Use of direct oral anticoagulants and low molecular weight heparin in venous thromboembolism associated with cancer: real-world evidence in Argentina.

BACKGROUND: Venous thromboembolism (VTE) and major bleeding (MB) are common in cancer patients. Reduced-doses of antithrombotics as secondary prophylaxis have limited data. This work aims to describe and to compare treatments and outcomes for cancer-associated VTE. RESEARCH DESIGN AND METHODS: Retrospective study. Adults with cancer-associated VTE were included. After 3-6 months of full-doses of anticoagulants, three strategies were considered: A) lowering the doses; B) maintaining full-doses; C) stopping treatment. The strategy and medication used were shown in a descriptive analysis and the rate of bleeding and VTE-recurrence between those in a comparative analysis. RESULTS: A total of 420 patients were included, 56.2% received DOACs, 43.8% enoxaparin. Strategy was defined in 257 patients: A (50.2%), B (46.3%), and C (3.5%). Forty-one (9.8%) had VTE-recurrence and 15 (3.6%) had MB or clinically relevant non-major bleeding (CRNMB).According to strategy, recurrent-VTE was 8.5% (A), 4.2% (B), and 11.1 (C) (p = 0.22), MB or CRNMB was 0.8% (A), 1.7% (B), and 0% (C) (p = 0.64). CONCLUSIONS: DOACs and strategy A were the most frequently used agent and strategy, respectively. There were no differences between medications or strategies used. The results must be interpreted with caution, and it is a retrospective single-center study, probably with information and selection bias.

Enfermedad Diverticular: análisis de defunciones según sexo, grupo etario y regiones en Chile

Objetivo: Describir las defunciones por enfermedad diverticular de intestino en el período 2016 - 2020 en Chile según sexo, grupo etario y región. Material y Método: Estudio descriptivo. Se describieron 406 defunciones por enfermedad diverticular según sexo, grupo etario y región entre los años 2016-2020, realizando un análisis estadístico con el software IBM SPSS Statistics ® que incluyó una Prueba Binomial para análisis de defunciones según "sexo" y la Prueba de Kruskal Wallis para el estudio de significancia entre las variables "sexo" y "grupo etario". Se utilizó un intérvalo de confianza del 99% (p < 0,01). Resultados: se obtuvo una tasa de mortalidad 0,46/100.000 habitantes para el período estudiado. El sexo femenino fue predominante con una relación cercana a 3:1 (p < 0,01). Las defunciones aumentaron con la edad y el grupo etario con mayor número de defunciones fue el de 80-89. Se demostró relación entre sexo y grupo etario (p < 0,01). Las regiones con mayor tasa de mortalidad observada fueron Magallanes, Valparaíso y Maule. Discusión: La tasa de mortalidad es similar a la reportada a nivel mundial. Las mujeres mueren en una proporción mayor que los hombres, tal como es descrito en otros estudios. La mayor tasa de mortalidad observada en algunas regiones del país se podría asociar a la elevada prevalencia de factores de riesgo para la enfermedad. Conclusión: Las defunciones por enfermedad diverticular disminuyeron desde el año 2018, se evidencia que las mujeres presentan un número significativamente mayor de defunciones que los hombres y que existieron diferencias por región.

Aim: To describe deaths from diverticular bowel disease in the period 2016-2020 in Chile according to sex, age group and region. Material and Method: Descriptive study. 406 deaths due to diverticular disease were described according to sex, age group and region between the years 2016-2020, performing a statistical analysis with the IBM SPSS Statistics ® software that included a Binomial Test for analysis of deaths according to "sex" and the Kruskal Wallis Test for the study of significance between the variables "sex" and "age group". A 99% confidence interval (p < 0.01) was used. Results: A mortality rate of 0.46/100,000 inhabitants was obtained for the period. The female sex was predominant in a ratio close to 3:1 (p < 0.01). Deaths increased with age and the age group with the higher number of deaths was 80-89. A relationship between sex and age group was demonstrated (p < 0.01). The regions with the highest observed mortality rate were Magallanes, Valparaíso and Maule. Discussion: The mortality rate is similar to that reported worldwide. Women die at a higher rate than men, as described in other studies. The higher mortality rate observed in some regions of the country could be associated with the high prevalence of risk factors for the disease. Conclusion: Deaths from diverticular disease decreased since 2018, in conjunction with showing that women present a significantly higher number of deaths than men and that there were differences by region.

