habsburgo, la emperatriz Carlota logró el establecimiento de una "casa de maternidad e infancia". Tiempo después se planea el primer centro de higiene infantil y se funda la Casa Cuna de Coyoacán.El 30 de abril de 1943 se funda oficialmente el Hospital Infantil de México Federico Gómez (HIMFG) e inician los cursos de enfermería pediátrica, que con el tiempo cambian para constituir la especialidad en Enfermería infantil y dar origen a la especialidad en Neonatología y Oncología.

The care of children has a relevant place in Mexico nursing history; in Aztec culture, children were prepared for their future activities in the calmecac, telpuchcalli and culcalli; in the pre-Cortesian period the main figure was the tlamatqui-ticitl (midwife), who looked after pregnant women and their newborn during the first months.Subsequently, the Hospital de la Inmaculada Concepción (nowadays Hospital de Jesús) was founded, as well as protection centers for indigenous, mestizo and criollo children administered by Augustinian, Franciscan, Dominican and Jesuit monks. Vasco de Quiroga also founded an orphanage, that earned him the title of "protector of the Indian child of America". Archbishop Francisco de Lorenzana y Butrón founded as well the Casa de Niños Expósitos in Mexico City.During the Maximilian of Habsburg Empire, empress Carlota managed to establish a "maternity and childhood home". Eventually, the first child hygiene center was planned and the Casa Cuna de Coyoacán was founded.On April 30, 1943, the Hospital Infantil de México Federico Gómez (HIMFG) was officially founded, and its pediatric nursing courses were settled, which changed over time to constitute the specialty in pediatric nursing and give rise to the specialty in neonatology and oncology.

Predicting Within-City Spatial Variations in Outdoor Ultrafine Particle and Black Carbon Concentrations in Bucaramanga, Colombia: A Hybrid Approach Using Open-Source Geographic Data and Digital Images.

Outdoor ultrafine particles (UFP, <0.1 µm) and black carbon (BC) vary greatly within cities and may have adverse impacts on human health. In this study, we used a hybrid approach to develop new models to estimate within-city spatial variations in outdoor UFP and BC concentrations across Bucaramanga, Colombia. We conducted a mobile monitoring campaign over 20 days in 2019. Regression models were trained on land use data and combined with predictions from convolutional neural networks (CNN) trained to predict UFP and BC concentrations using satellite and street-level images. The combined UFP model (R2 = 0.54) outperformed the CNN (R2 = 0.47) and land use regression (LUR) models (R2 = 0.47) on their own. Similarly, the combined BC model also outperformed the CNN and LUR BC models (R2 = 0.51 vs 0.43 and 0.45, respectively). Spatial variations in model performance were more stable for the CNN and combined models compared to the LUR models, suggesting that the combined approach may be less likely to contribute to differential exposure measurement error in epidemiological studies. In general, our findings demonstrated that satellite and street-level images can be combined with a traditional LUR modeling approach to improve predictions of within-city spatial variations in outdoor UFP and BC concentrations.

Hipovitaminosis D y malnutrición por exceso en niños asmáticos hospitalizados / Hypovitaminosis D and malnutrition by excess in hospitalized asthmatic children

La tasa de hospitalización por crisis de asma en niños chilenos se ha duplicado en los últimos años. Diversos estudios muestran una asociación entre hipovitaminosis D y crisis de asma. El objetivo principal del presente estudio fue describir la prevalencia de déficit e insuficiencia de vitamina D (vitD) en escolares asmáticos hospitalizados por crisis de asma y evaluar su estado nutricional. METODOLOGÍA: Estudio analítico, transversal, que incluyó a todos los pacientes de 5 años o más que se hospitalizaron por crisis de asma durante un año calendario en el Servicio de Pediatría del Hospital Clínico de la Universidad de Chile. Se aplicó una encuesta que incluyó datos sociodemográficos y clínicos, se evaluó el nivel de control del asma mediante el cuestionario Asthma Control Test (ACT), se determinó el estado nutricional y se midió la concentración de vitD. RESULTADOS: Se observó que 6 de cada 10 pacientes presentaba déficit o insuficiencia de vitD (22,8 ng/ml ± 10,5), encontrándose una asociación positiva entre concentración de vitD y ACT. La malnutrición por exceso estaba presente en casi la mitad de los pacientes. Aquellos pacientes que se hospitalizaron por más de 3 días tenían una concentración sérica de vitD significativamente menor. CONCLUSIONES: La hipovitaminosis D afectó a la mayoría de los niños hospitalizados por crisis de asma. Se encontró una asociación significativa entre concentración de vitD con días de hospitalización y control de la enfermedad medido por ACT.

