Epstein-Barr Virus BARF1 Is Expressed in Lung Cancer and Is Associated with Cancer Progression.

BACKGROUND: Epstein-Barr virus (EBV) is involved in the development of lymphomas, nasopharyngeal carcinomas (NPC), and a subgroup of gastric carcinomas (GC), and has also been detected in lung carcinomas, even though the role of the virus in this malignancy has not yet been established. BamH1-A Rightward Frame 1 (BARF1), a suggested exclusive epithelial EBV oncoprotein, is detected in both EBV-associated GCs (EBVaGC) and NPC. The expression and role of BARF1 in lung cancer is unknown. METHODS: A total of 158 lung carcinomas including 80 adenocarcinomas (AdCs) and 78 squamous cell carcinomas (SQCs) from Chilean patients were analyzed for EBV presence via polymerase chain reaction (PCR), Immunohistochemistry (IHC), or chromogenic in situ hybridization (CISH). The expression of BARF1 was evaluated using Reverse Transcription Real-Time PCR (RT-qPCR). Additionally, A549 and BEAS-2B lung epithelial cells were transfected with a construct for ectopic BARF1 expression. Cell proliferation, migration, invasion, and epithelial-mesenchymal transition (EMT) were evaluated. RESULTS: We found that EBV was present in 37 out of 158 (23%) lung carcinomas using PCR. Considering EBV-positive specimens using PCR, IHC for Epstein-Barr nuclear antigen 1 (EBNA1) detected EBV in 24 out of 30 (80%) cases, while EBERs were detected using CISH in 13 out of 16 (81%) cases. Overall, 13 out of 158 (8%) lung carcinomas were shown to be EBV-positive using PCR/IHC/CISH. BARF1 transcripts were detected in 6 out of 13 (46%) EBV-positive lung carcinomas using RT qPCR. Finally, lung cells ectopically expressing BARF1 showed increased migration, invasion, and EMT. CONCLUSIONS: EBV is frequently found in lung carcinomas from Chile with the expression of BARF1 in a significant subset of cases, suggesting that this viral protein may be involved in EBV-associated lung cancer progression.

Factors Influencing Health Professionals' Decisions Regarding the Indication of Infant Formula: A Qualitative Exploration in Uruguay.

BACKGROUND: Health systems are fundamental to the promotion and protection of breastfeeding. Health professionals have a pivotal influence on families' infant feeding decisions and may act as facilitators or barriers to adequate breastfeeding practices. RESEARCH AIM: To explore factors influencing health professionals' decisions regarding the indication of infant formula in Montevideo, the capital of Uruguay, an emerging Latin American country. METHOD: This was a qualitative study based on semi-structured interviews with 30 health professionals (neonatologists, pediatricians, family doctors, and nurses) working in primary and secondary care in both private and public health institutions. The interviews were audio-recorded, transcribed, and analyzed using content analysis based on deductive-inductive coding. RESULTS: The narratives of the participants identified maternity wards as the healthcare sites where the indication of infant formula occurs most frequently. Motives underlying the indication of infant formula by health professionals were diverse. The type of birth and the conditions of the child and the mother were the most relevant in secondary care, whereas maternal work was the main determining factor in primary care. A wide range of factors encouraging and discouraging the indication of infant formula were identified by health professionals in primary and secondary healthcare locations, which were related to all the levels of influence of the socioecological model. CONCLUSIONS: Strategies to reduce the use of infant formula in Uruguay should include improving the support and guidance provided to families in the maternity ward, strengthening the implementation and monitoring of the Baby-Friendly Hospital Initiative, and improving the current maternity leave regulations.

Madia sativa (Asteraceae), an Araucanian plant / Madia sativa (Asteraceae), una planta araucana

Madia sativa remains important to the traditional culture of many first peoples of Chile and is being studied for its biological abilities by medical researchers. The used of this specie in Chile is researched through a series of retrospective analysis. This research indicated the use this plant populations mapuche a long time ago.

Madia sativa sigue siendo importante para la cultura tradicional de muchos pueblos originarios de Chile y está siendo estudiada por sus capacidades biológicas por investigadores médicas. El uso de esta especie en Chile se investiga a través de una serie de análisis retrospectivos. Esta investigación indica el uso de esta planta en poblaciones mapuche desde hace mucho tiempo.

