Comprehensive assessment for hygrothermal comfort with heat and mass fluxes through a clothing layer during cooling seasons.

A comprehensive analysis is carried out for achieving hygrothermal comfort by using bidirectional heat and mass fluxes between the human skin and its surroundings during cooling seasons, considering the main characteristics of climate, metabolic rate, and clothing fabrics. As hygrothermal comfort is mainly seen as one-direction heat and mass flux from the close surroundings to the human body, without the emitted heat and mass by the human skin, the purpose of the analysis is to find out proper features of the respective clothing fabric according to the inlet boundary conditions, i.e. heat and mass flux from the human body, and the outlet boundary features, i.e. heat and mass flux due to the climate conditions. Thereby, a novel mathematical modelling is developed for heat and mass transfer, respectively. Then, the software Wolfram Mathematica is applied for the numerical solutions of the model. After the model is validated, a sensitivity analysis is carried out. Thereby, it is found that the sensible heat removal by convection, dependent on both airflow and humidity rates, has a great influence on the hygrothermal comfort. Furthermore, solar reflectivity for shortwave radiation, along with longwave radiation from the skin, have influence on the hygrothermal comfort when both ventilation and sweating are set as minimum. Therefore, if the conditions of temperature and relative humidity are proper, both high conductivity and air permeability clothes are recommended. Nevertheless, regarding the reflectivity, it depends on the presence of shortwave radiation, sweating, ventilation, and longwave radiation to consider light-toned or dark colors.

Factors affecting the relative abundance in an overfished stock: red grouper (Epinephelus morio) in the Southeastern Gulf of Mexico.

The most important fisheries are recording catches below their historical averages despite increased effort. This level of overfishing is worrying and requires the establishment of feasible and precise measures to prevent a continuing decrease in biomass. Determining the factors that lead to changes in the abundance and distribution of overfished resources would allow us to identify the strengths and weaknesses of management schemes; this approach would also make it possible to estimate more accurate parameters for their evaluation. We hypothesize that environmental, temporal, spatial, and operational components contribute to the variation in the relative abundance. Thus, we analyzed the red grouper fishery, the most important demersal fishery in the southeastern Gulf of Mexico (SGM); it is locally known as escama. We employed the catch per unit effort (CPUE) as an index of relative abundance recorded by the semi-industrial fleet (kilogram per effective fishing day) and the small-scale fleet (kilogram per effective fishing hour) during the overexploitation phase (from 1996 to 2019). We fitted several variables of the components using generalized additive models (GAM) and used multi-model inference to determine the best GAM for each fleet. For both fleets, the operational and temporal components (fishing gear and year) have had a greater impact on the distribution and abundance of red grouper in the SGM than the spatial and environmental components (the place of origin and sea surface temperature). These findings encourage the exploration of métier schemes for more efficient fishery management. In addition, we have identified several strategies that would support the recovery of the resource, such as restricting fishing in the quadrants located to the northeast or regulating scuba diving. We recommend that in the future, researchers use the indices we have generated in the present study to evaluate the red grouper fishery.

Cu2+-dependent hydrolysis of O-hexyl 2,5-dichlorophenyl phosphoramidate by reptile sera.

