SELNET clinical practice guidelines for bone sarcoma.

Bone sarcoma are infrequent diseases, representing < 0.2% of all adult neoplasms. A multidisciplinary management within reference centers for sarcoma, with discussion of the diagnostic and therapeutic strategies within an expert multidisciplinary tumour board, is essential for these patients, given its heterogeneity and low frequency. This approach leads to an improvement in patient's outcome, as demonstrated in several studies. The Sarcoma European Latin-American Network (SELNET), aims to improve clinical outcome in sarcoma care, with a special focus in Latin-American countries. These Clinical Practice Guidelines (CPG) have been developed and agreed by a multidisciplinary expert group (including medical and radiation oncologist, surgical oncologist, orthopaedic surgeons, radiologist, pathologist, molecular biologist and representatives of patients advocacy groups) of the SELNET consortium, and are conceived to provide the standard approach to diagnosis, treatment and follow-up of bone sarcoma patients in the Latin-American context.

Derecho a la alimentación: ¿Qué dicen las constituciones de América y el Caribe?

RESUMEN Introducción: Numerosos países de América y el Caribe cuentan con el derecho constitucional a la Alimentación. Chile no cuenta con este derecho constitucionalizado. Objetivo: Describir comparativamente cómo se encuentra explícito el derecho a la alimentación (DA) en la Constitución de los países de América y el Caribe, generando insumos para aquellos países que no cuentan con este derecho explícito, como en Chile. Fuentes de datos: Esta búsqueda se realizó en las plataformas: Seguridad Alimentaria y Nutricional (SAN-CELAC), Derecho a la Alimentación en el Mundo (FAO) y Constitute Project que presenta las constituciones del mundo. Método de revisión: Se realizó una revisión todas las constituciones disponibles de los países independientes de América y el Caribe y de países con territorios dependientes y departamentos de ultramar en la Región. Posteriormente, en aquellos países que presentan el DA de forma explícita en su texto constitucional, se realizó una revisión sobre las características generales del texto constitucional y de los conceptos asociados a la definición del DA, sugeridos por la FAO. La revisión se llevó a cabo entre los meses de junio y septiembre de 2020. Resultados: Del total de los países revisados (n= 42), solo el 40,5% presentó el DA explícito en su texto constitucional. La seguridad alimentaria es el concepto que aparece con mayor frecuencia. Conclusión: La mayor parte de las constituciones acompañan el DA con características de seguridad alimentaria, disponibilidad y accesibilidad, e incluyen alguna forma de judicialización, conceptos que deberían ser incorporadas la nueva Carta Magna de Chile.

ABSTRACT Introduction: Many American and Caribbean countries consider the right to food as constitutional right. Chile does not have this explicit right in the Constitution. Objective: To describe comparatively how the right to food is explicit in the constitutions of American and Caribbean countries, generating inputs for those countries that do not have this constitutional right, such as the case of Chile. Data sources: This research was carried out on platforms: Food and Nutritional Security (SAN-CELAC), Right to Food in the World (FAO) and Constitute Project which presents constitutions of the world. Revision method: A revision was made of all available constitutions of American and independent Caribbean countries, dependent territories and overseas departments in the Region. Subsequently, in those countries which explicitly consider the right to food in constitutional texts, a review of general characteristics and right to food-associated concepts, suggested by FAO, was carried out. The review was carried out between June and September 2020. Results: Of the total of countries reviewed (n= 42), 40.5% presented the right to food in constitutional text. The most frequently associated concept was food security. Conclusion: Most of the revised constitutions accompany the right to food with food safety, availability and accessibility characteristics, and include kinds of judicialization, concepts that should be incorporated into the new Magna Carta of Chile.

