An inactivated SARS-CoV-2 vaccine is safe and induces humoral and cellular immunity against virus variants in healthy children and adolescents in Chile

BackgroundMultiple vaccines against SARS-CoV-2 have been evaluated in clinical trials, but very few include the pediatric population. The inactivated vaccine CoronaVac(R) has shown to be safe and immunogenic in a phase 1/2 clinical trial in a pediatric cohort in China. This study is an interim safety and immunogenicity report of a phase 3 clinical trial for CoronaVac(R) in healthy children and adolescents in Chile. MethodsParticipants aged 3 to 17 years old received two doses of CoronaVac(R) in a four-week interval. Local and systemic adverse reactions were registered in 699 participants that received the first dose and 381 that received the second dose until December 31st, 2021. Whole blood samples were collected from 148 participants for humoral and cellular immunity analyses. ResultsThe primary adverse reaction reported after the first and second dose was pain at the injection site. The adverse reactions observed were primarily mild and local, and no severe adverse events were reported. Four weeks after the second dose, a significant increase in the levels of total and neutralizing antibodies was observed. Increased activation of specific CD4+ T cells was also observed four weeks after the second dose. Although antibodies induced by vaccination neutralize variants Delta and Omicron, titers were lower than the D614G variant. Importantly, comparable T cell responses were detected against these variants of concern. ConclusionsCoronaVac(R) is safe and immunogenic in subjects aged 3-17 years old and is thus likely to confer protection against infection caused by SARS-CoV-2 variants in this target population.

Safety and efficacy of two immunization schedules with an inactivated SARS-CoV-2 vaccine in adults. A randomized non-inferiority clinical trial.

BackgroundSeveral vaccines have been developed to control the COVID-19 pandemic. CoronaVac(R) (Sinovac Life Sciences), an inactivated SARS-CoV-2 vaccine, has demonstrated safety and immunogenicity in previous studies, preventing severe COVID-19 cases. We further investigated the safety and efficacy of two immunization schedules of CoronaVac(R) in a non-inferiority trial in healthy adults. MethodsThis is a multi-center and randomized clinical trial. Healthy adults were enrolled at eight centers in Chile. Participants were randomly assigned to two vaccination schedules, receiving two doses with either 14 (0-14) or 28 (0-28) days between each. 2302 participants were vaccinated. The primary safety and efficacy endpoints were solicited adverse events (AE) within 7 days after each dose and compared the number of cases of SARS-CoV-2 infection 14 days after the second dose between schedules, respectively. FindingsThe most frequent local AE was pain at the injection site, which was less frequent in participants aged [≥]60 years. Other local AEs were reported in less than 5% of participants. The most frequent systemic AEs were headache, fatigue, and myalgia. The remaining AEs were minor allergic reactions and fever. Most AEs were mild and transient. There were no significant differences for local and systemic AE between schedules. No anaphylactic reactions or vaccine-related severe AEs were observed. 58 COVID-19 cases were confirmed, and all but two of them were mild. No differences were observed in protection between schedules. InterpretationCoronaVac(R) is safe, especially in [≥]60 years-old participants. Both schedules protected against COVID-19 hospitalizations. FundingMINSAL, Chile, CPC & IMII, Chile. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSCoronaVac(R) (an inactivated SARS-CoV-2 vaccine) was approved on June 1st, 2021, by the WHO for its use in humans. Sinovac Life Sciences generated this vaccine in China and conducted phase 1/2 trials. Good safety, efficacy, and immunogenicity profiles were reported. The results from this study led to the use of CoronaVac(R) in other countries, such as Brazil, Turkey, and Chile, with phase 3 trials being held on them. Added-value of this studyThis work compares the safety and efficacy of two immunization schedules with CoronaVac(R), with each dose administrated two or four weeks after the first dose on healthy Chilean adults. To date, no studies showing the safety and efficacy of these two immunization schedules with CoronaVac(R) in healthy adults in a population other than the Chinese have been published. We show that CoronaVac(R) is safe and prevents hospitalization due to COVID-19 in both immunization schedules. No differences were found in the incidence of adverse events between both schedules, and no related severe adverse events were reported. These results give further insight into the immune response induced by CoronaVac(R) and are relevant when deciding on the immunization schedule chosen for vaccination. Implications of all the available evidenceThe data reported here show that using either immunization schedule with two doses of CoronaVac(R) protects against SARS-CoV-2. The data also indicate that CoronaVac(R) does not induce severe adverse events in either immunization schedule, and the adverse events registered are mild and transient, confirming the safety of this vaccine.

