Socio-spatial analysis of migrant school students according to Bourdieu's capitals in Santiago de Chile (2017-2020).

Chile has experienced a substantial immigration boom in the last 10 years. The urban areas of this nation present high levels of residential segregation, represented in its main city, Santiago. This article presents results of an exploratory analysis of the relationship between residential segregation, immigration rate by educational institutions and changes in school performance. Based on the generation of clusters characterized by cultural, social, economic and symbolic capital, an analysis of the changes in school performance in those schools that received the greatest number of migrants is generated.

Taxonomic distinctness and diversity patterns of a polychaete (Annelida) community on the continental shelf of the Southern Gulf of Mexico.

The spatial patterns of taxonomic diversity of annelid polychaete species from the continental shelf in the Southern Gulf of Mexico were examined in this study. We used taxonomic distinctness and its spatial variations to explore the diversity patterns and how they change between Southern Gulf of Mexico regions. In addition, using taxonomic distinctness as a dissimilarity measure and Ward's Clustering, we characterized three distinct faunal assemblages. We also investigated patterns of richness, taxonomic distinctness, and distance decay of similarity between sampling stations as a ß-diversity measure. Finally, we examined the spatial relationships between polychaete assemblages and environmental variables to test the relative importance of spatial and environmental components in annelid polychaete community structure from the Southern Gulf of Mexico. We used a combination of eigenvector-based multivariate analyses (dbMEMs) and distance-based redundancy analysis (dbRDA) to quantify the relative importance of these explanatory variables on the spatial variations of taxonomic distinctness. The significance level of spatial and environmental components to the distribution of polychaete species showed that the combined effect of spatial processes and sediment characteristics explained a higher percentage of the variance than those parameters could alone.

Exploring Audiologic Outcomes in Sudden Sensorineural Hearing Loss: A Retrospective Analysis.

Objective This retrospective study aims to present the audiologic outcomes of patients aged 18 years and above who underwent treatment for sudden sensorineural hearing loss (SSNHL) at the tertiary Hospital Central Sur Petróleos Mexicanos in Mexico City, Mexico, between January 2000 and December 2015. Main outcome measures The main outcome measures were patient demographics (age, sex, comorbidities) time from symptom onset to diagnosis and treatment initiation, initial threshold, treatment details (type, dosage, duration), adverse effects, audiometry at diagnosis and at the end of treatment, follow-up duration, and pure-tone average. Results A total of 72 patients were included, with a mean follow-up duration of four months. Comorbidities such as type 2 diabetes mellitus, hypertension, and hypertriglyceridemia were observed in a significant portion of patients. However, these conditions and the use of salvage therapy and adjuvant drugs did not impact hearing recovery. A longer delay from symptom onset to medical attention was associated with a lower gain in decibels (p=0.307). Diabetic patients who received steroid treatment showed a significant gain of at least 15 dB, indicating the greatest benefit in this subgroup. Conclusions Adjuvant drugs may be unnecessary and ineffective in treating SSNHL. Metabolic disorders may be linked to the development of SSNHL. Steroid treatment is the only effective therapeutic option for improving hearing recovery in diabetic patients. Early initiation of treatment after symptom onset is crucial for maximizing auditory recovery.

Molecular Characterization of the Convergent Carbapenem-Resistant and Hypervirulent Klebsiella pneumoniae Strain K1-ST23, Collected in Chile during the COVID-19 Pandemic.