This study shows the EDTA-resistant, Ca2+ and Cu2+-dependent hydrolysis of O-hexyl 2,5-dichlorophenyl phosphoramidate (HDCP) compound in reptiles sera determined by spectrophotometry UV/Vis and chiral chromatography. Samples of ten reptile species were incubated with aliquot of 100 or 400 µM HDCP in presence of 100 or 300 µM Cu2+, or 2.5 mM Ca2+ or 5 mM EDTA at 37 °C for 30-60 min. The results shown an activator effect of Cu2+ on HDCP hydrolysis in freshwater turtles sera (Trachemys scripta, Chelydra serpentina and Macrochelys temminckii) because the levels of 2,5-dichlorophenol (DCP; product hydrolysis) were similar (∼37 µM DCP) to chicken serum (positive control group). The marine turtles (Chelonia mydas and Eretmochelys imbricata) and crocodiles (Crocodylusacutus and Crocodylus moreletii) showed ∼50% less HDCPase activity (13-17 µM DCP) compared to the HDCPase activity of the freshwater turtle species. Terrestrial reptile species (snakes and lizards) showed around 25% of activity (7-13 µM DCP) with both copper concentrations. These Cu2+-dependent hydrolysis were stereospecific to R(+)-HDCP (p˂0.05) in the three freshwater turtle species that showed similar hydrolysis to the chicken serum. However, the Ca2+ did not show a significant activating effect on the HDCPase activity (1-8 µM DCP) in any reptile serum. Their hydrolysis levels were very similar to those of EDTA-resistant activity. The present study demonstrates a Cu2+-dependent A-esterase (HDCPase) activity in turtles and points serum albumin as the cuproprotein responsible for this activity, reinforcing its N-terminal sequence (DAEH) as a catalytic center.

[Remarks on the "Dignified death and palliative care" bill]. / Comentarios al proyecto de ley "Muerte digna y cuidados paliativos".

The Chilean House of Representatives is discussing the bill on "Dignified death and palliative care", which regulates the so-called medical assistance in dying or euthanasia. This paper will critically analyze the different aspects of the bill, particularly concerning four main dimensions, namely, the patient's condition at the time of requesting euthanasia; the doctor-patient relationship and respect for the autonomy of both parties; the idea of medicine involved in it; and the possible therapeutic alternatives to euthanasia. This critical analysis raises the need to discuss in more depth a project that has to do with such important decisions about our lives and that implies a radical change in the way of thinking and practicing medicine.

Amoebic liver abscess in a COVID-19 patient: a case report.

BACKGROUND: Amoebiasis is a parasitic disease caused by Entamoeba histolytica, which affects people living in low- and middle-income countries and has intestinal and extraintestinal manifestations. To date, knowledge on coronavirus disease 2019 (COVID-19) coinfection with enteric parasites is limited, and E. histolytica coinfection has not been previously described. Here we present the case of a patient with COVID-19 who, during hospitalisation, presented a clinical picture consistent with an amoebic liver abscess (ALA). CASE PRESENTATION: A 54-year-old man, admitted as a suspected case of COVID-19, presented to our hospital with dyspnoea, malaise, fever and hypoxaemia. A nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse-transcription polymerase chain reaction. After 7 days, he developed diarrhoea, choluria and dysentery. An abdominal ultrasound showed a lesion compatible with a liver abscess; stool examination revealed E. histolytica trophozoites, and additional serology for E. histolytica was positive. After 12 days of treatment with metronidazole, ceftazidime and nitazoxanide, the patient reported acute abdominal pain, and an ultrasound examination revealed free liquid in the abdominal cavity. An emergency exploratory laparotomy was performed, finding 3000 mL of a thick fluid described as "anchovy paste". Computed tomography scan revealed a second abscess. He ended up receiving 21 days of antibiotic treatment and was discharged with satisfactory improvement. CONCLUSION: Here we present, to the best of our knowledge, the first report of ALA and COVID-19 co-presenting. Based on their pathophysiological similarities, coinfection with SARS-CoV-2 and E. histolytica could change the patient's clinical course; however, larger studies are needed to fully understand the interaction between these pathogens.

Multisystem Inflammatory Syndrome in Children (MIS-C) Following SARS-CoV-2 Infection: Role of Oxidative Stress.

