NEDD4-1 deficiency impairs satellite cell function during skeletal muscle regeneration

BACKGROUND: Satellite cells are tissue-specific stem cells primarily responsible for the regenerative capacity of skeletal muscle. Satellite cell function and maintenance are regulated by extrinsic and intrinsic mechanisms, including the ubiquitin-proteasome system, which is key for maintaining protein homeostasis. In this context, it has been shown that ubiquitin-ligase NEDD4-1 targets the transcription factor PAX7 for proteasome-dependent degradation, promoting muscle differentiation in vitro. Nonetheless, whether NEDD4-1 is required for satellite cell function in regenerating muscle remains to be determined. RESULTS: Using conditional gene ablation, we show that NEDD4-1 loss, specifically in the satellite cell population, impairs muscle regeneration resulting in a significant reduction of whole-muscle size. At the cellular level, NEDD4-1-null muscle progenitors exhibit a significant decrease in the ability to proliferate and differentiate, contributing to the formation of myofibers with reduced diameter. CONCLUSIONS: These results indicate that NEDD4-1 expression is critical for proper muscle regeneration in vivo and suggest that it may control satellite cell function at multiple levels.

Reconocimiento docente de los valores éticos y morales en la formación curricular de la carrera de odontología de la Universidad de Viña del Mar, Chile / Teaching recognition of ethical and moral values in the curriculum training of the dentistry career of the Universidad de Viña del Mar, Chile

El objetivo de esta investigación es determinar la coherencia entre lo declarado por los programas de estudios de pregrado en la carrera de Odontología de la Universidad de Viña del Mar, en relación a los valores éticos y morales y, cómo son reconocidos efectivamente por los docentes en los estudiantes. El diseño de investigación corresponde a un estudio descriptivo y transversal. Para esto se adaptaron dos instrumentos, el primero: "cuestionario sobre percepción en la categorización de valores" que busca determinar la importancia que le dan los docentes a los valores. Mientras que en el segundo: "Encuesta sobre valores en estudiantes de odontología" solicita que cada docente evalúe la frecuencia con que se manifiestan ciertos valores éticos y morales en sus estudiantes. Se consideraron los 28 académicos que constituyen la totalidad del universo de docentes clínicos de los cursos de 4to y 5to años de la carrera de odontología en el año 2019. Se discuten los resultados comparándolos con experiencias similares en otras instituciones. Los resultados muestran la percepción y el reconocimiento de los valores por parte del cuerpo docente en los estudiantes, donde se identificó que los valores incorporados de mejor manera son la dignidad, el trato humano y el dialogo; mientras que la autocrítica y el conocimiento fueron los menos incorporados, estos son clave para establecer reflexión y mejoras en los planes de estudio. Se marca el punto de inicio para la generación de futuras líneas de investigación que incorporen otros aspectos como la perspectiva de los pacientes, los estudiantes, así como también continuar recabando información para utilizar metodologías que puedan contribuir a la integración de valores y poner en debate la importancia de ellos en la formación de pregrado.

The aim of this article is to determine the coherence between what is declared by the undergraduate study programs in the Dentistry career at the University of Viña del Mar, in relation to ethical and moral values and how they are effectively recognized by teachers in the students. The research design corresponds to a descriptive and cross-sectional study. Two instruments were adapted for this, the first: "questionnaire on perception in the categorization of values" that seeks to determine the importance that teachers give to values. While in the second: "Survey on values in dentistry students" requests that each teacher evaluates the frequency of certain ethical and moral values which are manifested in their students. 28 academics constituting the entire universe of clinical teachers of the 4th and 5th year courses of dentistry career in 2019 were considered. The results were discussed, comparing them with similar experiences in other institutions. Results show the perception and recognition of the values by the teaching staff in the students. These values incorporated in the best way were dignity, humane treatment and dialogue; while self-criticism and knowledge were the least incorporated. These are key values to establish a reflection and subsequent improvements in the study plans. This article marks a starting point for the generation of future lines of research that incorporate other aspects such as the perspective of patients, students, as well as continuing to collect information to use methodologies that can contribute to the integration of values and put them into a debate about the importance of them in undergraduate training.