Evaluation of the impact of the intensive exploitation of groundwater and the mega-drought based on the hydrochemical and isotopic composition of the waters of the Chacabuco-Polpaico basin in central Chile.

A hydrogeochemical and isotopic study has been carried out to understand the hydrogeological functioning of a small alluvial aquifer in central Chile in a context of mega-drought and intensive exploitation of its waters. Additionally, two mine tailings dams from porphyry copper mining are situated in the area. The prolonged mega-drought, which has lasted for over thirteen years, has resulted in a significant decrease in rainfall recharge and a drop of up to 50 m in piezometric levels, although no serious groundwater contamination problems have yet been detected, except for a rise in nitrate contents (ranging between 23 and 45 mg/L NO3) attributed to return irrigation. Groundwaters are calcium-bicarbonate and calcium-sodium-bicarbonate in composition. The values of δ18O and δ2H of the alluvial aquifer indicate fractionation by evaporation that would be explained by the recirculation of water that occurs in the agricultural areas of the basin, where the excess irrigation water that go back to the aquifer presents fractionation by evaporation. The δ34S and δ18O of dissolved sulfate point to pyrite oxidation, which could be related to the pyrite present in the copper porphyry and recognized in the Andes Cordillera. The 87Sr/86Sr isotopic values of the alluvial aquifer waters are close to the isotopic fingerprint of the volcanic rocks of the Abanico Formation. However, the water from the wells located further downstream in the basin and close to the tailing dams show δ34S and δ18O of dissolved sulfate and 87Sr/86Sr consistent with Miocene intrusive mineralogies of the copper porphyry type. The groundwater chemistry does not show water seepage from the tailings dam. Therefore, a minor contribution of minerals related to the intrusive rocks is proposed, which would originate from the movement of fine particles by the wind from the dams to the valley floor. The 14C activities indicate that groundwater is recent.

The Idealization of Infant Formula: A Longitudinal Analysis of Labels in Uruguay.

BACKGROUND: Labels are a key element of the marketing strategies of infant formula companies, and often include text or images that idealize their use, undermining efforts to promote breastfeeding. RESEARCH AIMS: To evaluate the prevalence of marketing cues that idealize infant formula on labels of products commercialized in Uruguay and to assess changes after a periodic monitoring of compliance with the International Code of Marketing of Breast-Milk Substitutes (IC). METHOD: This study is a descriptive, observational, and longitudinal assessment of the information included on infant formula labels. The first data collection was in 2019, as part of a periodic assessment to monitor the marketing of human-milk substitutes. In 2021, the same products were purchased to evaluate changes in their labels. Thirty-eight products were identified in 2019, of which 33 were still available in 2021. All information available on the labels was analyzed through content analysis. RESULTS: Most products included at least one textual or visual marketing cue idealizing infant formula in both 2019 (n = 30, 91%) and 2021 (n = 29, 88%). This represents a violation of both the IC and national regulations. References to nutritional composition were the most frequent marketing cue, followed by references to child growth and development. No relevant changes were observed after the periodic assessment conducted by the Uruguayan government. CONCLUSIONS: Monitoring compliance with the IC per se cannot be expected to trigger changes in the marketing strategies of infant formula companies. More explicit regulations and strong enforcement mechanisms are needed to end the inappropriate marketing practices on infant formula labels.

The content of Instagram posts featuring ultra-processed products through the lens of the heuristic-systematic model.

