Observational analysis of clinical and pathological characteristics and their prognostic impact in Mexican patients with breast cancer: A multi-center study.

Breast cancer is the most incidental and deadly neoplasm worldwide; in Mexico, very few epidemiologic reports have analyzed the pathological features and its impact on their clinical outcome. Here, we studied the relation between pathological features and the clinical presentation at diagnosis and their impact on the overall and progression-free survival of patients with breast cancer. For this purpose, we collected 199 clinical records of female patients, aged at least 18 years old (y/o), with breast cancer diagnosis confirmed by biopsy. We excluded patients with incomplete or conflicting clinical records. Afterward, we performed an analysis of overall and progression-free survival and associated risks. Our results showed an average age at diagnosis of 52 y/o (24-85), the most common features were: upper outer quadrant tumor (32%), invasive ductal carcinoma (76.8%), moderately differentiated (44.3%), early clinical stages (40.8%), asymptomatic patients (47.8%), luminal A subtype (47.8%). Median overall survival was not reached, but median progression-free survival was 32.2 months (29.75-34.64, CI 95%) associated risk were: clinical stage (p < 0.0001) symptomatic presentation (p = 0.009) and histologic grade (p = 0.02). Therefore, we concluded that symptom presence at diagnosis impacts progression-free survival, and palpable symptoms are related to an increased risk for mortality.

La imagen corporal en las personas de la comunidad LGBT-Transgenero, Transexual, tras la develación de su identidad de género desde una visión psicomotriz / Body image in people from the LGBT-Transgender community, Transsexual, after the unveiling of their gender identity from a psychomotor perspective

La presente investigación pretende por medio de la observación analizar las características de imagen corporal de las personas de la comunidad LGBT- transgénero, transexual para lo cual el objetivo específico primero es describir la percepción de la imagen corporal de las personas transgénero transexual, así teniendo al objetivo segundo en la que se deberá identificar las particularidades develatorias de su identidad de género, para converger en el tercer especifico que es explicar las características de la imagen corporal y la develación de las personas tras, mediante el último objetivo, proponer actividades de interacción verbal y representación corporal.

Timing matters: age-dependent impacts of the social environment and host selection on the avian gut microbiota.

BACKGROUND: The establishment of the gut microbiota in early life is a critical process that influences the development and fitness of vertebrates. However, the relative influence of transmission from the early social environment and host selection throughout host ontogeny remains understudied, particularly in avian species. We conducted conspecific and heterospecific cross-fostering experiments in zebra finches (Taeniopygia guttata) and Bengalese finches (Lonchura striata domestica) under controlled conditions and repeatedly sampled the faecal microbiota of these birds over the first 3 months of life. We thus documented the development of the gut microbiota and characterised the relative impacts of the early social environment and host selection due to species-specific characteristics and individual genetic backgrounds across ontogeny by using 16S ribosomal RNA gene sequencing. RESULTS: The taxonomic composition and community structure of the gut microbiota changed across ontogenetic stages; juvenile zebra finches exhibited higher alpha diversity than adults at the post-breeding stage. Furthermore, in early development, the microbial communities of juveniles raised by conspecific and heterospecific foster parents resembled those of their foster family, emphasising the importance of the social environment. In later stages, the social environment continued to influence the gut microbiota, but host selection increased in importance. CONCLUSIONS: We provided a baseline description of the developmental succession of gut microbiota in zebra finches and Bengalese finches, which is a necessary first step for understanding the impact of the early gut microbiota on host fitness. Furthermore, for the first time in avian species, we showed that the relative strengths of the two forces that shape the establishment and maintenance of the gut microbiota (i.e. host selection and dispersal from the social environment) change during development, with host selection increasing in importance. This finding should be considered when experimentally manipulating the early-life gut microbiota. Our findings also provide new insights into the mechanisms of host selection. Video Abstract.

SERPINE1 rs6092 Variant Is Related to Plasma Coagulation Proteins in Patients with Severe COVID-19 from a Tertiary Care Hospital.

