Epidemiological changes of invasive fungal disease in children with cancer: Prospective study of the National Child Program of Antineoplastic Drugs network, Chile.

BACKGROUND: Invasive fungal diseases (IFD) are high morbidity and mortality infections in children with cancer suffering episodes of high-risk febrile neutropenia (HRFN). IFD epidemiology has changed in the last two decades, with an increasing incidence in recent years due to the growing number of immunocompromised children at risk for IFD. The aim of this study was to evaluate the incidence of IFD in children with cancer in the period 2016-2020 compared to 2004-2006 in six hospitals in Chile. METHODS: Prospective, multicentre study, carried out between 2016 and 2020 in six hospitals in Chile. The defined cohort corresponds to a dynamic group of HRFN episodes in patients <18 years old with cancer, who at the fourth day of evolution still presented fever and neutropenia (persistent HRFN). Each episode was followed until resolution of FN. The incidence of IFD was calculated between 2016 and 2020 and compared with data obtained in the period 2004-2006. The incidence rate was estimated. RESULTS: A total of 777 episodes of HRFN were analysed; 257 (33.1%) were considered as persistent-HRFN occurring in 174 patients. The median age was 7 years (IQR: 3-12 years) and 52.3% (N = 91) were male. Fifty-three episodes of IFD were detected: 21 proven, 14 probable and 18 possible. Possible IFD were excluded, leaving 239 episodes of persistent-HRFN with an IFD incidence of 14.6% (95% CI 10.5-19.9) and an incidence rate of 13.6 IFD cases per 1000 days of neutropenia (95% CI 9.5-20.0). Compared to 2004-2006 cohort (incidence: 8.5% (95% CI 5.2-13.5)), a significant increase in incidence of 6.1% (95% CI 0.2-12.1, p = .047) was detected in cohorts between 2016 and 2020. CONCLUSION: We observed a significant increase in IFD in 2016-2020, compared to 2004-2006 period.

Zika virus non-coding RNAs antagonize antiviral responses by PKR-mediated translational arrest.

Zika virus (ZIKV) is an emerging mosquito-borne flavivirus that causes severe outbreaks in human populations. ZIKV infection leads to the accumulation of small non-coding viral RNAs (known as sfRNAs) that are crucial for evasion of antiviral responses and for viral pathogenesis. However, the mechanistic understanding of how sfRNAs function remains incomplete. Here, we use recombinant ZIKVs and ribosome profiling of infected human cells to show that sfRNAs block translation of antiviral genes. Mechanistically, we demonstrate that specific RNA structures present in sfRNAs trigger PKR activation, which instead of limiting viral replication, enhances viral particle production. Although ZIKV infection induces mRNA expression of antiviral genes, translation efficiency of type I interferon and interferon stimulated genes were significantly downregulated by PKR activation. Our results reveal a novel viral adaptation mechanism mediated by sfRNAs, where ZIKV increases its fitness by repurposing the antiviral role of PKR into a proviral factor.

Patch Test Results with the Latin American Baseline Series in a Colombian Population. 2016-2021.

Background: Contact dermatitis (CD) is one of the most prevalent skin diseases. It is commonly divided into irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD). Patch testing is a procedure used to support the diagnosis of ACD. This test should be interpreted along with the clinical history and morphology of the skin lesions to determine clinical relevance. Objective: To describe the sensitization patterns of patients undergoing patch testing with the Latin American baseline series. Methods: A single-center retrospective study was performed. For the study, patients older than 18 years with a clinical diagnosis of contact dermatitis, who underwent patch testing using the Latin American baseline series were considered. These tests took place at the Alma Mater Hospital of Antioquia between January 1, 2016, and December 31, 2021. Results: A total of 648 patients were included. Patch tests were positive in 63% of cases, with a mean age of 51.5 years. Around 36.6% had atopy-related diseases. The main occupation was housework (30.7%). The hands were the most affected area in the body (31%). The main allergens were nickel sulfate (34%), sodium tetrachloropalladate (24.2%), and thimerosal (8.0%). Fifteen allergens had a percentage below 1%. Hydrocortisone and budesonide did not yield positive results. Conclusion: Nickel sulfate was the most frequent allergen, and women were the most affected. The information gathered could be useful for adjusting the allergens that should be included in the regional baseline series, taking into account the frequency found.

[Microorganisms isolated from blood cultures and resistance profile in children with cancer and high-risk febrile neutropenia. Red PINDA, Chile, 2016-2021]. / Microorganismos aislados de hemocultivos y su perfil de resistencia en niños con cáncer y neutropenia febril de alto riesgo. Red PINDA, Chile, 2016-2021.