Digital marketing has seen a rapid rise in the last decade as a consequence of the increased popularity of social media. However, few studies so far have analyzed the prevalence and persuasive power of digital marketing of ultra-processed products. The present study aimed at: (i) analyzing the content of Instagram posts of ultra-processed products through the lens of the heuristic-systematic model, and (ii) evaluating the influence of the content of the posts on user interactions. A search for Instagram accounts of ultra-processed products was performed using a master list of products commercialized in the two most popular online supermarkets in Uruguay. For each of the identified Instagram accounts, all the content posted in a 6-month period was recorded (August 15th, 2020 to February 15th, 2021). The posts were analyzed using content analysis based on inductive coding, and gradient boosting models (GBMs) were used to address the second study objective. A total of 2178 Instagram posts promoting specific ultra-processed products or brands were identified. The posts included a diverse set of cues to trigger both systematic and heuristic processing. References to the pleasure derived from product consumption as well as health-related cues were most prevalent. The GBM showed that references to contests and raffles and invitations to interact encouraged users to engage with the posts through posting comments. Taken together, results stress the need to implement comprehensive regulatory approaches to reduce exposure to and the power of digital marketing of ultra-processed products given the harmful health-related consequences associated with excessive consumption of such products.

Doppler echocardiography in a healthy, non-sedated Southern Sea Lion (Otaria flavescens) - a preliminary approach about the feasibility and clinical utility.

Echocardiography is commonly used in veterinary clinical practice for many species but is not as easily applied in non-sedated marine mammals. Additionally, Doppler echocardiography provides further information on hemodynamics, estimation of cardiac output, characterization of flow patterns, and diastolic function. However, its applications in marine mammals have not been as widely explored either. The present report aimed to characterize the left ventricle structure and function of the Southern Sea Lion (Otaria flavescens) through a Doppler echocardiography study. Data were obtained from a healthy animal trained for different veterinary examination routines. This communication constitutes the first report of Doppler echocardiography with stroke volume, and cardiac output measurement in pinnipeds, and the first report of measurement of myocardial performance index in aquatic mammals. This data brought initial information about in vivo structure and function of the heart of the Southern Sea Lion that can be safely and effectively evaluated with the use of transthoracic Doppler echocardiography. Our data have both clinical and research implications for future studies evaluating diseases of the cardiopulmonary system in pinnipeds, and cardiovascular physiology investigation in diving mammals.

Marketing of commercial foods for infant and young children in Uruguay: sugary products, health cues on packages and fun social products on Facebook.

OBJECTIVE: To analyse the content of the marketing of commercial foods for infants and young children on packages and social media. DESIGN: Commercial foods targeted at children, regarded as potential breast-milk substitutes according to the Uruguayan breast-feeding standard, were considered: dairy products; teas, juices and bottled waters; glucose solutions; cereals and mixtures of fruits and vegetables. All the products sold at forty-four retail outlets were purchased. A Facebook search was performed to identify accounts of these products. For each account, all the content posted by the brands between July 2017 and July 2019 was recorded. The visual and textual information included in the packages and Facebook posts was analysed using content analysis. Products were classified using the nutrient profile model of the Pan American Health Organization. SETTING: Montevideo, Uruguay. RESULTS: Seventy-six unique commercial foods targeted at infants and young children were identified, 96 % of which were excessive in sugar. Packages frequently included textual and visual elements to convey health-related associations, including images of fruits and vegetables, nutrient content claims and endorsement logos. Ten Facebook accounts were identified, which generated 302 posts. Parents and caregivers were the main target audience of the posts, which mainly included content related to fun and social aspects of food consumption. Additionally, the posts frequently conveyed the idea that products would contribute to children's growth and development. CONCLUSIONS: Results suggest the need to implement comprehensive regulations on the marketing of commercial foods targeted at children, regarded as potential breast-milk substitutes according to the Uruguayan breast-feeding standard.

Do blood parasites increase immature erythrocytes and mitosis in amphibians? / ¿Causan los parásitos sanguíneos un aumento en los eritrocitos inmaduros y la mitosis en los anfibios?