An impaired coagulation process has been described in patients with severe or critical coronavirus disease (COVID-19). Nevertheless, the implication of coagulation-related genes has not been explored. We aimed to evaluate the impact of F5 rs6025 and SERPINE1 rs6092 on invasive mechanical ventilation (IMV) requirement and the levels of coagulation proteins among patients with severe COVID-19. Four-hundred fifty-five patients with severe COVID-19 were genotyped using TaqMan assays. Coagulation-related proteins (P-Selectin, D-dimer, P-selectin glycoprotein ligand-1, tissue plasminogen activator [tPA], plasminogen activator inhibitor-1, and Factor IX) were assessed by cytometric bead arrays in one- and two-time determinations. Accordingly, SERPINE1 rs6092, P-Selectin (GG 385 pg/mL vs. AG+AA 632 pg/mL, p = 0.0037), and tPA (GG 1858 pg/mL vs. AG+AA 2546 pg/mL, p = 0.0284) levels were different. Patients carrying the CT F5-rs6025 genotype exhibited lower levels of factor IX (CC 17,136 pg/mL vs. CT 10,247 pg/mL, p = 0.0355). Coagulation proteins were also different among IMV patients than non-IMV. PSGL-1 levels were significantly increased in the late stage of COVID-19 (>10 days). The frequencies of F5 rs6025 and SERPINE1 rs6092 variants were not different among IMV and non-IMV. The SERPINE1 rs6092 variant is related to the impaired coagulation process in patients with COVID-19 severe.

TNFRSF1B and TNF Variants Are Associated With Differences in Levels of Soluble Tumor Necrosis Factor Receptors in Patients With Severe COVID-19.

BACKGROUND: The impact of genetic variants in the expression of tumor necrosis factor-α (TNF-α) and its receptors in coronavirus disease 2019 (COVID-19) severity has not been previously explored. We evaluated the association of TNF (rs1800629 and rs361525), TNFRSF1A (rs767455 and rs1800693), and TNFRSF1B (rs1061622 and rs3397) variants with COVID-19 severity, assessed as invasive mechanical ventilation (IMV) requirement, and the plasma levels of soluble TNF-α, TNFR1, and TNFR2 in patients with severe COVID-19. METHODS: The genetic study included 1353 patients. Taqman assays were used to assess the genetic variants. ELISA was used to determine soluble TNF-α, TNFR1, and TNFR2 in plasma samples from 334 patients. RESULTS: Patients carrying TT (TNFRSF1B rs3397) exhibited lower PaO2/FiO2 levels than those with CT + CC genotypes. Differences in plasma levels of TNFR1 and TNFR2 were observed according to the genotype of TNFRSF1B rs1061622, TNF rs1800629, and rs361525. According to the studied genetic variants, there were no differences in the soluble TNF-α levels. Higher soluble TNFR1 and TNFR2 levels were detected in patients with COVID-19 requiring IMV. CONCLUSIONS: Genetic variants in TNF and TNFRSFB1 influence the plasma levels of soluble TNFR1 and TNFR2, implicated in COVID-19 severity.

Implementing a telemedicine curriculum for internal medicine residents during a pandemic: the Cleveland Clinic experience.

Telemedicine training was not a substantial element of most residency programmes prior to the COVID-19 pandemic. Social distancing measures changed this. The Cleveland Clinic Internal Medicine Residency Programme (IMRP) is one of the largest programmes in the USA, which made the task of implementing a telemedicine curriculum more complex. Here we describe our experience implementing an effective, expedited telemedicine curriculum for our ambulatory resident clinics. This study was started in April 2020 when we implemented a resident-led curriculum and training programme for providing ambulatory telemedicine care. The curriculum was finalised in less than 5 weeks. It entailed introducing a formal training programme for residents, creating a resource guide for different video communication tools and training preceptors to safely supervise care in this new paradigm. Residents were surveyed before the curriculum to assess prior experience with telemedicine, and then afterward to assess the curriculum's effectiveness. We also created a mini-CEX assessment for residents to solicit feedback on their performance during virtual appointments. Over 2000 virtual visits were performed by residents in a span of 10 weeks. Of 148 residents, 38% responded to the pre-participation survey. A majority had no prior telemedicine experience and expressed only slight comfort with the modality. Through collaboration with experienced residents and faculty, we expeditiously deployed an enhancement to our ambulatory care curriculum to teach residents how to provide virtual care and help faculty with supervision. We share our insights on this experience for other residency programmes to use.

