Análisis y visualización de datos de infección por SARS-CoV-2 de la población atendida en los establecimientos de salud de atención primaria de la Corporación Municipal de Viña del Mar, durante los años 2021-2022 / Analysis and visualization of data on infection by SARS-CoV-2 the population of the primary care health attended in the establishments of the Corporación Municipal de Viña del Mar, during the years 2021-2022

ntroducción: en Chile, la circulación del virus SARS-CoV-2 se inició el 03 de marzo de 2020, desencadenando un rápido aumento de casos en el país. Los datos epidemiológicos y de movilidad fueron fundamentales, para evitar la propagación y severidad de la infección. Sin embargo, la limitación de ser extrapolados desde niveles de división administrativa mayor a niveles menores, ha dificultado la toma de decisiones. Una forma de resolver esto, es analizar y visualizar los datos de la infección en su contexto local, como los datos recopilados desde la Atención Primaria en Salud. Materiales y Métodos: estudio que analizó y visualizó, mediante Microsoft Excel, Stata y Looker Studio, 173.881 exámenes de SARS-CoV-2 realizados en la Corporación Municipal de Viña del Mar (366.981 beneficiarios), durante los años 2021-2022. Resultados: Se obtuvieron 33.633 casos positivos para SARS-CoV-2, de los cuales 11.084 pertenecen al rango etario entre 30 a 49 años. CESFAM Dr. Jorge Kaplán presentó mayor cantidad de casos positivos (5.838), mientras que CECOSF Villa Hermosa la menor cantidad (628). CECOSF Sergio Donoso y Santa Julia presentaron una cantidad notable de casos positivos entre 0 a 14 y 70 a 79 años, respectivamente. Discusión: existió una relación importante entre la cantidad de muestras y casos positivos según lugar de toma de muestra, jurisdicción, población per cápita atendida por jurisdicción y su distribución espacial. Conclusión: la metodología realizada permitió analizar y visualizar los datos de infección por SARS-CoV-2 por jurisdicción, lo que se puede utilizar para observar tendencias y generar estrategias para la comuna.

Introduction: in Chile, the circulation of the SARS-CoV-2 virus began on March 3, 2020, triggering a rapid increase in cases in the country. Epidemiological and mobility data were essential to prevent the spread and severity of the infection. However, the limitation of being extrapolated from higher levels of administrative division to lower levels has made decision-making difficult. One way to solve this is to analyze and visualize infection data in its local context, such as data collected from Primary Health Care.Materials and Methods: a study that analyzed and visualized, using Microsoft Excel, Stata, and Looker Studio, 173,881 SARS-CoV-2 tests performed in the Viña del Mar Municipal Corporation (366,981 beneficiaries) during 2021-2022.Results: there were 33,633 positive cases for SARS-CoV-2, of which 11,084 were in the age range between 30 and 49 years. CESFAM Dr. Jorge Kaplán had the highest positive cases (5,838), while CECOSF Villa Hermosa had the lowest number (628). CECOSF Sergio Donoso and Santa Julia had a notable number of positive cases between 0 and 14 and 70 to 79 years, respectively. Discussion: there was a significant re lationship between the number of samples and positive cases by sampling site, jurisdiction, population per capita served by jurisdiction, and spatial distribution. Conclusion: The methodology used allowed for the analysis and visualization of SARS-CoV-2 infection data by jurisdiction, which the municipality can use to observe trends and generate strategies.

One CGIAR and the Integrated Agri-food Systems Initiative: From short-termism to transformation of the world's food systems.

Agri-food systems are besieged by malnutrition, yield gaps, and climate vulnerability, but integrated, research-based responses in public policy, agricultural, value chains, and finance are constrained by short-termism and zero sum thinking. As they respond to current and emerging agri-food system challenges, decision makers need new tools that steer toward multi-sector, evidence-based collaboration. To support national agri-food system policy processes, the Integrated Agri-food System Initiative (IASI) methodology was developed and validated through case studies in Mexico and Colombia. This holistic, multi-sector methodology builds on diverse existing data resources and leverages situation analysis, modeled predictions, and scenarios to synchronize public and private action at the national level toward sustainable, equitable, and inclusive agri-food systems. Culminating in collectively agreed strategies and multi-partner tactical plans, the IASI methodology enabled a multi-level systems approach by mobilizing design thinking to foster mindset shifts and stakeholder consensus on sustainable and scalable innovations that respond to real-time dynamics in complex agri-food systems. To build capacity for these types of integrated, context-specific approaches, greater investment is needed in supportive international institutions that function as trusted in-region 'innovation brokers.' This paper calls for a structured global network to advance adaptation and evolution of essential tools like the IASI methodology in support of the One CGIAR mandate and in service of positive agri-food systems transformation.