Excess adiposity and low physical fitness hamper Supine-to-Stand test performance among sedentary adolescents

Abstract Objective: The aim of this study was to analyze the relationship between body adiposity and physical fitness with performance in the Supine-to-Stand test (STS-test) in sedentary adolescents. Methods: Sixty-two adolescents, of both sexes, between 10 and 16 years old, participated in the study. Body mass (BM), height, waist circumference (WC), fat mass (FM), fat-free mass (FFM), right and left handgrip strength (HGS-right, HGS-left), abdominal resistance (ABDO), flexibility (FLEX), and cardiorespiratory fitness (VO2peak) were measured. Body mass index (BMI), z-score BMI (BMI-z), tri-ponderal mass index (TMI) and waist-to-height ratio (WHtR) were calculated. The STS-test was applied to evaluate the STS-MC by the movement patterns in the execution of the test. The STS-time in seconds (s) was categorized into terciles: fast (FG < 2.0 s), intermediate (IG = 2.0-2.6 s) and slow (SG > 2.6 s). One-way ANOVA, Chi-square, Spearman's correlation coefficient as well as non-parametric tests were used, with significance p 0.05. Results: The SG presented higher BMI, BMI-z, TMI, WHtR, FM, %FM, as well as lower averages for %FFM, HGS-right, HGS-left, FLEX, ABDO, VO2peak, VO2peak relative to BM (VO2peakBM) in relation to GF. The BMI, BMI-z, TMI, WC, WHtR and FM showed moderate and direct correlations with STS-time and inverse with STS-MC (p < 0.01). HGS-right, HGS-left, ABDO, and VO2peakBM showed moderate and an inverse correlation with STS-time (p < 0.05). The VO2peakBM was moderate and with direct correlations to STS-MC (p < 0.01). Conclusion: It is concluded that excess fat and low physical fitness hamper STS-test performance. Therefore, the STS-test can be used for screening students to assess MC.

A gauze-pad wrapping of the heart can save a patient's life

Abstract We describe one case of iatrogenic rupture of the left ventricle after mitral valve replacement and myectomy of the outflow tract. The cause and site of the rupture could not be identified, neither from the internal nor from the external examination. After unsuccessful use of hemostatic patches in the surface of the ruptured area, wrapping of the ventricles with a surgical gauze pad controlled the hemorrhage, hence saving the patient's life.

Riesgo de infecciones, enfermedades crónicas y trastornos de salud mental con posteridad a inundaciones por el Fenómeno del Niño Costero en poblaciones desplazadas, Piura, 2017 / Risk of infections, chronic diseases and mental health disorders after Floods by the Coastal Child Phenomenon in displaced populations, Piura, 2017

Introducción: En el Perú, la presencia del Fenómeno del niño costero produce inundaciones y aparición de enfermedades cíclicamente. Objetivo: Determinar los factores de riesgo de la presencia de enfermedades en poblaciones desplazadas en Piura por efecto del Niño Costero. Métodos: Investigación cuantitativa, longitudinal, analítico de casos y controles con 544 familias que fueron seleccionado a través de un muestreo aleatorio bietápico considerando la proporción de familias por manzana, zona y clúster. Se utilizaron diversos instrumentos diagnósticos y de seguimiento como el de la Organización Internacional para las Migraciones (OIM), la base de atenciones de salud y la aplicación de un instrumento para salud mental. Resultados: El análisis de la variación de atenciones en dos periodos de tiempo a los 3 y 9 meses se observa que hay cambios estadísticamente significativos en estos periodos que incluyen las infecciones de piel, infección del tracto urinario, dolores articulares, diabetes mellitus y violencia familiar. El 26.46% presentaron algún trastorno psicológico asociado a la convivencia en los albergues. El análisis bivariado se observó que las familias con menos de 80% de manejo de agua segura y almacenamiento de agua segura presentaban riesgo de presentar enfermedades diarreicas agudas con OR=6.15 (IC95% 5.97-6.95) y OR=2.08 (IC95% 1.06-2.97) respectivamente. Conclusiones: Los perfiles epidemiológicos demuestran la presencia de efectos psicológicos y la transición de enfermedades transmisibles al inicio del desastre y que con el tiempo en los albergados aparecen enfermedades no transmisibles y violencia asociados a los perfiles de salud previo de la población desplazada.

Introduction: In Peru, the presence of the Coastal Child Phenomenon produces floods and the appearance of diseases cyclically. Objective: To determine the risk factors for the presence of diseases in displaced populations in Piura due to the Nino Costero. Methods: Quantitative, longitudinal, analytical investigation of cases and controls with 544 families that were selected through a two-stage random sampling considering the proportion of families per block, area and cluster. For data collection, various diagnostic and monitoring instruments were used, such as that of the International Organization for Migration (IOM), the health care base and the application of an instrument for mental health. Results: The analysis of the variation of care in two time periods at 3 and 9 months shows that there are statistically significant changes in these periods that include skin infections, urinary tract infection, joint pain, diabetes mellitus and family violence. 26.46% presented some psychological disorder associated with coexistence in shelters. The bivariate analysis showed that families with less than 80% of safe water management and safe water storage were at risk of presenting acute diarrheal diseases with OR = 6.15 (95% CI 5.97-6.95) and OR = 2.08 (95% CI 1.06- 2.97) respectively. Conclusions: The epidemiological profiles show the presence of psychological effects and the transition of communicable diseases at the beginning of the disaster and that over time, non-communicable diseases and violence appear in the shelters associated with the previous health profiles of the displaced population.

