Evaluation of an automatized AMBU ESSI-1 INC designed at the Instituto Nacional de Cardiología Ignacio Chávez / Evaluación del AMBU automatizado ESSI-1 INC diseñado en el Instituto Nacional de Cardiología Ignacio Chávez

Abstract Objective: The objectives of this study were to evaluate an automated device for ventilatory support based on AMBU manufactured in March 2020. Methods: The ESSI-1 INC was evaluated through pulmonary mechanics and physiology parameters through compensatory spirometer tests (TISSOTs), and an artificial lung Model5600i Dual Adult PNEU VIEW SYSTEM; it was also compared to the anesthetic ventilatory support equipment (AEONMED 7500) in porcine models, measuring ventilatory, hemodynamic and gasometric parameters. Results: This equipment (ESSI-1 INC) was successfully tested by mechanical and biological models, such as pigs in which its performance was evaluated in terms of variability of tidal volume, ventilation frequency, and I/E relationship versus the manual performance of two medical interns. All the results turned out as expected and were satisfactory. Conclusions: It is safe and effective equipment and should be tested and used in diverse clinical conditions to standardize the ventilatory safety and care of patients who require it.

Resumen Objetivo: Evaluar un dispositivo automatizado para la asistencia ventilatoria basado en un AMBU manufacturado en Marzo del 2020. Métodos: El ESSI-1 INC fue evaluado por medio de parámetros fisiológicos y mecánica pulmonar a través de pruebas de espirómetro compensatorios (TISSOT); pulmón artificial (Modelo 5600i Dual Adult PNEU VIEW SYSTEM); así como su desempeño comparado a la máquina de anestesia (AEONMED 7500) en modelos porcinos, midiendo criterios ventilatorios, hemodinámicos y gasométricos. Resultados: Este equipo (ESSI-1 INC) fue exitosamente probado por modelos mecánicos y biológicos, tales como cerdos donde su desempeño fue evaluado en términos de la variabilidad del volumen tidal, frecuencia ventilatoria, y relación I/E versus el desempeño manual de dos médicos. Todos los resultados finalizaron como se esperaba de forma satisfactoria. Conclusiones: Es un equipo seguro y efectivo, el cual debería ser probado y usado en distintas condiciones clínicas para estandarizar la seguridad ventilatoria y cuidado de pacientes que lo requieran.

Inteligencia emocional en estudiantes de educación física / Emotional intelligence in physical education students / Inteligência emocional em estudantes de educação física

La inteligencia emocional se define como habilidades para conocer y dominar emociones propias y de otros/as. Los objetivos del presente estudio fueron validar un instrumento de inteligencia emocional en una muestra de estudiantes de Educación Física de Chile y describir las habilidades emocionales de la muestra. Se evaluaron 226 estudiantes de Educación Física de dos universidades de Santiago de Chile. Se aplicó la Escala rasgo de metaconocimiento emocional (TMMS-24). Los resultados revelan que el instrumento, reducido a 19 ítems, presenta tres factores que explican el 56,8% de la varianza total, con un alfa de Cronbach de 0,916. En relación con los niveles de inteligencia emocional, la muestra presenta valores altos, sin que existan diferencias significativas en las dimensiones claridad, atención y reparación del TMMS-24 entre damas y varones. Al comparar por años de carrera, sólo hay diferencias en la dimensión claridad, donde los/as estudiantes de 5º año poseen mayores puntajes que los/as de 2º. Se concluye que los/as estudiantes de Educación Física poseen altos índices de inteligencia emocional, sin diferencias entre damas y varones.

Emotional intelligence is defined as the ability to know and master one's and/or others' emotions. The objectives of this study were to validate an emotional intelligence instrument in a sample of physical education students from Chile, and to describe the emotional skills of the sample. 226 physical education students from two universities in Santiago de Chile were evaluated. The Emotional Metacognition Trait Scale (TMMS-24) was applied. The results reveal that the instrument, reduced to 19 items, presents three factors that explain 56,8% of the total variance, with a Cronbach alpha of 0,916. In relation to the levels of emotional intelligence, the sample presents high values, without there being significant differences in the dimension's clarity, attention, and repair of the TMMS-24 between women and men. When comparing years of career, there are only differences in the clarity dimension, where 5th year students had higher scores than/as 2nd years. It is concluded that physical education students have high rates of emotional intelligence, with no differences between women and men.