Asthma hospitalization rates in Chilean children has doubled in recent years. Multiple studies show an association between hypovitaminosis D and asthma attacks. OBJECTIVES: To determine the prevalence of vitamin D (vitD) deficiency and insufficiency in asthmatic school age children hospitalized for asthma crisis and to evaluate their nutritional status. METHODS: Cross-sectional, analytical study that included patients 5 years of age or older hospitalized for asthma attacks during one calendar year, in the Pediatric Service of the University of Chile Clinical Hospital. A survey was conducted that included sociodemographic and clinical data, the level of asthma control was evaluated using the Asthma Control Test questionnaire (ACT), the nutritional status was determined and the concentration of vitD was measured. RESULTS: 6 out of 10 patients had either Vit D deficiency or insufficiency (22,8 ng/ml ± 10,5), showing a positive association between vitD concentration and ACT. Malnutrition due to excess was present in almost half of the patients. Children hospitalized for more than 3 days had a significantly lower vitD serum concentration. CONCLUSIONS: Most of the patients had hypovitaminosis D. An association was found between vitD concentration and hospital stay and between vitD concentration and asthma control, measured by ACT .

Consenso chileno SOCHINEP-SER para el diagnóstico y tratamiento del asma en el escolar / Chilean SOCHINEP-SER consensus for asthma diagnosis and treatment in school age children

El asma bronquial es la enfermedad crónica más frecuente en la infancia. Sin embargo, en Chile existe un importante subdiagnóstico. Es fundamental estar atentos a los síntomas y signos que nos hacen sospechar el diagnóstico para iniciar un tratamiento oportuno, que asegure un buen control de la enfermedad. Debemos sospechar asma en todo escolar que presente cuadros repetidos de obstrucción bronquial. El diagnóstico debe confirmarse con pruebas de función pulmonar que demuestren obstrucción variable al flujo aéreo y respuesta broncodilatadora positiva. El tratamiento se basa en dos pilares fundamentales: la educación y el tratamiento farmacológico. Las actividades educativas deben incluir contenidos acerca de la enfermedad y su tratamiento, se debe monitorizar constantemente la adherencia al tratamiento de mantención, enseñar la técnica inhalatoria correcta y revisar en cada control, entregar un plan de acción escrito personalizado frente al inicio de una crisis y realizar controles médicos periódicos. Con respecto al tratamiento farmacológico, el estándar de oro es el uso de corticoides inhalados permanentes, en la mínima dosis posible que logre el control de la enfermedad. El objetivo del tratamiento es la supresión de los síntomas diarios y de las crisis. El tratamiento se irá incrementando en la medida que no haya una respuesta adecuada, pero antes de aquello se debe evaluar la adherencia al tratamiento de mantención, la técnica inhalatoria, presencia de comorbilidades asociadas y exposición ambiental. En el paciente leve, que esté sin tratamiento permanente, el rescate debe realizarse con broncodilatadores asociados siempre a un corticoide inhalado. Este consenso es una guía de apoyo para mejorar el diagnóstico oportuno, tratamiento y control del asma en el escolar.