Effect of Colchicine vs Usual Care Alone on Intubation and 28-Day Mortality in Patients Hospitalized With COVID-19: A Randomized Clinical Trial.

Importance: Hospitalized patients with COVID-19 pneumonia have high rates of morbidity and mortality. Objective: To assess the efficacy of colchicine in hospitalized patients with COVID-19 pneumonia. Design, Setting, and Participants: The Estudios Clínicos Latino América (ECLA) Population Health Research Institute (PHRI) COLCOVID trial was a multicenter, open-label, randomized clinical trial performed from April 17, 2020, to March 28, 2021, in adults with confirmed or suspected SARS-CoV-2 infection followed for up to 28 days. Participants received colchicine vs usual care if they were hospitalized with COVID-19 symptoms and had severe acute respiratory syndrome or oxygen desaturation. The main exclusion criteria were clear indications or contraindications for colchicine, chronic kidney disease, and negative results on a reverse transcription-polymerase chain reaction test for SARS-CoV-2 before randomization. Data were analyzed from June 20 to July 25, 2021. Interventions: Patients were assigned in a 1:1 ratio to usual care or usual care plus colchicine. Colchicine was administered orally in a loading dose of 1.5 mg immediately after randomization, followed by 0.5 mg orally within 2 hours of the initial dose and 0.5 mg orally twice a day for 14 days or discharge, whichever occurred first. Main Outcomes and Measures: The first coprimary outcome was the composite of a new requirement for mechanical ventilation or death evaluated at 28 days. The second coprimary outcome was death at 28 days. Results: A total of 1279 hospitalized patients (mean [SD] age, 61.8 [14.6] years; 449 [35.1%] women and 830 [64.9%] men) were randomized, including 639 patients in the usual care group and 640 patients in the colchicine group. Corticosteroids were used in 1171 patients (91.5%). The coprimary outcome of mechanical ventilation or 28-day death occurred in 160 patients (25.0%) in the colchicine group and 184 patients (28.8%) in the usual care group (hazard ratio [HR], 0.83; 95% CI, 0.67-1.02; P = .08). The second coprimary outcome, 28-day death, occurred in 131 patients (20.5%) in the colchicine group and 142 patients (22.2%) in the usual care group (HR, 0.88; 95% CI, 0.70-1.12). Diarrhea was the most frequent adverse effect of colchicine, reported in 68 patients (11.3%). Conclusions and Relevance: This randomized clinical trial found that compared with usual care, colchicine did not significantly reduce mechanical ventilation or 28-day mortality in patients hospitalized with COVID-19 pneumonia. Trial Registration: ClinicalTrials.gov Identifier: NCT04328480.

Hypomethylation of AHRR (cg05575921) Is Related to Smoking Status in the Mexican Mestizo Population.

Tobacco smoking results in a multifactorial disease involving environmental and genetic factors; epigenome-wide association studies (EWAS) show changes in DNA methylation levels due to cigarette consumption, partially reversible upon tobacco smoking cessation. Therefore, methylation levels could predict smoking status. This study aimed to evaluate the DNA methylation level of cg05575921 (AHRR) and cg23771366 (PRSS23) and their correlation with lung function variables, cigarette consumption, and nicotine addiction in the Mexican smoking population. We included 114 non-smokers (NS) and 102 current tobacco smokers (TS); we then further subclassified them as heavy smokers (HS) (n = 53) and light smokers (LS) (n = 49). We used restriction enzymes (MspI/HpaII) and qPCR to determine the DNA methylation level. We observed significant hypomethylation of cg05575921 in smokers compared to NS (p = 0.003); further analysis found a difference between HS and NS (p = 0.02). We did not observe differences between other groups or a positive correlation between methylation levels and age, BMI, cigarette consumption, nicotine addiction, or lung function. In conclusion, the cg05575921 site of AHRR is significantly hypomethylated in Mexican smokers, especially in HS (≥20 cigarettes per day).

Lung Damage Caused by Heated Tobacco Products and Electronic Nicotine Delivery Systems: A Systematic Review.

