Determinantes de la transición de la escuela al trabajo en Chile

(analítico) En Chile, actualmente la población categorizada como jóvenes que ni estudian ni trabajan (conocidos como nini) asciende a cerca de medio millón de personas, lo que presenta un desafío en la orientación de estrategias que les permitan insertarse en el mercado del trabajo o continuar sus estudios. Esta investigación tiene por finalidad determinar los factores que influyen en la transición de la escolaridad al trabajo en la población de jóvenes chilenos, por medio de modelos probabilísticos a partir de datos representativos a nivel nacional. Los resultados muestran que son determinantes la pobreza, la existencia de menores en el hogar, el género y la paternidad o maternidad adolescente. Se establecen algunas estrategias y se hace hincapié en continuar el estudio considerando la multitud de factores que están involucrados.

(analytical) In Chile, the population currently categorized as young people who neither study nor work (known as NEETs) is nearly half a million people, which presents a challenge in terms of developing policies that allow them to enter the labor market or continue their studies. The purpose of this study is to identify the factors that influence the transition from school to work for the population of young Chileans using probabilistic models based on nationally representative data. The results show that poverty, the existence of children in households, gender and adolescent parenthood are determining factors. Some strategies are highlighted and an emphasis is placed on the need to continue research in this area, taking into account the multitude of factors involved.

(analítico) No Chile, a população actualmente classificada como jovens que não estudam nem trabalham (doravante, NEM-NEM) ascende a quase meio milhão de pessoas, o que representa um desafio em termos de orientação de políticas que lhes permitam entrar no mercado de trabalho ou continuar os seus estudos. O objectivo deste estudo é determinar os fatores que influenciam a transição da escola para o trabalho na população de jovens chilenos, utilizando modelos probabilísticos baseados em dados representativos a nível nacional. Os resultados mostram que a pobreza, a existência de menores no lar, o gênero e a paternidade adolescente são fatores determinantes. Algumas estratégias são delineadas e a ênfase é colocada em estudos mais aprofundados, considerando a multiplicidade de fatores envolvidos.

Relação da Ascensão Matinal da Pressão Arterial com a Hipertrofia Ventricular Esquerda em Hipertensos Obesos / Association between Morning Surge and Left Ventricular Hypertrophy in Obese Hypertensive Patients

Resumo Fundamento O aumento do peso frequentemente desencadeia mecanismos que elevam a pressão arterial. A obesidade causa mudanças estruturais no miocárdio, incluindo aumento da massa ventricular, dilatação atrial, bem como disfunções diastólicas e sistólicas. Além disso, variações pressóricas nos hipertensos obesos, como a ascensão matinal (AM), podem ter relevância clínica na prevenção dos eventos cardiovasculares. A AM da pressão arterial é um fenômeno fisiológico, que quando elevada pode ser considerada um fator de risco independente para eventos cardiovasculares. Objetivo Avaliar valores da elevação da AM e sua associação com a hipertrofia ventricular esquerda (HVE) e com o Descenso do Sono (DS) em obesos e não obesos hipertensos. Métodos Estudo transversal que avaliou medidas pressóricas à monitorização ambulatorial da pressão arterial (MAPA) e a presença de HVE, avaliada pela ecocardiografia, em 203 pacientes hipertensos em tratamento ambulatorial, separados em dois grupos: 109 não obesos e 94 hipertensos obesos. O nível de significância adotado foi de 0,05 em testes bicaudais. Resultados A AM acima de 20 mmHg à MAPA foi detectada em 59,2% dos pacientes do grupo "não obesos" e em 40,6% no grupo "obesos". A HVE foi encontrada em 18,1% no grupo dos não-obesos e em 39,3% no grupo de obesos, p<0,001. No grupo "obesos" foi observado que AM >16 mmHg esteve associada à HVE, com [razão de prevalência: 2,80; IC95% (1,12-6,98), p=0,03]. Para o grupo dos "não obesos", o ponto de corte da AM para essa associação foi >22 mmHg. Conclusão A AM elevada associou-se positivamente com HVE, com comportamento peculiar na população de hipertensos e obesos.

Abstract Background Weight gain can trigger mechanisms that increase blood pressure. Nevertheless, obesity causes structural changes in the myocardium, including increased ventricular mass, atrial dilatation, and diastolic and systolic dysfunction. Additionally, blood pressure variations, like morning surge (MS) in obese hypertensive patients may have clinical relevance in cardiovascular events. Although morning blood pressure surge is a physiological phenomenon, excess MS can be considered an independent risk factor for cardiovascular events. Objective To evaluate MS values and their association with left ventricular hypertrophy (LVH) and nocturnal dipping (ND) in obese and non-obese hypertensive patients. Methods A cross-sectional study that evaluated BP measurements by ambulatory blood pressure monitoring (ABPM) and the presence of LVH by echocardiography in 203 hypertensive outpatients, divided into two groups: 109 non-obese and 94 obese hypertensives patients. The significance level was set at 0.05 in two-tailed tests. Results A MS above 20 mmHg by ABPM was detected in 59.2% of patients in the non-obese group and 40.6% in the obese group. LVH was found in 18.1% and 39.3% of patients in the non-obese and obese groups, respectively, p<0.001. In the "obese group", it was observed that a MS>16 mmHg was associated with LVH, [prevalence ratio: 2.80; 95%CI (1.12-6.98), p=0.03]. For the non-obese group, the cut-off point of MS for this association was >22 mmHg. Conclusion High MS was positively associated with LVH, with a particular behavior in the hypertensive obese group.