Bacteremia is a major cause of morbidity and mortality in patients with cancer and episodes of high-risk febrile neutropenia (HRFN). OBJECTIVE: To identify the frequency of microorganisms isolated from blood cultures (BC) and their antimicrobial resistance (R) profile in children with HRFN, compared with the same data from previous studies of the same group. METHOD: Prospective, multicenter, epidemiological surveillance study of microorganisms isolated from BC in patients under 18 years of age, from 7 PINDA network hospitals, between 2016 and 2021. RESULTS: 284 episodes of HRFN with positive BC were analyzed out of 1091 enrolled episodes (26%). Median age 7.2 years [3.0-12.3]. The main isolates were gram-negative bacilli (GNB) 49.2%, gram-positive cocci (GPC) 43.8%, and fungi 3.6%. The most frequently isolated microorganisms were viridans group Streptococci (VGS) (25.8%), Escherichia coli (19.8%), Pseudomonas spp. (11.2%), Klebsiella spp. (10.9%), and coagulase negative Staphylococci (CoNS) (10.9%). There was an increase in R to third-generation cephalosporins (p = 0.011) in GNB and to oxacillin in CoNS (p = 0.00), as well as a decrease in R to amikacin in non-fermenting GNB (p = 0.02) and to penicillin in VGS (p = 0.04). CONCLUSION: VGS is the main agent isolated in BC from pediatric patients with cancer and episodes of HRFN, followed by E. coli, Pseudomonas spp., and Klebsiella spp. Having epidemiological surveillance of microorganisms isolated from BC and their antimicrobial R profile is essential to favor the rational use of antimicrobials.

Building an implementation strategy for community-based rehabilitation for mental health in Colombia.

INTRODUCTION: Scientific evidence indicates that the community-based rehabilitation (CBR) model is recommended for recovery from mental disorders. However, this approach encounters barriers and often lacks implementation strategies. AIM: The aim of this study was to create a strategy for the implementation of CBR for mental health in Colombia through the identification of barriers and facilitators, together with the expected outcomes, from the perspective of mental health decision-makers in Colombia. METHODS: This study adopts a qualitative descriptive approach, using focus group data collection methods and thematic analysis to code and analyze the data. RESULTS: A total of 208 individuals participated in the study, including mental health decision-makers and health care professionals. Intersectoral collaboration, contextualization, financial resources, and community commitment and autonomy were identified as barriers and facilitators. The element that was considered a priority for successful implementation was the contextualization of strategies. CONCLUSIONS: CBR needs to be strengthened through implementation science if these strategies are to be successfully developed and implemented in various contexts. SPANISH ABSTRACT: http://links.lww.com/IJEBH/A210.

Efficacy and safety of withholding antimicrobial therapy in children with cancer, fever, and neutropenia, with a demonstrated viral respiratory infection: a randomized clinical trial.

OBJECTIVES: To validate the efficacy and safety of withholding antimicrobial therapy in a new cohort of children with cancer and febrile neutropenia (FN) having a demonstrated viral respiratory tract infection. METHODS: Prospective, multicenter, noninferiority, randomized study, approved by the ethical committee, in children presenting with FN at seven hospitals in Chile, evaluated at admission for diagnosis of bacterial and viral pathogens. Children who were positive for a respiratory virus, negative for a bacterial pathogen, and had a favourable evolution after 48-72 hours of antimicrobial therapy were randomized to either maintain or withhold antimicrobial therapy. The primary endpoint was the percentage of episodes with an uneventful resolution, whereas the secondary endpoints were days of fever, days of hospitalization, requirement of antimicrobial treatment readministration, sepsis, paediatric intensive care unit admission, and death. RESULTS: A total of 301 of 939 children with FN episodes recruited between March 2021 and December 2023 had a respiratory virus as a unique identified microorganism, of which 139 had a favourable evolution at 48-72 hours and were randomized, 70 to maintain and 69 to withdraw antimicrobial therapy. The median days of antimicrobial therapy was 5 (IQR 3-6) versus 3 (IQR 3-6) days (p < 0.001), with similar frequency of uneventful resolution 66/70 (94%) and 66/69 (96%); relative risk, 1.01; (95% CI, 0.93 to 1.09), absolute risk difference 0.01; (95% CI, -0.05 to 0.08) and similar number of days of fever and days of hospitalization. No cases of sepsis, paediatric intensive care unit admission, or death were reported. DISCUSSION: We validated the strategy of withdrawal antimicrobial therapy in children with FN and viral respiratory tract infection based on clinical and microbiological/molecular diagnostic criteria. This will enable advances in antimicrobial stewardship strategies with a possible future impact on antimicrobial resistance.

Support Groups Versus Primary Mental Healthcare on Disability and Continuity of Care: Community Trial [Support Groups for Recovery].