Coping and Resilience: PTSD Screening and Brief Intervention for Underrepresented Students at a Public University.

The undetected and untreated PTSD symptoms (difficulty paying attention, nightmares and difficulty sleeping, irritability or aggression, flashbacks, diminished interest in activities, self-destructive behavior, and feeling isolated) of college students may interfere with their relationships, well-being, learning, and academic success. To examine the feasibility, acceptability, and impact of providing a short-term trauma-specific evidence-based group intervention, Coping & Resilience (C&R), an adaptation of Cognitive Behavioral Intervention for Trauma in Schools (CBITS) was implemented at a large urban public university. Fifty college students (54 percent male, 90 percent students of color), with a mean PTSD symptom score of 34 at pretest (considered in the moderate range of symptom severity) participated in C&R groups. As expected, student PTSD symptoms improved after group participation. A Quade test showed a significant decrease in the scores from pretest to follow-up for PTSD and two subscales (intrusion and avoidance). Large public universities serving underrepresented students are uniquely positioned to become trauma- and resilience-informed systems and to provide trauma support services to promote student well-being.

Peritonealized urachal remnant and obstructive congenital peritoneal band. A case report. / Remanente uracal peritonizado y banda peritoneal congénita obstructiva. Reporte de caso.

INTRODUCTION: Intestinal obstruction as a result of congenital peritoneal bands is rare in surgical practice. It typically compromises the small bowel, and it also has been reported to involve the appendix or a Meckel's diverticulum. However, peritonealized urachal remnant as part of a congenital band is highly infrequent. CASE REPORT: 5-year-old boy presenting with intestinal obstruction related to a peritoneal band from the mesentery to the appendix and a peritonealized urachal remnant, associated with an incidental finding of a Meckel's diverticulum. Diagnosis was achieved laparoscopically. The peritoneal band, the urachal remnant, and the Meckel's diverticulum were resected. DISCUSSION: Kerkeni's congenital band classification consists of 4 independent groups. This case combines both a band stemming from an embryological remnant and an idiopathic band.

INTRODUCCION: La obstrucción intestinal por bandas peritoneales congénitas es poco común en la práctica quirúrgica. Su ubicación más frecuente compromete el intestino delgado y existen reportes que involucran el apéndice y el divertículo de Meckel, pero que un remanente uracal peritonizado haga parte de una banda congénita es verdaderamente singular. CASO CLINICO: Niño de 5 años de edad con cuadro de obstrucción intestinal en el que confluyen una banda peritoneal, que va del mesenterio al apéndice y que se une a un remanente uracal peritonizado, asociado al hallazgo incidental de un divertículo de Meckel. El diagnóstico se definió por medio de una laparoscopia y como tratamiento se realizó la resección de la banda peritoneal, del remanente uracal y del divertículo de Meckel. DISCUSION: La clasificación de bandas congénitas de Kerkeni comprende 4 grupos independientes, en este caso confluyen una banda derivada de un remanente embriológico junto con el tipo idiopático.

Targets, Mechanisms and Cytotoxicity of Half-Sandwich Ir(III) Complexes Are Modulated by Structural Modifications on the Benzazole Ancillary Ligand.

Cancers are driven by multiple genetic mutations but evolve to evade treatments targeting specific mutations. Nonetheless, cancers cannot evade a treatment that targets mitochondria, which are essential for tumor progression. Iridium complexes have shown anticancer properties, but they lack specificity for their intracellular targets, leading to undesirable side effects. Herein we present a systematic study on structure-activity relationships of eight arylbenzazole-based Iridium(III) complexes of type [IrCl(Cp*)], that have revealed the role of each atom of the ancillary ligand in the physical chemistry properties, cytotoxicity and mechanism of biological action. Neutral complexes, especially those bearing phenylbenzimidazole (HL1 and HL2), restrict the binding to DNA and albumin. One of them, complex 1[C,NH-Cl], is the most selective one, does not bind DNA, targets exclusively the mitochondria, disturbs the mitochondria membrane permeability inducing proton leak and increases ROS levels, triggering the molecular machinery of regulated cell death. In mice with orthotopic lung tumors, the administration of complex 1[C,NH-Cl] reduced the tumor burden. Cancers are more vulnerable than normal tissues to a treatment that harnesses mitochondrial dysfunction. Thus, complex 1[C,NH-Cl] characterization opens the way to the development of new compounds to exploit this vulnerability.