Validity Evidence of the Work-Family Conflict Scale for Public Security Professionals / Evidências de Validade da Escala Conflito Trabalho-Família para Profissionais da Segurança Pública

Abstract The aim of this article is to present evidence of validity for the 'work-family conflict scale' with a sample of 10,383 professionals working in Brazilian public security. Cross-validation procedures were applied through the definition of two subsamples, exploratory and confirmatory factor analyses were performed. All ethical procedures were followed. The results found in both the exploratory factor analysis ('Work Interference with Family' Factor, with factor loadings between .91 and .81 and alpha of .93, and 'Family Interference with Work' Factor, with factor loadings between .96 and .71 and alpha of .90) and the confirmatory analysis (χ2/df <5; CFI >.98; TLI >.98; RMSEA <.10) demonstrate robust evidence of validity, indicating the use of the scale in other organizational contexts.

Resumo O artigo tem como objetivo geral apresentar evidências de validade da escala 'conflito trabalho-família' junto a uma amostra de 10.383 profissionais que atuam na segurança pública brasileira. Optou-se pela condução dos procedimentos de validação cruzada, por meio da definição de duas subamostras, foram realizadas análises fatoriais exploratórias e confirmatórias. Todos os procedimentos éticos foram adotados. Os resultados encontrados tanto na análise fatorial exploratória (Fator 'Interferência do Trabalho na Família', com cargas fatoriais entre 0,91 e 0,81 e alpha de 0,93 e Fator 'Interferência da Família no Trabalho, com cargas entre 0,96 a 0,71 e alpha de 0,90) quanto confirmatória (χ2/gl < 5; CFI > 0,98; TLI > 0,98; RMSEA < 0,1) demonstram robustas evidências de validade, indicando o uso da escala em outros contextos organizacionais.

Estratégia Farmacoinvasiva em Idosos até 75 Anos ou Não Idosos: Análise de Parâmetros Bioquímicos e de Ressonância Nuclear Magnética Cardíaca / Pharmacoinvasive Strategy in Elderly Up to 75 Years or Non-Elderly: Analysis of Biochemical and Cardiac Magnetic Resonance Imaging Parameters

Resumo Fundamento A estratégia farmacoinvasiva é uma alternativa na inviabilidade da intervenção coronária percutânea primária (ICP). Objetivos Este estudo teve como objetivo avaliar os efeitos da estratégia farmacoinvasiva precoce sobre o tamanho da área infartada e a fração de ejeção ventricular esquerda em pacientes idosos e não idosos. O papel dos marcadores inflamatórios também foi avaliado. Métodos Pacientes (n=223) com infarto do miocárdio com elevação do segmento ST (IAMCSST) foram prospectivamente incluídos e submetidos à trombólise medicamentosa nas primeiras seis horas, e à angiografia coronariana e à ICP, quando necessária, nas primeiras 24 horas. As amostras de sangue foram coletadas no primeiro dia (D1) e 30 dias após (D30). A ressonância magnética cardíaca foi realizada no D30. O nível de significância estatística foi estabelecido em p<0,05. Resultados Pacientes idosos e não idosos apresentaram porcentagem similares de massa infartada [13,7 (6,9-17,0) vs. 14,0 (7,3-26,0), respectivamente p=0,13)] [mediana (intervalo interquartil)]. No entanto, os pacientes idosos apresentaram maior fração de ejeção ventricular esquerda [53 (45-62) vs. 49 (39-58), p=0,025)]. As concentrações de interleucina (IL)1beta, IL-4, IL-6, e IL-10 não foram diferentes entre D1 e D30, mas pacientes idosos apresentaram níveis mais elevados de IL-18 em D1 e D30. O número absoluto de linfócitos B e T foram similares em ambos os grupos em D1 e D30, porém, pacientes idosos apresentaram uma razão neutrófilo-linfócito mais alta em D30. A análise de regressão linear multivariada dos desfechos de RMC de toda a população do estudo mostrou que os preditores independentes não foram diferentes entre pacientes idosos e não idosos. Conclusão A estratégia farmacoinvasiva em pacientes idosos foi associada a pequenas diferenças nos parâmetros inflamatórios, tamanho do infarto similar, e melhor função ventricular esquerda em comparação a pacientes não idosos