Bronchial asthma is the most prevalent chronic condition among children, however, in Chile, it is underdiagnosed. This may be due to medical professionals failing to recognize the disease. It is essential to be aware of the symptoms and signs that are suggestive of the disease in order to begin an appropriate treatment to achieve disease control. Asthma must be suspected in school age children who present repeated episodes of bronchial obstruction. The diagnosis should be confirmed with lung function tests that demonstrate variable airflow obstruction with a positive bronchodilator response. Treatment is based on two fundamental pillars: education and pharmacological treatment. Educational activities must include: information about the disease and its treatment, regular monitoring of treatment adherence, teaching and reviewing the correct inhalation technique at every checkup, developing a personalized written action plan and scheduling regular follow-up appointments. The gold standard for treatment is maintenance inhaled corticosteroids, in the lowest possible dose that enables disease control. The goal of the treatment is to eliminate daily symptoms and asthma crisis. Therapy should be increased if control is not achieved, but before starting it, adherence to maintenance treatment, inhalation technique, presence of associated comorbidities and environmental exposure should be evaluated. In the mild patient, who is not receiving maintenance therapy, rescue treatment should be done with bronchodilators, always associated with inhaled corticosteroids. This consensus is a guide to improve the diagnosis, treatment and control of asthma in schoolchildren

Consenso chileno SOCHINEP-SER para el diagnóstico y tratamiento del asma en el escolar / Chilean SOCHINEP-SER consensus for asthma diagnosis and treatment in school age children

Bronchial asthma is the most prevalent chronic condition among children, however, in Chile, it is underdiagnosed. This may be due to medical professionals failing to recognize the disease. It is essential to be aware of the symptoms and signs that are suggestive of the disease in order to begin an appropriate treatment to achieve disease control. Asthma must be suspected in school age children who present repeated episodes of bronchial obstruction. The diagnosis should be confirmed with lung function tests that demonstrate variable airflow obstruction with a positive bronchodilator response. Treatment is based on two fundamental pillars: education and pharmacological treatment. Educational activities must include: information about the disease and its treatment, regular monitoring of treatment adherence, teaching and reviewing the correct inhalation technique at every checkup, developing a personalized written action plan and scheduling regular follow-up appointments. The gold standard for treatment is maintenance inhaled corticosteroids, in the lowest possible dose that enables disease control. The goal of the treatment is to eliminate daily symptoms and asthma crisis. Therapy should be increased if control is not achieved, but before starting it, adherence to maintenance treatment, inhalation technique, presence of associated comorbidities and environmental exposure should be evaluated. In the mild patient, who is not receiving maintenance therapy, rescue treatment should be done with bronchodilators, always associated with inhaled corticosteroids. This consensus is a guide to improve the diagnosis, treatment and control of asthma in schoolchildren.

El asma bronquial es la enfermedad crónica más frecuente en la infancia. Sin embargo en Chile existe un importante subdiagnóstico. Es fundamental estar atentos a los síntomas y signos que nos hacen sospechar el diagnóstico para iniciar un tratamiento oportuno, que asegure un buen control de la enfermedad. Debemos sospechar asma en todo escolar que presente cuadros repetidos de obstrucción bronquial. El diagnóstico debe confirmarse con pruebas de función pulmonar que demuestren obstrucción variable al flujo aéreo y respuesta broncodilatadora positiva. El tratamiento se basa en dos pilares fundamentales: la educación y el tratamiento farmacológico. Las actividades educativas deben incluir contenidos acerca de la enfermedad y su tratamiento, se debe monitorizar constantemente la adherencia al tratamiento de mantención, enseñar la técnica inhalatoria correcta y revisar en cada control, entregar un plan de acción escrito personalizado frente al inicio de una crisis y realizar controles médicos periódicos. Con respecto al tratamiento farmacológico, el estándar de oro es el uso de corticoides inhalados permanentes, en la mínima dosis posible que logre el control de la enfermedad. El objetivo del tratamiento es la supresión de los síntomas diarios y de las crisis. El tratamiento se irá incrementando en la medida que no haya una respuesta adecuada, pero antes de aquello se debe evaluar la adherencia al tratamiento de mantención, la técnica inhalatoria, presencia de comorbilidades asociadas y exposición ambiental. En el paciente leve, que esté sin tratamiento permanente, el rescate debe realizarse con broncodilatadores asociados siempre a un corticoide inhalado. Este consenso es una guía de apoyo para mejorar el diagnóstico oportuno, tratamiento y control del asma en el escolar.