A inteligência emocional é definida como habilidades para conhecer e dominar emoções próprias e de outros/as. Os objetivos do presente estudo foram validar um instrumento de inteligência emocional em uma mostra de estudantes de Educação Física do Chile e descrever as habilidades emocionais da mostra. Foram avaliados 226 estudantes de Educação Física de duas universidades de Santiago do Chile. Foi aplicada a Escala característica de meta-conhecimento emocional (TMMS-24). Os resultados revelam que o instrumento, reduzido a 19 itens, apresenta três fatores que explicam 56,8% da variância total, com um alfa de Cronbach de 0,916. Em relação aos níveis de inteligência emocional, a amostra apresenta valores altos, sem que existam diferenças significativas nas dimensões clareza, atenção e reparação do TMMS-24 entre mulheres e homens. Ao comparar por anos de carreira, só há diferenças na dimensão clareza, onde os/as estudantes de 5º ano possuem maiores pontuações que os/as de 2º. Conclui-se que os/as estudantes de Educação Física possuem altos índices de inteligência emocional, sem diferenças entre mulheres e homens.

Multicenter comparative study of open, laparoscopic, and robotic pyeloplasty in the pediatric population for the treatment of ureteropelvic junction obstruction (UPJO)

ABSTRACT Introduction: Dismembered open pyeloplasty described by Anderson and Hynes is the "gold standard" for the treatment of ureteropelvic junction obstruction. The aim of our study was to compare the results of open (OP) vs laparoscopic (LP) vs robotic (RALP) pyeloplasty. Material and Methods: A multicenter prospective review was conducted of pyeloplasty surgeries performed at five high-volume centers between 2014 and 2018. Demographic data, history of prenatal hydronephrosis, access type, MAG3 renogram and differential renal function, surgery time, length of hospital stay, and complication rate (Clavien-Dindo) were recorded. Access type was compared using the Kruskal-Wallis, Chi-square, or Fisher's exact tests. Results: A total of 322 patients were included: 62 OP, 86 LP, and 174 RALP. The mean age was 8.13 (r: 1-16) years, with a statistically significant lower age (mean 5 years) in OP (p < 0.001). There were no significant differences in the distribution of the side affected. Operative time was 110.5 min for OP, 140 min for LP, and 179 min for RALP (p < 0.0001). Hospital stay was significantly shorter in the RALP group than in the other groups (p < 0.0001). There were no differences in postoperative complications and reoperations between the three groups. Conclusions: Minimally invasive surgery for the management of UPJO in children is gaining more acceptance, even in patients younger than 1-year-old. Operative time continues to be significantly shorter in OP than in LP and RALP. Hospital stay was shorter in RALP compared to the other techniques. No differences were found in complication rates, type of complications, and reoperation rate.

Seguimiento a 5 años de prótesis híbrida con subestructura sinterizada. Reporte de caso

RESUMEN: La rehabilitación de rebordes severamente atróficos mediante prótesis híbridas con subestructura cromo-cobalto fabricadas por sinterizado láser asegura el ajuste pasivo, aumentando la estabilidad de los tejidos de soporte a largo plazo. Los controles periódicos y enseñanza de técnicas de higiene son fundamentales para el éxito de rehabilitaciones complejas sobre implantes. El propósito de este reporte de caso es realizar la evaluación clínica y radiográfica a 5 años de prótesis híbridas maxilar y mandibular fabricadas mediante sinterizado láser, encontrándose resultados satisfactorios en la evaluación y seguimiento.

ABSTRACT: Rehabilitation of severely atrophic ridges using hybrid cobalt-chrome substructures manufactured by laser sintering ensures passive fit, increasing support tissue stability. Regular check-ups and the teaching of hygiene techniques are essential for the success of complex implant restorations. The purpose of this case report is to perform a 5-year clinical and radiographic evaluation of hybrid maxillary and mandibular prostheses manufactured using laser sintering, achieving satisfactory results in the evaluation and follow-up.

Aloinjerto fresco de rótula y defectos osteocondrales / Fresh patellar allograft and osteochondral defects

Introducción: Las lesiones condrales de la rótula son un reto para el cirujano, principalmente en pacientes jóvenes y activos. La mayoría de los defectos condrales de la rótula son lesiones superficiales y pueden ser manejadas con técnicas de preservación articular; sin embargo, las lesiones profundas pueden requerir otro tipo de manejo. El objetivo de este artículo es comunicar el tratamiento de defectos osteocondrales de la rótula en pacientes jóvenes, mediante la técnica de aloinjerto fresco de donante cadavérico. materiales y métodos: Se seleccionaron pacientes con dolor anterior de rodilla, lesión condral de la rótula grado III-IV y que habían recibido o no algún tipo de manejo médico o quirúrgico. En estos pacientes, se usó un aloinjerto fresco de rótula con el fin de solucionar el cuadro y mejorar la función. Resultados: Todos los pacientes recuperaron la función y los arcos de movilidad, y no refirieron dolor. Se comprobó la integración del aloinjerto fresco al área receptora, sin evidencia de rechazos del tejido o infecciones. Conclusiones: El uso de aloinjerto fresco de rótula para tratar defectos osteocondrales amplios es una téc-nica quirúrgica valiosa, fácil de implementar, que no requiere una curva de aprendizaje extensa y que mejora considerablemente el dolor y la función en pacientes jóvenes. Nivel de Evidencia: IV