The tobacco industry promotes electronic nicotine delivery systems (ENDS) and heated tobacco products (HTP) as a safer alternative to conventional cigarettes with misleading marketing sustained by studies with conflict of interest. As a result, these devices sell without regulations and warnings about their adverse effects on health, with a growing user base targeting young people. This systematic review aimed to describe the adverse effects on the respiratory system in consumers of these devices. We conducted a systematic review and bibliometric analysis of 79 studies without conflict of interest evaluating ENDS and HTP effects in the respiratory system in experimental models, retrieved from the PubMed database. We found that the damage produced by using these devices is involved in pathways related to pulmonary diseases, involving mechanisms previously reported in conventional cigarettes as well as new mechanisms particular to these devices, which challenges that the tobacco industry's claims. The present study provides significant evidence to suggest that these devices are an emerging public health problem and that they should be regulated or avoided.

The Gut Microbial Composition Is Species-Specific and Individual-Specific in Two Species of Estrildid Finches, the Bengalese Finch and the Zebra Finch.

Microbial communities residing in the gastrointestinal tracts of animals have profound impacts on the physiological processes of their hosts. In humans, host-specific and environmental factors likely interact together to shape gut microbial communities, resulting in remarkable inter-individual differences. However, we still lack a full understanding of to what extent microbes are individual-specific and controlled by host-specific factors across different animal taxa. Here, we document the gut microbial characteristics in two estrildid finch species, the Bengalese finch (Lonchura striata domestica) and the zebra finch (Taeniopygia guttata) to investigate between-species and within-species differences. We collected fecal samples from breeding pairs that were housed under strictly controlled environmental and dietary conditions. All individuals were sampled at five different time points over a range of 120 days covering different stages of the reproductive cycle. We found significant species-specific differences in gut microbial assemblages. Over a period of 3 months, individuals exhibited unique, individual-specific microbial profiles. Although we found a strong individual signature in both sexes, within-individual variation in microbial communities was larger in males of both species. Furthermore, breeding pairs had more similar microbial profiles, compared to randomly chosen males and females. Our study conclusively shows that host-specific factors contribute structuring of gut microbiota.

Giardia intestinalis coiled-coil cytolinker protein 259 interacts with actin and tubulin.

Giardia intestinalis is a human parasite that causes a diarrheal disease in developing countries. G. intestinalis has a cytoskeleton (CSK) composed of microtubules and microfilaments, and the Giardia genome does not code for the canonical CSK-binding proteins described in other eukaryotic cells. To identify candidate actin and tubulin cross-linking proteins, we performed a BLAST analysis of the Giardia genome using a spectraplakins consensus sequence as a query. Based on the highest BLAST score, we selected a 259-kDa sequence designated as a cytoskeleton linker protein (CLP259). The sequence was cloned in three fragments and characterized by immunoprecipitation, confocal microscopy, and mass spectrometry (MS). CLP259 was located in the cytoplasm in the form of clusters of thick rods and colocalized with actin at numerous sites and with tubulin in the median body. Immunoprecipitation followed by mass spectrometry revealed that CLP259 interacts with structural proteins such as giardins, SALP-1, axonemal, and eight coiled-coils. The vesicular traffic proteins detected were Mu adaptin, Vacuolar ATP synthase subunit B, Bip, Sec61 alpha, NSF, AP complex subunit beta, and dynamin. These results indicate that CLP259 in trophozoites is a CSK linker protein for actin and tubulin and could act as a scaffold protein driving vesicular traffic.

HealthyBlock: Blockchain-Based IT Architecture for Electronic Medical Records Resilient to Connectivity Failures.

The current information systems for the registration and control of electronic medical records (EMR) present a series of problems in terms of the fragmentation, security, and privacy of medical information, since each health institution, laboratory, doctor, etc. has its own database and manages its own information, without the intervention of patients. This situation does not favor effective treatment and prevention of diseases for the population, due to potential information loss, misinformation, or data leaks related to a patient, which in turn may imply a direct risk for the individual and high public health costs for governments. One of the proposed solutions to this problem has been the creation of electronic medical record (EMR) systems using blockchain networks; however, most of them do not take into account the occurrence of connectivity failures, such as those found in various developing countries, which can lead to failures in the integrity of the system data. To address these problems, HealthyBlock is presented in this paper as an architecture based on blockchain networks, which proposes a unified electronic medical record system that considers different clinical providers, with resilience in data integrity during connectivity failure and with usability, security, and privacy characteristics. On the basis of the HealthyBlock architecture, a prototype was implemented for the care of patients in a network of hospitals. The results of the evaluation showed high efficiency in keeping the EMRs of patients unified, updated, and secure, regardless of the network clinical provider they consult.