Abstract Introduction: In amphibians, blood may act as a hematopoietic tissue. However, the knowledge concerning hematological features is scarce, there is not much information that allows an analysis about the possible explanations of this physiological feature. Objective: This study aimed to evaluate the relationship between immature red blood cells (RBCs) mitosis and the presence of blood parasites in amphibians. Methods: We sampled 116 amphibians (31 species) in six Colombian localities. Blood was taken by cardiac puncture or maxillary vein puncture. Smears were prepared, fixed, and Giemsa stained for microscopical analysis. The variables analyzed were the percentage of immature RBCs, mitotic cells in peripheral blood, and blood parasite infection. Data were analyzed using Wilcoxon's rank test and exact Fisher statistical tests. Results: Sixty-two individuals showed mitosis in peripheral blood, and these mitotic RBCs shared morphological features with immature RBCs. Overall, parasite prevalence was 30.1 %, distributed as follows: Trypanosoma (24.1 %), Hepatozoon-like (6 %), Dactylosoma (4.3 %), Karyolysus-like (0.9 %), and Filarioidea (2.6 %). A positive association between the percentage of immature RBCs and the presence of mitotic RBCs was found, and also between the blood parasite infection and the percentage of immature RBCs. Conclusions: In this study, we found that the presence of blood parasites, immature RBCs, and RBCs mitosis are frequent events in amphibians' peripheral blood, and our analysis suggests an association between those features. Thus, the release of immature RBCs and the mitosis of those cells in peripheral blood may be a physiological response to blood parasite infection. Further studies characterizing hematology in amphibians and wildlife, in general, are desirable.

Resumen Introducción: En anfibios, la sangre puede actuar como un tejido hematopoyético. Sin embargo, el conocimiento acerca de las características hematológicas es escaso y no hay información que permita un análisis acerca de las posibles explicaciones a este rasgo fisiológico. Objetivo: La intención de este estudio fue evaluar la relación entre la presencia de eritroblastos, mitosis de glóbulos rojos (GRs) y la infección por hemoparásito en sangre periférica de anfibios. Métodos: Se muestrearon 116 anfibios (31 especies) en seis localidades de Colombia. Se tomaron muestras de sangre mediante punción cardiaca o punción a la vena maxilar. Se prepararon extendidos sanguíneos, se fijaron y tiñeron con Giemsa para su posterior análisis por microscopía. Se analizaron variables como porcentaje de GRs inmaduros, células mitóticas en sangre periférica e infección por hemoparásitos. Los datos fueron analizados mediante el test de rango de Willcoxon y el test exacto de Fisher. Resultados: sesenta y dos individuos evidenciaron mitosis en sangre periférica y dichas mitosis compartían características morfológicas con GRs inmaduros. La prevalencia general de parásitos fue del 30.1 %, distribuido de la siguiente forma: Trypanosoma (24.1 %), Hepatozoon-like (6 %), Dactylosoma (4.3 %), Karyolysus-like (0.9 %), y Filarioidea (2. 6 %). Hay una asociación positiva entre el porcentaje de GRs inmaduros y la presencia de células mitóticas, también se encontró una relación entre la infección por hemoparásitos y el porcentaje de GRs inmaduros. Conclusiones: En este estudio encontramos que la presencia de parásitos sanguíneos, GRs inmaduros y mitosis de GRs son eventos frecuentes en sangre periférica de anfibios, y nuestros resultados sugieren una asociación entre dichas características. Por tanto, la liberación de GRs inmaduros y la mitosis de estas células en sangre periférica podría ser una respuesta fisiológica a infecciones parasitarias. Posteriores estudios que caractericen la hematología en anfibios y en vida silvestre en general, son deseables.

The idealisation of bottle feeding: content analysis of feeding bottles and teats packages in Uruguay.

OBJECTIVE: The information displayed on the packages of feeding bottles and teats commercialised in Montevideo (Uruguay) was analysed using content analysis with the goal of identifying key marketing practices that may discourage breast-feeding. DESIGN: The study was conducted as part of the periodic assessment performed by the Uruguayan government to monitor the marketing of breast milk substitutes. All the feeding bottles and teats sold in forty-four retail outlets selling breast milk substitutes were purchased. The information available on the packages was analysed using content analysis and descriptive statistics. SETTING: Montevideo, Uruguay. RESULTS: A total of 197 feeding bottles and 71 teats were found. The majority of the packages included information to enable caregivers to adequately use the products, including recommended age, instructions on how to use the products and instructions on the use of hygienic practices. However, the packages frequently included information that implied that bottle feeding was equivalent to breast-feeding, particularly from a physiological perspective, or that idealised product use. Idealisations included ability to reduce colic, improvements in the feeding experience and improvements in children's health, well-being and development. Statements on the superiority of breast-feeding were infrequent. CONCLUSIONS: The results from the present work showed the high prevalence of marketing practices on the packages of feeding bottles and teats that may discourage breast-feeding. Stricter and more detailed regulations seem necessary to enable caregivers to make informed feeding decisions for infants.