Reference values of leukocyte and lymphocytes populations in umbilical cord and capillary blood in healthy Mexican newborns

INTRODUCTION: In newborns, dramatic changes occur in the blood and bone marrow during the first hours; there are rapid fluctuations in the quantities of leukocytes populations. In this work, we investigated leukocytes subsets counts in two types of blood samples (cord blood and capillary blood) extracted from healthy newborns. METHODS: Blood samples from Mexican neonates were collected by Instituto Nacional de Pediatría with written informed consent. For all samples we determined leukocytes populations; neutrophils, monocytes, total lymphocytes, and populations: T CD3+ cells, TCD4+ cells, T CD8+ cells, B CD19+ cells and NK CD16+56 cells by flow cytometry. We used the Mann-Whitney U test to compare leukocytes of cord and capillary blood; also to analyze the differences between gender and we obtained reference values of the cord and capillary blood in neonates. RESULTS: We observed higher absolute counts and frequencies of total lymphocyte in capillary blood compared with cord blood. In absolute numbers, the capillary blood showed significant differences in neutrophils, monocytes, lymphocytes, T CD3+ cells, T CD4+ cells, T CD8+ cells, B CD19+ cells, and NK cells; no significant differences were observed between genders. DISCUSSION: Our data contribute to newborn Mexican reference values for all these populations of leukocytes. We found that the dispersal range differs between the two types of blood, suggesting a different fate in the immune response. Immunophenotyping of the blood cell population to identify these cells is an essential tool in the diagnosis and follow-up of neonates with immunodeficiencies and other immune disorders

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Reference values of leukocyte and lymphocytes populations in umbilical cord and capillary blood in healthy Mexican newborns.

INTRODUCTION: In newborns, dramatic changes occur in the blood and bone marrow during the first hours; there are rapid fluctuations in the quantities of leukocytes populations. In this work, we investigated leukocytes subsets counts in two types of blood samples (cord blood and capillary blood) extracted from healthy newborns. METHODS: Blood samples from Mexican neonates were collected by Instituto Nacional de Pediatría with written informed consent. For all samples we determined leukocytes populations; neutrophils, monocytes, total lymphocytes, and populations: T CD3+ cells, TCD4+ cells, T CD8+ cells, B CD19+ cells and NK CD16+56 cells by flow cytometry. We used the Mann-Whitney U test to compare leukocytes of cord and capillary blood; also to analyze the differences between gender and we obtained reference values of the cord and capillary blood in neonates. RESULTS: We observed higher absolute counts and frequencies of total lymphocyte in capillary blood compared with cord blood. In absolute numbers, the capillary blood showed significant differences in neutrophils, monocytes, lymphocytes, T CD3+ cells, T CD4+ cells, T CD8+ cells, B CD19+ cells, and NK cells; no significant differences were observed between genders. DISCUSSION: Our data contribute to newborn Mexican reference values for all these populations of leukocytes. We found that the dispersal range differs between the two types of blood, suggesting a different fate in the immune response. Immunophenotyping of the blood cell population to identify these cells is an essential tool in the diagnosis and follow-up of neonates with immunodeficiencies and other immune disorders.

Improving multi-technique monitoring using Sentinel-1 and Cosmo-SkyMed data and upgrading groundwater model capabilities.