Impact of the change of the Atalah standard cut-off point to classify underweight nutritional status during pregnancy

ABSTRACT Chile, and several Latin American countries, use the Atalah standard to assess nutritional status during pregnancy. However, this standard (underweight: pre-pregnancy body mass index (BMI)<20 kg/m2 and normal weight: pre-pregnancy BMI= 20-24.9 kg/m2) differ from those recommended by the US Institute of Medicine (IOM2009) (underweight: BMI<18.5 kg/m2 and normal weight: 18.5-24.9 kg/m2). Using a large population database from a Chilean public hospital, we compared the prevalence of underweight and normal weight at the beginning of pregnancy with Atalah and IOM2009 standards. Additionally, we evaluated the performance of both standards in detecting adverse neonatal outcomes and gestational weight gain. Methods: Data from clinical records of single birth pregnancies (n= 59,476) at the Sótero del Río Hospital, between 2003-2012 were collected. We compared 1. nutritional status, 2. proportion of excessive gestational weight gain, 3. association between nutritional status and neonatal outcomes (large/small for gestational age, low birth weight, preterm birth and macrosomia), using logistic regression models, and 4. Sensitivity, specificity, and predictive values to predict adverse neonatal outcomes per nutritional status. Results: Pre-pregnancy underweight decreased from 8.6% to 2.5% and women with BMI between 18.5-19.9kg/m2, who exceeded the recommended gestational weight gain increased from 32.7% to 49.2% when using IOM2009 instead of Atalah. Both standards showed low sensitivity, but the IOM2009 cut-off points showed better specificity for identifying healthy newborns. Conclusion: The cut-off points recommended by the IOM2009 better identify the prevalence of underweight and normal weight during pregnancy without increasing neonatal risk. This study supports the recent change of the Ministry of Health in adopting the WHO cut-off points during pregnancy.

RESUMEN Chile y diversos países Latinoaméricanos utilizan el estándar de Atalah para evaluar el estado nutricional (EN) durante el embarazo. Sin embargo, los puntos de corte de este estándar (bajo peso, BP: índice de masa corporal pre-gestacional (IMC)<20 kg/m2 y normal, NP: IMC pregestacional= 20-24,9 kg/m2) difieren de los recomendados por el Instituto de Medicina de EE.UU. (IOM2009) (BP: BMI<18.5kg/m2 and NP: 18,5-24,9 kg/m2). Con datos obtenidos desde el Hospital Sótero del Río, nosotros evaluamos la prevalencia de BP y NP al comienzo del embarazo con los estándares de Atalah e IOM2009. Adicionalmente, nosotros comparamos el comportamiento de ambos estándares en detectar resultados neonatales (RN) adversos y en la clasificación de la ganancia de peso gestacional (GPG). Métodos: Se obtuvieron datos de embarazos simples entre 2003-2012, (n= 59.476). Nosotros comparamos: 1. Prevalencia de EN, 2. Proporción de excesiva GPG, 3. Asociación entre EN y RN, usando modelos de regresión logística, y 4. Sensibilidad, especificidad y valores predictivos para predecir RN según EN. Resultados: La prevalencia de BP pregestacional disminuyó de 8,6% a 2,5% y las mujeres con IMC entre 18,5-19,9 kg/m2 que excedieron la GPG recomendada, incrementaron desde 33% a 50% cuando se utilizó el estándar IOM2009 en vez de Atalah. Ambos estándares mostraron baja sensibilidad, pero IOM2009 mostró mejor especificidad para identificar recién nacidos saludables. Conclusión: Estandar IOM2009 identifica con mayor precisión la prevalencia de BP y NP durante la gestación sin incrementar el riesgo neonatal. Este estudio respalda el reciente cambio del MINSAL al adoptar los puntos de corte de la OMS durante el embarazo.

Dermatomicosis superficiales: cuando el diagnóstico lo entrega la histología / Superficial dermatomycosis: when the diagnosis is provided by histology

Superficial dermatomycosis are prevalent pathologies in the medical field and their diagnosis is fundamentally clinical. Histopathology is not considered part of his study, however, the diagnosis is exceptionally obtained by biopsy, when dermatomycosis was not suspected. Unpublished retrospective work is carried out on patients who had the histopathological diagnosis of superficial dermatomycosis between the years 2000-2019 at the HCUCH, based on selection criteria, obtaining 19 patients, in which the following were analyzed: age, gender, clinical characteristics, location, presumptive diagnosis and mycological and histological examinations. He stressed, as was our hypothesis, that dermatomycosis was not clinically suspected, since the presumptive diagnoses were various dermatoses. The most suspected dermatosis was psoriasis, as a result that 57.8% of the dermatoses studied had erythematous scaly plaques on examination. Another relevant fact is that only 21% of the cases underwent a direct mycological prior to the biopsy, which was negative ('' false negative''). It is concluded, then, that superficial dermatomycosis should be considered clinical simulators of other dermatoses, so clinical suspicion and support of mycological examination and fungal culture is essential. (AU)

Comparison of bio-sociodemographic, obstetric and perinatal characteristics among immigrant and native women in the Metropolitan Region in Chile.