Social representations of breastfeeding and infant formula: An exploratory study with mothers and health professionals to inform policy making.

Although several efforts to promote breastfeeding have been implemented worldwide, the prevalence of exclusive breastfeeding in the first 6 months of life remains low. One of the factors responsible for this trend is the widespread sales and marketing of breast-milk substitutes. In this context, the present work aimed at exploring mothers and health professionals' social representations of breastfeeding and infant formula. The study was conducted in Montevideo (Uruguay), as part of the periodic assessment performed by the Uruguayan government to monitor the marketing of breast-milk substitutes according to the OMS/UNICEF NetCode toolkit. A total of 330 mothers of children under 24 months old and 154 health professionals were recruited at 33 health care facilities. Participants were asked to complete two word association tasks, one with breastfeeding and the other with infant formula. Inductive coding was used to classify the responses into categories and dimensions. The structure of the social representations was explored considering the frequency of mention and the average rank of appearance of the categories. Results showed that mothers' social representations mainly positioned breastfeeding as a feeding practice, whereas infant formulas were mainly perceived as a complement to breast-milk that provides support. In the case of health professionals, the social representations of breastfeeding and infant formulas were in line with scientific evidence and health recommendations. These results suggest that efforts to promote breastfeeding should focus on raising public awareness of the risks associated with breast-milk substitutes and on overcoming the systemic barriers to breastfeeding, particularly among working mothers.

Sex Differences Among Participants in the Latin American Stroke Registry.

Background Reports on sex differences in stroke outcome and risk factors are scarce in Latin America. Our objective was to analyze clinical and prognostic differences according to sex among participants in the LASE (Latin American Stroke Registry). Methods and Results Nineteen centers across Central and South America compiled data on demographics, vascular risk factors, clinical stroke description, ancillary tests, and functional outcomes at short-term follow-up of patients included from January 2012 to January 2017. For the present study, all these variables were analyzed according to sex at hospital discharge. We included 4788 patients with a median in-hospital stay of 8 days (interquartile range, 5-8); 2677 were male (median age, 66 years) and 2111 female (median age, 60 years). Ischemic stroke occurred in 4293: 3686 as cerebral infarction (77%) and 607 as transient ischemic attack cases (12.7%); 495 patients (10.3%) corresponded to intracerebral hemorrhage. Poor functional outcome (modified Rankin scale, 3-6) was present in 1662 (34.7%) patients and 38.2% of women (P<0.001). Mortality was present in 6.8% of the registry, with 7.8% in women compared with 6.0% in men (P=0.01). Death and poor functional outcome for all-type stroke showed a higher risk in female patients (hazard ratio, 1.3, P=0.03; and hazard ratio, 1.1, P=0.001, respectively). Conclusions A worse functional outcome and higher mortality rates occurred in women compared with men in the LASE, confirming sex differences issues at short-term follow-up.

Active Commuting to University and its Association with Sociodemographic Factors and Physical Activity Levels in Chilean Students.