1-Deoxysphingolipids cause autophagosome and lysosome accumulation and trigger NLRP3 inflammasome activation.

1-Deoxysphingolipids (deoxySLs) are atypical sphingolipids of clinical relevance as they are elevated in plasma of patients suffering from hereditary sensory and autonomic neuropathy (HSAN1) or type 2 diabetes. Their neurotoxicity is described best but they inflict damage to various cell types by an uncertain pathomechanism. Using mouse embryonic fibroblasts and an alkyne analog of 1-deoxysphinganine (doxSA), the metabolic precursor of all deoxySLs, we here study the impact of deoxySLs on macroautophagy/autophagy, the regulated degradation of dysfunctional or expendable cellular components. We find that deoxySLs induce autophagosome and lysosome accumulation indicative of an increase in autophagic flux. The autophagosomal machinery targets damaged mitochondria that have accumulated N-acylated doxSA metabolites, presumably deoxyceramide and deoxydihydroceramide, and show aberrant swelling and tubule formation. Autophagosomes and lysosomes also interact with cellular lipid aggregates and crystals that occur upon cellular uptake and N-acylation of monomeric doxSA. As crystals entering the lysophagosomal apparatus in phagocytes are known to trigger the NLRP3 inflammasome, we also treated macrophages with doxSA. We demonstrate the activation of the NLRP3 inflammasome by doxSLs, prompting the release of IL1B from primary macrophages. Taken together, our data establish an impact of doxSLs on autophagy and link doxSL pathophysiology to inflammation and the innate immune system.Abbreviations: alkyne-doxSA: (2S,3R)-2-aminooctadec-17yn-3-ol; alkyne-SA: (2S,3R)-2- aminooctadec-17yn-1,3-diol; aSA: alkyne-sphinganine; ASTM-BODIPY: azido-sulfo-tetramethyl-BODIPY; CerS: ceramide synthase; CMR: clonal macrophage reporter; deoxySLs: 1-deoxysphingolipids; dox(DH)Cer: 1-deoxydihydroceramide; doxCer: 1-deoxyceramide; doxSA: 1-deoxysphinganine; FB1: fumonisin B1; HSAN1: hereditary sensory and autonomic neuropathy type 1; LC3: MAP1LC3A and MAP1LC3B; LPS: lipopolysaccharide; MEF: mouse embryonal fibroblasts; MS: mass spectrometry; N3635P: azido-STAR635P; N3Cy3: azido-cyanine 3; N3picCy3: azido-picolylcyanine 3; NLRP3: NOD-like receptor pyrin domain containing protein 3; P4HB: prolyl 4-hydroxylase subunit beta; PINK1: PTEN induced putative kinase 1; PYCARD/ASC: PYD and CARD domain containing; SPTLC1: serine palmitoyltransferase long chain base subunit 1; SQSTM1: sequestosome 1; TLC: thin layer chromatography.

[Quantification of liver fat infiltration by magnetic resonance]. / Cuantificación de esteatosis hepática no alcohólica por resonancia magnética.

BACKGROUND: A simple and inexpensive method is required to assess fatty infiltration of the liver non-invasively. AIM: To develop and compare different methods to quantify liver fat by magnetic resonance and compare it against ultrasound. MATERIAL AND METHODS: Three algorithms were implemented: region growing (RG), graph cuts (GC) and hierarchical (HR), all based on the IDEAL method to obtain water and fat images. Using these images, the proton density fat fraction (PDFF) was calculated. The three methods were tested in phantoms with known fat percentages and later on we acquired images from 20 volunteers with an ultrasound diagnosis of fatty liver disease in different stages. For everyone, the PDFF of the nine liver segments was determined. RESULTS: In phantoms, the mean error between the real fat percentage and the value obtained through the three methods was -1,26, -1 and -0,8 for RG, GC and HR, respectively. The hierarchical method was more precise and efficient to obtain PDFF. The results in volunteers revealed that ultrasound showed errors categorizing the severity of hepatic steatosis in more than 50% of volunteers. CONCLUSIONS: We developed a tool for magnetic resonance, which allows to quantify fat in the liver. This method is less operator dependent than ultrasound and describes the heterogeneity in the fat distribution along the nine hepatic segments.