Risk-Prediction Model for Transfusion of Erythrocyte Concentrate During Extracorporeal Circulation in Coronary Surgery

Abstract Introduction: Our objective was to identify preoperative risk factors and to develop and validate a risk-prediction model for the need for blood (erythrocyte concentrate [EC]) transfusion during extracorporeal circulation (ECC) in patients undergoing coronary artery bypass grafting (CABG). Methods: This is a retrospective observational study including 530 consecutive patients who underwent isolated on-pump CABG at our Centre over a full two-year period. The risk model was developed and validated by logistic regression and bootstrap analysis. Discrimination and calibration were assessed using the area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow (H-L) test, respectively. Results: EC transfusion during ECC was required in 91 patients (17.2%). Of these, the majority were transfused with one (54.9%) or two (41.8%) EC units. The final model covariates (reported as odds ratios; 95% confidence interval) were age (1.07; 1.02-1.13), glomerular filtration rate (0.98; 0.96-1.00), body surface area (0.95; 0.92-0.98), peripheral vascular disease (3.03; 1.01-9.05), cerebrovascular disease (4.58; 1.29-16.18), and hematocrit (0.55; 0.48-0.63). The risk model developed has an excellent discriminatory power (AUC: 0,963). The results of the H-L test showed that the model predicts accurately both on average and across the ranges of deciles of risk. Conclusions: A risk-prediction model for EC transfusion during ECC was developed, which performed adequately in terms of discrimination, calibration, and stability over a wide spectrum of risk. It can be used as an instrument to provide accurate information about the need for EC transfusion during ECC, and as a valuable adjunct for local improvement of clinical practice. OR=odds ratio Key Question: What is the risk of the need for use of erythrocyte concentrate (EC) during cardiopulmonary bypass? Key Findings: Risk factors with the greatest prediction for EC transfusion. Take-Home Message: The implementation of this model would be an important step in optimizing and improving the quality of surgery.

Efecto De Las Variantes De SARS-CoV-2 En La Transmisión De COVID-19 En El Perú / Effect of SARS-CoV-2 variants on the transmission of COVID-19 in Peru

El SARS-CoV-2, es el coronavirus que causa la pandemia de COVID-19 y está constituido de un ARN que evoluciona rápidamente. Este virus presenta continuas mutaciones genómicas a medida que se transmite. Un enfoque principal de la investigación actual sobre la genética del SARS-CoV-2 es si alguna de estas mutaciones tiene el potencial de alterar significativamente propiedades virales importantes, como el modo o la velocidad de transmisión, o la capacidad de causar mayor letalidad. Ya se reportaron mutaciones importantes en Reino Unido, en donde de 25.000 secuenciamientos del genoma se identificó la mutación D614G en SARS-CoV-2, una mutación que da como resultado un desplazamiento del ácido aspártico con glicina en la posición 614 de la proteína espiga (S)del virus que si bien es cierto no están asociadas a una mayor mortalidad o gravedad clínica por COVID-19, pero el 614G se asocia con una carga viral más alta y una edad más joven de los pacientes.

SARS-CoV-2 is the coronavirus that causes the COVID-19 pandemic and is made up of a rapidly evolving RNA. This virus presents continuous genomic mutations as it is transmitted. A major focus of current research on the genetics of SARS-CoV-2 is whether any of these mutations have the potential to significantly alter important viral properties, such as the mode or rate of transmission, or the ability to cause increased lethality. Important mutations have already been reported in the United Kingdom, where out of 25,000 genome sequencing, the D614G mutation was identified in SARS-CoV-2, a mutation that results in a displacement of aspartic acid with glycine at position 614 of the spike protein ( S) of the virus that, although it is true, are not associated with greater mortality or clinical severity due to COVID-19, but 614G is associated with a higher viral load and a younger age of the patients.