Introduction: Chondral lesions of the patella are a challenge for the surgeon, mainly in young and active patients. Most patellar chondral defects are superficial injuries and can be managed with joint preservation techniques; however, deep injuries may require other types of management. The objective of this article is to manage osteochondral defects of the patella in young patients, using the technique of fresh allograft from a cadaveric donor. Materials and methods: Patients with anterior knee pain, with grade III - IV chondral lesion of the patella and who had or had not undergone some type of medical or surgical management were included. They received a fresh patellar allograft that sought to provide a solution and improvement of the functionality. Results: In all cases, recovery of functionality and mobility, absence of pain and integration of the fresh allograft into the recipient area were achieved, without evidence of tissue rejection or infection. Discussion: The use of fresh patellar allograft for the management of wide osteochondral defects is a valuable surgical technique, easy to implement, that does not require a long learning curve and that considerably improves pain and functionality in young patients. Conclusions: The advent of fresh osteochondral grafts allows adequate management and evolution of patients, with the aim of favoring joint preservation and avoiding total knee arthroplasty over time. Level of Evidence: IV

Un caso clínico de implante valve in valve mitral: nuevo horizonte en el tratamiento de la disfunción valvular protésica / A clinical case of mitral valve in valve implant: new skyline in the treatment of prosthetic valve dysfunction / Presentação de um caso clínico do valve in valve mitral: um novo horizonte no tratamento da disfunção valvular protética

La disfunción valvular protésica es cada vez más frecuente debido al envejecimiento de la población portadora de bioprótesis y se presenta como un desafío en el momento de su diagnóstico, valoración y tratamiento. Aplicar un enfoque imagenológico multimodal es fundamental para su manejo. Respecto al tratamiento, surge como nueva alternativa un procedimiento mínimamente invasivo de sustitución valvular percutánea, denominado valve in valve, principalmente en pacientes con riesgo quirúrgico elevado. Presentamos uno de los primeros casos locales de implante percutáneo de prótesis mitral transeptal dentro de una bioprótesis mitral quirúrgica disfuncionante.

Prosthetic valve dysfunction is increasingly common due to the aging of the bioprosthesis-bearing population, and it presents a challenge at the time of diagnosis, evaluation, and treatment. A multimodal imaging approach is essential for its management. In relation to treatment, a minimally invasive percutaneous valve replacement procedure called valve in valve arises as a new alternative, mainly in patients with high surgical risk. We present one of first local cases of percutaneous implantation of a transseptal mitral prosthesis within a dysfunctional surgical mitral bioprosthesis.

A disfunção valvular protética é cada vez mais comum devido ao envelhecimento da população portadora de biopróteses e representa um desafio no momento do diagnóstico, avaliação e tratamento. A multimodalidade da imagem cardiovascular é essencial para sua avaliação. Em relação ao tratamento, um procedimento de troca valvular percutânea minimamente invasivo, denominado valve in valve, surge como uma nova alternativa, principalmente em pacientes com alto risco cirúrgico. Apresentamos um dos primeiros casos realizados no Uruguai de implantação percutânea de prótese mitral transeptal dentro de bioprótese mitral cirúrgica disfuncional.

Social desirability in the measurement of subjective well-being: A study with Chilean university students / Deseabilidad social en la medición del bienestar subjetivo: un estudio con estudiantes universitarios de Chile

Abstract The present study aimed at determining the association between life satisfaction and subjective happiness while controlling for social desirability, and to explore whether overall satisfaction with life can be predicted by satisfaction with life dimensions while controlling for social desirability. The study had a quantitative, non-experimental cross-sectional design, with 279 participants from different universities of the Council of Rectors of Chile recruited through a non-probabilistic sampling method for convenience. The participants completed an online questionnaire that inquired about their global and dimensional satisfaction with life, subjective happiness, social desirability, and sociodemographic variables. The data was analysed using partial correlations and multiple regression analyses. Bivariate correlation results indicate weak and direct associations between social desirability and life satisfaction and subjective happiness, and a strong and direct association between the latter. According to the results of the partial correlation analysis, the association between life satisfaction and subjective happiness is maintained even when social convenience is controlled. The results of the multiple regression analyses indicate that although social desirability predicts life satisfaction by itself, when satisfaction with life dimensions is added to the model, social desirability loses its predictive power. In conclusion, although social desirability is associated with the two components, affective and cognitive, of subjective well-being, this association loses predictive power when other variables are considered in predictive models. Study limitations include a relatively low reliability score on the social desirability scale, possible bias due to the study's self-report design and sampling method used. The present study aimed at determining the association between life satisfaction and subjective happiness while controlling for social desirability, and to explore whether overall satisfaction with life can be predicted by satisfaction with life dimensions while controlling for social desirability. The study had a quantitative, non-experimental cross-sectional design, with 279 participants from different universities of the Council of Rectors of Chile recruited through a non-probabilistic sampling method for convenience. The participants completed an online questionnaire that inquired about their global and dimensional satisfaction with life, subjective happiness, social desirability, and sociodemographic variables. The data was analysed using partial correlations and multiple regression analyses. Bivariate correlation results indicate weak and direct associations between social desirability and life satisfaction and subjective happiness, and a strong and direct association between the latter. According to the results of the partial correlation analysis, the association between life satisfaction and subjective happiness is maintained even when social convenience is controlled. The results of the multiple regression analyses indicate that although social desirability predicts life satisfaction by itself, when satisfaction with life dimensions is added to the model, social desirability loses its predictive power. In conclusion, although social desirability is associated with the two components, affective and cognitive, of subjective well-being, this association loses predictive power when other variables are considered in predictive models. Study limitations include a relatively low reliability score on the social desirability scale, possible bias due to the study's self-report design and sampling method used.