The aim of this study was to investigate the genomic features of a carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKp) isolate (K-2157) collected in Chile. Antibiotic susceptibility was determined using the disk diffusion and broth microdilution methods. Whole-genome sequencing (WGS) and hybrid assembly were performed, using data generated on the Illumina and Nanopore platforms. The mucoid phenotype was analyzed using both the string test and sedimentation profile. The genomic features of K-2157 (e.g., sequence type, K locus, and mobile genetic elements) were retrieved using different bioinformatic tools. Strain K-2157 exhibited resistance to carbapenems and was identified as a high-risk virulent clone belonging to capsular serotype K1 and sequence type 23 (ST23). Strikingly, K-2157 displayed a resistome composed of ß-lactam resistance genes (blaSHV-190, blaTEM-1, blaOXA-9, and blaKPC-2), the fosfomycin resistance gene fosA, and the fluoroquinolones resistance genes oqxA and oqxB. Moreover, several genes involved in siderophore biosynthesis (ybt, iro, and iuc), bacteriocins (clb), and capsule hyperproduction (plasmid-borne rmpA [prmpA] and prmpA2) were found, which is congruent with the positive string test displayed by K-2157. In addition, K-2157 harbored two plasmids: one of 113,644 bp (KPC+) and another of 230,602 bp, containing virulence genes, in addition to an integrative and conjugative element (ICE) embedded on its chromosome, revealing that the presence of these mobile genetic elements mediates the convergence between virulence and antibiotic resistance. Our report is the first genomic characterization of a hypervirulent and highly resistant K. pneumoniae isolate in Chile, which was collected during the coronavirus disease 2019 (COVID-19) pandemic. Due to their global dissemination and public health impact, genomic surveillance of the spread of convergent high-risk K1-ST23 K. pneumoniae clones should be highly prioritized. IMPORTANCE Klebsiella pneumoniae is a resistant pathogen involved primarily in hospital-acquired infections. This pathogen is characterized by its notorious resistance to last-line antibiotics, such as carbapenems. Moreover, hypervirulent K. pneumoniae (hvKp) isolates, first identified in Southeast Asia, have emerged globally and are able to cause infections in healthy people. Alarmingly, isolates displaying a convergence phenotype of carbapenem resistance and hypervirulence have been detected in several countries, representing a serious threat to public health. In this work, we analyzed the genomic characteristics of a carbapenem-resistant hvKp isolate recovered in 2022 from a patient with COVID-19 in Chile, representing the first analysis of this type in the country. Our results will provide a baseline for the study of these isolates in Chile, which will support the adoption of local measures aimed at controlling their dissemination.

Understanding the natural expansion of white mangrove (Laguncularia racemosa) in an ephemeral inlet based on geomorphological analysis and remote sensing data.

The interactions between local tides and river discharges are crucial in the processes related to the recruitment of mangrove propagules in estuarine systems. This investigation aimed to determine the causes of the recent natural recruitment and expansion of Laguncularia racemosa in mudflats within an ephemeral inlet in Mexico. We conducted a fluvial and coastal geomorphology assessment with spaceborne and UAV-based images. We deployed and recorded continuous data loggers in the estuarine system to assess water level and salinity. Depending on the available data, we used a combination of cloud-computing Google Earth Engine, UAV-Digital Surface Models, LiDAR, Google Earth images, and biophysical variables to monitor mangrove forests from 2005 to 2022. When the inlet is open, the estuarine system presents a full tidal range (∼1-1.5 m) with a strong salinity gradient (0-35 mS/cm), in contrast to the strong freshwater influence and minimal water level variability (<10 cm) that prevails for three months when the inlet is closed. Once the mouth of the river closes, there is considerable sediment accumulation, creating mudflat areas adjacent to the mangrove forests where Laguncularia racemosa propagules begin to establish under minimal water level variability and oligohaline conditions. After 16 years, the new forest expanded by 12.3 ha, presenting a very high density (10000 stems/ha), a considerable basal area (54-63 m2/ha), and a maximum canopy height of 15.8 m, which largely surpasses that of other semiarid Laguncularia racemosa forests within permanent open-inlet systems or even in ephemeral inlets with different hydrological conditions. Our study will help to understand the causes of natural Laguncularia racemosa recruitment in extremely dynamic systems.

Consciousness, philosophy, and neuroscience.

The aim of this mini-review paper is to present an overview of work on consciousness from a philosophical perspective, and to argue for the continuing relevance of philosophy in consciousness research. After introducing some major philosophical positions about the relationship between consciousness and matter, we argue that the problem of consciousness that many authors have focused on-the mind-body or mind-brain problem-is only one among several problems of consciousness. We illustrate the idea that the perplexities about consciousness go beyond its relationship with matter by discussing the relationship between consciousness, self-consciousness, and selfhood. This discussion also indicates ways in which philosophy and neuroscience can learn from each other.