Interim Report: Safety And Immunogenicity Of An Inactivated Vaccine Against Sars-Cov-2 In Healthy Chilean Adults In A Phase 3 Clinical Trial

BackgroundThe ongoing COVID-19 pandemic has had a significant impact worldwide, with an incommensurable social and economic burden. The rapid development of safe and protective vaccines against this disease is a global priority. CoronaVac is a vaccine prototype based on inactivated SARS-CoV-2, which has shown promising safety and immunogenicity profiles in pre-clinical studies and phase 1/2 trials in China. To this day, four phase 3 clinical trials are ongoing with CoronaVac in Brazil, Indonesia, Turkey, and Chile. This article reports the safety and immunogenicity results obtained in a subgroup of participants aged 18 years and older enrolled in the phase 3 Clinical Trial held in Chile. MethodsThis is a multicenter phase 3 clinical trial. Healthcare workers aged 18 years and older were randomly assigned to receive two doses of CoronaVac or placebo separated by two weeks (0-14). We report preliminary safety results obtained for a subset of 434 participants, and antibody and cell-mediated immunity results obtained in a subset of participants assigned to the immunogenicity arm. The primary and secondary aims of the study include the evaluation of safety parameters and immunogenicity against SARS-CoV-2 after immunization, respectively. This trial is registered at clinicaltrials.gov (NCT04651790). FindingsThe recruitment of participants occurred between November 27th, 2020, until January 9th, 2021. 434 participants were enrolled, 397 were 18-59 years old, and 37 were [≥]60 years old. Of these, 270 were immunized with CoronaVac, and the remaining 164 participants were inoculated with the corresponding placebo. The primary adverse reaction was pain at the injection site, with a higher incidence in the vaccine arm (55.6%) than in the placebo arm (40.0%). Moreover, the incidence of pain at the injection site in the 18-59 years old group was 58.4% as compared to 32.0% in the [≥]60 years old group. The seroconversion rate for specific anti-S1-RBD IgG was 47.8% for the 18-59 years old group 14 days post immunization (p.i.) and 95.6% 28 and 42 days p.i. For the [≥]60 years old group, the seroconversion rate was 18.1%, 100%, and 87.5% at 14, 28, and 42 days p.i., respectively. Importantly, we observed a 95.7% seroconversion rate in neutralizing antibodies for the 18-59 years old group 28 and 42 days p.i. The [≥]60 years old group exhibited seroconversion rates of 90.0% and 100% at 28 and 42 days p.i. Interestingly, we did not observe a significant seroconversion rate of anti-N-SARS-CoV-2 IgG for the 18-59 years old group. For the participants [≥]60 years old, a modest rate of seroconversion at 42 days p.i. was observed (37.5%). We observed a significant induction of a T cell response characterized by the secretion of IFN-{gamma} upon stimulation with Mega Pools of peptides derived from SARS-CoV-2 proteins. No significant differences between the two age groups were observed for cell-mediated immunity. InterpretationImmunization with CoronaVac in a 0-14 schedule in adults of 18 years and older in the Chilean population is safe and induces specific IgG production against the S1-RBD with neutralizing capacity, as well as the activation of T cells secreting IFN-{gamma}, upon recognition of SARS-CoV-2 antigens. FundingMinistry of Health of the Chilean Government; Confederation of Production and Commerce, Chile; Consortium of Universities for Vaccines and Therapies against COVID-19, Chile; Millennium Institute on Immunology and Immunotherapy.

Impact of the home confinement related to COVID-19 on the device-assessed physical activity and sedentary patterns of Spanish older adults