resumen está disponible en el texto completo

Design, manufacture and initial tests of a drug-eluting coronary stent / Diseño, fabricación y pruebas iniciales de una endoprótesis coronaria liberadora de fármaco

Abstract Introduction: A drug-eluting coronary stent is being developed at the National Institute of Cardiology of Mexico for the treatment of ischemic heart disease. Objective: To establish the best animal model for the tests, to show the advances in the drug-eluting stent prototype, to assess two drugs’ antiproliferative activity and histological results. Method: Smooth muscle cell culture tests were performed in order to assess sirolimus and paclitaxel antiproliferative properties. The drugs were encapsulated inside the polymeric matrix of the stents. Rabbits and pigs were used as animal models. Results: Sirolimus and paclitaxel showed an inhibitory effect, which was higher for the latter. Infrared spectroscopy and light and optical microscopy showed that the drug/polymer layer properly adhered to the stent. At a four-week follow-up, both animal models showed satisfactory clinical evolution and adequate histological response, although the porcine model was shown to be more suitable for future protocols. Conclusions: Preliminary tests of the drug-eluting stent provided bases for the development of a study protocol with an adequate number of pigs and with clinical angiographic and histopathological three-month follow-up.

Resumen Introducción: En el Instituto Nacional de Cardiología de México se desarrolla una endoprótesis (stent) coronaria liberadora de fármacos para el tratamiento de la cardiopatía isquémica. Objetivo: Establecer el mejor modelo animal para las pruebas, mostrar los avances en el prototipo del stent liberador de fármacos, evaluar la actividad antiproliferativa de dos fármacos y los resultados histológicos. Método: Se realizaron cultivos de células de músculo liso para evaluar las propiedades antiproliferativas de sirolimus y paclitaxel. Los fármacos fueron encapsulados en el interior de la matriz polimérica de los stents. Se emplearon conejos y cerdos como modelos animales. Resultados: Sirolimus y paclitaxel mostraron efecto inhibitorio, mayor en el segundo. La espectroscopia infrarroja y la microscopia óptica y electrónica mostraron que la capa del polímero con el fármaco se adhería adecuadamente al stent. A las cuatro semanas de seguimiento, ambos modelos animales mostraron evolución clínica satisfactoria y adecuada respuesta histológica, si bien el modelo porcino resultó más conveniente para protocolos futuros. Conclusiones: Las pruebas preliminares del stent liberador de fármaco brindó bases para desarrollar el protocolo con un número adecuado en cerdos y con seguimiento clínico angiográfico e histopatológico a tres meses.

Design and manufacture of a coronary stent INC-1 and initial tests in experimental animal model / Diseño y fabricación del stent coronario INC-1y pruebas iniciales en animales de experimentación

Abstract In this paper, we describe our coronary stent (INC-1) design and development, the way that we found the specific characteristics needed for our device including biophysics aspects, design, finite element testing, manufacturing, and mechanic trials, we submitted and animal models experiences. The stent platform was cobalt-chromium L605 (Co-Cr), with struts thickness of 80 μm, balloon expandable. We placed the coronary stent INC-1 on a rabbit and dog models so we can evaluate efficacy and security of the device in relationship to its biomechanical properties including navigation capacity, traceability, symmetric expansion, and safety, as well as endothelial attachment, thrombogenicity, and lack of involvement of secondary branches in these models. We succeeded in efficacy and safety of the device after fluoroscopy-guided implant proving excellent capacity of release system, traceability, fluoroscopic visualization, symmetric expansion, and complete endothelial attach. Furthermore, we obtained a good post-implant balloon withdrawal, functional integrity, and no vascular complications. We observed adequate clinical evolution 3 weeks after the stent implantation.