Aquifer-systems have become a strategic source of fresh water in the present climatic conditions, especially under stress in arid regions like the Iberian Mediterranean Arc. Understanding the behavior of groundwater reservoirs is crucial to their well-management and mitigation of adverse consequences of overexploitation. In this work, we use space geodetic measurements from satellite interferometric synthetic aperture radar (InSAR) and Global Positioning System (GPS) data, covering the period 2011-2017, to predict and validate the ground surface displacement over the fastest subsiding basin due to groundwater withdrawal in Europe (>10 cm/year). The 2D decomposition of InSAR displacements from Cosmo-SkyMed and Sentinel-1 satellites allows us to detect horizontal deformation towards the basin center, with a maximum displacement of 1.5 cm/year. InSAR results were introduced in a newly developed methodology for aquifer system management to estimate unknown pumping rates for the 2012-2017 period. This study illustrates how the combination of InSAR data, groundwater flow and deformation models can be used to improve the aquifer-systems sustainable management.

Caracterización clínica y epidemiológica de pacientes con Covid-19 atendidos en Servicio de Emergencia del Hospital Clínico Universidad de Chile entre marzo y mayo 2020 / Clinical and epidemiological characterization of patients with Covid-19 treated in the Emergency Service of the Hospital Clínico Universidad de Chile between March and May 2020

In December 2019, a novel coronavirus (SARS-CoV-2) emerged in China and has spread globally, creating a pandemic. The objective of this is study is to determinate clinical and epidemiological characteristics of patients with coronavirus en emergency department. The HCUCH Emergency Service treated a total of 6959 patients between March 13th and May 31th, of whom 1.278 were positive and had confirmed with coronavirus. The male sex was the most prevalent (59.7%). The most frequent symptoms in both groups were cough, myalgia and fever. In the group of ambulatory patients, headache stood out in 50% and in hospitalized patients, dyspnea with 67%. The mortality rate in hospitalized patients was 15.6%. Of these, 66.6% were older than 65 years. Regarding diagnosis of hospital discharge, 87.5% correspond to pneumonia. There is a higher prevalence of coronavirus disease in male patients. The most frequent comorbidities in hospitalized patients were HT and DM2. The highest rate of hospitalization and case fatality in people over 65 years of age. This information helps to characterize the profile of patients at risk in which prevention efforts should be focused. (AU)

Low percentages of regulatory T cells in common variable immunodeficiency (CVID) patients with autoimmune diseases and its association with increased numbers of CD4+CD45RO+ T and CD21low B cells

Background: Common variable immunodeficiency (CVID) is a heterogeneous group of primary antibody deficiencies defined by marked reductions in serum IgG, IgA and/or IgM levels and recurrent bacterial infections. Some patients are associated with defects in T cells and regulatory T cells (Tregs), resulting in recurrent viral infections and early-onset autoimmune disease. Methods: We analyzed whether there is an association between Tregs cells (CD4+CD25+CD127low and CD4+CD25+FoxP3+); memory T cells (CD4+CD45RO+); memory B cells (CD19+CD27-IgD-); and CD21low B cells (CD19+CD38lowCD21low); as well as autoimmune manifestations in 36 patients with CVID (25 women and 11 men, mean age 24 years), all by flow cytometry. Results: Fourteen patients presented with autoimmune diseases (AI) (39%), including 11 with autoimmune thrombocytopenia (ITP) (31%); two with vitiligo (6%); one with systemic lupus erythematosus (LES) (3%); and one with multiple sclerosis (MS) (3%). CVID patients with AI had a reduced proportion of Tregs (both CD4+CD25+CD127low and FoxP3+ cells) compared with healthy controls. CVID patients with AI had expanded CD21low B cell populations compared with patients who did not have AI. A correlation between increased CD4+CD45RO T cell populations and reduced Tregs was also observed. Conclusions: Our results showed that 39% of patients with CVID had AI and reduced Tregs populations. Research in this area might provide noteworthy data to better understand immune dysfunction and dysregulation related to CVID

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Expanding the clinical features of autoinflammation and phospholipase Cγ2-associated antibody deficiency and immune dysregulation by description of a novel patient.