ObjectivesThe main objective of this study was to device-assess the levels of physical activity and sedentary behaviour patterns of older adults during the situation prior to COVID-19 pandemic, home-quarantine and the ending of isolation. We also aimed analysing the effectiveness of an unsupervised home-based exercise routine to counteract the potential increase in sedentary behaviour during the periods within the pandemic. Methods18 non-institutionalized elderly (78.4{+/-}6.0 y.), members of the Spanish cohort of EXERNET-Elder 3.0 project participated in the study. They were recommended to perform an exercise prescription based on resistance, balance and aerobic exercises during the pandemic. Wrist triaxial accelerometers (ActiGraph GT9X) were used to assess the percentage of sedentary time, physical activity and sedentary bouts and breaks of sedentary time. An ANOVA for repeated measures was performed to analyse the differences between the three different periods. ResultsDuring home-quarantine, older adults spent more time in sedentary behaviours (71.6{+/-}5.3%) in comparison with either the situation prior to the pandemic (65.5{+/-}6.7%) or the ending of isolation (67.7{+/-}7.1%) (all p<0.05). Moreover, participants performed less bouts of physical activity and with a shorter duration during home quarantine (both p<0.05). Additionally, no differences in the physical activity behaviours were found between the situation prior to the pandemic and the ending of isolation. ConclusionsAccording with our results, the home-quarantine could negatively affect health due to increased sedentary lifestyle and the reduction of physical activity. Therefore, our unsupervised exercise program does not seem to be a completely effective strategy at least in this period. What is already known on this topicO_LIAlthough the available information is scarce and includes subjective methodology (questionnaires), it seems that the COVID-19 pandemic has negatively affected physical activity patterns. C_LIO_LIIt is known that physical activity interventions are effective in improving health and reducing sedentary lifestyle in older adults. Nevertheless, little is known about whether an unsupervised home-based exercise routine is an effective alternative to counteract the potential increase in sedentary behaviour in this specific population during the pandemic lockdown. C_LI What are the findings? / What this study addsO_LIDespite unsupervised training, during home-quarantine, older adults spent more sedentary time than in the situation prior to COVID-19 and the ending of isolation (phase 0). C_LIO_LIThere were no differences in break of sedentary time patterns between the situation prior to COVID-19 and the periods within the pandemic. C_LIO_LIDuring home-quarantine older adults performed fewer and shorter physical activity bouts than in the situation prior to COVID-19 despite unsupervised training. C_LIO_LIOur unsupervised home-exercise routine was not a completely effective alternative to avoid the increase of sedentary behaviour during home-quarantine. C_LI How might it impact on clinical practice in the future?O_LIOur findings can be used as a starting point to manage isolation restrictions more effectively and to develop strategies to promote physical activity and reduce sedentary behaviour among older adults during situations of forced lockdowns, as in the present COVID-19 pandemic. C_LI

Which states and cities protect residents from water shutoffs in the COVID-19 pandemic?

Many U.S. states and cities have imposed water disconnection moratoriums during the COVID-19 pandemic. Using logistic and Cox Proportional-Hazards models, we assess factors that differentiate which governments imposed moratoriums. States, which have economic regulation of private water utilities, were more likely to impose moratoriums, and those with higher COVID-19 case rates imposed moratoriums earlier. States with unified Republican Control and cities with more 2016 Trump voters were less likely to impose moratoriums on water disconnection. Cities in states without statewide moratoriums, were more likely to impose moratoriums if they had higher income, more minority residents, and more income inequality.

Comparing the Personality Traits of Patients with an Eating Disorder versus a Dual Diagnosis.

Objectives: This cross-sectional study explored personality traits of individuals receiving treatment in a private clinic for an eating disorder (ED) compared to those receiving treatment for a dual diagnosis (DD; defined as an addiction to illegal drugs and/or alcohol along with a mental illness, in this case an ED). The aims of this study were to: (a) assess the personality profiles and differentiating traits between the ED and DD groups, (b) analyze differences in personality traits of restrictive ED versus bingeing ED profiles, and lastly (c) compare the individuals Temperament and Character Inventory-Revised (TCI-R) results to their personality clusters as per the Diagnostic and Statistical Manual of Mental Disorders - 5th edition (DSM-5). Methods: The TCI-R is a self-report questionnaire consisting of seven scales, each with their own subscales, which provide a fuller understanding of each temperament and character trait evaluated. This questionnaire was given to patients (n = 67) receiving treatment at a private institute specialized in eating disorders in Barcelona, Spain and the surrounding areas, along with the State-Trait Anxiety Inventory (STAI), Beck Depression Inventory-II (BDI-II), and the Barratt Impulsiveness Scale-11 (BIS-11). These subsequent questionnaires were given as they are often found to be comorbidities of ED. Results: The ED group (n = 41), regarding the TCI-R scales, showed higher scores in harm avoidance (HA), reward dependence (RD), persistence (P), cooperativeness (C) and self-directedness (SD). Whereas, the DD (n = 26) group, showed higher scores in novelty seeking (NS) and self-transcendence (ST). Also, there was a significant positive correlation between the DD group and the extravagance (NS3) subscale of novelty seeking across models. When comparing the two ED groups, the restrictive profile (RP) to the bingeing profile (BP), there were significant negative correlations in the TCI-R subscales of dependence (RD4) and perfectionism (P4) whereas there were positive correlations in the TCI-R subscale of responsibility (SD1). Conclusions: These results support previous studies and help to appraise differences in personality traits between specific groups in a clinical setting.