Abstract Background Pharmacoinvasive strategy is an alternative when primary percutaneous coronary intervention (PCI) is not feasible. Objectives This study aimed to evaluate the effects of early pharmacoinvasive strategy on the infarct size and left ventricular ejection fraction in elderly and non-elderly patients. The role of inflammatory markers was also examined. Methods Patients (n=223) with ST segment elevation myocardial infarction (STEMI) were prospectively included and submitted to pharmacological thrombolysis in the first six hours, and underwent coronary angiogram and PCI when necessary, in the first 24 hours. Blood samples were collected in the first day (D1) and after 30 days (D30). Cardiac magnetic resonance imaging (cMRI) was performed at D30. Significance was set at p<0.05. Results Elderly and non-elderly patients showed similar percentage of infarcted mass (13.7 [6.9-17.0] vs. 14.0 [7.3-26.0], respectively, p=0.13) (median [interquartile range]). However, elderly patients had better left ventricular ejection fraction (53 [45-62] vs. 49 [39-58], p=0.025). Titers of interleukin (IL)1beta, IL-4, IL-6, and IL-10 did not differ between D1 and D30, but elderly patients had higher titers for IL-18 at D1 and D30. Absolute numbers of B and T lymphocytes were similar in both groups at D1 and D30, but elderly patients had higher neutrophil/lymphocyte ratio at D30. Multivariate linear regression analysis of cMRI outcomes in the whole population showed that the independent predictors were not different between elderly and non-elderly patients. Conclusion Pharmacoinvasive strategy in elderly patients was associated with small differences in inflammatory parameters, similar infarct size and better left ventricular function than non-elderly patients.

Predictores de fenómeno de no reflujo en infarto agudo del miocardio con elevación del segmento ST / Predictors in no-reflow phenomenon in acute myocardial infarction with ST-segment elevation

Resumen Antecedentes: El fenómeno de «no reflujo¼ (NR) es una de las complicaciones más temidas tras una intervención coronaria percutánea (ICP) en el tratamiento del infarto de miocardio con elevación del segmento ST (IAMCEST) por su elevada morbimortalidad. Objetivo: Describir los factores predictores para el fenómeno de NR en un grupo de sujetos con IAMCEST tratados con ICP. Método: Se estudiaron 103 casos de IAMCEST a los que se les realizó una ICP. Los sujetos se dividieron de acuerdo con la presencia del fenómeno de NR. Se estudió mediante un análisis multivariante la edad, el sexo, presencia de comorbilidades, el peso y otros parámetros clínicos y de laboratorio como predictores del fenómeno de NR. Resultados: En este estudio, el análisis con regresión logística identificó como factores independientes para el desarrollo de fenómeno de NR el flujo TIMI basal ≤ 2 (razón de momios [OR]6.03; intervalo de confianza del 95% [IC 95%]: 0.9-11.8; p = 0.04), estadio enfermedad renal según KDIGO (Kidney Disease Improving Global Outcomes) ≥ 3 (OR 3.49; IC 95%: 1.2-2.6; p = 0.02) y nivel de glucosa ≥ 180 mg/dl(OR 2.61; IC 95%: 1.0-2.4; p = 0.04). Conclusiones: El fenómeno de NR sigue siendo un reto para la morbimortalidad a corto y a largo plazo en el IAMCEST. Los factores identificados pueden ser utilizados para la estratificación de los casos con IAMCEST y riesgo de fenómeno de NR previo a la ICP.

Abstract Background: No-reflow (NR) phenomenon is one of the most feared complications after percutaneous coronary intervention (PCI) in the treatment of ST-segment elevation myocardial infarction (STEMI) due to its high morbidity and mortality. Objective: To describe the predictive factors for NR phenomenon in a group of subjects with STEMI treated with PCI. Method: One hundred and three cases of STEMI who underwent PCI. The subjects were divided according to the presence of NR phenomenon. In a multivariate analysis age, gender, comorbidities, weight, and other clinical and laboratory parameters were studied as predictors of NR phenomenon were studied. Results: In this study, logistic regression analysis identified as independent factors for the development of NR phenomenon baseline TIMI flow ≤ 2 (OR 6.03; 95% CI, 0.9 to 11.8; p = 0.04), ER KDIGO ≥ 3 (OR OR 2.61; 95% CI, 1.0 to 2.4; p = 0.04). Conclusions: NR phenomenon continues to be a challenge for short and long-term morbidity and mortality in STEMI. The identified factors can be used for the stratification of cases with STEMI and risk of NR phenomenon prior to PCI.