Resumen En esta publicación se describen el diseño y el desarrollo de un stent coronario (INC-1), la forma en que se determinaron las características biofísicas deseadas, el diseño y las pruebas computacionales por elemento finito, su fabricación, así como las pruebas mecánicas a las que se sometió el prototipo y por último las primeras experiencias en modelos animales. La plataforma del stent desarrollado fue de cobalto y cromo L605 (Co-Cr), con struts de 80 μm de grosor, expandido por balón. La colocación del stent coronario INC-1 se realizó en un modelo de conejo y uno canino con el objetivo de evaluar el éxito técnico y de seguridad del stent en relación con las propiedades biomecánicas (capacidad de navegación, maniobrabilidad, expansión simétrica del stent) y de seguridad (fijación a la pared vascular y ausencia de compromiso de ramas secundarias y formación de trombos en el momento de la colocación del stent en el modelo animal). Se obtuvo éxito técnico y de seguridad del stent después del implante guiado por fluoroscopia, lo que demostró adecuada capacidad del sistema liberador, excelente maniobrabilidad, adecuada visualización fluoroscópica, expansión simétrica y fijación completa a la pared vascular, capacidad para retirar el balón desinflado después del implante, e integridad funcional y sin complicaciones vasculares. La evolución clínica fue favorable a tres semanas del seguimiento planeado.

Human pilot study of bare-metal stent: INC-01

ABSTRACT Background: The cost of performing a percutaneous coronary intervention is considerably high for the patient as well as for health systems, which have promoted the development of local technology to help meet the need for these devices. Methods: The INC-01 bare-metal stent was developed at the National Institute of Cardiology in Mexico City and was first implanted on porcine models with technical success in 100% of the evaluated parameters. Presentation of Cases: We present the first three cases of patients with ischemic heart disease, to whom the INC-01 bare-metal stent was implanted. Intracoronary ultrasonography was performed post-stent implantation, showing all the characteristics of implant success during evaluation and clinical follow-up. Conclusions: Angiography and intracoronary ultrasound were carried out demonstrating that the INC-01 bare-metal stent has physical, biological, and histological characteristics similar to those found in commercial metallic stents.

Inestabilidad vesical, constipación y disfunción vésico-intestinal (DVI) / Bladder instability, constipation and vesical-intestinal dysfunction (DVI)

La inestabilidad vesical y la constipación son manifestaciones clínicas frecuentes en la consulta pediátrica y predisponen a un problema urológico significativo,provocando una disfunción vésico-intestinal (DVI), que ocasiona complicaciones en el funcionamiento normal del sistema urinario, con enuresis, incontinencia de orina, micción frecuente, encopresis y episodios recurrentes de infección urinaria.Es fundamental el interrogatorio exhaustivo sobre los hábitos evacuatorios,tiempo de control de esfínteres, hábitos alimenticios y maduración psicofísica para no equivocar el rumbo, y llegar a un correcto diagnóstico y posterior tratamiento, evitando tratamientos inútiles y la pérdida de tiempo y frustraciones del paciente y la familia.El presente trabajo intenta dar un poco de luz en este problema, insistiendo en la importancia del médico pediatra como factor fundamental en la pesquisa y diagnóstico de la disfunción vésico-intestinal

Bladder instability and constipation are frequent clinical manifestations in pediatric practice, and predispose to a significant urological problem, causing a vesical-intestinal dysfunction (DVI), which causes complications in the normal functioning of the urinary system, with enuresis, urinary incontinence, frequent urination, encopresis and recurrent episodes of urinary infection.Comprehensive interrogation of evacuation habits, sphincter control time, eating habits and psychophysical maturation is essential to avoid misguiding the course,and to arrive at a correct diagnosis and subsequent treatment, avoiding useless treatments and the loss of time and frustrations of the patient and the family.The present work tries to give a little light on this problem, insisting on the importance of the pediatrician as a fundamental factor in the investigation and diagnosis of vesical-intestinal dysfunction

Ecografía renal en la evaluación inicial del hipospadias aislado. ¿Es necesaria? / Renal ultrasound in the initial evaluation of hypospadias isolated. It is necessary?

En la actualidad es frecuente la solicitud de ultrasonido renal pediátrico en pacientes con hipospadias. Si bien es necesario en hipospadias asociados con otras malformaciones, no parece ser útil en pacientes con hipospadias aislados

At present, the request for renal ultrasound is frequent pediatric in patients with hypospadias. Although it is necessary in hypospadias associated with other malformations, does not appear to be useful in patients with isolated hypospadias

Relación entre el patrón dactiloscópico epidérmico y dérmico / Relationship between the epidermal and the dermal dactyloscopic pattern