Thorax masculinization in a transsexual patient: Inferior pedicle mastectomy without an inverted T scar.

Transsexual individuals with gender dysphoria or gender identity disorder are rare, with a prevalence reported to range from 0.002% to 0.014%. Studies have shown that mastectomy yields significant improvements in body image and self-esteem in female-to-male transsexual patients. In patients with grade III breast ptosis, mastectomy with a nipple-areolar complex (NAC) graft is the most commonly used technique, although it has several disadvantages. In the case described herein, a bilateral mastectomy preserving the NAC in an inferior pedicle was performed. Additionally, a thin superior thoracic dermal-fat flap was preserved and eventually sutured at the previous inframammary fold, preventing an inverted T scar. This case shows the advantage of this technique for preserving the blood supply and innervation of the NAC, with a low hypopigmentation risk. Furthermore, in this technique, the patch effect does not impair the results of the NAC graft, and there is no need to use an inverted T scar that may result in thoracic feminization.

Thorax masculinization in a transsexual patient: Inferior pedicle mastectomy without an inverted T scar

Transsexual individuals with gender dysphoria or gender identity disorder are rare, with a prevalence reported to range from 0.002% to 0.014%. Studies have shown that mastectomy yields significant improvements in body image and self-esteem in female-to-male transsexual patients. In patients with grade III breast ptosis, mastectomy with a nipple-areolar complex (NAC) graft is the most commonly used technique, although it has several disadvantages. In the case described herein, a bilateral mastectomy preserving the NAC in an inferior pedicle was performed. Additionally, a thin superior thoracic dermal-fat flap was preserved and eventually sutured at the previous inframammary fold, preventing an inverted T scar. This case shows the advantage of this technique for preserving the blood supply and innervation of the NAC, with a low hypopigmentation risk. Furthermore, in this technique, the patch effect does not impair the results of the NAC graft, and there is no need to use an inverted T scar that may result in thoracic feminization.

Associations between insulin resistance and three B-vitamins in European adolescents: the HELENA study / Asociaciones entre la resistencia a la insulina y tres vitaminas del grupo B en adolescentes europeos: el estudio HELENA

Objective: To assess whether adolescents with high body mass index (BMI), or fat mass index (FMI), in combination with insulin resistance (assessed with the Homeostatic Model Assessment [HOMA] index), had also lower blood vitamin B6, folate and vitamin B12 concentrations. Methods and materials: Six hundred and fifteen adolescents from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, with data on B-vitamins (both intakes and status), and BMI, FMI, HOMA, were selected. Intakes were assessed by two non-consecutive 24-h recalls. B-vitamins biomarkers were measured by chromatography and immunoassay. Analysis of covariance was applied to elucidate the differences in B-vitamins between combinations of groups defined according to the median of the z-scores of markers of body composition and insulin sensitivity. Results: When considering energy intakes and education of the mother in the model, in females, vitamin B6 intakes were higher in the high BMI/ high HOMA group than in the high BMI-low HOMA group. Similarly, vitamin B6 intakes were higher in the high FMI/high HOMA group than in the low FMI/low HOMA group. Plasma vitamin B12 was significantly lower in males in the high FMI/high HOMA group than in the low FMI/low HOMA group, keeping also significant their trends throughout the groups, a fact that can be observed also for females (p < 0.05). Conclusion: Adolescents with combined higher adiposity and higher HOMA insulin sensitivity showed lower vitamin B12 plasma concentrations. These differences do not seem to be explained by dietary vitamin B12 intake (AU)