BACKGROUND: Autoinflammation and phospholipase Cγ2-associated antibody deficiency and immune dysregulation (APLAID) is an exceedingly rare monogenic autoinflammatory disease. To date, only five cases have been reported with four distinct pathogenic mutations. OBJECTIVES: We present a novel case of APLAID, corroborated by molecular analysis, with newly described clinical findings including central nervous system vasculitis (CNSV); and distinctive histopathological characteristics that may expand our knowledge of this rare disease's phenotype. METHODS: This is a case report presentation of a 3-year-old boy, seen at a reference paediatric hospital in Mexico. His parents authorized the use of his clinical information and photographs. RESULTS: A 3-day-old boy presented to the emergency department with a vesiculo-pustular rash that resolved within 1 week. Two months later, he developed widespread papules and pseudovesicles that evolved into infiltrated plaques. He also had periodical flares of conjunctivitis, diarrhoea and erythematous blistering acral plaques triggered by upper respiratory infections. By the age of 10 months, he experienced seizures and CNSV. Laboratory work-up showed mild neutropenia, decreased serum levels of immunoglobulins and B-cell lymphopenia. A skin biopsy revealed a dense, perivascular and interstitial histiocytic and granulomatous infiltrate, with palisading granulomas, and leucocytoclastic vasculitis with karyorrhexis. APLAID syndrome was confirmed by Sanger sequencing of PLCG2 gene [heterozygous genotype LRG_376t1:c.2543T>C or p.(Leu848Pro)]. CONCLUSIONS: Presence of CNSV has not been previously described in APLAID, however as the number of reported patients with APLAID is very small, it is possible that the overall spectrum of clinical manifestations has not been completely elucidated. The herein identified p.(Leu848Pro) variant was also documented in a Portuguese patient, suggesting that it could be a PLCG2 gene 'hot-spot'.

Hiperfosfatasemia transitoria benigna de la infancia, reporte de un caso / Benign transient hyperphosphatasemia of childhood: a case report

La Hiperfosfatasemia Transitoria Benigna (HTB) es la causa más frecuente de elevación aislada de la Fosfatasa Alcalina (FA) en la población pediátrica. Es relevante tener la sospecha de esta entidad dada su frecuencia, carácter auto limitado y fácil diagnóstico, a pesar de esto, es poco conocida y estudiada en la Pediatría. Su clínica se asocia a niños sanos como a infecciones virales respiratorias, gastrointestinales y al retraso ponderal. El presente trabajo tiene como objetivo reportar un caso clínico y revisar el diagnóstico de la HBT.

Benign Transient Hyperphosphatasemia (BTH) is the most frequent cause of isolated elevation of Alkaline Phosphatase (AF) in the pediatric population. It is relevant to have the suspicion of this entity given its frequency, self limited character and easy diagnosis, despite this, it is little known and studied in Pediatrics. Its symptoms are associated with healthy children, such as viral respiratory, gastrointestinal infections and delayed weight gain. The objective of this work is to report a clinical case and review the diagnosis of HBT.

Low percentages of regulatory T cells in common variable immunodeficiency (CVID) patients with autoimmune diseases and its association with increased numbers of CD4+CD45RO+ T and CD21low B cells.

BACKGROUND: Common variable immunodeficiency (CVID) is a heterogeneous group of primary antibody deficiencies defined by marked reductions in serum IgG, IgA and/or IgM levels and recurrent bacterial infections. Some patients are associated with defects in T cells and regulatory T cells (Tregs), resulting in recurrent viral infections and early-onset autoimmune disease. METHODS: We analyzed whether there is an association between Tregs cells (CD4+CD25+CD127low and CD4+CD25+FoxP3+); memory T cells (CD4+CD45RO+); memory B cells (CD19+CD27-IgD-); and CD21low B cells (CD19+CD38lowCD21low); as well as autoimmune manifestations in 36 patients with CVID (25 women and 11 men, mean age 24 years), all by flow cytometry. RESULTS: Fourteen patients presented with autoimmune diseases (AI) (39%), including 11 with autoimmune thrombocytopenia (ITP) (31%); two with vitiligo (6%); one with systemic lupus erythematosus (LES) (3%); and one with multiple sclerosis (MS) (3%). CVID patients with AI had a reduced proportion of Tregs (both CD4+CD25+CD127low and FoxP3+ cells) compared with healthy controls. CVID patients with AI had expanded CD21low B cell populations compared with patients who did not have AI. A correlation between increased CD4+CD45RO T cell populations and reduced Tregs was also observed. CONCLUSIONS: Our results showed that 39% of patients with CVID had AI and reduced Tregs populations. Research in this area might provide noteworthy data to better understand immune dysfunction and dysregulation related to CVID.