Remanente uracal peritonizado y banda peritoneal congénita obstructiva. Reporte de caso / Peritonealized urachal remnant and obstructive congenital peritoneal band. A case report

Introducción: La obstrucción intestinal por bandas peritoneales con-génitas es poco común en la práctica quirúrgica. Su ubicación más fre-cuente compromete el intestino delgado y existen reportes que involucranel apéndice y el divertículo de Meckel, pero que un remanente uracal pe-ritonizado haga parte de una banda congénita es verdaderamente singular.Caso clínico: Niño de cinco años de edad con cuadro de obstruc-ción intestinal en el que confluyen una banda peritoneal, que va delmesenterio al apéndice y que se une a un remanente uracal peritonizado,asociado al hallazgo incidental de un divertículo de Meckel. El diag-nóstico se definió por medio de una laparoscopia y como tratamientose realizó la resección de la banda peritoneal, del remanente uracal ydel divertículo de Meckel.Discusión: La clasificación de bandas congénitas de Kerkenicomprende 4 grupos independientes, en este caso confluyen una bandaderivada de un remanente embriológico junto con el tipo idiopático.

Introduction. Intestinal obstruction as a result of congenital peri-toneal bands is rare in surgical practice. It typically compromises thesmall bowel, and it also has been reported to involve the appendix ora Meckel’s diverticulum. However, peritonealized urachal remnant aspart of a congenital band is highly infrequent.Case report: 5-year-old boy presenting with intestinal obstructionrelated to a peritoneal band from the mesentery to the appendix and aperitonealized urachal remnant, associated with an incidental findingof a Meckel’s diverticulum. Diagnosis was achieved laparoscopically.The peritoneal band, the urachal remnant, and the Meckel’s diverticulumwere resected.Discussion: Kerkeni’s congenital band classification consists of 4independent groups. This case combines both a band stemming froman embryological remnant and an idiopathic band.

The Chilean socio-ethno-genomic cline.

Studies of the current Chilean population performed using classical genetic markers have established that the Chilean population originated primarily from the admixture of European people, particularly Spaniards, and Amerindians. A socioeconomic-ethno-genetic cline was established soon after the conquest. Spaniards born in Spain or Chile occupied the highest Socioeconomic Strata, while Amerindians belonged to the lowest. The intermediate strata consisted of people with different degrees of ethnic admixture; the larger the European admixture, the higher the Socioeconomic Level. The present study of molecular genomic markers sought to calculate the percentage of Amerindian admixture and revealed a finer distribution of this cline, as well as differences between two Amerindian groups: Aymara and Mapuche. The use of two socioeconomic classifications - Class and Socioeconomic Level - reveals important differences. Furthermore, Self-reported Ethnicity (self-assignment to an ethnic group) and Self-reported Ancestry (self-recognition of Amerindian ancestors) show variations and differing relationships between socioeconomic classifications and genomic Amerindian Admixture. These data constitute a valuable input for the formulation of public healthcare policy and show that the notions of Ethnicity, Socioeconomic Strata and Class should always be a consideration in policy development.

[Consensus of infectious complications in patients treated with selected biological therapies: first Part]. / Consenso sobre riesgo de complicaciones infecciosas en pacientes usuarios de medicamentos biológicos seleccionados. Parte I.

The use of biological therapies has meant a great improvement in the management of several conditions like autoimmune, neoplastic or others diseases. Although its use has implied significant improvements in the prognosis of these diseases, it is not exempt from complications: infectious diseases as one of them. The objective of this consensus was to evaluate, from an infectious viewpoint, the safeness of the most frequently used biological therapies and give recommendations for the prevention of infections in patients treated with these drugs. These recommendations were based on the highest quality evidence available for the selected biologics. The consensus counts of two manuscripts. This first part details the risks of developing infectious complications depending on the type of biological used for a certain pathology. This evaluation included a broad search in MEDLINE and Epistemonikos of systematic reviews and meta-analyzes of controlled clinical trials and casecontrol examining post-treatment infections with anti-TNF alpha, anti-CD20, anti-CD52, CTLA4-Ig and anti-integrins. The research was complemented by a review of: multicentre cohorts of biological users, the MMWR of the CDC, Atlanta, U.S.A., and national registers and scientific societies in which infectious complications derived from the use of biological therapies were mentioned.