Based on the need to implement strategies to reduce recovery gaps in mental health with the community as axes of recovery, the objective of the present study was to assess the impact on psychosocial disability and care continuity in individuals with suicidal behavior, of the clinical and community components of the Mental Health Gap Action Program (mhGAP), versus exclusive psychiatric care. For this, a controlled community trial carried out in 2023 was conducted, comprising intervention groups: Support Group (SG), mhGAP Group (mhGAPG) and a Control Group (CG). Self-report measurements were collected pretest and posttest, utilizing the Psychosocial Disability Scale and the Alberta Continuity of Care Scale. The study involved the participation of 94 individuals with a history of suicidal behavior, with 30 individuals in the SG, 34 in the mhGAP group, and 30 in the CG. Categorical variables were summarized using frequency distribution tables. Descriptive statistics were used to examine participants' characteristics at the study outcome and estimate treatment compliance. The Mann-Whitney U Test examined differences in sociodemographic variable frequencies. The Jarque-Bera test confirmed a normal distribution for psychological variables, warranting the use of parametric tests. Differences in mean values across groups, each with two measurements per individual, were assessed using a type II repeated measures ANOVA. There were significant differences based on the intervention, with the effect being greater in the SG across all domains. Significant improvement was observed in all domains of the disability and continuity of care scale within the intervention groups. Both groups showed improvement, with better results for the SG. In conclusion, a methodology is proposed for implementing support groups based on core components, which effectively enhances psychosocial disability and the continuity of mental health care, especially in suicidal behavior.

Ultrasonografía del diámetro de la vaina del nervio óptico en voluntarios sanos

Fundamento: La ultrasonografía del diámetro de la vaina del nervio óptico ha sido utilizada como medidor no invasivo de la presión intracraneal. Una de las deficiencias enunciadas resulta, la no existencia de un valor estándar, que sugiera el límite entre la normalidad y la hipertensión intracraneal. Objetivo: Determinar el diámetro de la vaina del nervio óptico mediante ecografía en voluntarios sanos. Métodos: Se realizó un estudio ecológico de poblaciones múltiples en 160 voluntarios sanos que cumplieron con los criterios de inclusión. Se realizaron 3 mediciones ultrasonográficas en modo B en cada ojo, se tomó como valor final el promedio. Las variables estudiadas fueron: edad, sexo, color de la piel y diámetro de la vaina del nervio óptico. Se calculó el porcentaje, media, mediana, límite y estándar. Con un valor de referencia al 95 % del intervalo de confianza. La relación entre las variables se determinó mediante análisis de regresión logística simple con el paquete estadístico de SPSS 22.0. Resultados: El diámetro de la vaina del nervio óptico, en los sujetos, se cuantificó entre 4,62 - 4,80 mm y 4,66 - 4,83 mm para los ojos derecho e izquierdo respectivamente. Al análisis de regresión lineal simple, solo el sexo se asoció al valor del diámetro de la vaina del nervio óptico (p= 0,000). Conclusiones: En una población de voluntarios sanos el valor del diámetro de la vaina del nervio óptico fue similar a otras descripciones, con diferencias entre el sexo, lo cual sugiere tomar en consideración esta variable al hacer la medición.

Foundation: Ultrasonography of the diameter of the optic nerve sheath has been used as a non-invasive measure of intracranial pressure. One of the deficiencies stated is the non-existence of a standard value that suggests the limit between normality and intracranial hypertension. Objective: Determine the diameter of the optic nerve sheath using ultrasound in healthy volunteers. Methods: A multi-population ecological study was conducted on 160 healthy volunteers who met the inclusion criteria. Three ultrasonographic measurements were performed in B mode in each eye, the average was taken as the final value. The variables studied were: age, sex, skin color and diameter of the optic nerve sheath. The percentage, mean, median, limit and standard were calculated. With a reference value at the 95% confidence interval. The relationship between the variables was determined by simple logistic regression analysis with the SPSS 22.0 statistical package. Results: That diameter of the optic nerve sheath, in the subjects, was quantified between 4.62 - 4.80 mm and 4.66 - 4.83 mm for the right and left eyes respectively. In the simple linear regression analysis, only sex was associated with the value of the diameter of the optic nerve sheath (p= 0.000). Conclusions: In a population of healthy volunteers, the value of the diameter of the optic nerve sheath was similar to other descriptions, with differences between sex, which suggests taking this variable into consideration when making the measurement.

Self-confidence and satisfaction of nursing students in preoperative telesimulation: cross-sectional study / Autoconfianza y satisfacción de estudiantes de enfermería en la telesimulación preoperatoria: estudio transversal / Autoconfiança e satisfação de estudantes de Enfermagem na telessimulação pré-operatória: estudo transversal

Objective: To assess the self-confidence and satisfaction of Nursing students based on a preoperative telesimulation scenario. Method: Exploratory-descriptive quantitative study conducted from June 2021 to June 2022 at a public university in southern Brazil. The study included 28 undergraduate Nursing students who participated in a telesimulation on preoperative nursing. After the telesimulation, the Student Satisfaction and Self-confidence in Learning Scale and the Scale of Satisfaction with Simulated Clinical Experiences were applied through an electronic questionnaire. Descriptive statistics were used for data analysis. Results: Participants reported higher satisfaction (mean 4.36) than self-confidence (mean 3.83). Satisfaction with simulated clinical experiences showed that the cognitive dimension had the highest mean (9.25), followed by the realism dimension (8.83) and practical activity (8.64). Conclusion: Preoperative telesimulation is capable of promoting satisfaction and self-confidence in the Nursing students' learning. (AU)