Estratégia Fármaco-Invasiva no Infarto do Miocárdio: Análise Descritiva, Apresentação de Sintomas Isquêmicos e Preditores de Mortalidade / Pharmaco-invasive Strategy in Myocardial Infarction: Descriptive Analysis, Presentation of Ischemic Symptoms and Mortality Predictors

Resumo Fundamento O infarto do miocárdio com elevação do segmento-ST (IAMCSST) é definido por sintomas acompanhados por alterações típicas do eletrocardiograma. Entretanto, a caracterização dos sintomas isquêmicos não é clara, principalmente em subgrupos, como mulheres e idosos. Objetivos Analisar a tipificação dos sintomas isquêmicos, métricas temporais e observar a ocorrência de desfechos intra-hospitalares, em análise dos escores preditivos, em pacientes com IAMCSST, em estratégia fármaco-invasiva. Métodos Estudo envolvendo 2.290 pacientes. Tipos de apresentações clínicas pré-definidas: dor típica, dor atípica, dispnéia, sincope. Medimos o tempo entre o início dos sintomas à demanda pelo atendimento e o intervalo entre a chegada à unidade-médica e trombólise. Odds-ratios (OR; IC-95%) foram estimadas em modelo de regressão. Curvas ROCs foram construídas para preditores de mortalidade. Nível de significância adotado (alfa) foi de 5%. Resultados Mulheres apresentaram alta prevalência de sintomas atípicos; maior tempo entre o início dos sintomas e a procura por atendimento; atraso entre a chegada ao pronto-socorro e a fibrinólise. A mortalidade hospitalar foi de 5,6%. Predição de risco pela classificação Killip-Kimball: AUC: [0,77 (0,73-0,81)] em classe ≥II. Subgrupos estudados [OR (IC-95%)]: mulheres [2,06 (1,42-2,99); p=0,01]; insuficiência renal crônica [3,39 (2,13-5,42); p<0,001]; idosos [2,09 (1,37-3,19) p<0,001]; diabéticos [1,55 (1,04-2,29); p=0,02]; obesos 1,56 [(1,01-2,40); p=0,04]; acidente vascular cerebral prévio [2,01 (1,02-3,96); p=0,04] correlacionaram-se com maiores taxas de mortalidade. Conclusão Apesar das mais altas taxas de mortalidade em alguns subgrupos, disparidade significativa persiste nas mulheres, com atrasos no reconhecimento dos sintomas e trombólise imediata. Destaca-se a aplicabilidade do escore Killip-Kimball na predição, independentemente da apresentação clínica.

Abstract Background ST-segment elevation myocardial infarction (STEMI) is defined by symptoms accompanied by typical electrocardiogram changes. However, the characterization of ischemic symptoms is unclear, especially in subgroups such as women and the elderly. Objectives To analyze the typification of ischemic symptoms, temporal metrics and observe the occurrence of in-hospital outcomes, in the analysis of predictive scores, in patients with STEMI, in a drug-invasive strategy. Methods Study involving 2,290 patients. Types of predefined clinical presentations: typical pain, atypical pain, dyspnea, syncope. We measured the time between the onset of symptoms and demand for care and the interval between arrival at the medical unit and thrombolysis. Odds-ratios (OR; CI-95%) were estimated in a regression model. ROC curves were constructed for mortality predictors. The adopted significance level (alpha) was 5%. Results Women had a high prevalence of atypical symptoms; longer time between the onset of symptoms and seeking care; delay between arrival at the emergency room and fibrinolysis. Hospital mortality was 5.6%. Risk prediction by Killip-Kimball classification: AUC: [0.77 (0.73-0.81)] in class ≥II. Subgroups studied [OR (CI-95%)]: women [2.06 (1.42-2.99); p=0.01]; chronic renal failure [3.39 (2.13-5.42); p<0.001]; elderly [2.09 (1.37-3.19) p<0.001]; diabetics [1.55 (1.04-2.29); p=0.02]; obese 1.56 [(1.01-2.40); p=0.04]: previous stroke [2.01 (1.02-3.96); p=0.04] correlated with higher mortality rates. Conclusion Despite higher mortality rates in some subgroups, significant disparity persists in women, with delays in symptom recognition and prompt thrombolysis. We highlight the applicability of the Killip-Kimball score in prediction, regardless of the clinical presentation.

Manejo de las fracturas maxilofaciales y sus complicaciones / Management of maxillofacial fractures and its complications

RESUMEN Antecedentes: el trauma maxilofacial corresponde a toda lesión traumática del macizo facial. Actualmente representa uno de los problemas de salud más importantes en el mundo. Nuestro objetivo es realizar un análisis de nuestra experiencia en las intervenciones realizadas en pacientes internados y sus complicaciones. Material y métodos: se realizó un estudio descriptivo, retrospectivo y observacional de 205 pacientes con fracturas maxilofaciales desde el año 2011 hasta el año 2019. Resultados: el 81,46% fueron hombres (n: 167) y el rango etario más afectado osciló entre los 21 y 30 años con el 38,54% (n:79). El accidente de tránsito 56,1% (n:115) fue el mecanismo de trauma más frecuente. Los tipos de fracturas faciales fueron: panfaciales 12,2% (n: 25), tercio superior 1,46% (n:3), tercio medio 72,2% (n:148) y tercio inferior 14,15% (n:29). Dentro del tercio superior, el 66,67% (n:2) fueron fracturas del seno frontal asociadas al hueso frontal, en el tercio medio las combinadas en un 54,73% (n:81) y en el tercio inferior, las complejas en el 34,48% (n:10). Fueron intervenidos 199 pacientes (97,07%). Solo el 11,56% (n:23) presentó alguna complicación. No se observaron complicaciones graves. Discusión: según nuestra serie, la mayoría de los pacientes fueron hombres jóvenes; la causa más frecuente, el accidente de tránsito, y el tercio medio, el más afectado, resultados estos similares a los de otros estudios publicados. El tratamiento quirúrgico fue principalmente reducción abierta y fijación con material de osteosíntesis de titanio, un procedimiento seguro y fiable, que permite restablecer la funcionalidad previa al traumatismo, con un índice muy bajo de complicaciones posoperatorias.