Consenso sobre riesgo de complicaciones infecciosas en pacientes usuarios de medicamentos biológicos seleccionados. Parte I / Consensus of infectious complications in patients treated with selected biological therapies: first Part

Resumen La incorporación de terapias biológicas ha significado un gran avance en el manejo de diversas patologías de origen autoinmune, neoplásico u otros. Si bien su uso ha implicado mejoras significativas en el pronóstico de estas enfermedades, no está exento de complicaciones, entre estas, las infecciosas. El objetivo de este consenso fue evaluar el perfil de seguridad, desde la mirada infectológica, de las terapias biológicas de uso más frecuente y dar recomendaciones para la prevención de infecciones en pacientes tratados con ellas, basándose en la evidencia de mayor calidad disponible para los biológicos seleccionados. El consenso cuenta de dos manuscritos. Esta primera parte detalla los riesgos de desarrollar complicaciones infecciosas dependiendo del tipo de biológico utilizado para determinada patología. La revisión incluyó búsqueda amplia en MEDLINE y Epistemonikos de revisiones sistemáticas y meta-análisis de estudios clínicos controlados y caso/control que examinaban infecciones posteriores al tratamiento con anti-TNF alfa, anti-CD20, anti-CD52, CTLA4-Ig y anti-integrinas. Esta búsqueda se complementó con revisión de cohortes multicéntricas de usuarios de biológicos, del MMWR del CDC, Atlanta, E.U.A. y de registros nacionales y/o de sociedades científicas en la que se hiciera mención a complicaciones infecciosas derivadas del uso de biológicos.

The use of biological therapies has meant a great improvement in the management of several conditions like autoimmune, neoplastic or others diseases. Although its use has implied significant improvements in the prognosis of these diseases, it is not exempt from complications: infectious diseases as one of them. The objective of this consensus was to evaluate, from an infectious viewpoint, the safeness of the most frequently used biological therapies and give recommendations for the prevention of infections in patients treated with these drugs. These recommendations were based on the highest quality evidence available for the selected biologics. The consensus counts of two manuscripts. This first part details the risks of developing infectious complications depending on the type of biological used for a certain pathology. This evaluation included a broad search in MEDLINE and Epistemonikos of systematic reviews and meta-analyzes of controlled clinical trials and casecontrol examining post-treatment infections with anti-TNF alpha, anti-CD20, anti-CD52, CTLA4-Ig and anti-integrins. The research was complemented by a review of: multicentre cohorts of biological users, the MMWR of the CDC, Atlanta, U.S.A., and national registers and scientific societies in which infectious complications derived from the use of biological therapies were mentioned.

Neuro-ophthalmological manifestations of POEMS syndrome. / Manifestaciones neurooftalmológicas del síndrome de POEMS.

The cases is presented of a 38 year-old male with a constitutional syndrome, fever, multiple swollen lymph nodes, and hepatosplenomegaly of 2 months onset. There was also mention of headache, bilateral blurred vision, and myiodesopsias. Best correct visual acuity was 20/50 and 20/200. The anterior segment was unremarkable. The fundus of both eyes showed raised and erased discs, accompanied by serous detachment, greater in the left eye. Complementary studies of both eyes showed a visual field with increased blind spot; fluorescein angiography indicated late disc hyperfluorescence. The electroretinogram showed compromise of cones and rods, and the visual evoked potential detected alteration in the perception and conduction of stimuli. The imaging studies were essentially normal. During his hospital admission he presented with paraparesis, renal failure, endocrinopathy, skin alterations, and osteoblastic lesions with negative biopsies. Monoclonal gammopathy was documented, and the diagnosis of POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy, and Skin changes) syndrome was made. The chemotherapy started with dexamethasone/melphalan, with a good response at 3 months.

Strong Influence of Ancillary Ligands Containing Benzothiazole or Benzimidazole Rings on Cytotoxicity and Photoactivation of Ru(II) Arene Complexes.