Interacción entre los determinantes medioambientales y socioeconómicos para el riesgo para leishmaniasis cutánea en América Latina / Interaction among environmental and socioeconomic determinants of risk for cutaneous leishmaniasis in Latin America / Interação entre os determinantes ambientais e socioeconômicos para o risco de leishmaniose cutânea na América Latina

RESUMEN Objetivo. Determinar y caracterizar áreas de riesgo potencial de la ocurrencia de leishmaniasis cutánea (LC) en América Latina (AL). Método. Estudio observacional ecológico con unidades de observación definidas por municipios con transmisión de LC entre 2014-2018. Se utilizaron variables medioambientales y socioeconómicas disponibles para al menos 85% de los municipios, combinados en una sola base de datos, a través del software R. Se combinó la metodología de análisis de componentes principales con un análisis de conglomerados jerárquicos para la formación de conglomerados de municipios en función de su similitud. Se estimó el V-test para definir la asociación positiva o negativa de las variables con los conglomerados y separación por divisiones naturales para determinar cuáles contribuyeron más a cada conglomerado. Se incorporaron los casos para atribuir el riesgo de LC para cada conglomerado. Resultados. Se incluyeron en el estudio 4 951 municipios con transmisión de LC (36,5% del total en AL) y se definieron siete conglomerados por su asociación con 18 variables medioambientales y socioeconómicas. El riesgo histórico de LC se asocia de manera positiva y en forma decreciente con los conglomerados Amazónico, Andino y Sabana; y de manera negativa con los conglomerados Boscoso/perenne, Boscoso/cultivo y Boscoso/poblado. El conglomerado Agrícola no reveló ninguna asociación con los casos de LC. Conclusiones. El estudio permitió identificar y caracterizar el riesgo de LC por conglomerados de municipios y conocer el patrón propio epidemiológico de distribución de la transmisión, lo que proporciona a los gestores una mejor información para las intervenciones intersectoriales para el control de la LC.

ABSTRACT Objective. Determine and characterize areas at potential risk for the occurrence of cutaneous leishmaniasis (CL) in Latin America. Method. Ecological observational study with observation units defined by municipalities with CL transmission during 2014-2018. Environmental and socioeconomic variables available for at least 85% of municipalities were combined in a single database, using R software. Principal component analysis was combined with hierarchical cluster analysis for the formation of clusters of municipalities according to their similarity. The V-test was used to define positive or negative association of variables with clusters and separation by natural divisions to determine which contributed more to each cluster. Cases were included to attribute CL risk for each cluster. Results. The study included 4 951 municipalities with CL transmission (36.5% of municipalities in Latin America); seven clusters were defined by their association with 18 environmental and socioeconomic variables. Historical risk of CL is associated positively and in descending order with the Amazonian, Andean, and Savanna clusters; and negatively with the Forest/perennial, Forest/cultivated, and Forest/populated clusters. The Agricultural cluster showed no association with CL cases. Conclusions. The study made it possible to identify and characterize CL risk by clusters of municipalities and to understand the characteristic epidemiological distribution patterns of transmission, providing program managers with better information for intersectoral interventions to control CL.

RESUMO Objetivo. Determinar e caracterizar as áreas de risco de ocorrência de leishmaniose cutânea na América Latina. Método. Estudo observacional ecológico com unidades de observação definidas por municípios com transmissão de leishmaniose cutânea entre 2014 e 2018. Foram usadas as variáveis ambientais e socioeconômicas disponíveis em 85% ou mais dos municípios, reunidas em uma única base de dados com o uso do software R. A metodologia de análise de componentes principais foi combinada a uma análise de conglomerados com agrupamento hierárquico para formar conglomerados de municípios por semelhança. O teste V foi usado para estabelecer a associação (positiva ou negativa) das variáveis com os conglomerados e uma separação por divisões naturais foi usada para determinar as variáveis que mais contribuíram em cada conglomerado. Os casos foram incluídos para avaliar o risco de leishmaniose cutânea em cada conglomerado. Resultados. A amostra do estudo compreendeu 4.951 municípios com transmissão de leishmaniose cutânea (36,5% do total na América Latina). Foram definidos sete conglomerados por apresentarem associação com 18 variáveis ambientais e socioeconômicas. Foi observada associação positiva e decrescente do risco histórico de leishmaniose cutânea com os conglomerados Amazônico, Andino e Savana e negativa com os conglomerados Mata/perene, Mata/cultivo e Mata/povoado. O conglomerado Agrícola não demonstrou associação com casos de leishmaniose cutânea. Conclusões. Este estudo permitiu identificar e caracterizar o risco de leishmaniose cutânea por conglomerados de municípios e conhecer o padrão epidemiológico de distribuição da transmissão da doença, oferecendo às autoridades dados melhores para subsidiar as intervenções intersetoriais para o controle da leishmaniose cutânea.

The global burden of rheumatic heart disease: population-related differences (it is not all the same!)