Objetivo: Evaluar la autoconfianza y satisfacción de los estudiantes de Enfermería basándose en un escenario de telesimulación preoperatoria. Método: Estudio cuantitativo exploratorio-descriptivo realizado de junio de 2021 a junio de 2022 en una universidad pública del sur de Brasil. El estudio incluyó a 28 estudiantes de pregrado en Enfermería que participaron en una telesimulación sobre enfermería preoperatoria. Después de la telesimulación, se aplicaron la Escala de Satisfacción y Autoconfianza del Estudiante en el Aprendizaje y la Escala de Satisfacción con Experiencias Clínicas Simuladas a través de un cuestionario electrónico. Se utilizó estadística descriptiva para el análisis de datos. Resultados: Los participantes reportaron una mayor satis-facción (media de 4,36) que autoconfianza (media de 3,83). La satisfacción con las experiencias clínicas simuladas mostró que la dimensión cognitiva tuvo la media más alta (9,25), seguida de la dimensión de realismo (8,83) y actividad práctica (8,64). Conclusión: La telesimulación preoperatoria es capaz de promover la satisfacción y autoconfianza en el aprendizaje de los estudiantes de Enfermería. (AU)

Objetivo: Avaliar a autoconfiança e a satisfação dos estudantes de Enfermagem a partir de um cenário de telessimulação pré-operató-ria. Método: Estudo quantitativo exploratório-descritivo realizado de junho de 2021 a junho de 2022 em uma universidade pública do Sul do Brasil. Participaram do estudo 28 estudantes do curso de graduação em Enfermagem, por meio de telessimulação sobre enfermagem pré-operatória. Após a telessimulação, aplicou-se a Escala de Satisfação dos Estudantes e Autoconfiança na Aprendizagem e Escala de Satisfação com as Experiências Clínicas Simuladas, por meio de questionário eletrônico. Utilizou-se estatística descritiva para análise de dados. Resultados: Os participantes apresentaram-se mais satisfeitos (média 4,36) do que autoconfiantes (média 3,83). A satisfação com as experiências clínicas simuladas demonstra que a dimensão cognitiva apresentou maior média (9,25), seguida da dimensão realismo (8,83) e atividade prática (8,64). Conclusão: A telessimulação em cenário pré-operatório é capaz de promover satisfação e autoconfiança na aprendizagem dos estudantes de Enfermagem. (AU)

Capacitación al personal de salud del Municipio Sipe Sipe Cochabamba en el desarrollo infantil temprano, a través del enfoque psicomotor para la atención integral de salas de estimulación temprana / Training of health personnel of the Sipe Sipe Cochabamba Municipality in early childhood development, through the psychomotor approach for the comprehensive care of early stimulation rooms

Con el fin de mejorar la calidad de servicios de desarrollo infantil temprano, el Gobierno de Bolivia solicito un préstamo al BID, para implementar el Programa de Desarrollo Infantil Temprano" Crecer Bien para Vivir Bien". Teniendo como objetivo, contribuir a mejorar en forma sostenible y con pertinencia cultural el desarrollo cognoscitivo, socio afectivo y motriz de niños/as bolivianos. Tal programa es implementado primeramente en los departamentos de Chuquisaca y Potosí. viendo los resultados significativos que tuvieron ambos departamentos y con el objetivo de institucionalizarlo permitiendo la sostenibilidad del mismo, se llevó a cabo la consultoría en 5 municipios del departamento de Cochabamba, a partir de ahí e empezó hacer las gestiones, el BID contrato a la Universidad Salesiana, específicamente la carrera de Psicomotricidad para hacer este trabajo. Una de las modalidades del programa está la implementación de salas de estimulación, que beneficiaría a los niños y niñas menores de 6 años que presente rezago en su desarrollo, de los municipios más vulnerables, siendo uno de ellos el municipio de Sipe Sipe. El fin del proyecto es que el personal de salud que se haga cargo de las salas de estimulación temprana se encuentre capacitados y con la disponibilidad suficiente para realizar así una detección temprana de posibles rezagos en los niños/as, donde los padres y el personal de salud ofrezcan un acompañamiento en el desarrollo del niño brindando no solo una atención unidireccional sino apoyando al entorno social, familiar y cultural desde una mirada integral. Todo ello a partir de la capacitación brindada por un Psicomotricista.

POTENTIAL CONTRIBUTION OF ChatGPT® TO LEARNING ABOUT SEPTIC SHOCK IN INTENSIVE CARE / POTENCIAL APORTE DE APLICAR ChatGPT® EN LA ENSEÑANZA DE SHOCK SÉPTICO EN CUIDADOS INTENSIVOS / CONTRIBUIÇÃO POTENCIAL DE APLICAÇÃO DO ChatGPT® NA APRENDIZAGEM DO CHOQUE SÉPTICO EM TERAPIA INTENSIVA

ABSTRACT Objective: to demonstrate the application of some prompts and to problematize the use of ChatGPT® to guide the best answers for nursing students and teachers on septic shock in intensive care learning. Method: a methodological study where prompt technology was applied in ChatGPT® to support nursing learning in intensive care with an emphasis on septic shock. The study was organized in 3 stages, covering an understanding of ChatGPT® and models, as well as testing and exercising prompts. Results: applications of prompts were presented, based on a structure of pre-defined stages that made it possible to exemplify the answers given and to organize an output generation diagram as a way of summarizing the process of decision support in intensive care. Conclusion: ChatGPT® is a natural language processing model that uses deep learning approaches to generate human-like answers. However, the generation of prompts for the teaching-learning process in intensive care nursing requires in-depth association with the pillars of evidence-based practice.