With the appearance of the SARS-CoV-2 virus in December 2019, all countries in the world have implemented different strategies to prevent its spread and to intensively search for effective treatments. Initially, severe cases of the disease were considered in adult patients; however, cases of older school-age children and adolescents who presented fever, hypotension, severe abdominal pain and cardiac dysfunction, positive for SARS-CoV-2 infection, have been reported, with increased pro-inflammatory cytokines and tissue damage, condition denominated multisystemic inflammatory syndrome (MIS-C); The emerging data from patients with MIS-C have suggested unique characteristics in the immunological response and also clinical similarities with other inflammatory syndromes, which can support as a reference in the search for molecular mechanisms involved in MIS-C. We here in propose that oxidative stress (OE) may play a very important role in the pathophysiology of MIS-C, such as occurs in Kawasaki disease (KD), severe COVID-19 in adults and other processes with characteristics of vascular damage similar to MIS- C, for which we review the available information that can be correlated with possible redox mechanisms.

Comentarios al proyecto de ley "Muerte digna y cuidados paliativos" / Remarks on the "Dignified death and palliative care" bill

The Chilean House of Representatives is discussing the bill on "Dignified death and palliative care", which regulates the so-called medical assistance in dying or euthanasia. This paper will critically analyze the different aspects of the bill, particularly concerning four main dimensions, namely, the patient's condition at the time of requesting euthanasia; the doctor-patient relationship and respect for the autonomy of both parties; the idea of medicine involved in it; and the possible therapeutic alternatives to euthanasia. This critical analysis raises the need to discuss in more depth a project that has to do with such important decisions about our lives and that implies a radical change in the way of thinking and practicing medicine.

Nematicidal Effect and Histological Modifications Induced by Hydrolysable Tannin Extract on the Third-Stage Infective Larvae of Haemonchus contortus.

Haemonchus contortus is the most frequent and most important nematode parasite in the ruminants production of tropical and subtropical regions. There are strains resistant to all families of available anthelmintics. Consequently, the conduction of research to find other resources that allow effective control of this parasitic disease, preferably focusing on green production, is necessary. The aim of this study was to evaluate the effect of hydrolysable tannin extract (HTE) on larvae 3 (L3) of H. contortus in vitro. L3 were exposed to different HTE concentrations and times. In addition, both light and scanning electron microscopy were used to explore physical damage on L3 subjected to HTE activity. After 72 h of incubation, the mean lethal concentration of HTE was 2 mg/mL; this concentration has been previously referred to as safe for consumption in cattle. Scanning electron microscopy revealed H. contortus L3 destruction, damage was evident by separation of the sheath mainly in the cervical and caudal regions of the larva and by rupture of the cuticle with larval evisceration. Our results suggest that hydrolysable tannin extract from chestnut could be considered as a green alternative for parasitic control in ruminants.

Effects of Taenia Pisiformis Infection and Obesity on Clinical Parameters, Organometry and Fat Distribution in Male Rabbits.

Taenia pisiformis infection causes important economic loss in farms. It is suggested that obesity has a major impact on infection and reproduction. We addressed the impact of T. pisiformis infection in normal and obese rabbits to evaluate its effect on parameters important in behavior and reproduction. T. pisiformis infection in obese rabbits decreased body weight. In the obese-infected rabbits, eosinophils and heterophiles were increased 23% by the infection (P ≤ 0.05). T. pisiformis decreased cholesterol by 13% in normal weight infected rabbits and 10% in obese group (P ≤ 0.05), while triglyceride and VLDL were increased by 23% and 45% in the non-infected obese group (P ≤ 0.05). The infection increased serum cortisol levels only in normal weight rabbits (P ≤ 0.05). Liver weight was 20% higher in obese and obese-infected rabbits (P ≤ 0.05). Testicular weight in obese-infected was 46% higher than normal weight (P ≤ 0.0001) and 20% more than the obese-non-infected (P ≤ 0.0001). Furthermore, the infection reduced the weight of submandibular glands in infected and obese-infected rabbits (P ≤ 0.05), body fat increased 10% in the obese-infected than in the obese, and infected group was 35% over the normal weight non-infected (P ≤ 0.01). Our results show that T. pisiformis alters metabolic characteristics in rabbits, which can impact on the production and welfare of animals.

[Ethical guidelines for medical decision-making during COVID-19 pandemic in Chile]. / Orientaciones éticas para la toma de decisiones médicas en el contexto de la pandemia de COVID-19 en Chile.