Abstract Rheumatic heart disease (RHD) remains the most common cardiovascular disease in young adults and adolescents in need of heart surgery in low- and middle-income countries (LMICs). The mean age of patients is 20-25 years, often much younger. By contrast, the few patients with chronic RHD in developed countries present a mean age of around 55 years. It is absolutely fundamental to differentiate these two types of population. Pathology, lesions and surgical methods are different, and the results should not be compared. It is not all the same! A certain enthusiasm for mitral repair has recently surged, with several reports showing excellent results in children and young adults, resulting from the renewed interest of cardiac surgeons, also based on new and modified techniques developed in the meantime. While surgery is easily accessible to patients in developed countries, the situation in LMICs is often dramatic, with countries where there is a complete absence of or few surgical facilities absolutely unable to meet gigantic demands. Many foreign surgical teams conduct humanitarian missions in several of these countries. They are just a "drop of water in the ocean" of needs. In some cases, however, these missions led to the establishment of local teams that now work independently and, in some cases, outperform the foreign teams still visiting.

Mixoma auricular izquierdo como causa de accidente cerebral isquémico transitorio e infarto agudo de miocardio con elevación del ST / Left atrial myxoma as a cause of a transient ischaemic stroke and acute myocardial infarction with ST elevation

Resumen Los mixomas son los tumores cardíacos primarios más comunes. La mayoría tiene curso benigno y pueden tratarse de hallazgos incidentales o ser casi asintomáticos. Los síntomas dependen de su ubicación, en cuyo caso la más frecuente es la aurícula izquierda, de ahí que el riesgo embólico sea elevado. El principal lugar de embolia es el sistema nervioso central; sin embargo, en ocasiones puede afectar los sistemas respiratorio, periférico o coronario(1). Se expone el caso de una paciente con mixoma auricular izquierdo, el cual se manifiesta con accidente cerebral isquémico transitorio, seguido de infarto agudo de miocardio con elevación del segmento ST en la pared ínfero-posterior.

Abstract The myxomas are the most common primary cardiac tumours. The majority of them are benign and can be an incidental finding or be almost asymptomatic. The symptoms depend on their location, with the most common being the left atrium, which carries an increased risk of clots. The main effects of the clots are on the central nervous system, but occasionally they can involve the respiratory, peripheral, or coronary system. The case is presented of a patient with left atrial myxoma, as well as a transient ischaemic stroke and acute myocardial infarction with ST elevation in the inferior-posterior wall.

Abordaje radial distal izquierdo a través de la tabaquera anatómica para la realización de angiografía coronaria / Left distal radius approach through the anatomical snuff box to perform coronary angiography

Resumen Objetivo: describir la experiencia de un servicio en angiografía coronaria en cuanto al abordaje radial distal izquierdo a través de la tabaquera anatómica. Material y método: de abril a agosto de 2018 se asignaron 40 pacientes a angiografía coronaria por vía radial izquierda distal a través de la tabaquera anatómica. Se hizo un análisis de tipo descriptivo de las principales variables cuantitativas asociadas al procedimiento (frecuencia de acceso fallido, procedimiento fallido, tiempo de procedimiento, tiempo de fluoroscopia, nivel de dolor en el paciente, sensación de comodidad para el paciente y para el operador, cantidad de medio de contraste empleado y algunas variables demográficas). Se incluyeron pacientes mayores de 18 años con indicación de arteriografía coronaria para estudio diagnóstico y con pulso palpable en la zona de la tabaquera anatómica. Resultados y conclusión: la cantidad de medio de contraste en promedio empleada fue de 49 ml (SD ± 13), el tiempo promedio de procedimiento fue de 11,3 minutos (SD ± 4.3) y el tiempo de fluoroscopia promedio fue de 3,3 minutos (SD ± 2.8). La mediana para el nivel de dolor en los pacientes fue de 4, la mediana para la comodidad del operador fue de 10 y la mediana para la comodidad en el paciente fue de 10. Se concluye así que el acceso radial distal izquierdo es una alternativa técnicamente factible, ofrece comodidad para el paciente y el operador, y arroja bajas tasas de falla y complicaciones en pacientes seleccionados.