Isolation of an Extensively Drug-Resistant Pseudomonas aeruginosa exoS+/O4 Strain Belonging to the "High-Risk" Clone ST654 and Coproducer of NDM-1 and the Novel VIM-80.

The aim of this study was to investigate the genomic features of an extensively drug-resistant (XDR) Pseudomonas aeruginosa isolate (P-469) emerging in Chile. Antibiotic susceptibility was determined by disk diffusion and "colistin agar" test. Whole-genome sequencing (WGS) was performed by the Illumina NextSeq 2000 platform, and epidemiologically and clinically relevant data (i.e., sequence-type, serotype, mobile genetic elements, virulome, resistome, plasmidome, prophages, and CRISPR-Cas systems) were retrieved using multiple bioinformatic tools. The P-469 strain displayed an XDR profile, remaining susceptible to colistin. Genomic analysis revealed that this isolate belonged to the "high-risk" clone ST654 (CC654), serotype O4, and genotype exoS+. Strikingly, two CRISPR-Cas systems, five intact prophages sequences, and a broad resistome that included blaNDM-1 and the novel blaVIM-80 carbapenemase genes were predicted. Our results revealed the genomic characteristics of P. aeruginosa belonging to the high-risk clone ST654/O4 coproducing NDM-1 and VIM-80 in Chile, supporting that genomic surveillance is necessary to track the emergence and spread of epidemiologically successful WHO's critical priority pathogens in order to prevent their rapid dissemination.

[Implementation of a protocol for neuropsychiatric disease surveillance in a general hospital]. / Implementación de un sistema protocolizado de pesquisa temprana de patología psiquiátrica en un hospital general. Protocolo de Vigilancia Neuropsiquiátrica (VNP): avanzando hacia un modelo de psiquiatría de enlace proactivo.

BACKGROUND: The COVID-19 pandemic increased the incidence of neuropsychiatric diseases. Proactive models of consultation-liaison psychiatry (CLP-p) could play a key role in the prevention and management of these diseases in a general hospital. AIM: To develop a protocol for implementing screening tools for neuropsychiatric symptoms in routine clinical practice. MATERIAL AND METHODS: Elements of the Plan-Do-Study-Act (PDSA) model were used to modify the Neuropsychiatric Surveillance protocol implemented at a clinical hospital during the COVID-19 pandemic by members of the hospital's CLP team. RESULTS: A flowchart for active follow-up of neuropsychiatric symptoms during hospitalization is presented, with sequential management and referral flows, accompanied by suggestions for pre-discharge evaluation to define continuity of care actions. The COSMOS tool is also presented, designed for the detection of risk factors and actions for the prevention of neuropsychiatric diseases in general hospitals. CONCLUSIONS: The neuropsychiatric surveillance protocol facilitates early and timely interventions and establishes criteria for the continuity of post-discharge care. These changes could improve the quality of care in general hospitals and reduce the gap between mental and physical health.

[Delirium, catatonia and substance withdrawal syndrome manifested as psychomotor agitation in COVID-19: a pharmacological management approach for the general hospital setting]. / Delirium, catatonía y síndrome de abstinencia manifestados como agitación psicomotora en COVID-19: una propuesta de manejo farmacológico en el hospital general.

BACKGROUND: Neuropsychiatric symptoms can be part of the clinical spectrum of COVID-19 infections. AIM: To devise an evidence based clinical algorithm as a guide for clinicians, to identify and treat underlying clinical syndromes of psychomotor agitation, such as delirium, catatonia or substance withdrawal in patients who are hospitalized and infected with SARS-CoV-2. MATERIAL AND METHODS: A review of the literature about the pharmacological management of neuropsychiatric manifestations of COVID-19 at the general hospital, to develop a clinical protocol based on a consensus from an interdisciplinary expert panel at a Clinical Hospital. RESULTS: A consensual clinical algorithm for the management of delirium, catatonia, and substance withdrawal, manifested as psychomotor agitation in patients hospitalized with COVID-19, was developed as a clinical proposal for physicians at different levels of complexity in health services. CONCLUSIONS: Cooperation among different clinical units in the general hospital facilitated the implementation of a clinical algorithm for clinicians for the management of psychomotor agitation in COVID-19 patients.