Objetivo: evaluar si los adolescentes con mayor índice de masa corporal (IMC), o de masa grasa (IMG), en combinación con la resistencia a la insulina (medida con el Modelo de Valoración Homeostática [índice HOMA]), ingieren y tienen valores más bajos de vitamina B6, folato y vitamina B12. Métodos y materiales: seiscientos quince adolescentes participantes en el estudio Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA), con valores de ingesta y concentraciones de las vitaminas B6, folato y B12, e IMC, IMG y HOMA, fueron seleccionados. Las ingestas se midieron mediante dos recuerdos de 24 horas no consecutivos. Los biomarcadores de las vitaminas fueron obtenidos mediante cromatografía e inmunoensayo. Se aplicó el análisis de la covarianza para evaluar las diferencias entre las vitaminas (ingesta y concentraciones) entre las combinaciones de los grupos definidos según las medianas de los valores z de los marcadores de la composición corporal y de la sensibilidad a la insulina. Resultados: considerando la ingesta energética y la educación de la madre en el modelo en chicas, las ingestas de vitamin B6 fueron mayores en el grupo de mayor IMC/mayor HOMA que en el grupo mayor IMC/menor HOMA. Del mismo modo, el grupo constituido por mayor IMG/mayor HOMA presentó mayores ingestas de esta vitamina que el grupo formado por la combinación entre menor IMG/menor HOMA. La vitamina B12 plasmática en chicos fue significativamente menor en el grupo formado por mayor IMG/mayor HOMA que en el grupo menor IMG/menor HOMA, manteniendo también la tendencia significativa en los grupos, lo que también se puede observar en las chicas (p < 0.05). Conclusiones: los adolescentes con mayor adiposidad en combinación con una mayor sensibilidad a la insulina mostraron menores valores de vitamina B12 plasmática. Estas diferencias no parecen estar explicadas por diferencias en la ingesta de vitamina B12 (AU)

Evaluation of the Antioxidant and Antiproliferative Effects of Three Peptide Fractions of Germinated Soybeans on Breast and Cervical Cancer Cell Lines.

Soybeans are an important source of bioactive molecules, such as peptides, which generation can improve through germination. In this study, the antioxidant and antiproliferative activities of three peptide fractions (>10 kDa, 5-10 kDa and <5 kDa) that were obtained by ultrafiltration of soybean protein hydrolysate after six days of germination were evaluated. The antioxidant activities of the peptide fractions were assessed by reducing power, Cu+2 and Fe+2 chelation and OH· scavenging assays, whereas their antiproliferative effects against cervical (HeLa, SiHa, CasKi) and breast (MCF7 and MDA-MB-231) cancer cell lines were evaluated by the MTT assay. Apoptosis was determined by Hoechst-PI staining. The most active peptide fraction (MAPF) was the >10 kDa fraction, which showed the greatest antioxidant and antiproliferative activity. The most sensitive cancer cell lines were the HeLa, CasKi and MDA-MB-231 cells, which had IC50 values of 16.2, 14.3 and 15.2 mg/mL, respectively, and apoptotic indices above 50 % after 6 or 8 h of exposure. The effect of MAPF on normal cells (HaCaT) was minimal. The amino acid composition of MAPF was characterized by high proline, phenylalanine and tyrosine content, and MALDI-TOF/TOF analysis showed six signals with molecular weights of 12 to 42 kDa.

Inimputabilidad por trastornos mentales en el sistema legal / Criminal responsibility by mental disorders in the legal system

Resumen:El código penal costarricense admite la posibilidad de eximir de responsabilidad penal a los individuos que presentan algún trastorno mental en el momento del acto delictivo. La psiquiatría forense tiene como uno de usus fines determinar el grado de imputabilidad de todo sujeto a quien se le presuma afectado de enfermedad psíquica. La intervención es objetiva y esto se consigue a través de la entrevista y el examen del estado mental del sujeto. Durante el interrogatorio se evalúa la conciencia, la lucidez, el raciocinio, el jucio y la impulsividad. Se han determinado enfermedades que se excluyen de responsabilidad penal total o parcial como la esquizofrena, la paranoia en forma de delirio y la epilepsia en sus diferentes variables. Asimismo, se hace referencia al trastorno mental transitorio (TMT) que se da cuando el curso de la alteración implica un estado de recuperación de las facultades mentales superiores y el acusado puede retornar a una condición de normalidad psíquica.

Abstract:Costa Rica's penal code allows the possibility of exempting from criminal responsibility to individuals who have a mental disorder at the time of the criminal act. Forensic psychiatry aims to determine the degree of accountability of every person who is presumed will be affected by mental illness. The intervention is objective and this is achieved through the interview and mental exam. At the examination, the professional has to evaluate consciousness, lucidity, reasoning, judgment and impulsiveness. There are certain diseases that are excluded from total or partial criminal liability as different variables of schizophrenia, paranoia, delirium and epilepsy. In addition, referring to transient mental disorder (TMD), it occurs when the course of the alteration involves a recovery state of the mental faculties and the person can return to a normal mental condition.