ABSTRACT Background: Maxillofacial trauma corresponds to all traumatic injuries affecting the facial bones. Nowadays, it represents one of the main healthcare issues worldwide. The aim of this study is to analyze our experience in the interventions performed in hospitalized and their complications. Material and methods: We performed a retrospective and observational study of 205 patients with maxillofacial fractures from 2011 to 2019. Results: 81.46% were men (n = 167) and 38.54% (n = 79) of the patients were between 21 and 30 years of age. Traffic collision was the most common mechanism of trauma (56,1%, n = 115). The types of facial fractures were panfacial (12.2%; n = 25), of the upper-third (1.43%; n = 3), of the middle-third (72.2%; n = 148) and of the lower third (14.15%; n = 29). In the upper third of the face frontal sinus fractures associated with the frontal bone were the most common (66.67%; n =2); in the middle-third combined fractures were most prevalent (54.73%; n = 81) while complex fractures were most frequent in the lower third (34,48%; n = 10). One-hundred and ninety-one patients were operated on (97.07%). Complications occurred in only 11.56% (n = 23) and were not serious. Discusion: In our series, most patients were young men, traffic collisions were the most common cause of trauma, and the middle third of the face was the most affected region. These results are similar to our publications. Surgical management, mostly by open reduction and fixation with titanium-based osteosynthesis material, is an effective, safe and reliable procedure, which allows the restoration of pre-trauma function, with very low rate of postoperative complications.

Encefalitis asociada a astrovirus bovino neurotrópico, ¿una enfermedad subdiagnosticada en Sudamérica? / Neurotropic bovine astrovirus-associated encephalitis: An underdiagnosed diseasein South America?

Resumen Describimos un caso de encefalitis asociada a infección por astrovirus bovino neu-rotrópico en una vaca lechera, raza Jersey, del departamento de San José, Uruguay. Esterepresenta el segundo caso reportado de esta condición en el hemisferio sur. La vaca, únicaafectada de un rodeo de 70 bovinos, manifestó signos clínicos neurológicos con curso de 2 días,luego de los que murió espontáneamente. El examen histopatológico reveló meningoencefalitislinfocítica, histiocítica y plasmacítica, con necrosis neuronal, sin cuerpos de inclusión. No sedetectaron en el cerebro otros agentes infecciosos, incluyendo el virus de la rabia (Lyssavirus),alfaherpesvirus bovino-1 y alfaherpesvirus bovino-5 (Varicellovirus), virus de la diarrea viralbovina (Pestivirus), virus del Nilo Occidental (Flavivirus), Listeria monocytogenes, Histophi-lus somni y otras bacterias. Dado que el descubrimiento de astrovirus neurotrópicos en variasespecies de mamíferos, incluidos humanos, es reciente, proponemos que los casos de encefalitis por astrovirus pudieron haber pasado inadvertidos en Sudamérica. Discutimos brevementeel diagnóstico patológico diferencial de encefalitis infecciosas en bovinos.

Abstract We describe a case of neurotropic bovine astrovirus-associated encephalitis in a Jer-sey dairy cow from the department of San José, Uruguay. This represents the second case of thiscondition reported in the Southern Hemisphere. The cow was the only one affected in a herd of70 cows, showing neurological signs with a 2-day clinical course, before dying spontaneously.Histopathological examination revealed lymphocytic, histiocytic, and plasmacytic meningoen-cephalitis with neuronal necrosis, without detectable inclusion bodies. Other infectious agents,including Rabies virus (Lyssavirus), Bovine alphaherpesvirus-1 and Bovine alphaherpesvirus-5(Varicellovirus), Bovine viral diarrhea virus (Pestivirus), West Nile virus (Flavivirus), Listeriamonocytogenes, Histophilus somni and other bacteria, were not detected in the brain. We pro-pose that given the recent discovery of neurotropic astroviruses in various mammalian species,including humans, cases of astrovirus encephalitis may have gone undetected in South America.We briefly discuss the differential pathologic diagnosis of infectious bovine encephalitis.