El método más utilizado en identificación humana es el dactiloscópico, que registra, analiza y coteja los tipos fundamentales y puntos característicos de las figuras presentes en el dactilograma, determinando el grado de coincidencia, entre un patrón de identidad dubitada y uno de identidad indubitada. Debido a los procesos que afectan la piel de cadáveres, como la putrefacción entre otros, se utilizan las técnicas necropapiloscópicas que ocupan los patrones dérmicos para la identificación humana. El objetivo del presente trabajo es comparar registros epidérmicos con dérmicos, y validar científicamente, este método de identificación (epidérmico - dérmico). Para ello se utilizaron 32 dedos de cadáveres de individuos chilenos, de ambos sexos y de entre 40 y 80 años. Para obtener el registro físico artificial epidérmico y dérmico se utilizó la técnica de obtención de impresiones necrodactilares y se comparó a través de la técnica de cotejo dactiloscópico. Estos procedimientos fueron realizados por peritos criminalísticos de Carabineros de Chile. Se logró evidenciar diferencias importantes entre epidermis y dermis en cuanto a cantidad y calidad de puntos característicos y presencia de líneas seniles. En relación a tipos fundamentales, se evidenció que en dermis es difícil la observación de tipos fundamentales (borrosos) pero no se encontró ningún dígito que presentara tipo fundamental diferente entre epidermis y dermis. También se constataron diferencias por sexo y edad. Finalmente se pudo evidenciar, que existe una relación morfológica semejante entre registros físicos artificiales de patrones papiloscópicos epidérmicos con dérmicos provenientes del mismo individuo. Esto permite utilizar los registros dérmicos para la identificación humana positiva. Los resultados de este trabajo son importantes al aportar evidencia científica para la identificación humana en base al patrón dactiloscópico dérmico.

The most used method in human identification is the dactyloscopy, which registers, analyzes and collates the fundamental types and characteristic points of figures present in the dactylogram determining the degree of coincidence, between a pattern of identity that is dubious, and one that is indubious. Due to the processes that affect the skin of corpses, such as putrefaction, the necropapiloscopy techniques that occupy the dermal patterns for human identification are used. The objective of the present work is to compare epidermal with dermal records and validate scientifically, this method of identification (epidermal - dermal). For this purpose, 32 cadaveric fingers of Chilean individuals, of both sexes and between 40 and 80 years were used. In order to obtain the epidermal and dermal artificial physical record, the technique of obtaining necrodactyle impressions was used and compared through of the technique of dactyloscopic comparison. These procedures were carried out by criminalistic experts of Carabineros de Chile. It was possible to show important differences between epidermis and dermis in terms of quantity and quality of characteristic points and presence of senile lines. In relation to fundamental types, it was evidenced that in the dermis it is difficult to observe fundamental types (blurred) but no digit was found that presented a different of fundamental type between epidermis and dermis. There were also differences by sex and age. Finally, it was possible to demonstrate that there is a similar morphological relationship between artificial physical records of epidermal papiloscopic patterns with dermal patterns from the same individual. This allows the use of dermal records for positive human identification. The results of this work are important in providing scientific evidence for human identification based on the dermal fingerprint pattern.

Incidencia del síndrome de abstinencia en niños críticamente enfermos / Incidence of withdrawal syndrome in critically ill children

Objetivo: determinar la incidencia del síndrome de abstinencia (SA), describir presentación clínica e identificar la presencia de factores de riesgo. Metodología: se realizó un estudio prospectivo, observacional, de evaluaciones reiteradas usando la Sophia Observation Withdrawal Symptoms Scale (SOWS), en la Unidad de Cuidado Intensivo de Niños (UCIN) de 20 camas, del Centro Hospitalario Pereira Rossell (CHPR). Se incluyeron los niños ingresados en UCIN entre el 1 de noviembre de 2013 y el 30 de setiembre de 2014 tratados con benzodiacepinas y/o opiáceos por cinco días o más. Se registró: duración de la estadía, fármacos utilizados para sedación y analgesia, días de uso, máximo de dosis, dosis total acumulada. El diagnóstico de SA se realizó a través del uso de la SOWS. Los pacientes fueron divididos en dos grupos, con y sin SA. Se analizaron y compararon las características de ambos grupos. Resultados: se incluyeron 39 niños. La incidencia de SA fue 18% (7/39). Los ítems del SOWS más frecuentes fueron ansiedad y sueño menor a 1 hora. Los niños que desarrollaron SA presentaron dosis acumulativas más elevadas tanto de midazolam (54,1 mg/kg vs 44,2 mg/kg) como de fentanilo (464,2 mg/kg vs 380,1 mg/kg). Conclusiones: el SA fue frecuente en este grupo de niños. Las dosis acumulativas fueron mayores en el grupo con SA. La SOWS es una herramienta útil y de fácil aplicación para el diagnóstico de SA.