Monitoring detailed mangrove hurricane damage and early recovery using multisource remote sensing data.

Due to their location in tropical latitudes, mangrove forests are susceptible to the impact of hurricanes and can be vastly damaged by their high-speed winds. Given the logistic difficulties regarding field surveys in mangroves, remote sensing approaches have been considered a reliable alternative. We quantified trends in damage and early signs of canopy recovery in a fringe Rhizophora mangle area of Marismas Nacionales, Mexico, following the landfall of Hurricane Willa in October 2018. We monitored (2016-2021) broad canopy defoliation using 21 vegetation indices (VI) from the Google Earth Engine tool (GEE). We also mapped a detailed canopy fragmentation and developed digital surface models (DSM) during five study periods (2018-2021) with a consumer-grade unmanned aerial vehicle (UAV) over an area of 100 ha. Based on optical data from the GEE time series, results indicated an abrupt decline in the overall mangrove canopy. The VARI index was the most reliable VI for the mangrove canopy classification from a standard RGB sensor. The impact of the hurricane caused an overall canopy defoliation of 79%. The series of UAV orthomosaics indicate a gradual recovery in the mangrove canopy, while the linear model predicts at least 8.5 years to reach pre-impact mangrove cover conditions. However, the sequence of DSM estimates that the vertical canopy configuration will require a longer time to achieve its original structure.

Ungual Spitz Nevus: Description of Dermoscopic Data.

Introduction: Spitz nevus is an uncommon, benign melanocytic proliferation that primarily appears on face, trunk or lower extremities of children. This lesion may share clinical and microscopical characteristics with melanoma, making it a diagnostic and management challenge. Case Report: A 13-year old male presented with an asymptomatic chronic dermatosis located on the third left-hand nail. Cutaneous examination revealed a homogeneous dark brown melanonychia which extended up to the cuticle. Upon dermoscopy, longitudinal bands measuring less than 3 mm wide of heterogeneous colors ranging from light to dark brown, and positive Hutchinson's sign were observed. Discussion/Conclusion: We report the second case of a Spitz nevus ungually localized which strongly resembled an ungual melanoma with a positive Hutchinson's sign upon dermoscopy. Describing the infrequent presentation and location of the Spitz nevus poses an opportunity to establish diagnostic and management criteria in the near future.

Subjective Well-Being and Schools in South Africa: A Post-COVID-19 Analysis.

From the analysis of the Wave 5 National Income Dynamics Study - Coronavirus Rapid Mobile Survey 2021 dataset, the study conducted in South Africa, we developed a model of analysis based on three dimensions, namely, subjective well-being, material living conditions, and importance attributed to education during the COVID-19 pandemic. A cross-sectional analysis of the data for Gauteng area indicates that the dimension of subjective well-being of families in South Africa-even in relation to the factors such as conditions of deprivation (e.g., hunger)-does not necessarily influence the importance the respondents attach to their children's education, this as reflected in whether or not they send them to school when COVID-19 restrictions allowed for schools to come back to face-to-face teaching. Subjective well-being of parents and guardians is, however, a predictor of concern about their children's education and future. Our working hypothesis is that, although there is little evidence that subjective well-being has a significant association with the respondents' willingness for their children to continue their schooling, there is a significant indirect effect of subjective well-being-which is especially determined by the gender as well as of the living material conditions-and the greater or lesser importance that the respondents attribute to their children's education. Likewise, and in more general terms, subjective well-being is clearly related to gender, with women having the lowest levels of subjective well-being.