A new family of neutral ruthenium(II) arene complexes of the type [Ru(η6-arene)X(κ2- O, N-L)] (η6-arene = p-cym, bz; X = Cl-, SCN-; HL1 = 2-(2'-hydroxyphenyl)benzimidazole, HL2 = 2-(2'-hydroxyphenyl)benzothiazole) has been synthesized and characterized. The cytotoxic activity of the Ru(II) complexes was evaluated in several tumor cell lines (A549, HepG2 and SW480) both in the dark and after soft irradiation with UV and blue light. None of the complexes bearing benzimidazole (HL1) as a ligand displayed phototoxicity, whereas the complexes with a benzothiazole ligand (HL2) exhibited photoactivation; the sensitivity observed for UV was higher than for blue light irradiation. The interesting results displayed by HL2 and [Ru(η6- p-cym)(NCS)(κ2- O, N-L2)], [3a], in terms of photo cytotoxicity prompted us to analyze their interaction with DNA, both in the dark and under irradiation conditions, in an effort to shed some light on their mechanism of action. The results of this study revealed that HL2 interacts with DNA by groove binding, whereas [3a] interacts by a dual mode of binding, an external groove binding, and covalent binding of the metal center to the guanine moiety. Interestingly, both HL2 and [3a] display a clear preference for AT base pairs, and this causes fluorescence enhancement. Additionally, cleavage of the pUC18 plasmid DNA by the complex is observed upon irradiation. The study of the irradiated form demonstrates that the arene ligand is released to yield species such as [Ru(κ2- O, N-L2)(κ1- S-DMSO)2(µ-SCN)]2 [3c] and [Ru(κ2- O, N-L2)(κ1- S-DMSO)3(SCN)] [3d]. Such photo dissociation occurs even in the absence of oxygen and leads to cytotoxicity enhancement, an effect attributed to the presence of [3d], thus revealing the potential of [3a] as a pro-drug for photoactivated anticancer chemotherapy (PACT).

Identification of clinical isolates of Aspergillus, including cryptic species, by matrix assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS).

An expanded library of matrix assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) has been constructed using the spectra generated from 42 clinical isolates and 11 reference strains, including 23 different species from 8 sections (16 cryptic plus 7 noncryptic species). Out of a total of 379 strains of Aspergillus isolated from clinical samples, 179 strains were selected to be identified by sequencing of beta-tubulin or calmodulin genes. Protein spectra of 53 strains, cultured in liquid medium, were used to construct an in-house reference database in the MALDI-TOF MS. One hundred ninety strains (179 clinical isolates previously identified by sequencing and the 11 reference strains), cultured on solid medium, were blindy analyzed by the MALDI-TOF MS technology to validate the generated in-house reference database. A 100% correlation was obtained with both identification methods, gene sequencing and MALDI-TOF MS, and no discordant identification was obtained. The HUVR database provided species level (score of ≥2.0) identification in 165 isolates (86.84%) and for the remaining 25 (13.16%) a genus level identification (score between 1.7 and 2.0) was obtained. The routine MALDI-TOF MS analysis with the new database, was then challenged with 200 Aspergillus clinical isolates grown on solid medium in a prospective evaluation. A species identification was obtained in 191 strains (95.5%), and only nine strains (4.5%) could not be identified at the species level. Among the 200 strains, A. tubingensis was the only cryptic species identified. We demonstrated the feasibility and usefulness of the new HUVR database in MALDI-TOF MS by the use of a standardized procedure for the identification of Aspergillus clinical isolates, including cryptic species, grown either on solid or liquid media.

Incidencia de bacterias multi-resistentes en unidades de cuidados intensivos de hospitales chilenos / Incidence of multi-resistant bacteria in Intensive Care Units of Chilean hospitals