Placentitis and abortion caused by a multidrug resistant strain of Campylobacter fetus subspecies fetus in a sheep in Uruguay / Placentitis y aborto causado por una cepa de Campylobacter fetus subespecie fetus multirresistente a antibióticos en una oveja en Uruguay

Abstract Campylobacter fetus fetus (Cff) is a major infectious cause of abortion in sheep worldwide, and an opportunistic human pathogen. Information on Cff as an ovine abortifacient in South America is limited. We describe a case of abortion caused by a multidrug resistant strain of Cff in a sheep in Uruguay. In August 2017, 3/57 pregnant ewes (5.3%) aborted whithin one week. Histopathologic examination of the placenta of an aborted ewe revealed severe neutrophilic and fibrinonecrotizing placentitis with vasculitis and thrombosis of the chorionic arterioles. Cff was isolated on microaerobic culture in Skirrow agar, and further confirmed by 16S rDNA PCR amplification and sequencing, and endpoint and real time PCR assays. Antimicrobial sensitivity testing revealed resistance to tetracyclines, nalidixic acid, telithromycin and clindamycin. Other abortifacients were not detected. Further studies are necessary to determine the geographic distribution, ecology, epidemiology, economic impact, and antimicrobial resistance of Cff in sheep flocks in Uruguay.

Resumen Campylobacter fetus fetus (Cff) es una importante causa de abortos en ovinos y un patógeno oportunista en humanos. La información sobre Cff como abortifaciente en ovinos en Sudamérica es limitada. Describimos un caso de aborto causado por una cepa de Cff mul tirresistente a antibióticos en una oveja en Uruguay. En agosto de 2017, 3/57 ovejas prenadas (5,3%) abortaron en una semana. El examen histopatológico de la placenta de una de ellas reveló placentitis neutrofílica fibrinonecrosante severa, vasculitis y trombosis. Cff fue aislado en microaerobiosis en agar Skirrow, y confirmado mediante amplificación del ADNr 16S por PCR seguida de secuenciación, y por PCR punto final y qPCR. Las pruebas de sensibilidad antimicrobiana revelaron resistencia a tetraciclinas, ácido nalidíxico, telitromicina y clindamicina. No se detectaron otros abortifacientes. Son necesarios más estudios para determinar la distribución geográfica, ecología, epidemiología, el impacto económico y la resistencia antimicrobiana de Cff en majadas ovinas de Uruguay.

Axenfeld-Rieger Syndrome: Case Report

Aims:To describe a Axenfeld-Rieger Syndrome.Presentation of Case: MCL, 7 years old, female, brown, was taken to the ophthalmology outpatient clinic of the Hospital Universit醨io Ant鬾io Pedro, Brazil by her parents, complaining of low visual acuity and malformation of the pupil perceived since birth.Discussion: Axenfeld-Rieger Syndrome is a rare and hereditary disease. Clinically, Axenfeld's anomaly is characterized by the presence of posterior embryotoxon, and there may be adherence of iridian tissue in its periphery. In addition to Rieger's anomaly, posterior embryotoxon is added to iris hypoplasia and iris thickness defects, uveal ectropion and pupillary alterations, such as corectopia. Rieger's syndrome is associated with extraocular changes, of which hypodontia, myicrodontia, maxillary hypoplasia, telecanthus, hypertelorism and hypospadias stand out.Conclusions: Therefore, the importance of early diagnosis, follow-up and adequate treatment becomes evident in order to preserve the visual function of patients and thus avoid an unfavorable evolution.

Fishes from the Colombian Amazonia region: species composition from the river systems within the rainforest biome / Peces de la región de la Amazonía Colombiana: composición de especies de los sistemas fluviales del bioma de selva húmeda

Abstract The Colombian Amazon region is part of the Neotropical rainforest (humid forest biome) covering an area of 483,163 km2 and includes tributaries of both the Amazon and Orinoco River basins. The aquatic ecosystems found there include: rivers and alluvial plains originating in Andean headwaters, on eroded soils of tropical forests in the lowlands, and Guiana Shield formations, comprising a dense fluvial drainage network in the lowlands, with Paleogene/Neogene geological formations (terra firme streams in higher places that don't usually flood) and Paleozoic (shield streams); and Andean and Guiana Shield streams above 200-250 m a.s.l. We present here an exhaustive compilation of published information, supported by fish collections, consisting of a list of 1104 species distributed in 375 genera, 53 families, and 16 orders. We include occurrence data of these species in each sub-basin. The presence/absence species matrix was analyzed using a dendrogram and non-metric multidimensional scaling (NMDS) analysis to identify patterns of similarity between basins and sub-basins. We evaluated species composition between basins and among the different geological origins using PERMANOVA. The dendrogram shows co-occurrences of 404 species in the two basins. It also shows two clear groupings of the sub-basins of the Amazon (except Guainía-Negro drainages) and those of the Orinoco. Within the Amazon Basin, there are two nodes according to the geological origin: systems of Andean origin and those of the lowlands. The dendrogram results are consistent with the NMDS analysis, which shows a clear grouping according to the connectivity of the basins; the Guainía-Negro is included in the Amazon basin. Species distribution patterns were supported by the PERMANOVA, and differed significantly between basins (F = 4.3, R = 0.26, P = 0.003) and geological origin (F = 3.6, R = 0.23, P = 0.003). The number of species in this study represents almost a fifth of the ichthyofauna of the Neotropics and about a third of that of the Amazon River basin; clearly supporting Colombia's status among the countries with the greatest diversity of freshwater fish species of the planet. We include here a significant number of new records (75 spp), provide a first approximation of the distribution patterns, and a framework for future biogeographical studies.