Abstract Objective: To present the experience of one Department in coronary angiography as regards the left distal radius approach through the anatomical snuff box. Material and Method: A total of 40 patients were subjected to coronary angiography through the anatomical snuff box, from April to August 2018. A descriptive analysis was performed on the quantitative variables associated with the procedure (frequency of failed access, failed procedure, procedure time, fluoroscope time, patient pain level, feeling of comfort for the patient and for the operator, amount of contrast used, and some demographic variables). The study included patients over 18 years-old with an indication for coronary angiography for a diagnostic study, and with a palpable pulse in the anatomic snuff box area. Results and conclusion: The mean amount of contrast media employed was 49 ml (SD ± 13), the mean procedure time was 11.3 minutes (SD ± 4.3), and the mean fluoroscope time was 3.3 minutes (SD ± 2.8). The median for the pain level in patients was 4, the median for comfort of the operator was 10, and the median for comfort of the patient was also 10. It was able to be concluded that the left distal radial access is a technically feasible alternative. It is comfortable for the patient and the operator, with low failure rates and complications in selected patients.

Enfermedad aneurismática coronaria / Coronary aneurysm disease

Resumen La enfermedad aneurismática coronaria se define como la dilatación de un segmento arterial coronario más 1,5 veces el diámetro de las arterias adyacentes de tamaño normal. Puede ser difusa, y afectar todo el trayecto de la arteria, o localizada y afectar sólo un segmento arterial específico. Puede encontrarse entre un 3 a un 8% de los estudios angiográficos y entre un 0,22% a un 1,4% de las necropsias clínicas. Se presenta 3 reportes de casos, donde la presentación clínica, los hallazgos angiográficos y el manejo farmacológico es diverso como corresponde a esta entidad.

Abstract Coronary aneurysm disease is defined as the dilation of a coronary artery segment more than 1.5 times the diameter of the adjacent arteries of normal size. It may be diffuse, and affect the whole trajectory of the artery, or localised and only affect a specific arterial segment. It can be found in between 3% and 8% of angiograph studies, with between 0.22% and 1.4% in clinical post-mortems. Three case reports are presented in which the clinical presentation, the angiographic findings, and the pharmacological management are shown to be as diverse as this condition itself.

Cardio protected areas in Mexico / Áreas cardioprotegidas en México

Abstract Sudden cardiac death (SCD) remains a major public health problem. Fortunately, with timely access to early defibrillation and high-quality cardiopulmonary resuscitation, an improvement in survival of victims of sudden death has been demonstrated. Efforts made in different countries to create programs for access to public defibrillation have shown great benefits in counteracting mortality associated with this type of event. Hence, we need more programs (such as cardio protected environments) and changes in public health policies. The objective of this work is to raise awareness among the population and decision makers, of importance establishing this type of programs in our country since there continues to be high mortality associated with SCD in our countrymen.

Resumen La muerte súbita cardíaca es todavía un problema importante de salud pública. Por fortuna, con un acceso oportuno a una desfibrilación temprana y una reanimación cardiopulmonar de alta calidad, se ha demostrado una mejoría en la sobrevida de las víctimas de muerte súbita. Los esfuerzos realizados en deferentes países para crear programas de acceso a la desfibrilación pública han mostrado grandes beneficios en contrarrestar la mortalidad relacionada con este tipo de episodios. Se necesitan más programas (como espacios cardioprotegidos) y cambios en las políticas de salud pública. El objetivo de este trabajo es poder concientizar a la población y a los tomadores de decisiones de la importancia de establecer este tipo de programas en el país, ya que aún existe una alta mortalidad relacionada con la muerte cardíaca súbita.

Body composition among long distance runners

SUMMARY OBJECTIVE The current study aimed to examine the body composition of adult male ultra-trail runners (UTR) according to their level of participation (regional UTR-R, vs. national UTR-N). METHODS The sample was composed of 44 adult male UTR (aged 36.5±7.2 years; UTR-R: n=25; UTR-N: n=19). Body composition was assessed by air displacement plethysmography, bioelectrical impedance, and dual-energy X-ray absorptiometry. In addition, the Food Frequency Questionnaire (FFQ) was applied. A comparison between the groups was performed using independent samples t-test. RESULTS Significant differences between groups contrasting in the competitive level were found for chronological age (in years; UTR-R: 38.8±8.2 vs. UTR-N: 33.5±4.1); body density (in L.kg-1; UTR-R: 1.062±0.015 vs. UTR-N: 1.074±0.009); and fat mass (in kg; UTR-R: 12.7±6.8 vs. UTR-N: 7.6±2.7). CONCLUSION UTR-N were younger, presented higher values for body density, and had less fat mass, although no significant differences were found for fat-free mass. The current study evidenced the profile of long-distance runners and the need for weight management programs to regulate body composition.