Implementación de un sistema protocolizado de pesquisa temprana de patología psiquiátrica en un hospital general. Protocolo de Vigilancia Neuropsiquiátrica (VNP): avanzando hacia un modelo de psiquiatría de enlace proactivo / Implementation of a protocol for neuropsychiatric disease surveillance in a general hospital

BACKGROUND: The COVID-19 pandemic increased the incidence of neuropsychiatric diseases. Proactive models of consultation-liaison psychiatry (CLP-p) could play a key role in the prevention and management of these diseases in a general hospital. AIM: To develop a protocol for implementing screening tools for neuropsychiatric symptoms in routine clinical practice. MATERIAL AND METHODS: Elements of the Plan-Do-Study-Act (PDSA) model were used to modify the Neuropsychiatric Surveillance protocol implemented at a clinical hospital during the COVID-19 pandemic by members of the hospital's CLP team. RESULTS: A flowchart for active follow-up of neuropsychiatric symptoms during hospitalization is presented, with sequential management and referral flows, accompanied by suggestions for pre-discharge evaluation to define continuity of care actions. The COSMOS tool is also presented, designed for the detection of risk factors and actions for the prevention of neuropsychiatric diseases in general hospitals. CONCLUSIONS: The neuropsychiatric surveillance protocol facilitates early and timely interventions and establishes criteria for the continuity of post-discharge care. These changes could improve the quality of care in general hospitals and reduce the gap between mental and physical health.

Delirium, catatonía y síndrome de abstinencia manifestados como agitación psicomotora en COVID-19: una propuesta de manejo farmacológico en el hospital general

Background: Neuropsychiatric symptoms can be part of the clinical spectrum of COVID-19 infections. Aim: To devise an evidence based clinical algorithm as a guide for clinicians, to identify and treat underlying clinical syndromes of psychomotor agitation, such as delirium, catatonia or substance withdrawal in patients who are hospitalized and infected with SARS-CoV-2. Material and Methods: A review of the literature about the pharmacological management of neuropsychiatric manifestations of COVID-19 at the general hospital, to develop a clinical protocol based on a consensus from an interdisciplinary expert panel at a Clinical Hospital. Results: A consensual clinical algorithm for the management of delirium, catatonia, and substance withdrawal, manifested as psychomotor agitation in patients hospitalized with COVID-19, was developed as a clinical proposal for physicians at different levels of complexity in health services. Conclusions: Cooperation among different clinical units in the general hospital facilitated the implementation of a clinical algorithm for clinicians for the management of psychomotor agitation in COVID-19 patients.

[Rituximab as treatment for refractory pemphigus in Mexican patients]. / Rituximab como tratamiento de pénfigo refractario en pacientes mexicanos.

BACKGROUND: Pemphigus (Pm) is a chronic and recalcitrant autoimmune disease that affects the skin and mucous membranes. The first line of treatment are systemic corticosteroids; however, there are patients who are refractory to them, as well as to other immunosuppressants. Rituximab has been used as a successful alternative since 2000 with good results but without information on its behavior in the Mexican population. OBJECTIVE: To assess the clinical response to treatment with rituximab in Mexican patients with pemphigus. METHODS: This was a cross-sectional, retrospective study in a tertiary hospital, which included patients with moderate-severe pemphigus who had been treated with rituximab from 2007 to 2020. RESULTS: Six medical records of patients diagnosed with pemphigus were obtained; four of them with Pm vulgaris, and two of them with pemphigus foliaceus; all patients had received systemic immunosuppressive therapy prior to rituximab. All six patients went into remission of the disease in an average of 12.5 weeks. CONCLUSION: The use of rituximab for the treatment of patients with moderate-severe Pm who were refractory to immunosuppressive therapy proved to be very useful, and control of the disease was achieved in the medium term, without severe or idiosyncratic adverse effects in the analyzed Mexican population.