RESUMEN Objetivo: demostrar la aplicación de algunos prompts y debatir cómo se utiliza ChatGPT® para orientar las mejores respuestas a estudiantes y profesores de Enfermería sobre shock séptico en la enseñanza de cuidados intensivos. Método: estudio metodológico en el que se aplicó la tecnología de prompts en ChatGPT® para respaldar la enseñanza de Enfermería en cuidados intensivos con énfasis en shock séptico. El estudio se organizó en 3 etapas, contemplando lo que se sabe sobre ChatGPT® y diversos modelos, al igual que pruebas y prácticas con prompts. Resultados: Se presentaron aplicaciones de prompts a partir de una estructura de etapas predefinidas que permitieron ejemplificar respuestas dadas por el sistema y organizar un diagrama de generación de salidas como una manera de resumir el proceso de apoyo a las decisiones que se toman en cuidados intensivos. Conclusión: ChatGPT® es un modelo de procesamiento del lenguaje natural que utiliza enfoques de aprendizaje profundo para generar respuestas semejantes a las humanas. Sin embargo, la generación de los prompts para el proceso de enseñanza-aprendizaje en Enfermería de cuidados intensivos requiere una profunda asociación con los pilares de la práctica basada en evidencias.

RESUMO Objetivo: Demostrar a aplicação de alguns prompts e problematizar o uso do ChatGPT® para guiar as melhores respostas aos estudantes e professores de enfermagem sobre choque séptico na aprendizagem em terapia intensiva. Método: Estudo metodológico, com aplicação de tecnologia de prompts no ChatGPT® para apoiar a aprendizagem de enfermagem em terapia intensiva com ênfase no choque séptico. O estudo foi organizado em 3 etapas, contemplando o entendimento sobre o ChatGPT®, modelos, bem como teste e exercício de prompts. Resultados: Foram apresentadas aplicações de prompts a partir de uma estrutura de etapas pré-definidas que permitiram exemplificar respostas dadas e organizar um diagrama de geração de saídas como uma forma de resumir o processo de apoio à tomada de decisão em terapia intensiva. Conclusão: O ChatGPT® é um modelo de processamento de linguagem natural que usa abordagens de aprendizagem profunda para gerar respostas semelhantes às humanas. Contudo, a geração dos prompts para o processo de ensino-aprendizagem em enfermagem de terapia intensiva requer associação profunda com os pilares da prática baseada em evidência.

Fuzzy Controller Implemented for Movement of a Tendon-Driven 3D Robotic Lumbar Spine Mechanism.

Notable efforts have been devoted to the development of biomechanical models of the spine, so the development of a motion system to control the spine becomes expressively relevant. This paper presents a fuzzy controller to manipulate the movement of a 3D robotic mechanism of the lumbar spine, which is driven by tendons. The controller was implemented in Matlab/Simulink R2023a software, MathWorks (Brazil), considering mathematical modeling based on the Lagrangian methodology for simulating the behavior of the lumbar spine dynamic movement. The fuzzy controller was implemented to perform movements of two joints of the 3D robotic mechanism, which consists of five vertebrae grouped into two sets, G1 and G2. The mechanism's movements are carried out by four servomotors which are driven by readings from two sensors. For control, the linguistic variables of position, velocity and acceleration were used as controller inputs and the torque variables were used for the controller output. The experimental tests were carried out by running the fuzzy controller directly on the 3D physical model (external to the simulation environment) to represent flexion and extension movements analogous to human movements.

Anemia, deficiencia de hierro y factores asociados en niños cubanos de 6 a 59 meses