The catastrophic emergency experienced by many countries with the COVID-19 pandemic emphasized the importance of bioethics for decision-making, both at the public health (equitable and effective policies) and at the clinical level. At the clinical level, the issues are the fulfillment of medical care demand with adequate health care teams, infrastructure, and supplies, and to cover critical care demands that surpass the available resources. Therefore, ethically correct approaches are required for the allocation of life sustaining resources. There are recommendations for the allocating life support during disasters based on multiple considerations, including ethical ones. However, the ethical criteria of existing guidelines are variable. Ethical principles usually considered are saving the greatest number of lives, saving the greatest number of years of life and the principle of the life cycle or the goal to give each individual equal opportunity to live through the various phases of life. However, the centrality of the human being and the search for the common good should be considered. Knowledge of public perspectives and moral benchmarks on these issues is essential. A successful assignment effort will require everyone's trust and cooperation. Decision making should be planned and discussed in advance, since in-depth deliberation will be extremely complex during the disaster. Our goal is to help the health care teams to wisely allocate resources in shortage periods.

Benefits of the Therapy With Abexol in Patients With Non-Alcoholic Fatty Liver Disease.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) encompasses a spectrum of diseases ranging from steatosis to steatohepatitis and cirrhosis. Given the increasing incidence of NAFLD and the long-term consequences of this disease, it is important to identify the risk factors and therapeutic measures. Abexol is a mixture of beeswax alcohols with antioxidant, gastro-protective and anti-inflammatory effects. The aim was to conduct a pooled analysis of clinical trials data of the effects of Abexol treatment in patients with NAFLD. METHODS: The present analysis includes the data of all patients with NAFLD obtained from medium-term randomized, double-blinded, placebo controlled clinical studies with Abexol. One hundred patients with NAFLD received Abexol (100 mg/day) or placebo for 6 months. Significant changes in the ultrasound analysis of the liver were considered a primary efficacy variable. Secondary endpoints were decreased homeostasis model assessment (HOMA) index and insulin levels, and improved clinical symptoms. Statistical analysis of all data was according to the intention-to-treat method. RESULTS: Both groups were statistically homogeneous at baseline conditions. At 6 months of treatment, the number of Abexol-treated patients exhibiting a normal liver echo pattern on ultrasonography was greater than that of the placebo patients (P < 0.05). Abexol significantly reduced (P < 0.05) insulin levels and HOMA index. The proportion of Abexol patients showing symptom improvement was higher (P < 0.01) than that of the placebo group. Treatments were safe and well tolerated. CONCLUSIONS: Treatment of Abexol during 6 months significantly ameliorates liver fat accumulation and insulin resistances, meanwhile improving clinical evolution in patients with NAFLD. The treatment was safe and well tolerated in these patients.

Orientaciones éticas para la toma de decisiones médicas en el contexto de la pandemia de COVID-19 en Chile / Ethical guidelines for medical decision-making during COVID-19 pandemic in Chile

The catastrophic emergency experienced by many countries with the COVID-19 pandemic emphasized the importance of bioethics for decision-making, both at the public health (equitable and effective policies) and at the clinical level. At the clinical level, the issues are the fulfillment of medical care demand with adequate health care teams, infrastructure, and supplies, and to cover critical care demands that surpass the available resources. Therefore, ethically correct approaches are required for the allocation of life sustaining resources. There are recommendations for the allocating life support during disasters based on multiple considerations, including ethical ones. However, the ethical criteria of existing guidelines are variable. Ethical principles usually considered are saving the greatest number of lives, saving the greatest number of years of life and the principle of the life cycle or the goal to give each individual equal opportunity to live through the various phases of life. However, the centrality of the human being and the search for the common good should be considered. Knowledge of public perspectives and moral benchmarks on these issues is essential. A successful assignment effort will require everyone's trust and cooperation. Decision making should be planned and discussed in advance, since in-depth deliberation will be extremely complex during the disaster. Our goal is to help the health care teams to wisely allocate resources in shortage periods.