Hepatotoxicidad por sustancias de origen botánico / Hepatotoxicity substances of botanical origin

Existe un interés creciente en prevenir la enfermedad y mejorar la salud, por lo que se han desarrolladosuplementos nutricionales percibidos por la población como inofensivos, sin embargo, las plantas son productorasde sustancias químicas que pueden inducir a daño hepático. Los suplementos usados para fisicoculturismo yreducción de peso son los productos naturales que más han reportado hepatotoxicidad en los últimos tiempos.El diagnóstico de la lesión hepática asociado a productos naturales debe hacerse de forma sistematizada ydebe incluir información sobre el inicio del consumo del producto natural, el periodo de tratamiento y el periodode latencia. Comúnmente, el cuadro clínico es agudo y los síntomas en su mayoría son inespecíficos. Se handefinido criterios de hepatotoxicidad a través de la medición de los niveles de la alanina aminotransferasa (ALT)y la fosfatasa alcalina (FA) y la relación entre estas dos variables. Con la cesación del agente implicado, lossignos clínicos generalmente ceden y se da una marcada disminución de los niveles de las enzimas hepáticas. Lapositividad de la reexposición no intencionada del producto es el gold standard para confirmar la hepatotoxicidadpor sustancias naturales. No existen hallazgos histológicos específicos de lesión hepática, por lo que la biopsiano forma parte de los algoritmos para diagnósitico. Con el fin de objetivizar la valoración de efectos adversos seutiliza la escala de CIOMS/RUCAM (Council for International Organizations of Medical Sciences/Roussel UclafCausality Assesment Method) que permite determinar la probabilidad de lesión hepática secundaria al producto.Además de la hepatotoxicidad directa producida por sustancias de origen botánico, se han descrito interaccionesentre medicamentos convencionales y los productos herbales, por lo que el médico tratante debe indagar sobreel uso de estos productos...

here is a growing interest in prevention of diseases and improvement of health. That is why nutritional supplementshave been developed and perceived by people as harmless, but plants produce chemical substances that can leadto liver damage. The supplements used for bodybuilding and weight reduction constituted the most common naturalproducts accounting for hepatotoxicity in last times. The diagnosis of liver injury associated to natural productsshould be done in a systematic way and should include information about the first use of the substance, the treatmentperiod and latency. Commonly, the clinic is an acute condition with nonspecific symptoms. The measurement oflevels of alanine aminotransferase (ALT), alkaline phosphatase (PA) and relationship between these variables serveas criteria of liver injury. With cessation of the agent involved, clinical signs usually yield and there is a markeddecrease in the liver biomarkers levels. Positive results for no intentional reexposure is the gold standard to confirmhepatotoxicity to natural substances. There are no specific histologic findings for liver damage, so biopsy cannotbe used for diagnosis. In order to objectify the adverse effects we use the CIOMS/RUCAM Scale (Council forInternational Organizations of Medical Sciences/ Roussel Uclaf Causality Assesment Method). In addition to thepotential for direct hepatotoxicity, some of the herbs may have interactions with certain prescription medications, sophysicians should ask for using natural products and prevention of concomitant use...

Abordaje del abuso sexual infantil: combatiendo la revictimizacion / Addressing child sexual abuse: fighting revictimization

Cuando el médico tiene poca experiencia o no suele enfrentarse a este tipo situaciones, el diagnóstico de abuso sexual es difícil y cuando es un niño o una niña es aún más complicado. En la dinámica de estos eventos intervienen diversos factores. Al evaluar al niño o niña afectada es indispensable evitar la revictimización, que al tomar lugar se convierte en una nueva agresión, para lograr lo anterior se requiere que sea un equipo interdisciplinario y con experiencia, el que lleve a cabo la evolución. Se debe evitar la duplicación de interrogatorios, entrevistas y exploración física. En los casos de abuso crónico, se puede prescindir del examen físico. La relación predominante en los casos de abuso es la de padre e hija y el tipo de agresión más frecuente es el tocamiento en casi el 90% de los casos. Premisa que nos lleva a considerar que es frecuente encontrar el área genito-anal totalmente indemne durante la exploración física. Las consecuencias de sucesos como estos dependerán del apoyo familiar, el grado de culpabilidad que se genere en el niño y del abordaje y las estrategias que se pongan en marcha para enfrentar la agresión.