Background and Objectives: Active commuting to and from university (ACU) could be a strategy to increase physical activity levels (PA) and promote health in young university students. We aimed to a) examine the patterns of commuting to university in Chilean students; b) the association between the mode of commuting to and from university and socio-demographic factors and PA-levels. Materials and Methods: A total of 496 university students (21.6 ± 2.4 years old) from two universities from Valparaíso (central coast of Chile) participated in this study. Personal data, home address, socio-economic status, PA, and the usual mode of commuting to and from the university were self-reported by a questionnaire. The commute distances were objectively measured using Google-Maps-software. Associations were examined using binary logistic regressions. Results: The main mode of commuting was by bus (to university: 55.2% vs. from university: 59.3%; p < 0.001). The least used mode was cycling (1.4% to and from university). Students living >5-km from university were less active commuters than those living in closer distances: (2-5 km, odds ratio (OR): 4.424, 95% and 95% confidence intervals (CI): 2.443-8.011, p < 0.001; 2 km, OR: 143.052, 95% CI: 55.154-371.030, p < 0.001). Students with low PA-levels were less active commuters than those with medium (OR: 1.446; 95% CI: 0.864-2.421; p = 0.160) or higher levels (OR: 1.880; 95% CI: 1.880-1.094; p = 0.022). Students who lived between 2 and 5 km, presented a significant association to be active commuters when they showed medium PA-levels (OR: 5.244, 95% CI: 1.358-20.246; p = 0.016). Conclusions: Chilean university students from Valparaíso are mainly passive commuters using public transport as the main mode of commuting to and from university; longer distances from home to the university are associated with low PA levels. ACU in distances between 2-5 km (mainly walking) could contribute to having medium PA-levels in Chilean university students. Thus, promoting the ACU walking to and from the university in such distances could be an effective strategy to increase the overall PA levels in Chilean university students.

Abscesos de hipófisis: presentación de dos casos clínicos y revisión de la literatura / Pituitary abscess: two cases assisted and review of the literature is presented

Resumen: El absceso de hipófisis es una enfermedad poco frecuente, constituye menos del 1% de la patología selar, con alta dificultad diagnóstica, clínica poco orientadora, imagenología inespecífica y necesidad de cirugía diagnóstico-terapéutica en gran número de casos. Se denominan primarios cuando asientan en una glándula sana, y secundarios cuando la misma tiene una enfermedad preexistente. La infección se desarrolla por vía hematógena, por contigüidad o por mecanismos no evidentes. La resolución debe ser urgente ya que el curso es impredecible. Se presentan dos casos clínicos asistidos en el transcurso de un año y se realiza revisión de la literatura.

ABSTRACT: Pituitary abscess is a rare disease, is less than 1% of the sellar pathology, with high diagnostic difficulty, little clinical counselor, nonspecific imaging and diagnostic- therapeutic need surgery in many cases. Are called primary when seated in a healthy, and secondary when the same side gland has a preexisting condition. The infection develops through the blood, contiguous or non-obvious mechanisms. The resolution must be urgently because the course is rarely. Two cases assisted in the course of a year and review of the literature is presented.

Influencia de las clases de educación física sobre el nivel de actividad física medido a través de una aplicación móvil en adolescentes / Influence of physical education classes on the level of physical activity measured through a mobile application in adolescents

La literatura científica ha demostrado a través de diversos métodos (cuestionarios y acelerómetros, principalmente) que las clases de educación física (EF) influyen positivamente en el logro de las recomendaciones de actividad física (AF) en la población escolar. Sin embargo, el uso de nuevas tecnologías como los teléfonos móviles o smartphone, parecen ser una interesante herramienta de bajo costo que también podrían ayudar a determinar el nivel de AF. Por tanto, el objetivo del presente estudio fue describir como influye la clase de EF en el número de pasos diarios en escolares que utilizaron una aplicación móvil “RuntasticPedometer” para monitorear dicha variable. La muestra estuvo compuesta por 50 estudiantes (edad media de 14.1 +/-1.6 años) pertenecientes al Instituto de Educación Secundaria “Melchor de Macanaz” de la localidad de Hellín (Albacete, España). Tras analizar los datos, se observaron diferencias significativas (p<0.05) durante los días en que los escolares realizaron la clase de EF y los que no (9.950 vs. 8.023 pasos/día,respectivamente). Además, la variación entre los días con y sin EF también fueron estadísticamente diferentes entre niños y niñas (2.644 vs. 1.579 pasos/día, respetivamente).Finalmente, se podría concluir que las clases de EF parecen influir positivamente en el aumento del número de pasos en escolares, lo que elevaría las posibilidades de que estos niños y niñas logren los parámetros mínimos de AF recomendada por las diversas organizaciones de salud. Por otro lado, cabe señalar que el uso de nuevas tecnologías de uso masivo como los smartphone, podrían ser una interesante herramienta a validar orientadas al monitoreo de la AF.