The skin microbiome of elasmobranchs follows phylosymbiosis, but in teleost fishes, the microbiomes converge.

BACKGROUND: The vertebrate clade diverged into Chondrichthyes (sharks, rays, and chimeras) and Osteichthyes fishes (bony fishes) approximately 420 mya, with each group accumulating vast anatomical and physiological differences, including skin properties. The skin of Chondrichthyes fishes is covered in dermal denticles, whereas Osteichthyes fishes are covered in scales and are mucous rich. The divergence time among these two fish groups is hypothesized to result in predictable variation among symbionts. Here, using shotgun metagenomics, we test if patterns of diversity in the skin surface microbiome across the two fish clades match predictions made by phylosymbiosis theory. We hypothesize (1) the skin microbiome will be host and clade-specific, (2) evolutionary difference in elasmobranch and teleost will correspond with a concomitant increase in host-microbiome dissimilarity, and (3) the skin structure of the two groups will affect the taxonomic and functional composition of the microbiomes. RESULTS: We show that the taxonomic and functional composition of the microbiomes is host-specific. Teleost fish had lower average microbiome within clade similarity compared to among clade comparison, but their composition is not different among clade in a null based model. Elasmobranch's average similarity within clade was not different than across clade and not different in a null based model of comparison. In the comparison of host distance with microbiome distance, we found that the taxonomic composition of the microbiome was related to host distance for the elasmobranchs, but not the teleost fishes. In comparison, the gene function composition was not related to the host-organism distance for elasmobranchs but was negatively correlated with host distance for teleost fishes. CONCLUSION: Our results show the patterns of phylosymbiosis are not consistent across both fish clades, with the elasmobranchs showing phylosymbiosis, while the teleost fish are not. The discrepancy may be linked to alternative processes underpinning microbiome assemblage, including possible historical host-microbiome evolution of the elasmobranchs and convergent evolution in the teleost which filter specific microbial groups. Our comparison of the microbiomes among fishes represents an investigation into the microbial relationships of the oldest divergence of extant vertebrate hosts and reveals that microbial relationships are not consistent across evolutionary timescales. Video abstract.

Presacral mass in the setting of an ovarian cyst and abdominal pain.

Tailgut cysts, also known as retrorectal hamartomas, are very rare neoplasms located in the presacral/retrorectal space that originate from the embryonic hindgut. Although a majority of lesions in this location are benign, 30% of the reported cases in the literature were found to be malignant. This report describes a case of a presacral mass found on CT of a 37-year-old woman who initially presented with worsening abdominal pain and a history of ovarian cyst rupture. This patient's clinical picture was complicated by an enlarging ovarian cyst. The risk of progression to malignancy warranted excision. She recovered well with resolution of her presenting symptoms. We report this case along with a brief review of the literature with a focus on the surgical considerations.

EARLY ONSET OF THE REPRODUCTIVE SEASON IN CAPTIVE WHITE-TAILED DEER ( ODOCOILEUS VIRGINIANUS VERAECRUCIS) IN EASTERN MEXICO.

The white-tailed deer ( Odocoileus virginianus) inhabits a wide latitudinal range in the Americas. Deer species dwelling throughout wide latitudinal ranges have developed subspecies with variations in their reproductive seasonality. In northern subspecies of white-tailed deer, such as those from Canada and the United States, the breeding season occurs from October through December. Odocoileus virginianus veraecrucis is a subspecies that inhabits eastern Mexico, and because its reproductive season has not been studied, it is believed to be similar to that from northern subspecies. The objective of the study was to determine the onset of the breeding season and the profile of fecal steroid hormone metabolites throughout the year in captive white-tailed deer subspecies veraecrucis in Mexico. Two groups of adult deer were included: 1) six does and one buck at a Wildlife Conservation Unit, and 2) five does and one buck at a zoo. From each group of deer, representative fecal samples were collected on a weekly basis for 1 yr for fecal analysis of progesterone and estradiol in the does, and testosterone in the bucks. Data on antler casting, parturitions, and velvet shedding were recorded. Progesterone was high during pregnancy and low throughout the parturition period. Estradiol fluctuated throughout the year. Testosterone was high during the rut and low after antler casting. Antlers were cast in March and velvet was shed in August at both sites. Parturitions started in February at the zoo and in April at the Wildlife Unit. In captive white-tailed deer subspecies veraecrucis the breeding season started in July, and therefore earlier than what has been reported for subspecies from northern latitudes.