Cuantificación de esteatosis hepática no alcohólica por resonancia magnética / Quantification of liver fat infiltration by magnetic resonance

Background: A simple and inexpensive method is required to assess fatty infiltration of the liver non-invasively. Aim: To develop and compare different methods to quantify liver fat by magnetic resonance and compare it against ultrasound. Material and Methods: Three algorithms were implemented: region growing (RG), graph cuts (GC) and hierarchical (HR), all based on the IDEAL method to obtain water and fat images. Using these images, the proton density fat fraction (PDFF) was calculated. The three methods were tested in phantoms with known fat percentages and later on we acquired images from 20 volunteers with an ultrasound diagnosis of fatty liver disease in different stages. For everyone, the PDFF of the nine liver segments was determined. Results: In phantoms, the mean error between the real fat percentage and the value obtained through the three methods was −1,26, −1 and −0,8 for RG, GC and HR, respectively. The hierarchical method was more precise and efficient to obtain PDFF. The results in volunteers revealed that ultrasound showed errors categorizing the severity of hepatic steatosis in more than 50% of volunteers. Conclusions: We developed a tool for magnetic resonance, which allows to quantify fat in the liver. This method is less operator dependent than ultrasound and describes the heterogeneity in the fat distribution along the nine hepatic segments.

Consenso sobre accidente cerebrovascular isquémico agudo / Consensus on acute ischemic stroke

El accidente cerebrovascular es la tercera causa de muerte y la primera de discapacidad en la Argentina. Los eventos isquémicos constituyen el 80% de los casos. Los accidentes vasculares cerebrales requieren la implementación de protocolos sistematizados que permitan reducir los tiempos en la atención, la morbilidad y mortalidad. En el consenso participaron especialistas de nueve sociedades médicas relacionadas con la atención de pacientes con enfermedad cerebrovascular. Se consensuó un temario separado en capítulos y para la redacción de los mismos se conformaron grupos de trabajo con miembros de diferentes especialidades médicas. Se discutió y acordó para cada tema el nivel de recomendación en base a la mejor evidencia clínica disponible para cada tópico. Se realizó una adaptación al ámbito local de las recomendaciones cuando se consideró necesario. El sistema de la American Heart Association se utilizó para redactar las recomendaciones y su grado de evidencia. La corrección y edición fue realizada por cinco revisores externos, que no participaron en la redacción y con amplia experiencia en enfermedad vascular. Finalizado el documento preliminar, se organizó una reunión general con todos los integrantes de los grupos de trabajo y los revisores para redactar las recomendaciones definitivas. El consenso abarca la atención del paciente con accidente cerebrovascular isquémico en la fase pre-hospitalaria, evaluación inicial en la central de emergencias, terapias de recanalización (trombolisis y/o trombectomía mecánica), craniectomía descompresiva, neuroimágenes y cuidados clínicos en la internación.

Stroke is the third cause of death and the first cause of disability in Argentina. Ischemic events constitute 80% of cases. It requires the implementation of systematized protocols that allow reducing the time of care, morbidity and mortality. Specialists from nine medical societies related to the care of patients with cerebrovascular disease participated in the consensus. A separate agenda was agreed upon in chapters and for the writing of them, work groups were formed with members of different medical specialties. The level of recommendation was discussed and agreed upon for each topic based on the best clinical evidence available for each of them. An adaptation to the local scope of the recommendations was made when it was considered necessary.The American Heart Association system was used to draft the recommendations and their level of evidence. The correction and editing were done by five external reviewers, who did not participate in the writing and with extensive experience in vascular pathology. Once the preliminary document was finalized, a general meeting was held with all the members of the working groups and the reviewers to reach final recommendations. The consensus covers the management of ischemic stroke in the pre-hospital phase, initial evaluation in the emergency center, recanalization therapies (thrombolysis and/ or mechanical thrombectomy), decompressive craniectomy, neuroimaging and clinical care in the hospital.