When the doctor has little experience, the diagnosis of sexual abuse is difficult and when the victim is a child, is even more complicated. The dynamic of these events involved several factors. When assessing the affected youth it is essential to avoid re-victimization, which becomes a new aggression. In order to achieve this is required an interdisciplinary and experienced team to develop the analysis. Avoid duplication of interrogations, interviews and physical examination. In cases of chronic abuse, the physicians can dispense physical examination. The predominant relationship in cases of abuse is father and daughter and the most frequent type of aggression is touching, almost in 90% of cases. Reason why is not uncommon to get no abnormal findings in physical examination. The consequences of these kinds of events will depend on family support, the degree of culpability that is generated on the child and the approach and the implemented strategies to deal with aggression.

Spectrum of Clostridium difficile infections: Particular clinical situations.

Incidence, pathogenesis, diagnostic techniques and therapeutic management of CDI have prompted abundant and adequate recent literature. However, report on clinical manifestations of CDI is frequently biased by the type of patients selected, the retrospective nature of many papers, the epidemic or endemic characteristics of the population reported. This article seeks to review some less discussed clinical and epidemiological aspects of CDI trying to include the clinical manifestations of this disease in unselected populations and also including discussion of CDI in specific groups of patients such as patients without colon and rectum, pediatric and critical care patients.

Improved Sepsis Alert With a Telephone Call From the Clinical Microbiology Laboratory: A Clinical Trial.

Early sepsis attention is a standard of care in many institutions and the role of different specialists is well recognized. However, the impact of a telephone call from a specialist in Clinical Microbiology upon blood cultures request has not been assessed to the best of our knowledge. We performed telephone calls followed by an interview with physicians and nurses in charge of adult patients (> 18 years old) whose blood cultures had just been received in the Microbiology Laboratory in a tertiary hospital. Patients were randomly classified in 2 different groups: group A (telephone call performed) and group B (no telephone call). At the end of the telephonic intervention, recommendations on the use of microbiology and biochemical tests as well as on the management and antibiotic therapy of sepsis were made if required. We included 300 patients. Of those fulfilling standard criteria of sepsis, 30.3% of the nurses and 50% of the physicians immediately recognized it. Advice to optimize the use of biochemical and microbiological tests was provided in 36% of the cases and to improve antimicrobial therapy in 57.6%. The median number of days of antibiotic use in groups A and B were, respectively, 6 days (IQR: 2-12) vs 9 days (IQR: 4-16) P = 0.008 and the median number of prescribed daily doses of antimicrobials (6 [IQR: 3-17] vs 10 [IQR: 5-22] P = 0.016) were lower in group A. We estimate a reduction, only in the use of antibiotic, of 1.8 million Euros per year. A telephone call with management advice, immediately after the arrival of blood cultures in the Microbiology Laboratory improves the recognition of sepsis and the use of diagnostic resources and reduces antimicrobial consumption and expenses.

Genotoxicity of glyphosate assessed by the comet assay and cytogenetic tests.

It was evaluated the genotoxicity of glyphosate which up to now has heterogeneous results. The comet assay was performed in Hep-2 cells. The level of DNA damage in the control group (5.42±1.83 arbitrary units) for tail moment (TM) measurements has shown a significant increase (p<0.01) with glyphosate at a range concentration from 3.00 to 7.50mM. In the chromosome aberrations (CA) test in human lymphocytes the herbicide (0.20-6.00mM) showed no significant effects in comparison with the control group. In vivo, the micronucleus test (MNT) was evaluated in mice at three doses rendering statistical significant increases at 400mg/kg (13.0±3.08 micronucleated erythrocytes/1000 cells, p<0.01). In the present study glyphosate was genotoxic in the comet assay in Hep-2 cells and in the MNT test at 400mg/kg in mice. Thiobarbituric acid reactive substances (TBARs) levels, superoxide dismutase (SOD) and catalase (CAT) activities were quantified in their organs. The results showed an increase in these enzyme activities.