Performance assessment of the database downscaled ocean waves (DOW) on Santa Catarina coast, South Brazil.

This work presents a validation of wave parameters from the new sixty years Downscaled Ocean Waves (DOW) reanalysis database. This study compares quantiles of the Gumbel distribution of Hs (significant wave height) and Tp (peak period) from simulated data with an 11 months' time series obtained from a buoy moored seaward on the Santa Catarina coast. Analysis by means of Gumbel distribution quantiles allows more weight to be given to the highest values of the time series, which are especially important in design projects. The statistical parameters used to verify the fit between the measured and the modeled data included: RMSE, BIAS, Scatter Index and Pearson Correlation Coefficient. Mean direction (θm) validation was conducted qualitatively. The database showed good fit of the mean conditions, especially Hs which was well reproduced by the wave model. Underestimation of Tp, related mainly to the low spatial and temporal resolution of wind data used to generate waves, highlights this general modeling problem. Based on calculated statistical parameters, DOW data were considered comparable to the values obtained by measurements; however, such data must be cautiously used for extreme events analysis and in areas of bimodal sea conditions, where major deficiencies in the database were observed.

The cochaperone SGTA (small glutamine-rich tetratricopeptide repeat-containing protein alpha) demonstrates regulatory specificity for the androgen, glucocorticoid, and progesterone receptors.

Steroid hormone receptors are ligand-dependent transcription factors that require the ordered assembly of multichaperone complexes for transcriptional activity. Although heat shock protein (Hsp) 90 and Hsp70 are key players in this process, multiple Hsp70- and Hsp90-associated cochaperones associate with receptor-chaperone complexes to regulate receptor folding and activation. Small glutamine-rich tetratricopeptide repeat-containing protein alpha (SGTA) was recently characterized as an Hsp70 and Hsp90-associated cochaperone that specifically regulates androgen receptor activity. However, the specificity of SGTA for additional members of the steroid hormone receptor superfamily and the mechanism by which SGTA regulates receptor activity remain unclear. Here we report that SGTA associates with and specifically regulates the androgen, glucocorticoid, and progesterone receptors and has no effect on the mineralocorticoid and estrogen receptors in both yeast and mammalian cell-based reporter assays. In both systems, SGTA knockdown/deletion enhances receptor activity, whereas SGTA overexpression suppresses receptor activity. We demonstrate that SGTA binds directly to Hsp70 and Hsp90 in vitro with similar affinities yet predominately precipitates with Hsp70 from cell lysates, suggesting a role for SGTA in early, Hsp70-mediated folding. Furthermore, SGTA expression completely abrogates the regulation of receptor function by FKBP52 (52-kDa FK506-binding protein), which acts at a later stage of the chaperone cycle. Taken together, our data suggest a role for SGTA at distinct steps in the chaperone-dependent modulation of androgen, glucocorticoid, and progesterone receptor activity.

Política Integral para el recurso médico de la atención primaria de Chile / Comprehensive policy for primary health care medical resource Chile