Resumo La región de la Amazonía colombiana hace parte del bosque húmero neotropical (bioma de selva húmeda) abarcando un área de 483.163 km2 e incluye afluentes de las cuencas del Amazonas y Orinoco. Los ecosistemas acuáticos encontrados allí incluyen: ríos y llanuras aluviales, originándose en cabeceras andinas, en suelos erosionados de bosques tropicales en tierras bajas y en formaciones de escudos; conformando una densa red fluvial en tierras bajas con formaciones geológicas paleógenas-neógenas (arroyos de terra firme en sitios elevados que usualmente no se inundan) y paleozoicas (arroyos de escudo); y arroyos andinos y del escudo Guayanés por encima de 200-250 m s.n.m. Presentamos aquí una recopilación exhaustiva de información publicada, sustentada por colecciones ictiológicas, consistiendo en una lista de 1104 especies distribuidas en 375 géneros, 53 familias y 16 órdenes. Incluimos datos de estas especies en cada subcuenca. La matriz de presencia/ausencia de especies fue analizada usando un dendrograma y un análisis de escalamiento multidimensional no métrico (NMDS) para identificar patrones de similitud entre cuencas y subcuencas. Se evaluó la composición de especies entre cuencas y entre los diferentes orígenes geológicos usando PERMANOVA. El dendrograma refleja coocurrencia de 404 especies en las dos cuencas. También muestra dos agrupaciones claras de las subcuencas del Amazonas (excepto Guainía-Negro) y las del Orinoco. Dentro de la cuenca amazónica existen dos nodos según el origen geológico: los sistemas de origen andino y los de tierras bajas. Los resultados del dendrograma son consistentes con el análisis NMDS, el cual muestra una clara agrupación según la conectividad de las cuencas; el Guainía-Negro está incluido en la cuenca del Amazonas. Los patrones de distribución de especies fueron respaldados por el PERMANOVA y difirieron significativamente entre cuencas (F = 4.3, R = 0.26, P = 0.003) y origen geológico (F = 3.6, R = 0.23, P = 0.003). El número de especies en este estudio representa casi la quinta parte de la ictiofauna del Neotrópico y alrededor de un tercio de la de la cuenca del río Amazonas; soportando el estatus de Colombia entre los países con mayor diversidad de especies de peces de agua dulce del planeta. Incluimos aquí un número importante de nuevos registros (75 spp), brindamos una aproximación de los patrones de distribución y un marco para futuros estudios biogeográficos.

Hemodynamic depression after carotid surgery: Incidence, risk factors and outcomes

Abstract Introduction: Hemodynamic Depression (HD) characterized by hypotension and bradycardia is a complication of carotid surgery due to direct autonomic stimulation in the carotid sinus. The authors believe the incidence of HD is high and possibly related to major cardiac complications. Methods: Analysis of patient records during admissions for carotid surgery between January 2014 and December 2018 in two hospitals. HD was defined as bradycardia or hypotension in the first 24 postoperative hours. Bradycardia was defined as heart rate < 50bpm; hypotension as systolic blood pressure < 90 mmHg, continuous use of vasopressors, or a drop in SBP > 20% compared to preoperative values. Myocardial infarction, stroke, and cardiovascular death were defined as adverse events. Results: Overall, 237 carotid surgeries (178 endarterectomies, 59 angioplasties) were studied, and the global incidence of HD was 54.4% (hypotension in 50.2%, bradycardia in 11.0%, and hypotension and bradycardia in 6.8%). The independent predictors of HD were asymptomatic carotid stenosis (OR = 1.824; 95% CI 1.014 −3.280; p = 0.045), endovascular surgery (OR = 3.319; 95% CI 1.675−6.576; p = 0.001) and intraoperative hypotension or bradycardia (OR = 2.144; 95% CI 1.222−3.762; p = 0.008). Hypotension requiring continuous vasopressor infusion was the only factor independently associated with adverse cardiovascular events (OR = 5.504; 95% CI 1.729-17.529; p = 0.004). Discussion/conclusion: Incidence of Hemodynamic Depression after carotid surgery is high and independently associated with surgical technique, symptomatic repercussion of the carotid stenosis, and intraoperative hypotension or bradycardia. Hypotension requiring the continuous infusion of vasopressors was independently associated with the occurrence of MACE.