Historia, presente y proyecciones de la Farmacopea / History, present and projections of the Pharmacopoeia

El término 'farmacopea' parece tener su origen en Grecia en el siglo II o III A.C y deriva de ϕαρµακον que significa hechizo, veneno o droga y πουεîν que significa hacer. Nace de la necesidad de disponer de un texto que estableciera normas y materiales de referencia para satisfacer los requerimientos de calidad, seguridad y eficacia de los productos farmacéuticos. En el transcurso de más de 500 años desde la aparición de las primeras farmacopeas, se generó trabajo en conjunto entre médicos y farmacéuticos, con predominio posterior del farmacéutico, armonización de los contenidos entre los diferentes textos, tanto nacionales como regionales para cubrir el mercado global. También se ha efectuado una actualización continua y modernización de los contenidos, transitando desde lo natural a lo químico y en la actualidad a lo químico-natural-biológico, en conjunto hoy en día con la incorporación de nuevas y sofisticadas metodologías que generan monografías, más modernas y completas

The term 'pharmacopoeia' seems to have originated in Greece in the second or third century B.C., and is derived from φαρµακον, which means ‘spell, poison or drugs’, and πουεîν that means ‘making’. This text was born from the need of a text to establish standards and reference materials to meet quality requirements, safety and efficacy for pharmaceutics. For over 500 years since the appearance of the first pharmacopoeias, there has been joint collaborative work between physicians and pharmacists, later with larger participation of pharmacists, and efforts for harmonization among various national and regional pharmacopeias to be inclusive of the global market. In addition, a continuous update and modernization of the contents has been carried out, moving from the natural to the chemical and currently to the chemical, natural and biological, together with the addition of innovative methodologies giving rise to today’s more modern and comprehensive current pharmacopeial monographs

Follow-up of an asymptomatic Chagas disease population of children after treatment with nifurtimox (Lampit) in a sylvatic endemic transmission area of Colombia.

BACKGROUND: Chagas disease is an anthropozoonosis caused by Trypanosoma cruzi. Two drugs are currently used for the etiological treatment of the disease: Nifurtimox (Lampit) and Benznidazole. This study presents a quasi-experimental trial (non-control group) of sixty-two patients who were treated for Chagas disease with Nifurtimox (Lampit), and were then followed for 30 months post-treatment. The safety of Nifurtimox (Lampit) for Chagas disease in this group of children primarily between 4 and 19 years old was also evaluated. MATERIALS AND METHODS: The 62 patients included in the study were selected when resulted seropositive for two out of three fundamentally different serological tests. All children were treated during two months according to protocols established by WHO. Monitoring was performed every twenty days to evaluate treatment safety. In 43 patients, two different serological tests: ELISA and IFAT; and two parasitological tests: blood culture, and real time PCR, (qPCR) were performed to assess therapeutic response, defined as post-treatment serological negativization. PRINCIPAL FINDINGS: All patients completed the treatment successfully, and six patients abandoned the post-treatment follow-up. Adverse effects occurred in 74% of patients, but only 4.8% of cases required temporary suspension to achieve 100% adherence to the 60-day treatment, and all symptoms reverted after treatment completion. Both parasite load (measured through qPCR) and antibodies (ELISA absorbance) evidenced a significant median reduction 6 months after treatment from 6.2 to 0.2 parasite equivalents/mL, and from 0.6 to 0.2 absorbance units respectively (p<0.001). Serological negativization by ELISA was evident since 6 months post-treatment, whereas by IFAT only after 18 months. Serological negativization by the two tests (ELISA and IFAT) was 41.9% (95%CI: 26.5-57.3) after 30 months post-treatment. qPCR was positive in 88.3% of patients pre-treatment and only in 12.1% of patients after 30 months. Survival analysis indicated that only 26.3% (95%CI: 15.5-44.8) persisted with negative qPCR during the whole follow-up period. CONCLUSIONS: Nifurtimox was very well tolerated and successfully reduced parasite load and antibody titers. Re-infection, lysed parasites or a lack of anti-parasitic activity could explain these persistently positive qPCR cases.