Fabrication of Silver Nanoparticles Using a Gas Phase Nanocluster Device and Preliminary Biological Uses.

Nanoparticles can be used in a large variety of applications, including magnetic sensing, biological, superconductivity, tissue engineering, and other fields. In this study, we explore the fabrication of gas phase silver nanoparticles using a sputtering evaporation source. This setup composed of a dual magnetron cluster source holds several advantages over other techniques. The system has independent control over the cluster concentration and a wide range of cluster size and materials that can be used for the clusters and for the matrix where it can be embedded. Characterization of these silver nanoparticles was done using transmission electron microscopy (TEM). We obtain a lateral width of 10.6 nm with a dispersion of 0.24 nm. With atomic force microscopy (AFM) a Gaussian fit of this distribution yields and average height of 6.3 nm with a standard deviation of 1.4 nm. We confirm that the deposited silver nanoparticles have a homogenous area distribution, that they have a defined shape and size distribution, and that they are single standing nanoparticles. Given that the scientific literature is not precise regarding the toxic concentration of the nanoparticles, devices such as ours can help clarify these questions. In order to explore further biological applications, we have done preliminary experiments of cell spreading (myoblast adhesion), obtaining interesting morphological changes correlated with the silver concentration on the surface. With a deposited silver concentration ranging from 100⁻620 ng/cm², the cells showed morphological changes in a short time of 2 h. We conclude that this high precision nanoparticle fabrication technique is adequate for further biological research.

Multiple sclerosis prevalence in Salta City, Argentina.

INTRODUCTION: Multiple Sclerosis (MS) is one of the leading causes of disability in young adults. Its prevalence varies according to different countries. In Argentina there is a wide heterogeneity regarding data published in different areas of the country. Prevalence established in most studies is 17 cases per 100,000 inhabitants; however, most of the available data comes from studies that took place in Buenos Aires. There is little or no information from other provinces, especially from Northwest of Argentina (NOA), where there are no studies of the disease prevalence. The aim of this study is to investigate MS prevalence, phenotypes and epidemiological characteristics in Salta, Argentina, in order to contribute to the current knowledge of MS epidemiology and distribution in our country. METHODS: A descriptive, observational, transversal study was carried out in the capital city of Salta. Researchers from all public and private hospitals with a Neurology Department have participated. Private researchers who are well known leaders in demyelinating diseases in the city provided valuable information. Patients who did not have medical control for the past two years as well as patients whose last address was not registered in Salta were excluded. RESULTS: 120 registries were obtained from the four hospitals that participated and from the 12 private researchers. Ten patients were excluded due to overlapping data. The population of the area based on 2010 census was 535,310, so we estimated an MS prevalence 23.8 cases per 100,000 inhabitants (95% CI 20.1-27.4), 24.1 cases per 100,000 inhabitants in female population (95% CI 21.2-28.6) and 18.2 cases per 100,000 inhabitants (95% CI 15.2-21.1) in male population. In our analysis, 64 (58.2%) were female and the average age was 42.1 years. 81.8% are recurrent remitting forms, 16.4% secondary progressive and 1.8% primary progressive. CONCLUSION: This is the first study that provides epidemiological data on the prevalence and clinical forms of MS in Salta City as well as in the entire Northwest Region of Argentina(NOA). We estimate a prevalence of 23.8 cases per 100,000 inhabitants, which establishes a moderate risk area for MS.