Introducción: La principal causa de anemia en los preescolares es la deficiencia dietética de hierro, pero existen otras condiciones asociadas y no evaluadas. Objetivo: Estimar la prevalencia de anemia y deficiencia de hierro en niños de 6 a 59 meses y su asociación con inflamación, sobrepeso global, ingestión de alimentos y nivel de instrucción materno. Métodos: Se realizó un estudio transversal nacional, con determinaciones de hemoglobina, ferritina, receptores de transferrina, proteína C reactiva y alfa-1 glicoproteína ácida. Se evaluó el estado nutricional, dieta y nivel de instrucción de la madre. Resultados: Se estudiaron 1417 niños. La prevalencia de anemia fue de un 22,5 %, la de deficiencia de hierro, de un 35,6 % y la de disfunción eritropoyética, de un 13,3 %; con inflamación 37,6 % y prevalencia de sobrepeso global 7,5 %. La anemia estuvo asociada al déficit de hierro OR = 2,07(1,45-2,97) y la inflamación OR = 2,01(1,45-2,78). No se encontraron asociaciones entre la anemia y el déficit de hierro con el sobrepeso global. El bajo consumo de huevos OR = 1,84 (IC95 %1,39-2,43), frutas OR = 1,73 (IC95 %1,29-2,34) y leguminosas OR = 1,68 (IC95 %1,25-2,25) resultaron ser un factor de riesgo de anemia. El análisis de regresión logística mostró que la anemia estaba asociada al grupo menor de 2 años, deficiencia de hierro, inflamación y bajo consumo de frutas; y el sobrepeso global fue un factor de protección. Conclusiones: La anemia y deficiencia de hierro clasifican como problemas de salud pública moderados asociados a la inflamación. El grupo menor de dos años y el bajo consumo de frutas resultó ser un factor de riesgo y el sobrepeso global resultó un factor de protección para la anemia.

Introduction: The main cause of anemia in preschoolers is dietary iron deficiency, nonetheless there are other associated and unevaluated conditions. Objective: To estimate the prevalence of anemia and iron deficiency in children aged 6 to 59 months and the association with inflammation, overall overweight, food intake and maternal educational level. Methods: A national cross-sectional study was carried out, with determinations of hemoglobin, ferritin, transferrin receptors, C-reactive protein and alpha-1 acid glycoprotein. The nutritional status, diet and educational level of the mother were evaluated. Results: One thousand four hundred and seventeen children were studied. The prevalence of anemia was 22.5%, 35.6% of iron deficiency, and 13.3% of erythropoietic dysfunction. 37.6% of cases presented inflammation and 7.5% presented global overweight prevalence. Anemia was associated with iron deficiency OR = 2.07(1.45-2.97) and inflammation OR = 2.01(1.45-2.78). No associations were found between anemia and iron deficiency with overall overweight. Low consumption of eggs OR = 1.84 (95% CI 1.39-2.43), fruits OR = 1.73 (95% CI 1.29-2.34) and legumes OR = 1.68 (CI 95% 1.25-2.25) were found to be a risk factor for anemia. The logistic regression analysis showed that anemia was associated with the group under two years of age. Conclusions: Anemia and iron deficiency classify as moderate public health problems associated with inflammation. The group under two years of age and low fruit consumption turned out to be a risk factor and overall overweight turned out to be a protective factor for anemia.

Estudio de los pacientes con monoartritis aguda en un hospital de tercer nivel / Acute monoarthritis in a third level hospital

Resumen Introducción: La monoartritis aguda (MA) represen ta una causa relevante de morbilidad que requiere de atención médica oportuna: El estudio del líquido sino vial constituye un elemento clave para su diagnóstico. El objetivo del estudio fue determinar la frecuencia y características clínicas-analíticas de los episodios de MA y bursitis agudas valoradas en un hospital durante un período de 6 años. Métodos: Estudio analítico retrospectivo de corte transversal en un hospital de Córdoba, Argentina. Se identificaron todos los episodios de monoartritis y bur sitis agudas que ocurrieron en pacientes de ≥18 años entre 2012 y 2017. Se excluyeron los cuadros de MA en embarazadas y las monoartritis crónicas. Resultados: Se incluyeron 180 episodios de MA y 12 de bursitis aguda. Entre las MA, 120 (66.7%) ocurrieron en hombres, la edad promedio fue 62.1±16.9 años. La principal causa de MA fue séptica, identificándose 70 (36%) casos, seguida la secundaria a microcristales con 54 episodios (28%) que correspondieron 27 (14%) a MA por gota y 27 (14%) a MA por depósitos de pirofosfato de calcio dihidratado (CPPD). Se identificaron cristales de urato monosódico en 26 (14.3%) pacientes, CPPD en 28 (15.6%) y de colesterol en 1 (0.6%). Discusión: La principal causa de MA fue séptica, seguida de la secundaria a microcristales (gota y secun daria a CPPD). La principal articulación afectada fue la rodilla, seguida del hombro. El análisis del líquido sino vial fue un elemento clave a la hora de poder realizar el diagnóstico diferencial entre las distintas causas de monoartritis aguda y bursitis.

Abstract Introduction: Acute monoarthritis (AM) represents a relevant cause of morbidity that requires prompt medical care. The study of synovial fluid becomes re levant to allow a rapid diagnostic approach. The main objective of the study was to determine the frequency and clinical-analytical characteristics of episodes of AM and acute bursitis evaluated in a hospital during a period of 6 years. Methods: Cross-sectional retrospective analytical study in a hospital at Córdoba, Argentina. All episodes of acute monoarthritis and bursitis that occurred in patients aged 18 years or older between 2012 and 2017 were included. AM in pregnant women and chronic monoarthritis were excluded. Results: One hundred and eighty episodes of AM and 12 of acute bursitis were included. Among the AM, 120 (66.7%) occurred in male patients and the average age was 62.1±16.9 years. The main cause of AM was septic, identifying 70 (36%) cases, followed by microcrystalline AM identify 54 (28%) cases, which corresponded to gout and calcium pyrophosphate dihydrate (CPPD) with 27 (14%) cases each one. Monosodium urate crystals were identified in 26 (14.3%) patients, CPPD in 28 (15.6%) and cholesterol in 1 (0.6%). Discussion: The main cause of AM was septic arthri tis, followed by microcrystalline AM (gout and secondary to CPPD). The main affected joint was the knee, followed by the shoulder. Synovial fluid analysis was a key ele ment when making the differential diagnosis between the different causes of acute monoarthritis and bursitis.