[Evaluation of a pilot intervention program for overweight and obese adults at risk of type 2 diabetes]. / Evaluación de un programa piloto de intervención en adultos con sobrepeso u obesidad, en riesgo de diabetes.

BACKGROUND: The Ministry of Health of Chile and selected obesity specialized centers implemented an interdisciplinary pilot program for overweight adults at risk of diabetes to decrease the risk of type 2 diabetes (T2D) and cardiovascular risk factors (CVRF). AIM: To assess the results of this program. PATIENTS AND METHODS: Beneficiaries of the public primary health system aged 18-45 years, with a body mass index (BMI) 25-38 kg/m(2) and fasting blood glucose 100-125 mg/dL or with any direct family member with T2D, were recruited. During the four months of the study, they were scheduled for three physician visits, four dietitian consultations, 14 physical activity sessions and four group workshops (two with a psychologist or therapist). In fasting blood samples, at the beginning and at the fourth month, glucose, insulin and lipids were determined. The Homeostasis model assessment (HOMA) index was calculated. RESULTS: Two hundred-seventy-six patients were recruited and 160 (141 women), completed the four months of follow up. In this subgroup, at the start and end of the intervention, a BMI equal to or greater than 30 kg/m(2) was observed in 69% and 52% of subjects respectively, a systolic blood pressure equal to or greater than 140 mm Hg was observed in 24% and 6% respectively, a diastolic blood pressure equal to or greater than 90 mm Hg was observed in 28% and 9% respectively, a blood glucose equal to or greater than 100 mg/dL was observed in 61% and 19% respectively, a plasma insulin equal to or greater than 12,5 microUl/ml was observed in 49% and 34% respectively and a HOMA equal to or greater than 2.5 was observed in 63% and 42% respectively (all these comparisons are significant with a p <0.05). CONCLUSIONS: In those patients that completed the follow up period, this intervention induced a significant decrease of some CVRF, such as BMI, fasting glucose levels and HOMA index.

Evaluación de un programa piloto de intervención en adultos con sobrepeso u obesidad, en riesgo de diabetes / Evaluation of a pilot intervention program for overweight and obese adults at risk of type 2 diabetes

Background: The Ministry of Health of Chile and selected obesity specialized centers implemented an interdisciplinary pilot program for overweight adults at risk of diabetes to decrease the risk of type 2 diabetes (T2D) and cardiovascular risk factors (CVRF). Aim To assess the results of this program. Patients and methods: Beneficiaries of the public primary health system aged 18-45 years, with a body mass index (BMI) 25-38 kg/m² and fasting blood glucose 100-125 mg/dL or with any direct family member with T2D, were recruited. During the four months of the study, they were scheduled for three physician visits, four dietitian consultations, 14 physical activity sessions and four group workshops (two with a psychologist or therapist). In fasting blood samples, at the beginning and at the fourth month, glucose, insulin and lipids were determined. The Homeostasis model assessment (HOMA) index was calculated. Results: Two hundred-seventy-six patients were recruited and 160 (141 women), completed the four months of follow up. In this subgroup, at the start and end of the intervention, a BMI equal to or greater than 30 kg/m² was observed in 69 percent and 52 percent of subjects respectively, a systolic blood pressure equal to or greater than 140 mm Hg was observed in 24 percent and 6 percent respectively, a diastolic blood pressure equal to or greater than 90 mm Hg was observed in 28 percent and 9 percent respectively, a blood glucose equal to or greater than 100 mg/dL was observed in 61 percent and 19 percent respectively, a plasma insulin equal to or greater than 12,5 fi Ul/rnl was observed in 49 percent and 34 percent respectively and a HOMA equal to or greater than 2.5 was observed in 63 percent and 42 percent respectively (all these comparisons are significant with a p <0.05). Conclusions: In those patients that completed the follow up period, this intervention induced a significant decrease of some CVRF, such as BMI, fasting glucose levels...