Fishes of the Mitú Region: middle basin of the río Vaupés, Colombian Amazon / Peces de la región de Mitú: cuenca media del río Vaupés, Amazonia colombiana

Abstract: The Amazon River basin hosts the most diverse freshwater ichthyofauna in the world, and yet huge areas of the basin remain unexplored. This is the case for the upper tributaries of the rio Negro, especially those draining the Colombian territory. Here we present a list of 224 species derived from the examination of specimens collected in the Mitú region (Vaupés Department, Colombia), the middle basin of the río Vaupés. Of the species identified in our study, 10 species are recorded from Colombia for the first time, and 26 species are newly recorded from the Colombian Amazon. The number of species we present here comprise almost one-third of the known species diversity of the Colombian Amazon and nearly a tenth of the total number of those known across the entirety of the Amazon basin. The most diverse orders were Characiformes (120 species) and Siluriformes (65 species), and the remaining six orders comprised less than 20% of total species. The study area comprised blackwater systems, which are considered to be nutrient-poor environments. We discuss some ecological aspects that might explain how this highly diverse ichthyofauna originates and is maintain in less productive systems. The list presented here adds an important number of new records and complements the information derived from previous studies, carried out thus far with regards to the fish fauna of the Colombian Amazon.

Resumo: La cuenca del río Amazonas alberga la ictiofauna dulceacuícola más diversa del mundo, sin embargo, grandes áreas de la cuenca permanecen inexploradas. Este es el caso de los afluentes de la parte alta del río Negro, especialmente los sistemas que drenan el territorio colombiano. A continuación, presentamos un listado de 224 especies derivadas del análisis de especímenes recolectados en la región de Mitú, cuenca media del río Vaupés (Departamento de Vaupés, Colombia). De las especies identificadas, 10 especies se registran en Colombia por primera vez y 26 especies para la Amazonía colombiana. El número de especies que presentamos aquí comprende casi un tercio de las especies conocidas para la Amazonía colombiana y casi una décima parte del total de las conocidas para la gran cuenca del Amazonas. Los órdenes más diversos fueron Characiformes (120 especies) y Siluriformes (65 especies), y los seis órdenes restantes comprendieron menos del 20% del total de especies. El área de estudio comprende sistemas de aguas negras que se consideran ambientes poco productivos por sus bajos contenidos de nutrientes. Discutimos aquí algunos aspectos ecológicos que podrían explicar cómo esta ictiofauna tan diversa tiene su origen y es mantenida en estos sistemas poco productivos. La información derivada del presente estudio adiciona nuevos registros de especies de peces para Colombia, y complementa la información derivada de los estudios realizados a la fecha en la Amazonía colombiana.

Panorámica de la COVID-19 en tres municipios de Guerrero, México, durante 2020 / Overview of COVID-19 in three municipalities of Guerrero, México during 2020

RESUMEN Objetivo Estimar la magnitud de daños a la salud por la pandemia de COVID-19 y su dinámica en Ometepec, Xochistlahuaca y Tlacoachistlahuaca, en Guerrero, México, durante 2020. Métodos Estudio retrospectivo hecho mediante un análisis secundario de la base de datos de COVID-19 de la Secretaría de Salud de México. Con análisis bivariado y regresión logística binaria, se desarrollaron estimaciones de series de tiempo y de magnitud del daño a la salud por COVID-19. Resultados Durante las semanas epidemiológicas 12 a 40 de 2020, se confirmaron 325 casos y 28 defunciones por COVID-19. De los casos confirmados, solo 16 % fueron indígenas. Dos de cada tres defunciones ocurrieron en las primeras 48 horas del ingreso hospitalario. Las variables predictoras que mejor se ajustaron al modelo de regresión, asociadas a la letalidad hospitalaria, fueron diabetes, neumonía asociada a COVID-19 y edad de 50 años o mayor. Conclusiones Es importante enfatizar los datos de alarma de la COVID-19 a la población indígena (en particular, la dificultad respiratoria) y factores asociados a complicaciones por COVID-19 como diabetes y edad avanzada, para incrementar el uso oportuno de los servicios de salud.

ABSTRACT Objective To estimate the magnitude and dynamics of health outcomes related to the COVID-19 pandemic and the dynamic in Ometepec, Xochistlahuaca and Tlacoachist-lahuaca in Guerrero, Mexico. Methods Retrospective study developed from the secondary analysis of the COVID-19 database, from the Mexican Ministry of Health in 2020. We developed time series and estimated the magnitude of the health effects of the pandemic by means of bivariate analysis and binary logistic regression models. Results The public health services registered 325 confirmed cases and 28 deaths from COVID-19 during epidemiologic weeks 12 to 40 in 2020. Nearly 16% of confirmed cases pertained to patients self-reported as indigenous people. Two out of three deaths occurred within 48 hours of hospital admission. Diabetes, COVID-19 pneumonia and being age 50 years or older were the predictor variables associated with hospital fatality which best fit our regression models. Conclusions It is essential to promote a greater use of government health services among indigenous populations by disseminating culturally relevant information on war-ning signs such as difficulty breathing and risk factors such as suffering from diabetes and being an older adult.