Infecciones fúngicas invasoras en niños con cáncer y portadores de aplasia medular severa en nueve hospitales de la red PINDA, Chile. 2016-2020 / Invasive fungal infections in children with cancer and severe aplastic anemia in nine hospitals from PINDA Network, Chile. 2016-2020

INTRODUCCIÓN: La infección fúngica invasora (IFI) es una causa importante de morbilidad y mortalidad en pacientes oncológicos pediátricos y portadores de aplasia medular (AM) severa. OBJETIVO: Describir la epidemiología de la IFI desde el año 2016 al 2020 en niños con cáncer y AM para evaluar la necesidad de profilaxis antifúngica. MÉTODOS: Estudio retrospectivo, multicéntrico, en pacientes pediátricos con cáncer y AM severa. Se incluyeron IFI probables y probadas. RESULTADOS: Se diagnosticaron 57 casos de IFI, mediana de edad 9 años, 70% probadas y 30% probables. Hubo 42% de infecciones por levaduras y 56% por hongos filamentosos. Los sitios de infección más frecuentes fueron pulmón 38%, sangre 36% y rinosinusal 21%. La frecuencia global fue 5,4%; de ellas 21% en AM severa, 10% en leucemia mieloide aguda (LMA), 6,9% en recaída de LMA, 5,4% en recaída de leucemia linfática aguda (LLA), 3,8% en LLA. Las infecciones por hongos filamentosos predominaron en LMA, recaída de LMA. y AM severa. La mortalidad en pacientes con IFI fue de 11%. CONCLUSIÓN: La frecuencia de IFI concuerda con la literatura médica. Recomendamos profilaxis antifúngica contra hongos filamentosos en pacientes con AM severa, LMA y recaída de LMA. Considerar en recaída de LLA de alto riesgo en etapa de inducción.

BACKGROUND: Invasive fungal infections (IFIs) are an important cause of morbidity and mortality in pediatric oncology patients and severe aplastic anemia (SAA). AIM: To describe the epidemiology of IFI from 2016 to 2020 in children with cancer and SAA to assess the indication of antifungal prophylaxis. METHODS: Multicenter, retrospective study of IFIs in pediatric oncology patients and SAA. Probable and proven IFIs were included. RESULTS: Over the 5-year period, 57 IFIs were found, median age 9 years, 70% were proven and 30% were probable. Yeast infections were 42% and mold infections 56%. The most frequent infection sites were lung 38%, blood 36% and rhinosinusal 21%. The total IFI frequency was 5.4%, 21% in SAA, 10% in acute myeloid leukemia (AML), 6.9% in relapsed AML, 5.4% in relapsed acute lymphoblastic leukemia (ALL), 3.8% in ALL. Mold infections were predominant in AML, relapsed AML, and SAA. IFIs mortality was 11%. CONCLUSION: Frequency of IFI was consistent with the literature. We strongly recommend antifungal prophylaxis against mold infections in patients with SAA, AML, and relapsed AML. Would consider in high risk ALL relapse in induction chemotherapy.

Exosomes: A Promising Strategy for Repair, Regeneration and Treatment of Skin Disorders.

The skin is the organ that serves as the outermost layer of protection against injury, pathogens, and homeostasis with external factors; in turn, it can be damaged by factors such as burns, trauma, exposure to ultraviolet light (UV), infrared radiation (IR), activating signaling pathways such as Toll-like receptors (TLR) and Nuclear factor erythroid 2-related factor 2 (NRF2), among others, causing a need to subsequently repair and regenerate the skin. However, pathologies such as diabetes lengthen the inflammatory stage, complicating the healing process and, in some cases, completely inhibiting it, generating susceptibility to infections. Exosomes are nano-sized extracellular vesicles that can be isolated and purified from different sources such as blood, urine, breast milk, saliva, urine, umbilical cord bile cells, and mesenchymal stem cells. They have bioactive compounds that, thanks to their paracrine activity, have proven to be effective as anti-inflammatory agents, inducers of macrophage polarization and accelerators of skin repair and regeneration, reducing the possible complications relating to poor wound repair, and prolonged inflammation. This review provides information on the use of exosomes as a promising therapy against damage from UV light, infrared radiation, burns, and skin disorders.

[Acute monoarthritis in a third level hospital]. / Estudio de los pacientes con monoartritis aguda en un hospital de tercer nivel.