Efficacy of Controlled Memory and Shape Memory Nickel Titanium Instruments in Removing Filling Material from Severely Curved Root Canals: An Ex Vivo Study.

Introduction: The aim of the present study was to compare the efficacy of four NiTi instruments with different properties (shape memory and control memory), in both rotary and reciprocating motions, during retreatment procedures. Methods and Materials: Mesial canals of thirty-two mandibular molars were instrumented, obturated, and then scanned with" Cone-beam Computed Tomography" (CBCT). Teeth were randomly divided into 4 groups (n=8) according to each system: "Shape Memory" (SM) instruments including Reciproc (R25 file) and ProTaper Next (X3 and X2 file), "Controlled Memory" (CM) instruments including WaveOne Gold (Primary file) and Hyflex (30.06 and 25.06 file). The specimens were rescanned after retreatment procedures. The volume of the residual material left inside the canals, the operating time and the fractured files were analyzed. ANOVA and student t-tests were used for statistical analysis. Results: There were no significant differences in the percentage of the residual filling material or requiring time amongst different groups of instruments (P>0.05). However, CM instruments presented the highest frequency of fractured files [2 SM instruments (12.5%) and 7 CM instruments (43.75%)] with a significant difference (P=0.023). Conclusions: This ex vivo study showed that CM and SM instruments can remove filling materials from mandibular mesial root canals during retreatment procedures; nonetheless the CM instruments had a higher frequency of fractured files. No system was able to completely remove the filling materials. Therefore, additional procedures and techniques are needed to improve root canal cleanliness.

Responsabilidad médica frente a casos de violencia al interior de las familias. Una mirada desde una perspectiva ética y legal / Medical responsibility in cases of violence within families. A look from an ethical and legal perspective

La violencia al interior de las familias (VIF), en sus distintas formas y con distintas víctimas, es un problema que nos toca en forma transversal a las distintas disciplinas médicas.En Chile, una de cada tres mujeres reporta haber experimentado VIF, y cerca de 45 mueren cada año por esta causa. Como país hemos optado por hacernos cargo de esta situación y nos hemos trazado como meta reducir la morbilidad, discapacidad y mortalidad prematura asociada a violencia, y, específicamente, a reducir los femicidios en un 33 por ciento. La denuncia es un instrumento legal que puede ayudar a este propósito.Este artículo reflexiona sobre conceptos médicos, legales y éticos involucrados en el abordaje inicial de una víctima de VIF, con especial foco en la denuncia. Se discute sobre los alcances de la nueva legislación vigente en Chile en materia de VIF, sobre la responsabilidad legal y ética del médico en Chile frente a este problema de salud, y sobre la postura de la Organización Mundial de la Salud al respecto. (AU)

Domestic violence (DV), in its different forms and with different victims, is a problem that affects us across several medical disciplines. In Chile, one out of three women reports being subject of domestic violence, and approximately 45 die each year for this reason. As a country, we have decided to deal with this situation, and we have self-imposed the goal of reducing morbidity, disability and premature mortality associated with violence, and to reduce femicide in 33 percent. Making a legal complaint is a tool that can help to achieve this purpose. The current article reflects on medical, legal and ethical concepts involved in the initial approach to a victim of domestic violence, with a focus in the act of make a legal complaint. We discuss the scope of the current legislation in Chile, about the legal and ethical responsibility of physicians confronted with this health problem, and about the position of the World Health Organization on this matter.(AU)

Efectividad de un programa de rehabilitación autoadministrado en el tratamiento del síndrome de hombro doloroso en atención primaria de salud: un estudio clínico aleatorizado, simple ciego / Effectiveness of a self-administered rehabilitation program for shoulder pain syndrome in primary health care