Antecedentes: El pénfigo es una enfermedad autoinmune crónica y recalcitrante que afecta piel y mucosas. El tratamiento de primera línea son los corticosteroides sistémicos, aunque hay pacientes refractarios a estos y a otros inmunosupresores. Como alternativa, desde el año 2000 se ha utilizado el rituximab con buenos resultados, pero sin información de su comportamiento en población mexicana. Objetivo: Evaluar la respuesta clínica al tratamiento con rituximab en pacientes mexicanos con pénfigo. Métodos: Se trató de un estudio transversal, retrospectivo en un hospital de tercer nivel, en el que se incluyeron pacientes con pénfigo moderado-severo tratados con rituximab entre 2007 y 2020. Resultados: Se obtuvieron seis expedientes de pacientes con diagnóstico de pénfigo, cuatro presentaron la variedad vulgar y dos, la variedad foliácea; todos recibieron tratamiento sistémico inmunosupresor previo al rituximab. Los seis pacientes tuvieron remisión de la enfermedad en un promedio de 12.5 semanas. Conclusión: El rituximab para el tratamiento de pacientes con pénfigo moderado-severo refractario a tratamiento inmunosupresor demostró ser de gran utilidad y logró un control de la enfermedad a mediano plazo, sin efectos adversos severos ni idiosincráticos en la población mexicana estudiada.

Un estudio exploratorio acerca de los deseos y recursos defensivos de personas en situación de aislamiento social, preventivo y obligatorio a causa del COVID-19 en Argentina / An exploratory study of people's desires and defensive resources during preventive and compulsory social isolation due to COVID-19 in Argentina

Se investigaron y compararon los deseos y recursos defensivos de 94 sujetos voluntarios, no consultantes, mayores de edad, argentinos, que se encuentran viviendo en el Área Metropolitana de Buenos Aires (AMBA) durante el aislamiento, social, preventivo y obligatorio (ASPO), medida excepcional dispuesta por el Gobierno nacional a causa de la pandemia por COVID-19, aplicando el Cuestionario Desiderativo (Sneiderman, S. 2012). Se han observado respuestas ricas y creativas, siendo esperable para una muestra no clínica. En relación a las defensas, aparecieron diferencias por género: las mujeres tienden a utilizar defensas neuróticas ligadas al embellecimiento estético como la represión, mientras que los hombres son más propensos a desmentir y disociar el afecto brindando respuestas teorizadas y abstractas. A pesar de esta distinción, observamos en ambas muestras que, en caso de fallar dichos recursos desplegados, se pone en juego a nivel pronóstico, una propensión para producir síntomas corporales, del orden de lo psicosomático(AU)

Using the Desiderative Questionnare (Sneiderman, S. 2012), the desires and defensive resources were investigated and compared in 94 voluntary subjects; they were argentinian adults, none clinical consultants, living in the Metropolitan Area of Buenos Aires (acronym in Spanish: AMBA), while during preventive and mandatory social isolation (acronym in Spanish: ASPO), an exceptional measure ordered by the national government in the critical context of the pandemic caused by COVID-19. Rich and creative responses were observed, being expected for a non-clinical sample. In relation to defenses, gender differences appeared: women tend to use neurotic defenses linked to aesthetic beautification such as repression, while men are more likely to disavow or deny and dissociate affect by providing theoretical and abstract answers. Despite this distinction, we observed in both samples that, if these deployed resources fail, a propensity to produce bodily symptoms, in the order of the psychosomatic, is put at risk as a prognostic level(AU)

COVID-19 and Multisystem Inflammatory Syndrome in Latin American Children: A Multinational Study.