BACKGROUND: International migration is an increasing public health concern, particularly regard to maternal and neonatal health. OBJECTIVE: To compare obstetric and neonatal variables among native and immigrant childbearing women in a clinical hospital in Santiago, Chile. METHOD: A cross-sectional, analytic study with 2598 childbearing women and their newborn examined between January and July 2015. Data were collected from clinical records by students who had previously been trained. Ethical approval was obtained from the local Ethics Committee at the hospital. All participants signed an informed consent form. A descriptive and comparative analysis was performed. For comparison, a Chi-square test was used for categorical variables, and Student t-test was used for quantitative variables. RESULTS: Among the included women, 41.5% (n = 1078) were immigrants. The immigrants' mean age was 28.1 ±â€¯6.4 years, and that of natives was 26.8 ±â€¯6.9 (p < 0.001). Among natives, the obesity rate was 38.3%, as compared to 19.3% among immigrants (p < 0.001). A significantly higher rate of caesarean section was seen among natives (36.8%) than among immigrants (31.7%). Obstetric morbidity, pre-eclampsia, gestational diabetes and prematurity were significantly higher among natives. There was no difference regarding low birth weights. CONCLUSION: In general, immigrants present better maternal and neonatal indicators than native women. Controversially, this is known as the 'healthy immigrant' phenomenon in the literature.

Effectiveness of an Intervention of Dietary Counseling for Overweight and Obese Pregnant Women in the Consumption of Sugars and Energy.

OBJECTIVE: Evaluate if an intervention based on nutritional counseling decreases total sugars and energy consumption in overweight and obese pregnant women, compared to their previous consumption and compared to women who only received routine counseling. METHODS: Randomized study of two groups: dietary counseling (Intervention Group: IG) and routine counseling (Control Group: CG). The intervention consisted of three educational sessions focused on decreasing intake of foods that most contribute to sugars consumption. Changes in sugars and energy consumption were evaluated by a food frequency questionnaire before and after the intervention. RESULTS: We evaluated 433 pregnant women, 272 in IG and 161 in CG, who before intervention had a mean consumption of 140 g total sugars and 2134 kcal energy per day. At the end of the intervention, the IG showed 15 g/day lower consumption of total sugars (95% CI: -25 and -5 g/day), 2% less total energy from sugars (95% CI: -3% and -1% g/day), and 125 kcal/day less energy than the CG (95% CI: -239 and -10 kcal/day). Table sugar, sweets, and soft drinks had the greatest reduction in consumption. CONCLUSIONS: The intervention focused on counseling on the decrease in consumption of the foods that most contribute to sugars consumption in overweight and obese pregnant women was effective in decreasing total sugars and energy consumption, mainly in the food groups high in sugars. Future studies should examine if this intervention has an effect on maternal and fetal outcomes.

Association between preterm birth and its subtypes and maternal sociodemographic characteristics during the post-transitional phase in a developing country with a very high human development index.