The scientific literature has demonstrated through various methods (questionnaires and accelerometers, mainly), the classes of physical education (PE) positively influence the achievement of the recommendations of physical activity (PA) in the school population. However, the use of new technologies such as mobile phones or smartphone, appear to be an interesting inexpensive tool that could also help determine the level of AF. Therefore, the objective of this study was to describe as PE class influences in the daily number of steps in school who used a mobile application "Runtastic Pedometer" to monitor the variable. The sample consisted of 50 students (mean age 14.1 +/- 1.6 years) belonging to the Institute of Secondary Education "MelchorMacanaz" from the Hellín (Albacete, Spain). After analyzing the data, significant differences (p <0.05) were observed during the days when the school made PE class and those without (8,023 vs. 9,950 steps / day, respectively). Moreover, the variations between days with and without EF were also statistically different between boys and girls (2,644 vs. 1,579 steps/day,respectively). Finally, one could conclude that PE classes seem positively influence the increase in the number of steps in school raising the chances that these children achieve the minimum standards recommended HF various health organizations. On the other hand, it notes that the use of new technologies in widespread use as the smartphone could be an interesting tool to validate oriented monitoring AF.

Caracterización farmacoterapéutica de los anticoagulantes orales utilizados en pacientes hospitalizados / Characterization of oral anticoagulant prescription in patients hospitalized (Costa Rica)

Justificación: los anticoagulantes orales requieren una estricta farmacovigilancia; describir y analizar la utilización de estos medicamentos es importante para editar guías, recomendaciones y advertencias ante el uso de esta terapia, y así brindar al personal médico una herramienta de apoyo para su adecuada utilización. Métodos: se seleccionaron pacientes a quienes durante su estancia hospitalaria se les prescribiera algún anticoagulante oral. Se recolectó la información específica que facilitara el análisis. Para validar lo recopilado se utilizaron las guías del Colegio Americano de Cirujanos Torácicos y las guías americanas y europeas de los colegios de cardiología. Resultados: se recopiló la información de un total de 176 pacientes. Los especialistas que prescriben estos medicamentos son ortopedistas (40%), internistas (14%), cardiólogos (13%) e intensivistas (11%), para el tratamiento de tromboprofilaxis de accidente cerebrovascular, tromboprofilaxis postoperatoria, tratamiento del tromboembolismo pulmonar y de trombosis venosa profunda; el 84% de los pacientes que usó estos medicamentos, lo hizo en indicaciones aprobadas. Se reportó un 3,4% de sangrados. Conclusión: la mayoría de las prescripciones se realizaron de acuerdo con lo establecido por las guías; a pesar de esto, existe una evidente incongruencia con respecto a los exámenes solicitados y su monitorización. La mayor proporción de los sangrados reportados se asoció a warfarina; aún así, seguirá siendo el estándar para el manejo de este tipo de pacientes, hasta que se apruebe tratamientos de reversión para los nuevos anticoagulantes y métodos adecuados para su monitorización, en los casos que se requiera.

Background: Oral anticoagulants require a strict pharmacovigilance; it is important to describe and analyze use of these drugs in order to draft guidelines, recommendations and warnings, and thus provide medical personnel with a tool for their adequate use. Methods: Inpatients that received oral anticoagulants were selected and the specific information for this analysis was collected. The guidelines of the American College of Chest Physicians, as well as those of the American and European professional associations of cardiology were used. Results: Information from 176 patients was collected. The specialists that prescribe these drugs are orthopedists (40%), internal medicine (14%), cardiologists (13%) and intensive care (11%), for the treatment of stroke thromboprophylaxis, postoperative thromboprophylaxis, treatment of pulmonary embolism and deep vein thrombosis; 84% of the patients that used these drugs did so in approved prescriptions. Bleeding related to these drugs was reported in 3.4 % of the cases. Conclusion: Most prescriptions were administered according to the guidelines, despite this there is a clear inconsistency between tests ordered and their monitoring. Most bleeding reports were associated to warfarin, yet it remains the standard treatment for this kind of patients until reversion treatments for new oral anticoagulants and suitable methods for monitoring, when required, are approved.