La actual reforma en salud planteó dar un impulso inédito a la Atención Primaria de Salud (APS) y conseguir la cobertura necesaria para solucionar el mayor número de problemas en la consulta médica junto a la implementación de programas de promoción, prevención y rehabilitación de la salud comunitaria. A pesar de las intenciones declaradas, existen problemas no abordados que amenazan el éxito de este proceso, por ejemplo, la ausencia de una política integral de desarrollo del recurso médico de la atención primaria, lo que produce que en la actualidad persista un significativo déficit de horas médicas en este nivel de atención. La Agrupación Nacional de Médicos de Atención Primaria surge frente a la necesidad de enfrentar los problemas que nos afectan, y está conformada por los médicos que trabajamos en el nivel primario del Sistema Público de Salud en Chile, incluye a los médicos con contrato municipal, así como aquellos regidos por el Artículo 9 de la Etapa de Destinación y Formación y los de la Etapa de Planta Superior de la Ley Médica con desempeño en los centros de salud. Nuestra organización desde sus inicios ha abordado de manera activa y propositiva la búsqueda de una política integral para el desarrollo del recurso humano de la Atención Primaria, así como también de un modelo de atención donde el nivel primario de salud sea capaz de responder con calidad y dignidad a las demandas de la comunidad. La propuesta de política integral para el desarrollo de los médicos de APS está contenida dentro de las 10 demandas determinadas por nuestra organización, que incluyen disminuir el déficit de al menos 1.500 médicos APS, mejorar los rendimientos de atención, trabajar en condiciones que permitan otorgar una atención de calidad, aumento de la resolutividad, destinar tiempo para prevención y promoción de salud, disminuir la inestabilidad laboral, regular laatención de urgencias, mejorar las remuneraciones...

The current health reform raised unprecedented boost to the Primary Health Care (PHC) and get the coverage needed to solve the most problems in medical practice by the implementation of programs of promotion, prevention and rehabilitation of health Community. Despite the stated intentions, there are problems not addressed that threaten the success of this process, for example, the absence of a comprehensive resource development of primary care physician, which currently produces a significant gap persists hour medical care at this level. The National Association of Primary Care Physicians address the need arises to deal with problems that affect us, and is comprised of physicians who work in the primary level public health system in Chile, including municipal contract physicians and as those governed by Article 9 of Destination and Training Stage and Stage of Plant Senior Medical Act performing at health centers. Our organization since its inception has dealt active and purposeful search for a comprehensive policy for human resource development for primary care, as well as a model of care which the primary care level is able to respond with quality and dignity to the demands of the community. The proposed comprehensive policy for the development of PHC physicians is contained within the 10 claims identified by our organization, including reducing the deficit of at least 1,500 doctors APS, improve yields care, work permit granted under care quality, increased problem-solving, allocating time for prevention and health promotion, decrease job instability, regular emergency care, better wages, estate administrative clinical meetings and participation in the Development Councils. The aim of this paper is to demonstrate the importance of implementing a Comprehensive Policy for Medical APS...

Asociación entre los valores de Rantes y la clínica en pacientes con rinitis alérgica / Association between rantes values and the clinical aspect in patients with allergic rhinitis

Objetivo: Determinar los valores de Rantes, después de la exposición a ácaros, para evaluar su asociación con la escala ARIA, en el grupo de pacientes seleccionado. Diseño: Estudio de corte transversal. Materiales y métodos: Se incluyeron 17 pacientes que consultaron por rinitis alérgica en el Hospital de La Samaritana entre el 1 de julio del 2010 y el 1 julio del 2011, y que cumplieron los criterios de selección, de los cuales se obtuvieron 34 muestras de lavados nasales posteriores a provocación intranasal con ácaros. Resultados: Los pacientes mostraron mayor tendencia a pertenecer al grupo de síntomas de mayor severidad y frecuencia según la escala ARIA. Los valores de Rantes encontrados en lavados nasales tuvieron un promedio de 8,1 pg/ml (+/– 19DS). Conclusión: Se encontró una positividad en los valores de la citoquina CCL5 en los lavados nasales del 20% de los pacientes. El coeficiente de correlación obtenido muestra una asociación débil.

Objective: Determine the values of Rantes, after exposure to mites, to evaluate its association with ARIA scale in the group of selected patients. Design: Cross sectional survey. Materials and Methods: We included 17 patients presenting with allergic rhinitis at the Samaritan Hospital between July 1, 2010 and July 1, 2011, and met the selection criteria, of which 34 samples were obtained from nasal washes after intranasal challenge with mites. Results: Patients showed a greater tendency to belong to the group of symptoms of greater severity and frequency according to the ARIA scale. Rantes values found in nasal washes had an average of 8.1 pg/ml (+/– 19DS). Conclusions: Positivity was found in the values of the cytokine CCL5 in nasal washes of 20% of patients. The correlation coefficient shows a weak association.