OBJECTIVES: Chile is a post-transitional country evolving towards a stationary population pyramid, which may be associated with increasing preterm birth (PTB) rates. This study aimed to compare maternal sociodemographic characteristics between the start of the post-transition phase (1994) and an established stage (2013) and to evaluate associations between these characteristics and PTB. STUDY DESIGN: An observational analytic design was conducted using national birth records (n = 4,956,311). METHODS: Variables analysed in the 20 birth cohorts from 1994 to 2013 were: length of gestation (preterm <37 weeks) subdivided by gestational age (extreme, moderate/severe and late); maternal age (≤19, 20-35 and >35 years); education level (<8, 8-12 and >12 years of education); employment; marital status; area of residence; and type of birth (singleton, twins, and triplets or higher order). The prevalence of PTB was expressed as a percentage, and associations between PTB and predictor variables were analysed using logistic regression models. RESULTS: Education level, age >35 years, maternal employment, unmarried status, twin delivery and urban residency rates increased between 1994 and 2013. According to the adjusted models, age >35 years and delivery of more than two foetuses were risk factors for all PTB subtypes. Maternal employment was a risk factor for moderate/severe, late and total PTB, and a low level of education was a risk factor for late and total PTB. On the other hand, age ≤19 years was protective against all PTB subtypes. CONCLUSIONS: All maternal characteristics changed between 1994 and 2013. Furthermore, the prevalence of PTB increased for all predictor variables studied over this period.

Sarcoidosis subcutánea sin compromiso sistématico / Subcutaneous sarcoidosis without compromise systemic

We present the case of a 52 year old woman with a history of bilateral ovarian cancer operated. The patient attended the dermatology unit for a sudden onset of a left plantar nodule of three weeks of evolution, painful on walking, with no other history in particular. At physical examination, the patient presented a surface nodule slightly hyperpigmented, with ill-defined edges, round shape, firm consistency, mobile and painful to compression, one cm of diameter, in the middle third of the left plant. No concomitant scars are seen. Doppler soft tissue ultrasound is requested, showing a granulomatous nodule on the surface of the plantar aponeurosis. The biopsy lesion revealed non-caseating granulomas in cell tissue, PAS and Ziehl-Neelsen staining are negative A left plantar subcutaneous sarcoidosis is diagnosed, systemic involvement is ruled out. Within the first year of follow-up, there are no new lesions or findings compatible with systemic disease. (AU)

Caracterización de pacientes pediátricos usuarios de fototerapia en el Servicio de Dermatología, Hospital Clínico Universidad de Chile (2007-2015) / Characterization of pediatrics patients users of phototherapy in dermatology service, Hospital Clínico Universidad Chile (2007-2015)

Phototherapy is the use of specific wavelenghts of light that have shown effectiveness in the treatment of several cutaneous diseases. Current indications for phototherapy in Dermatology include multiple pathologies and it is considered to be costeffective. Literature about its use in children is rare, there are no studies on phototherapy in Chilean children. Patients and methods: Observational, descriptive, retrospective study. Clinical records of pediatric patients treated with phototherapy at University of Chile Clinical Hospital between 2007 and 2015, were studied. For each patient, the following parameters were analyzed: age of starting treatment, sex, skin phenotype, diagnosis, prescribed phototherapy and weekly frecuency. Results: 146 patients, 85 girls and 51 boys, average age 11.7 +/- 4.0 years. Predominant skin phenotype, was Fitzpatrick type III. Vitiligo was identified as the most common indication for phototherapy (52,2 percent), followed by psoriasis (22,6 percent). By a large margin, the most used type of phototherapy was nb UVB (96.6 percent). Most of the patients were treated twice per week (69.2 percent). Discussion: The obtained results in this group are similar to those results described in the international literature. Further studies are required for a better knowledge about efficacy and possible long-term effects of phototherapy on Chilean children.

Melanoma Maligno acral en Chile: análisis clínico e histopatológicode 70 casos en la población consultante de hospitales públicos en Santiago, Chile / Acral malignant melanoma in Chile: clinical and histopathological analysis of 70 cases in Santiago, Chile

En este trabajo se analizan las características clínico patológicas del MM Acral en población consultante de hospitales públicos, en los períodos 1992-2001 y 2005-2009. La muestra contó con 70 casos, de los cuales 51.4 por ciento correspondió a sexo femenino, la edad promedio de la muestra fue 66,6 años. Casi la totalidad de los MM acrales fueron de planta de pies (97.1 por ciento). Los diagnósticos de derivación, fueron MM en el 78.6 por ciento, seguido por otros diagnósticos (17.1 por ciento). El tipo clínico más frecuente fue melanoma nodular (31.4 por ciento). El tipo histológico más frecuente fue el melanoma invasivo (62.9 por ciento). El índice de Breslow más frecuente fue > 1.7 mm en el 52.9 por ciento. Este estudio es uno de los primeros sobre MM acral en población chilena, con resultados similares a lo publicado en la literatura internacional, sin embargo, destaca una edad promedio de diagnóstico más tardía y un porcentaje no menor de derivación con otro diagnóstico.