Ciprofibrate therapy in patients with hypertriglyceridemia and low high density lipoprotein (HDL)-cholesterol: greater reduction of non-HDL cholesterol in subjects with excess body weight (The CIPROAMLAT study).

BACKGROUND: Hypertriglyceridemia in combination with low HDL cholesterol levels is a risk factor for cardiovascular disease. Our objective was to evaluate the efficacy of ciprofibrate for the treatment of this form of dyslipidemia and to identify factors associated with better treatment response. METHODS: Multicenter, international, open-label study. Four hundred and thirty seven patients were included. The plasma lipid levels at inclusion were fasting triglyceride concentrations between 1.6-3.9 mM/l and HDL cholesterol < or = 1.05 mM/l for women and < or = 0.9 mM/l for men. The LDL cholesterol was below 4.2 mM/l. All patients received ciprofibrate 100 mg/d. Efficacy and safety parameters were assessed at baseline and at the end of the treatment. The primary efficacy parameter of the study was percentage change in triglycerides from baseline. RESULTS: After 4 months, plasma triglyceride concentrations were decreased by 44% (p < 0.001). HDL cholesterol concentrations were increased by 10% (p < 0.001). Non-HDL cholesterol was decreased by 19%. A greater HDL cholesterol response was observed in lean patients (body mass index < 25 kg/m2) compared to the rest of the population (8.2 vs 19.7%, p < 0.001). In contrast, cases with excess body weight had a larger decrease in non-HDL cholesterol levels (-20.8 vs -10.8%, p < 0.001). There were no significant complications resulting from treatment with ciprofibrate. CONCLUSIONS: Ciprofibrate is efficacious for the correction of hypertriglyceridemia / low HDL cholesterol. A greater decrease in non-HDL cholesterol was found among cases with excess body weight. The mechanism of action of ciprofibrate may be influenced by the pathophysiology of the disorder being treated.

Delusión y esquizofrenia / Delusion and schizophrenia

Se revisan las concepciones clásicas de la esquizofrenia. Se destaca el interés inicial de los investigadores en el esclarecimiento y formulación de las variadas hipótesis explicativas del trastorno fundamental de esta psicosis, así como el cambio de orientación que se evidencia en las investigaciones modernas, tanto clínicas como etiológicas. Se revisan, igualmente, los estudios sobre el concepto de delusión enfatizando el contexto delusional, fundamentando la significación clínicas, complejidad y gravedad de este fenómeno psicopatológico.

The author reviews the classical concepts of schizophrenia. He points out the initial research focus on conceptual formulation and classification of explanatory hypothesis to explain the fundamental disturbance of this psychosis. He also emphasizes the changing trends of modern clinical and etiopathogenic research in this area. A general overview of conceptual studies on delusion is also given, stressing the notion of delusional context as a base of the clinical meaning, complexity and severity of this psychopathological phenomenon.

Clínica de las demencias: segunda parte / Clinics of dementias: second part

Los autores hacen algunas consideraciones sobre el interés médico acerca de las demencias basado en su aumento paralelo al del promedio de vida y sobre la clasificación actual menos insatisfactoria que los agrupa en corticales primarias y subcorticales primarias y secundarias. En lo clínico, las demencias comprenden diversas entidades, diferentes en su fisonomía, semejantes en su irreversibilidad y con un final bastante parecido. Resumen la clínica del envejecimiento normal, ofrecen una visión del peculiar mundo demencial, no siempre presente; señalan lo esencial de las demencias corticales primarias y de las subcorticales primarias y arterioescleróticas, este último grupo con síntomas neurológicos iniciales, mucho antes de la aparición de los síntomas de deterioro. En las demencias corticales, consideran la enfermedad de Alzheimer muy frecuente, siendo los síntomas iniciales: desmedro de la memoria, agnosia, de las fisonomías, alteraciones visuoespaciales, conservación de la personalidad por largo tiempo; en la enfermedad de Pick, rara, hay graves perturbaciones de la personalidad, mucho antes del menoscabo mnésico e intelectual; en ambas, al final, aparecen síntomas neurológicos. Terminan revisando dos problemas espinosos y discutibles hoy en las demencias: el de las relaciones entre el envejecimiento normal y las demencias primarias y el de la alzheimerización de las demencias