Objective: The study aims to determine the incidence of withdrawal syndrome, its clinical features and the presence of risk factors. Methodology: An observational and prospective study. Assessment was repeated and the Sophia Observation Withdrawal Symptoms Scale (SOWS) was used. The study was conducted at the Pediatric Intensive Care Unit (PICU) of Centro Hospitalario Pereira Rossell (CHPR). Hospitalized children in PICU between 1/11/2013- 30/9/2014 and treated with benzodiazepines and opioids during 5 days or more were included in the study. Days of stay at the PICU, agents used for sedation (dose, duration) and cumulative doses were recorded. Withdrawal syndrome diagnosis was done using the SOWS. Results: 39 children were included in the study. The incidence of withdrawal syndrome was 18% (7/39). Children who developed withdrawal syndrome presented higher cumulative doses of midazolam (54.1 mg/kg vs. 44.2 mg/kg) and fentanyl (464.2µg/kg vs. 380.1 µg/kg) than those without withdrawal syndrome. Conclusions: the withdrawal syndrome was frequent in this population. Cumulative doses of midazolam and fentanyl were higher in those with withdrawal symptoms. The SOWS is a useful resource for diagnosis.

Intubación al nacer con tubo nasal corto en la transición a la vida extrauterina en recién nacidos de muy bajo peso / Intubation with a short nasal tube at birth during the transition to extrauterine life in very low birth weight infants

Describimos cambios recientes en el cuidado convencional al nacer en recién nacidos de muy bajo peso al nacer y la utilización de un tubo nasal corto para apoyar la ventilación inicial en este nuevo contexto. Reportamos nuestra experiencia con los tres primeros casos en que usamos esta técnica simple para administrar nCPAP a recién nacidos durante el alumbramiento mientras existe función placentaria antes de cortar el cordón.

We describe recent changes in conventional care at birth of very low birth weight infants and the use of a short nasal tube to support ventilation. We report our experience in the first three cases with this simple technique to deliver nCPAP to newborn infants during the third stage of labour, while the placenta is still functioning and before cutting the cord

Meningitis tuberculosa en un lactante: Reporte de caso y revisión de la literatura / Tuberculous meningitis in an infant: Case report and literature review

La tuberculosis (TBC) sigue siendo uno de los principales problemas de salud pública mundial. Actualmente es considerada una enfermedad reemergente, notificándose un aumento de la incidencia en niños. La meningitis tuberculosa (MT) es la forma más grave y temida de TBC en la infancia, siendo los niños menores los más susceptibles a desarrollarla. Un diagnóstico temprano y el tratamiento oportuno son esenciales para mejorar el pronóstico. Se debe iniciar el tratamiento empírico temprano de los casos sospechosos, sin esperar los resultados confirmatorios. Comunicamos el caso de un varón de 5 meses que presentó una MT con manifestaciones clínicas características y mala evolución. Se revisan los mecanismos fisiopatológicos subyacentes y las recomendaciones diagnósticas y terapéuticas actuales.

Tuberculosis (TB) remains a major public health problem worldwide. It is currently considered a re-emergent disease and its incidence in children is increasing. Tuberculous meningitis (TBM) is the most feared and deadly form of TB, being the younger children particularly susceptible to develop it. Early diagnosis and prompt treatment are essential to improve outcomes. Empirical treatment in suspected cases without confirmatory tests must be initiated. We analyze the case of a 5 month old infant with typical TBM and poor outcome. We review the underlying pathophysiology and the current diagnostic and management recommendations.

Documentación filmográfica de la ventilación mecánica en un modelo animal / Filmed documentation of mechanical ventilation in an animal model

Introducción: el aprendizaje de la ventilación mecánica (VM) pediátrica requiere de tiempo y diversas estrategias educativas. En los últimos años se han utilizado los videopodcast para la educación médica. Objetivos: documentación filmográfica de los elementos básicos de la mecánica respiratoria durante la VM en un modelo animal. Creación de un videopodcast para la formación de recursos humanos especializados en VM pediátrica. Metodología: se prepararon diferentes secuencias de VM con ventilador y en forma manual. Se realizó exposición pulmonar mediante toracotomía y VM convencional en un cerdo. Se grabó simultáneamente lo monitorizado por el ventilador y la visualización in vivo del pulmón expuesto ante cada secuencia. Dos especialistas en cuidados intensivos pediátricos analizaron durante la edición las grabaciones y confeccionaron un guión explicativo de lo observado. Resultados: se editó un video con las diferentes secuencias previstas: VM basal, VM sin presión positiva teleespiratoria (PEEP), VM con niveles incrementales de PEEP, VM con bolsa autoinflable, aspiración de sonda endotraqueal con circuito cerrado y abierto durante VM con ventilador y manual con operador. Se editó un videopodcast con leyendas explicativas. Discusión: la utilización de recursos digitales para la enseñanza y divulgación de diversas especialidades médicas es cada vez más frecuente. El videopodcast se ha expandido como una nueva herramienta educativa. Se construyó un modelo para la capacitación de los recursos humanos en VM mediante este formato. La experiencia servirá para construir una videoteca universitaria dirigida a la enseñanza de cuidados críticos del niño y para la divulgación de experimentos biomédicos.