In this study we analyze the clinical and histopathological profile of acral MM in the population attending at state hospitals, during the periods (1992-2001) and (2005-2009). We analyzed 70 cases of acral MM, 51.4 percent were females, with average age of 66.6 years old. The majority of acral MM were located in soles (97.1 percent). The main clinical diagnosis was malignant melanoma (78.6 percent); however, a 17.1 percent of acral MM showed a different clinical diagnosis. The main clinical type of MM was Nodular Melanoma (31.4 percent). The most frequent histopathological type was invasive melanoma (62.9 percent). The most frequent Breslow thickness was > 1.7 mm (52,9 percent). This study is one of the first analyses of acral MM in the Chilean population, with similar results to the observed in the international literature; however, our patients presented an older average age of diagnosis and showed an important percentage of clinical diagnosis different to Malignant Melanoma.

Obesidad en mujeres chilenas en edad fértil / Prevalence of obesity among Chilean women in childbearing ages

Background: Women in childbearing ages (WCBA) represent a strategic intervention group to reverse the global trend of increasing obesity. Aim: To conduct a review of studies reporting obesity prevalence in WCBA in Chile in the last 25 years. Material and Methods: To describe obesity prevalence, we used three approaches, namely qualitative review of studies describing obesity prevalence in WCBA and a comparative study of the prevalence of obesity, overweight, abdominal and morbid obesity in WCBA from 2003 and 2009-10 National Health Surveys (ENS). Finally, nutrition status trends of pregnant women in the period 1987-2013 were plotted. Results: According to ENS, obesity prevalence exceeded 20% and excess weight 50%, both in 2003 and 2009-10 surveys. We found seven population studies, being difficult to compare them due to the heterogeneity of obesity definitions, design, and populations. Population studies showed that the prevalence of obesity increases along with age. The higher prevalence of obesity in WCBA aged 20 to 43 years was found in the city of San Carlos in 2007 (35.5%). The lowest was found in female university students, ranging from 0% to 5.9%. Obesity in pregnant women increased from 12.9% to 32.2% in the period 1987-2004 and from 20.3% to 26.3% in the period 2005-2013. Conclusions: There is a high and increasing prevalence of obesity among women in childbearing age, whether pregnant or not-pregnant.

[Prevalence of obesity among Chilean women in childbearing ages]. / Obesidad en mujeres chilenas en edad fértil.

BACKGROUND: Women in childbearing ages (WCBA) represent a strategic intervention group to reverse the global trend of increasing obesity. AIM: To conduct a review of studies reporting obesity prevalence in WCBA in Chile in the last 25 years. MATERIAL AND METHODS: To describe obesity prevalence, we used three approaches, namely qualitative review of studies describing obesity prevalence in WCBA and a comparative study of the prevalence of obesity, overweight, abdominal and morbid obesity in WCBA from 2003 and 2009-10 National Health Surveys (ENS). Finally, nutrition status trends of pregnant women in the period 1987-2013 were plotted. RESULTS: According to ENS, obesity prevalence exceeded 20% and excess weight 50%, both in 2003 and 2009-10 surveys. We found seven population studies, being difficult to compare them due to the heterogeneity of obesity definitions, design, and populations. Population studies showed that the prevalence of obesity increases along with age. The higher prevalence of obesity in WCBA aged 20 to 43 years was found in the city of San Carlos in 2007 (35.5%). The lowest was found in female university students, ranging from 0% to 5.9%. Obesity in pregnant women increased from 12.9% to 32.2% in the period 1987-2004 and from 20.3% to 26.3% in the period 2005-2013. CONCLUSIONS: There is a high and increasing prevalence of obesity among women in childbearing age, whether pregnant or not-pregnant.