Espondilodiscitis tuberculosa: uso de los exámenes complementarios con una nueva perspectiva: A propósito de dos casos clínicos y revisión de la literatura / Tuberculous spondylodiscitis: use of complementary tests with a new perspective: A report of two cases and review of literature

Introducción. La tuberculosis constituye actualmente un grave problema sanitario. Es una enfermedad reemergente, su principal factor de riesgo es la infección por el virus de la inmunodeficiencia humana (VIH), siendo las formas extrapulmonares mucho más frecuentes en este grupo respecto a la población general. La espondilodiscitis tuberculosa (ET) representa 3% del total de las infecciones tuberculosas y 35% de las formas extrapulmonares. Su clínica es insidiosa, de diagnóstico complejo, la imagenología y microbiología son imprescindibles para un correcto diagnóstico. Todo esto suele determinar un retraso importante en el manejo, con consecuencias directas en el pronóstico del paciente. Material y método. Se presentan dos casos de ET asistidos en un Hospital público uruguayo (2012-2013), en pacientes con inmunocompromiso severo y noción de contacto epidemiológico en uno de ellos, diagnosticados tras la sospecha clínico-imagenológica y confirmación microbiológica por punción-aspiración bajo tomografía computarizada (TC). Resultados. Se inició el tratamiento con una latencia superior a tres meses. Discusión y Conclusiones. Las técnicas de biología molecular e inmunología constituyen hoy día una herramienta de gran valor para el diagnóstico precoz de esta enfermedad, permitiendo abreviar los tiempos en el inicio del tratamiento y reduciendo la tasa de complicaciones asociadas a ella.

Introduction. Tuberculosis (TB) constitutes a serious health problem nowadays. It is a reemerging disease whose main risk factor is the human immunodeficiency virus (HIV) infection, in which extrapulmonary forms are much more frequent than in general population. Tuberculous spondylodiscitis (TS) represents 3% of all TB infections and 35% of extrapulmonary forms. It has an insidious clinical presentation; the diagnosis is difficult requiring imagenologic and microbiologic technics. These characteristics result in a significant diagnosis delay which impacts on patient prognosis. Materials and methods. We present two cases of TS admitted to a public hospital in Uruguay (2012-2013) in immunocompromised patients and with epidemiological notion of contact in one of them. Results. The diagnosis was done after clinical and radiological suspicion; needle aspiration guided by computed tomography was performed. The treatment was instituted with a latency exceeding three months. Discussion and conclusions. The techniques of molecular biology and immunology are now a valuable tool for early diagnosis of this disease, shortening the initiation of treatment and reducing the rate of complications associated with it.

Vacunación antigripal en personal de salud: cobertura, actitudes y barreras contra la vacunación en dos servicios de un hospital general / Influenza immunization in health care professionals: coverage, attitudes and barriers against immunization in two departments of a general hospital

Con el objetivo de conocer la cobertura y las barreras contra la vacunación antigripal, cuya aceptación estimábamos baja entre el personal de salud(PDS) se realizó un estudio transversal, descriptivo, con la metodología de encuesta, autoadministrada con opciones cerradas para su respuesta. Se utilizó una muestra de 142 PDS integrantes del Hospital Pasteur (MSP-ASSE), aleatorizada y adecuada para extraer conclusiones estadísticamente válidas. Los resultados mostraron que 87/142 (61,3%) de los encuestados conocía la campaña de vacunación antigripal en el Hospital, reconocieron tener indicación de vacunación antigripal 124/142 (87,3%) a pesar de lo cual se vacunaron en 2011 79/142 (55,6%) y en 2012 53/142 (37,3%). Los vacunados en 2012 respondieron como motivos principales de adherencia a la campaña protegerse a sí mismo de la enfermedad, pertenecer al PDS y proteger a su familia. De los no vacunados en 2012 respondieron como motivos principales: percepción de nunca haber contraído gripe, miedo a efectos adversos y descrédito al efecto inmunizador de las vacunas. Se confirmó la baja tasa de vacunación del PDS (37,3% en año 2012) a pesar de reconocer la indicación y tener accesibilidad a la misma; se identificaron como barreras las percepciones erróneas acerca de la vacunación...