RESUMO OBJETIVO O presente estudo objetivou examinar a composição corporal dos corredores de ultra-trail (UTR) e, adicionalmente, comparar dois grupos de acordo com o nível de participação (Regional vs. Nacional, respectivamente UTR-R e UTR-N). MÉTODOS A amostra foi composta por 44 corredores adultos masculinos (36,5±7,2 anos de idade; UTR-R: n=25; UTR-N: n=19). A composição corporal foi avaliada recorrendo à pletismografia de ar deslocado, bioimpedância elétrica e absorciometria de raios X de dupla energia. Adicionalmente, foi utilizado o Questionário de Frequência Alimentar. A comparação entre grupos foi realizada com base na prova t-student para amostras independentes. RESULTADOS Foram encontradas diferenças significativas por nível de competição para as seguintes variáveis dependentes: idade cronológica (em anos; UTR-R: 38,8±8,2 vs. UTR-N: 33,5±4,1); densidade corporal (em kg/L; UTR-R: 1,062±0,015 L/kg vs. UTR-N: 1,074±0,009); massa gorda (em kg; UTR-R: 12,7±6,8 kg vs. UTR-N: 7,6±2,7). CONCLUSÃO Os UTR-N tendem a ser mais jovens e apresentam valores superiores de densidade corporal e, consequentemente, valores menores de massa gorda, sendo a massa isenta de gordura semelhante entre os grupos. O presente estudo determinou o perfil dos corredores adultos masculinos de longa distância (ultra-trail), realçando a importância de uma cuidadosa regulação da massa corporal.

Physiological profile of adult male long-distance trail runners: variations according to competitive level (national or regional) / Perfil fisiológico de corredores de trilhas de longa distância adultos do sexo masculino: variações segundo o nível competitivo (nacional ou regional)

ABSTRACT Objective To describe and identify the importance of different indicators of the aerobic and anaerobic fitness of male ultra-trail runners according to their level of participation (regional or national). Methods Forty-four male ultra-trail runners were assessed (36.5±7.2 years). They were classified as regional (n=25) and national (n=19). Wingate test was used to assess the anaerobic pathway. A progressive incremental running test was performed and ventilatory thresholds registered, in parallel to heart rate and lactate concentration at the end of the protocol. Comparison between groups was performed using independent samples t-test. Results No significant differences were found between outputs derived from Wingate test. For aerobic fitness, while examining absolute values, differences were uniquely significant for the second ventilatory threshold (ultra-trail regional runners: 3.78±0.32L.min-1; ultra-trail national runners: 4.03±0.40L.min-1 p<0.05). Meantime, when aerobic fitness was expressed per unit of body mass, differences were significant for the second ventilatory threshold (ultra-trail regional runners: 50.75±6.23mL.kg-1.min-1; ultra-trail national runners: 57.88±4.64mL.kg-1.min-1 p<0.05) and also maximum volume of oxygen (ultra-trail regional runners: 57.33±7.66mL.kg-1.min-1; ultra-trail national runners: 63.39±4.26mL.kg-1.min-1 p<0.05). Conclusion This study emphasized the importance of expressing physiological variables derived from running protocols per unit of body mass. Also, the second ventilatory threshold appears to be the best and the only aerobic fitness variable to distinguish between trail runners according to competitive level. Maximal oxygen uptake seems of relative interest to distinguish between long distance runners according to competitive level.

RESUMO Objetivo Descrever e comparar indicadores de aptidão metabólica em corredores de trilhas de longa distância (ultra trail running) adultos do sexo masculino, de acordo com o nível de competição (regional ou nacional). Métodos Foram avaliados 44 corredores masculinos com média de idade de 36,5±7,2 anos classificados como de nível regional (n=25) ou nacional (n=19). Foi utilizado o teste de Wingate para avaliação da via anaeróbica, enquanto o teste incremental de corrida em esteira também foi realizado para determinar os limiares ventilatórios, o consumo máximo de oxigênio, a frequência cardíaca e a concentração de lactato ao final do protocolo. A comparação entre os grupos foi realizada por estatística teste t para amostras independentes. Resultados As variáveis obtidas do teste Wingate não diferiram de forma significativa entre os grupos. No que diz respeito à aptidão aeróbica, foram encontradas diferenças significativas entre variáveis expressas em valores absolutos no segundo limiar ventilatório (corredores de nível regional: 3,78±0,32L.min-1; corredores de nível nacional: 4,03±0,40L.min-1; p<0,05). Quando considerados os valores expressos por unidade de massa corporal, o segundo limiar ventilatório (corredores de nível regional: 50,75±6,23mL.kg-1.min-1; corredores de nível nacional: 57,88±4,64mL.kg-1.min-1; p<0,05) e o volume máximo de oxigênio (corredores de nível regional: 57,33±7,66mL.kg-1.min-1; corredores de nível nacional: 63,39±4,26mL.kg-1.min-1; p<0,05) também diferiram de forma significativa. Conclusão Este estudo destacou a importância de se expressarem variáveis fisiológicas derivadas de protocolos de corrida por unidade de massa corporal. Além disso, o segundo limiar ventilatório pareceu ser o melhor e único indicador de aptidão aeróbica para a diferenciação de corredores de trilha de longa distância, segundo o nível competitivo. O consumo máximo de oxigênio não é especialmente relevante para distinguir os corredores de trilha de longa distância, segundo o nível competitivo.