BACKGROUND: To date, there are no comprehensive data on pediatric COVID-19 from Latin America. This study aims to assess COVID-19 and Multisystem Inflammatory Syndrome (MIS-C) in Latin American children, to appropriately plan and allocate resources to face the pandemic on a local and international level. METHODS: Ambispective multicenter cohort study from 5 Latin American countries. Children 18 years of age or younger with microbiologically confirmed SARS-CoV-2 infection or fulfilling MIS-C definition were included. FINDINGS: Four hundred nine children were included, with a median age of 3.0 years (interquartile range 0.6-9.0). Of these, 95 (23.2%) were diagnosed with MIS-C. One hundred ninety-one (46.7%) children were admitted to hospital and 52 (12.7%) required admission to a pediatric intensive care unit. Ninety-two (22.5%) patients required oxygen support: 8 (2%) were started on continuous positive airway pressure and 29 (7%) on mechanical ventilation. Thirty-five (8.5%) patients required inotropic support. The following factors were associated with pediatric intensive care unit admission: preexisting medical condition (P < 0.0001), immunodeficiency (P = 0.01), lower respiratory tract infection (P < 0.0001), gastrointestinal symptoms (P = 0.006), radiologic changes suggestive of pneumonia and acute respiratory distress syndrome (P < 0.0001) and low socioeconomic conditions (P = 0.009). CONCLUSIONS: This study shows a generally more severe form of COVID-19 and a high number of MIS-C in Latin American children, compared with studies from China, Europe and North America, and support current evidence of a more severe disease in Latin/Hispanic children or in people of lower socioeconomic level. The findings highlight an urgent need for more data on COVID-19 in Latin America.

COVID-19 and Multisystem Inflammatory Syndrome in Latin American children: a multinational study

BackgroundTo date, there are no comprehensive data on pediatric COVID-19 from Latin America. This study aims to assess COVID-19 and Multisystem Inflammatory Syndrome (MIS-C) in Latin American children, in order to appropriately plan and allocate resources to face the pandemic on a local and International lever MethodsAmbispective multicentre cohort study from five Latin American countries. Children aged 18 years or younger with microbiologically confirmed SARS-CoV-2 infection were included. Findings409 children were included, with a median age of 53.0 years (IQR 0.6-9.0). Of these, 95 191 (23.2%) were diagnosed with MIS-C. 191 (46.7%) children were admitted to hospital and 52 (12.7%) required admission to a Pediatric Intensive Care Unite (PICU). 92 (22.5%) patients required oxygen support: 8 (2%) were started on continuous positive airway pressure (CPAP) and 29 (7%) on mechanical ventilation. 35 (8.5%) patients required inotropic support. The following factors were associated with PICU admission: pre-existing medical condition (P < 0.0001), immunodeficiency (P = 0.01), lower respiratory tract infection (P< 0.0001), gastrointestinal symptoms (P = 0.006), radiological changes suggestive of pneumonia and acute respiratory distress syndrome (P< 0.0001), low socioeconomic conditions (P 0.009). ConclusionsThis study shows a generally more severe form of COVID-19 and a high number of MIS-C in Latin American children, compared with studies from China, Europe and North America, and support current evidence of a more severe disease in Latin/Hyspanic children or in people of lower socioeconomic level. The findings highlight an urgent need of more data of COVID-19 in South America.

Colistin Heteroresistance among Extended Spectrum ß-lactamases-Producing Klebsiella pneumoniae.

Colistin-heteroresistant (CST-HR) Enterobacterales isolates have been identified recently, challenging the clinical laboratories since routine susceptibility tests fail to detect this phenotype. In this work we describe the first CST-HR phenotype in extended-spectrum ß-lactamase (ESBL)-producing Klebsiella pneumoniae isolates in South America. Additionally, we determine the genomic mechanisms of colistin heteroresistance in these strains. The CST-HR phenotype was analyzed by the population analysis profile (PAP) method, and mutations associated with this phenotype were determined by whole-genome sequencing (WGS) and the local BLAST+ DB tool. As a result, 8/60 isolates were classified as CST-HR according to the PAP method. From WGS, we determined that the CST-HR isolates belong to three different Sequence Types (STs) and four K-loci: ST11 (KL15 and KL81), ST25 (KL2), and ST1161 (KL19). We identified diverse mutations in the two-component regulatory systems PmrAB and PhoPQ, as well as a disruption of the mgrB global regulator mediated by IS1-like and IS-5-like elements, which could confer resistance to CST in CST-HR and ESBL-producing isolates. These are the first descriptions in Chile of CST-HR in ESBL-producing K. pneumoniae isolates. The emergence of these isolates could have a major impact on the effectiveness of colistin as a "last resort" against these isolates, thus jeopardizing current antibiotic alternatives; therefore, it is important to consider the epidemiology of the CST-HR phenotype.