INTRODUCTION: Acute monoarthritis (AM) represents a relevant cause of morbidity that requires prompt medical care. The study of synovial fluid becomes relevant to allow a rapid diagnostic approach. The main objective of the study was to determine the frequency and clinical-analytical characteristics of episodes of AM and acute bursitis evaluated in a hospital during a period of 6 years. METHODS: Cross-sectional retrospective analytical study in a hospital at Córdoba, Argentina. All episodes of acute monoarthritis and bursitis that occurred in patients aged 18 years or older between 2012 and 2017 were included. AM in pregnant women and chronic monoarthritis were excluded. RESULTS: One hundred and eighty episodes of AM and 12 of acute bursitis were included. Among the AM, 120 (66.7%) occurred in male patients and the average age was 62.1±16.9 years. The main cause of AM was septic, identifying 70 (36%) cases, followed by microcrystalline AM identify 54 (28%) cases, which corresponded to gout and calcium pyrophosphate dihydrate (CPPD) with 27 (14%) cases each one. Monosodium urate crystals were identified in 26 (14.3%) patients, CPPD in 28 (15.6%) and cholesterol in 1 (0.6%). DISCUSSION: The main cause of AM was septic arthritis, followed by microcrystalline AM (gout and secondary to CPPD). The main affected joint was the knee, followed by the shoulder. Synovial fluid analysis was a key element when making the differential diagnosis between the different causes of acute monoarthritis and bursitis.

Introducción: La monoartritis aguda (MA) representa una causa relevante de morbilidad que requiere de atención médica oportuna: El estudio del líquido sinovial constituye un elemento clave para su diagnóstico. El objetivo del estudio fue determinar la frecuencia y características clínicas-analíticas de los episodios de MA y bursitis agudas valoradas en un hospital durante un período de 6 años. Métodos: Estudio analítico retrospectivo de corte transversal en un hospital de Córdoba, Argentina. Se identificaron todos los episodios de monoartritis y bursitis agudas que ocurrieron en pacientes de =18 años entre 2012 y 2017. Se excluyeron los cuadros de MA en embarazadas y las monoartritis crónicas. Resultados: Se incluyeron 180 episodios de MA y 12 de bursitis aguda. Entre las MA, 120 (66.7%) ocurrieron en hombres, la edad promedio fue 62.1±16.9 años. La principal causa de MA fue séptica, identificándose 70 (36%) casos, seguida la secundaria a microcristales con 54 episodios (28%) que correspondieron 27 (14%) a MA por gota y 27 (14%) a MA por depósitos de pirofosfato de calcio dihidratado (CPPD). Se identificaron cristales de urato monosódico en 26 (14.3%) pacientes, CPPD en 28 (15.6%) y de colesterol en 1 (0.6%). Discusión: La principal causa de MA fue séptica, seguida de la secundaria a microcristales (gota y secundaria a CPPD). La principal articulación afectada fue la rodilla, seguida del hombro. El análisis del líquido sinovial fue un elemento clave a la hora de poder realizar el diagnóstico diferencial entre las distintas causas de monoartritis aguda y bursitis.

Uso de psicofármacos en personas con discapacidad intelectual en Extremadura, España / Use of Psychotropic Drugs in People with Intellectual Disability in Extremadura, Spain

Resumen El uso de psicofármacos es frecuente en adultos con discapacidad intelectual, a menudo por conductas desafiantes en ausencia de diagnóstico de trastorno mental. Investigaciones previas cuestionan la eficacia de estos tratamientos a falta de una enfermedad psiquiátrica, y destacan sus efectos secundarios. El objetivo de esta investigación es analizar el uso de psicofármacos en función del diagnóstico de enfermedad mental y conducta desafiante, así como la distribución de la población según el uso de psicofármacos en 569 adultos con discapacidad intelectual que presentan enfermedad mental o conductas desafiantes. Los datos acerca de la elevada prescripción de psicofármacos y, especialmente, de antipsicóticos alertan sobre la necesidad de una profunda revisión de la práctica clínica que permita reducir el uso de esta medicación en el tratamiento de la conducta y los trastornos mentales en esta población, para garantizar una atención de calidad y el respeto de los derechos de estas personas.

Abstract The use of psychotropic drugs in adults with an intellectual disability is frequent, often for defiant conduct due to the lack of a diagnosis of a mental disorder. Previous research has questioned the efficacy of such treatments in the absence of a psychiatric illness, and the stress has been on the side effects. The objective of this research is to analyze the use of psychotropic drugs based on the diagnosis of mental illness and behavioral disorders, as well as the distribution of the sample according to the use of psychotropic drugs in 569 adults with an intellectual disability who also suffer a mental illness and/or defiant conduct. Our data about the high prescription of psychotropic drugs and especially antipsychotics, warns of the need for a profound review of the clinical practice that would allow a reduction in the use of psychotropic drugs in the treatment of mental disorders and behaviour in the said collective, so as to guarantee quality mental health care for these persons and respect for their rights.