Migración y los efectos en la Salud Pública / Migration and the effects on public health

Entre los años 2000 al 2017, la cantidad de migrantes internacionales fue de 173 a 258 millones representando un incremento del 49% en este periodo. En la región de las Américas desde octubre de 2018, se ha intensificado el flujo migratorio de cerca de tres millones de venezolanos siendo acogidos cerca de 1,7 millones de migrantes (representa cerca del 70% de la migración) en los países de Colombia, Perú y Ecuador. En el Perú a partir del 2016, se incrementó el flujo de venezolanos al país, pasando de tener 6,615 residentes en dicho año a 728,120 a fines de marzo de 2019 siendo la ola migratoria más importante del siglo XXI en el Perú, convirtiéndose así en el segundo país en el mundo en albergar la mayor cantidad de venezolanos inmigrantes después de Colombia. En la actualidad, los venezolanos constituyen la comunidad extranjera más numerosa en el Perú.

Between 2000 and 2017, the number of international migrants was 173 to 258 million, representing a 49% increase in this period. In America, since October 2018, the migratory flow of nearly three million Venezuelans has been intensified; with about 1.7 million migrants(representing about 70% of the migration) being received in the countries of Colombia, Peru and Ecuador. In Peru since 2016, the flow of Venezuelans to the country has increased, from 6,615 residents in that year to 728,120 at the end of March 2019, being the most important migratory wave of the 21st century in Peru, turning it into the second country in the world to host the largest number of immigrant Venezuelans after Colombia. Currently, Venezuelans constitute the biggest foreign community in Peru.

Sarampión Amenaza Reemergente De Epidemia En El Perú / Measles: reemerging threat of epidemic in Peru

El sarampión considerado entre las infecciones transmisibles más contagiosas por su alto riesgo potencial epidémico de transmisión, se mantiene como foco de preocupación en el mundo por el incremento de casos y su consecuente morbilidad y mortalidad. El exantema se inicia habitualmente en la cara, y de forma centrifuga se disemina a tronco y extremidades. A pesar de que la enfermedad determina una fuerte respuesta inmune humoral y celular estimulando inmunidad específica de por vida, produce a la vez una importante inmunosupresión que dura varias semanas aumentando la susceptibilidad a infecciones secundarias. El sarampión se consideró eliminado de las Américas desde 2002 debido a la ausencia de transmisión endémica de la enfermedad en la región; logro alcanzado por los esfuerzos regionales por lograr altas coberturas de vacunación a través de pro gramas regulares de inmunización y campañas masivas de vacunación. Sin embargo, hasta abril del 2019 la Oficina Panamericana de la Salud informo que 12 países notificaron casos confirmados: Argentina, Bahamas, Brasil, Canadá, Chile, Colombia, Costa Rica, Estados Unidos de América, México, Perú, Uruguay y Venezuela. 09 países notificaron casos importados de países fuera de la Región con diferentes genotipos. Asimismo, entre el 1 de enero y el 11 de abril de 2019 se confirmaron 5556 casos de sarampión en 20 Estados de los Estados Unidos.

Measles, considered one of the most contagious transmissible infections due to its high potential epidemic risk of transmission, remains a focus of concern in the world due to the increase in cases and its consequent morbidity and mortality. The rash usually starts on the face, and in a centrifugal way it spreads to the trunk and extremities. Although the disease determines a strong humoral and cellular immune response stimulating specific immunity for life, it produces at the same time an important immunosuppression that lasts several weeks increasing the susceptibility to secondary infections. Measles was considered eliminated from the Americas since 2002 because to the absence of endemic transmission of the disease in the region; achievement achieved by regional efforts to achieve high vaccination coverage through regular immunization programs and mass vaccination campaigns. However, until April 2019 the Pan American Health Office reported that 12 countries reported confirmed cases: Argentina, Bahamas, Brazil, Canada, Chile, Colombia, Costa Rica, United States of America, Mexico, Peru, Uruguay and Venezuela. 09 countries reported cases imported from countries outside the Region with different genotypes. Also, between January 1 and April 11, 2019, 5556 cases of measles were confirmed in 20 States of the United States.