Influencia de la tiroiditis linfocitaria crónica en el pronóstico de pacientes con carcinoma papilar de tiroides / Influence of chronic lymphocytic thyroiditis on the prognostic outcome of patients with papillary thyroid carcinoma

Introducción: Algunos estudios atribuyen a la tiroiditis linfocitaria crónica (TLC) asociada al carcinoma papilar de tiroides (CPT) un efecto protector o de buen pronóstico; otros sugieren que sería un factor de riesgo para el desarrollo de recurrencias. Objetivo: Determinar la influencia de la TLC en el pronóstico de pacientes con CPT. Métodos: De un total de 406 CPT operados por un mismo cirujano (JLN), se seleccionaron 140 CPT que cumplieron los siguientes criterios de inclusión: pacientes operados con tiroidectomía total con criterio curativo y diagnóstico histológico de CPT variedad usual, sin tratamientos quirúrgicos previos y con seguimiento mínimo de 5 años. El diagnóstico de CPT y TLC lo realizó un mismo anatomopatólogo. Se definieron como factores de mal pronóstico, la edad ?45 años, el sexo masculino, los tumores grandes (>40 mm), los ganglios metastásicos al momento del diagnóstico de CPT, la multifocalidad tumoral y la invasión extratiroidea. Resultados: Se diagnosticaron histológicamente 51 (36.4%) CPT asociados con TLC y 89 (63.6%) sin TLC. Ninguno de los factores considerados mostró diferencias estadísticamente significativas entre los pacientes con y sin TLC (P=NS). Las tasas de recurrencia (3.6%) y muerte (2.1%) también fueron similares en ambos grupos (P=NS). Conclusión: La coexistencia de CPT y TLC es elevada y concordante con algunas publicaciones, pero la TLC no produjo ningún impacto sobre el pronóstico (recurrencia) de los pacientes. Aquellos que recurrieron y fallecieron presentaron 3 o más factores de mal pronóstico, sin que la TLC fuese un factor determinante del pronóstico.

Introduction: Some articles attribute a protect effect of chronic lymphocytic thyroiditis (CLT) on the prognostic outcome of patients with papillary thyroid carcinoma (PTC); others suggest it as a risk factor of PTC recurrences. Objective: To determine the influence of CLT on the prognostic outcome of patients with PTC. Methods: From 406 PTC patients surgically treated by a same surgeon (JLN), which received radioactive iodine ablative dosis, 140 PTC patients were selected that followed the following criteria: patients who underwent a total thyroidectomy for curative purpose, with histological diagnosis of pure PTC, without previous related surgeries, with a minimal 5-year follow-up. PTC and CLT histological diagnosis were performed by a same pathologist. Bad prognosis factors were defined: ?45 years old, male sex, big tumors (>40 mm), metastatic nodes at PTC diagnosis, multifocality and extrathyroideal extension. Results: 51 (36.4%) were found associated with CLT and 89 (63.6%) showed only pure PTC. No factors showed significantly statistical differences between patients with and without CLT (P=NS). Recurrence (3.6%) and death (2.1%) rates were similar in both groups, too (P=NS). Conclusion: Coexistence of CLT and PTC is high and it coincides with other experiences, but CLT did not cause any impact on the prognostic outcome (recurrence and/or death) of patients with PTC. Patients who had recurrence or died showed at least three risk factors, but CLT did not a bad prognosis factor.

Effect of a Psidii guajavae folium extract in the treatment of primary dysmenorrhea: a randomized clinical trial.

OBJECTIVE: To assess the efficacy of two different doses of a Psidii guajavae folium extract in the management of primary dysmenorrhea. METHODOLOGY: A double-blinded randomized clinical trial was conducted in 197 women with primary dysmenorrhea. Four intervention groups were defined: two extract doses (3 and 6 mg/day); ibuprofen (1200 mg/day); placebo (3mg/day). Participants were followed-up individually for 4 months. The main outcome variable was abdominal pain intensity measured according to a visual analogue scale (VAS). RESULTS: The average age of participants was 19 years; menarche occurred around age 12 years. Participants had menstrual cycles of 28 or 29 days, with menstruation lasting 5 days and mean of pain intensity of 8.2 on the VAS. During each successive treatment cycle, participants experienced a lower pain intensity score. Multiple regression analysis, after adjusting each cycle for baseline pain, treatment compliance and other variables, showed that the group receiving 6 mg/day extract had significantly reduced pain intensity (p<0.001). This effect was maintained in cycles 2 and 3, although the reduction in the mean of pain intensity was lower. The group receiving the 3mg/day extract did not show a consistent effect throughout the three cycles. CONCLUSION: At a dose of 6 mg/day, the standardized phyto-drug (Psidii guajavae folium extract) reduced menstrual pain significantly compared with conventional treatment and placebo.