Resumen Introducción: La vigilancia de incidencia de bacterias multi-resistentes es un indicador que permite estimar mejor la magnitud de la resistencia bacteriana en los servicios hospitalarios. Objetivo: Evaluar la incidencia de bacterias multi-resistentes relevantes en unidades de cuidados intensivos del país y establecer las diferencias entre población adulta y pediátrica. Metodología: Se solicitó a los hospitales participantes información del número de aislados de siete bacterias multi-resistentes epidemiológicamente relevantes de unidades de cuidados intensivos (UCI) de adulto y pediátrico entre enero de 2014 y octubre de 2015, y el número de días-cama ocupados en dichas unidades en el mismo período. Con estos datos se calculó incidencia por 1.000 pacientes-día para cada unidad. Resultados: Se recibió información de 20 UCI adultos y 9 UCI pediátricas. En UCI adultos las bacterias de mayor incidencia fueron K. pneumoniae productora de BLEE [4,72 × 1.000 días cama (1,21-13,89)] y S. aureus resistente a oxacilina [3,85 (0,71-12,66)]. En pediatría la incidencia fue menor, destacando K. pneumoniae productora de BLEE [2,71 (0-7,11)] y P. aeruginosa resistente a carbapenémicos [1,61 (0,31-9,25)]. Conclusión: Se observan importantes diferencias entre los distintos hospitales en la incidencia de las bacterias estudiadas. La incidencia de bacterias multi-resistentes en UCI de adultos es significativamente mayor que en UCI pediátrica para la mayoría de las bacterias estudiadas.

Introduction: Incidence of multi-resistant bacteria is an indicator that permits better estimation of the magnitude of bacterial resistance in hospitals. Aim: To evaluate the incidence of relevant multi-drug resistant bacteria in intensive care units (ICUs) of Chile. Methods: Participating hospitals submitted information about the number of isolates from infected or colonized patients with 7 epidemiologically relevant multi-resistant bacteria in adult and pediatric ICUs between January 1, 2014 and October 31, 2015 and the number of bed days occupied in these units in the same period was requested. With these data incidence was calculated per 1,000 patient days for each unit. Results: Information from 20 adults and 9 pediatric ICUs was reviewed. In adult ICUs the bacteria with the highest incidence were K. pneumoniae ESBL [4.72 × 1,000 patient day (1.21-13.89)] and oxacillin -resistant S. aureus [3.85 (0.71-12.66)]. In the pediatric units the incidence was lower, highlighting K. pneumoniae ESBL [2.71 (0-7.11)] and carbapenem -resistant P. aeruginosa [1.61 (0.31-9.25)]. Conclusion: Important differences between hospitals in the incidence of these bacteria were observed. Incidence of multi-resistant bacteria in adult ICU was significantly higher than in pediatric ICU for most of the studied bacterias.

Equipos de salud y su funcionalidad: oportunidades para el tratamiento del tabaquismo / Health teams and their functionality: opportunities for smoking cessation

Resumen Este capítulo propone acciones para una adecuada implementación de las estrategias definidas en las Primeras Guías de Práctica Clínica del Tratamiento del Tabaquismo, Chile 2017. En el subsistema público por una parte se han hecho esfuerzos importantes y progresivos para realizar la detección de fumadores y la consejería breve ABC en los distintos dispositivos de la red. En el subsistema privado por otra parte se han llevado adelante servicios especializados: Terapia Intensiva de Cesación del Tabaquismo. Se detecta un déficit de integración de servicios a partir de metas claras y compartidas que permitan alcanzar un impacto poblacional relevante. Se proponen lineamientos a seguir para lograr éxito en las intervenciones para el tratamiento de los fumadores.

This chapter proposes actions for an adequate implementation of the strategies defined in the Guidelines of Clinical Practice for Tobacco Treatment, Chile 2017. In the public subsystem, significant and progressive efforts have been made to carry out smoking detection and counseling ABC on the various devices in the network. In the private subsystem on the other hand specialized services have been carried out: Intensive Therapy for Smoking Cessation. A deficit of integration of services is detected based on clear and shared goals that allow to reach a relevant population impact. Guidelines are proposed to be followed to achieve success in the interventions for the treatment of smokers.

Family Communication Styles and Resilience among Adolescents.

Some adolescents manage to be resilient, whereas others develop posttraumatic stress disorder (PTSD) symptoms after experiencing trauma, but the mechanisms underlying these differences are unclear. Public secondary school students (N = 98) referred for counseling completed questionnaires assessing exposure to stressful events, family communication, and PTSD. Seventy percent of the sample reported PTSD symptoms in the clinical range. Open family communication was negatively associated with female gender, problem family communication (PFC), and PTSD symptom severity. PFC was positively associated with female gender, number of stressful events, and PTSD symptom severity. Family storytelling style had a negative association with age, PFC, and avoidance symptoms. In the full regression model only the number of life events and PFC appeared to have an independent effect on PTSD symptom severity. Results indicate that exposure to stressful life events and poor family communication are associated with increased risk for PTSD symptoms. Findings may be useful in family-focused approaches to treating adolescents with trauma histories and highlighting the importance of PTSD screening in school-based counseling.