Introduction: learning about mechanical ventilation (MV) in pediatrics requires time and several educational strategies. In recent years, videopodcast has been used for medical training. Objectives: to prepare a filmed documentary of the basic elements in respiratory mechanics during MV in an animal model. To create a videopodcast to train human resources specialized in MV in pediatrics. Material: different sequences of MV with ventilator and manual ventilation were prepared. Lungs were accessed through thoracotomy and MV was started in a pig. Monitored data from the ventilator was simultaneously recorded, the same as the live visualization of the visible lung for each sequence. Two specialists in pediatrics intensive care analysed the recording while it was edited and composed a script explaining what was observed. Results: a video was edited with the different sequences expected: basal MV, MV with zero PEEP, increasing PEEP levels, MV with self-inflating bag, traqueal suction with open and closed traqueal suction systems and manual ventilation with an operator. A videopodcast with explanatory subtitles was edited. Discussion: digital resources are increasingly being used to train physicians and disseminate several medical techniques. Today, videopodcast constitutes a new educational tool. A model was designed to train human resources in MV under this format. This experience will be used to build up a new university video library to assist the training in pediatric critical care and to disseminate biomedical experiments.

Soporte respiratorio no invasivo en el fallo respiratorio agudo del niño: análisis de un grupo de pacientes asistidos en una UCIP privada / Non invasive respiratory support in child acute respiratory failure: analysis of a group of patients seen in a private PICU

Introducción: el fallo respiratorio agudo (FRA) es la principal causa de morbimortalidad pediátrica. La ventilación mecánica no invasiva (VMNI) y la oxigenoterapia de alto flujo (CNAF) son cada vez más utilizados en las Unidades de Cuidados Intensivos pediátricos (UCIP) como alternativa a la ventilación mecánica invasiva (VMI). Objetivo: describir el perfil clínico-evolutivo de niños ingresados a una UCIP por FRA y tratados con VMNI-CNAF entre marzo y octubre de 2014. Metodología: corte transversal y observacional. Niños ingresados por FRA y tratados con VMNI-CNAF. Se clasificaron según éxito o fracaso (necesidad de VMI). Se calificó la gravedad según Escores PIM2 y Tal. Resultados: de 80 casos, 39 cumplieron criterios de inclusión, 15.4% fracasaron. Las causas de fracaso: depresión neuropsíquica, fallo cardiovascular y trabajo respiratorio. La mediana de edad fue 7 meses. Los que requirieron VMI eran menores de 1 año. Los indicadores de gravedad fueron similares en ambos grupos, así como sus comorbilidades. En cuatro de cada cinco pacientes se utilizó CNAF a un flujo promedio de 1,5 l/kg/min. El 64% de los diagnósticos fue bronquiolitis. Los días de soporte respiratorio requeridos fueron menores en los niños atendidos con métodos no invasivos. Ningún paciente falleció. Discusión: esta representa la primera descripción nacional de tratamiento ventilatorio no invasivo en el entorno de una UCIP. La VMNI-CNAF mostró ser una estrategia segura y exitosa en la gran mayoría de pacientes. Este trabajo servirá para planificación y elaboración de futuras investigaciones en UCIP en la era de los cuidados respiratorios no invasivos.

Introduction: acute respiratory failure (ARF) is the main cause of pediatric morbimortality. Non invasive ventilation (NIV) and high flow nasal cannula (HFNC) are increasingly being used un Pediatric Intensive Care Units (PICU) as an alternative to invasive mechanical ventilation (MV). Aim: to describe the characteristics and clinical course of children admitted to our PICU for ARF and treated with NIV and HFNC between March and October 2014. Methods: cross-sectional and observational study. Children admitted with ARF and treated with NIV and HFNC were included. They were classified in two groups: “responders” and “failure” (failure was defined if MV was needed). Severity was scored by PIM2 and Tal scores. Results: of 80 patients admitted for ARF, 39 were included for analysis, failure rate was 15.4%. Failure causes were: neurological failure, cardiovascular failure and work of breathing. Median age was 7 months. All who needed MV were younger than one year. Severity scores were similar in both groups, as well as their comorbidities. 4 out of 5 patients were treated with CNAF. Mean flow was 1,5 l/kg/min. Most frequent diagnosis was Bronchiolitis in 64%. Those treated with non invasive methods needed less days of respiratory support. No patient died and no complications were recorded. Conclusion: this represents the first national description of non invasive respiratory support in a PICU environment. NIV and HFNC showed to be a safe and successful strategy in most patients admitted with ARF. This results will help to plan and elaborate further research in the age of pediatric non invasive respiratory care.