Background: Shoulder pain syndrome (SPS) is frequent and management in primary care is precarious, with a high rate of referral without adequate treatment, overloading rehabilitation and orthopedic services. Aim: To assess the effectiveness of a self-administered rehabilitation program in adults with shoulder pain syndrome in primary care. Patients and Methods: A randomized, single-blind clinical trial (evaluators) with an experimental group (self-administered rehabilitation) and a control group (standard physical therapy) was carried out in 271 adult patients aged 18 or older with unilateral shoulder pain lasting more than six weeks and less than three months. The primary outcome was the recovery perceived by the patient. Constant score for function, quality of life using SF-36, simple shoulder test (SST) and the Disabilities of the Arm, Shoulder, and Hand (DASH) score were also calculated at six, 12 and 24 weeks of follow-up. Results: The self-administered rehabilitation program showed an adjusted effectiveness of 51% at the end of treatment compared to 54% of the standard physical therapy (p > 0.05). No differences in the evolution of the other scores assessed were observed between groups. Conclusions: A self-administered rehabilitation program for painful shoulder was non-inferior than usual physical therapy.

[Effectiveness of a self-administered rehabilitation program for shoulder pain syndrome in primary health care]. / Efectividad de un programa de rehabilitación autoadministrado en el tratamiento del síndrome de hombro doloroso en atención primaria de salud: un estudio clínico aleatorizado, simple ciego.

BACKGROUND: Shoulder pain syndrome (SPS) is frequent and management in primary care is precarious, with a high rate of referral without adequate treatment, overloading rehabilitation and orthopedic services. AIM: To assess the effectiveness of a self-administered rehabilitation program in adults with shoulder pain syndrome in primary care. PATIENTS AND METHODS: A randomized, single-blind clinical trial (evaluators) with an experimental group (self-administered rehabilitation) and a control group (standard physical therapy) was carried out in 271 adult patients aged 18 or older with unilateral shoulder pain lasting more than six weeks and less than three months. The primary outcome was the recovery perceived by the patient. Constant score for function, quality of life using SF-36, simple shoulder test (SST) and the Disabilities of the Arm, Shoulder, and Hand (DASH) score were also calculated at six, 12 and 24 weeks of follow-up. RESULTS: The self-administered rehabilitation program showed an adjusted effectiveness of 51% at the end of treatment compared to 54% of the standard physical therapy (p > 0.05). No differences in the evolution of the other scores assessed were observed between groups. CONCLUSIONS: A self-administered rehabilitation program for painful shoulder was non-inferior than usual physical therapy.

"In our own words": Defining medical professionalism from a Latin American perspective.

BACKGROUND: Latin America has experienced a tremendous growth in a number of medical schools, and there are concerns about their quality of training in critical areas such as professionalism. Medical professionalism is a cultural construct. The aim of the study was to compare published definitions of medical professionalism from Latin American and non-Latin American regions and to design an original and culturally sound definition. METHODS: A mixed methods approach was used with three phases. First, a systematic search and thematic analysis of the literature were conducted. Second, a Delphi methodology was used to design a local definition of medical professionalism. Third, we used a qualitative approach that combined focus groups and personal interviews with students and deans from four medical schools in Chile to understand various aspects of professionalism education. The data were analyzed using NVivo software. RESULTS: A total of 115 nonrepeated articles were identified in the three databases searched. No original definitions of medical professionalism from Latin America were found. Twenty-six articles met at least one of the three decisional criteria defined and were fully reviewed. Three theoretical perspectives were identified: contractualism, personalism, and deontology. Attributes of medical professionalism were classified in five dimensions: personal, interpersonal, societal, formative, and practical. Participants of the Delphi panel, focus groups, and personal interviews included 36 medical students, 12 faculties, and four deans. They took a personalistic approach to design an original definition of medical professionalism and highlighted the relevance of respecting life, human dignity, and the virtue of prudence in medical practice. Students and scholars differed on the value given to empathy and compassion. DISCUSSION: This study provides an original and culturally sound definition of medical professionalism that could be useful in Latin American medical schools. The methodology used in the study could be applied in other regions as a basis to develop culturally appropriate definitions of medical professionalism.