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

OBJECTIVES: To determine efficacy and safety of withholding antimicrobials in children with cancer, fever and neutropenia (FN) with a demonstrated respiratory viral infection. METHODS: Prospective, multicentre, randomized study in children presenting with FN at five hospitals in Santiago, Chile, evaluated at admission for diagnosis of bacterial and viral pathogens including PCR-microarray for 17 respiratory viruses. Children positive for a respiratory virus, negative for a bacterial pathogen and with a favourable evolution after 48 h of antimicrobial therapy were randomized to either maintain or withhold antimicrobials. Primary endpoint was percentage of episodes with uneventful resolution. Secondary endpoints were days of fever/hospitalization, bacterial infection, sepsis, admission to paediatric intensive care unit (PICU) and death. RESULTS: A total of 319 of 951 children with FN episodes recruited between July 2012 and December 2015 had a respiratory virus as a unique identified microorganism, of which 176 were randomized, 92 to maintain antimicrobials and 84 to withdraw. Median duration of antimicrobial use was 7 days (range 7-9 days) versus 3 days (range 3-4 days), with similar frequency of uneventful resolution (89/92 (97%) and 80/84 (95%), respectively, not significant; OR 1.48; 95% CI 0.32-6.83, p 0.61), and similar number of days of fever (2 versus 1), days of hospitalization (6 versus 6) and bacterial infections throughout the episode (2%-1%), with one case of sepsis requiring admission to PICU in the group that maintained antimicrobials, without any deaths. CONCLUSIONS: The reduction of antimicrobials in children with FN and respiratory viral infections, based on clinical and microbiological/molecular diagnostic criteria, should favour the adoption of evidence-based management strategies in this population.

[Incidence of multi-resistant bacteria in Intensive Care Units of Chilean hospitals]. / Incidencia de bacterias multi-resistentes en unidades de cuidados intensivos de hospitales chilenos.

INTRODUCTION: Incidence of multi-resistant bacteria is an indicator that permits better estimation of the magnitude of bacterial resistance in hospitals. AIM: To evaluate the incidence of relevant multi-drug resistant bacteria in intensive care units (ICUs) of Chile. METHODS: Participating hospitals submitted information about the number of isolates from infected or colonized patients with 7 epidemiologically relevant multi-resistant bacteria in adult and pediatric ICUs between January 1, 2014 and October 31, 2015 and the number of bed days occupied in these units in the same period was requested. With these data incidence was calculated per 1,000 patient days for each unit. RESULTS: Information from 20 adults and 9 pediatric ICUs was reviewed. In adult ICUs the bacteria with the highest incidence were K. pneumoniae ESBL [4.72 × 1,000 patient day (1.21-13.89)] and oxacillin -resistant S. aureus [3.85 (0.71-12.66)]. In the pediatric units the incidence was lower, highlighting K. pneumoniae ESBL [2.71 (0-7.11)] and carbapenem -resistant P. aeruginosa [1.61 (0.31-9.25)]. CONCLUSION: Important differences between hospitals in the incidence of these bacteria were observed. Incidence of multi-resistant bacteria in adult ICU was significantly higher than in pediatric ICU for most of the studied bacterias.

Diarrea aguda / Acute diarrhea

En este artículo se enfocará la diarrea aguda del adulto desde una perspectiva clínica, incorporando definiciones básicas de epidemiología, fisiopatología, enfrentamiento clínico, estudio cuando corresponda y tratamiento. Se presentarán nuevas herramientas diagnósticas basadas en biología molecular, de reciente introducción en clínica y que han significado un aporte en casos seleccionados. Además, se enfrentan situaciones especiales como la diarrea del viajero y de los pacientes inmunocomprometidos. La diarrea asociada a antibióticos se tratará en un artículo aparte.

In this article of acute diarrhea in adults, will present from a clinical perspective, including different basic definitions from epidemiology, pathophysiology, clinical approach, corresponding studies and treatment. It includes new diagnostic tools based on molecular biology, of recent use in medical practice, that have had a relevant effect in selected cases. It also includes special situations, such as traveler's diarrhea and immunosuppressed patients. We exclude from this article antibiotics-related diarrhea.