Respuesta inmune humoral por exposición a antígenos de SARS-CoV-2 en adultos con riesgo cardiovascular: The COmmunity Cohort / SARS-CoV-2 humoral immune response in patients with cardiovascular risk factors: The COmmunity Cohort Study

A partir de las recomendaciones emanadas del Comité Asesor en Vacunas y el Programa Nacional de Inmunizaciones, Chile implementó precozmente un proceso de vacunación de la población con vacunas provenientes de diferentes laboratorios. El estudio de los niveles de anticuerpos neutralizantes en diferentes subgrupos poblacionales, contribuye al establecimiento de los correlatos de protección frente a infección por SARS-CoV-2. En 2022 y 2023 establecimos una cohorte comunitaria de 914 adultos con factores de riesgo cardiovascular. En esta cohorte estamos midiendo la respuesta inmune humoral frente a exposición a antígenos de SARS-CoV-2, ya sea por vacunas o por infección, así como la incidencia de COVID-19 y otros eventos adversos. Esta cohorte, que llamamos, nos está entregando valiosa información sobre los niveles de anticuerpos neutralizantes en estas personas y su grado de protección frente al COVID-19.

Based on the recommendations of the Vaccine Advisory Committee and the National Immunization Program, Chile implemented an early vaccination process of the population with vaccines from different laboratories. The study of neutralizing antibody levels in different population subgroups contributes to the establishment of correlates of protection against SARS-CoV-2 infection. In 2022 and 2023 we set up a community cohort of 914 adults with cardiovascular risk factors. In this cohort we are measuring the humoral immune response to exposure to SARS-CoV-2 antigens, either by vaccines or infection, as well as the incidence of COVID-19 and other adverse events. This cohort, which we call The COmmunity Cohort, is providing us with valuable information on the levels of neutralizing antibodies in these individuals and their degree of protection against COVID-19.

Exploring physicians' perception of diagnostic information in clinical practice / Exploración de la percepción de los médicos sobre la información diagnóstica en la práctica clínica

A well-informed diagnostic process results in better health outcomes and less overdiagnosis. While there have been studies conducted to explore doctors' knowledge, attitudes, and practice regarding diagnostic test information, there are no reports from Latin America. We invited physician readers of a Latin American medical journal to answer a survey on their professional and demographic characteristics and previous exposure to diagnostic information training. Two hundred fifteen responded, of whom 88% agreed to some extent that diagnostic information is helpful for clinical practice and that more training is needed. This brief exploratory survey underscores the need for more resources to train in the diagnostic process and the utilization of diagnostic information in clinical practice. However, given the limitations of this study, more evidence is needed.

Un proceso de diagnóstico bien informado da lugar a mejores resultados de salud y a menos sobrediagnósticos. Aunque se han realizado estudios para explorar los conocimientos, las actitudes y la práctica de los médicos en relación con la información sobre las pruebas diagnósticas, no existen estudios realizados en América Latina. Invitamos a los médicos lectores de una revista médica latinoamericana a responder una encuesta de opinión sobre sus características profesionales y demográficas y su exposición previa a la formación en información diagnóstica. Recibimos 215 respuestas, de las cuales el 88% estuvo de acuerdo en que la información diagnóstica es útil para la práctica clínica, y que se necesita más capacitación. Esta breve encuesta exploratoria subraya la necesidad de dedicar más recursos en la formación sobre el proceso diagnóstico y la utilización de la información diagnóstica en la práctica clínica. Sin embargo, dado las limitaciones de este estudio se hace necesario mayor evidencia al respecto.

Impacto de gastroenteritis severa por rotavirus en niños chilenos menores de 3 años de edad / Incidence of severe rotavirus gastroenteritis among Chilean children under three years of age

Background: Rotavirus infections account every year in Chile, for approximately 53,000 emergency consultations and 8,000hospital admissions among children under three years of age. Aim: To estimate incidence rates of severe rotavirus gastroenteritis in children <3 years of age, living in the V and VIII Regions and to identify the predominant viral serotypes. Material and methods: A prospective hospital-based surveillance for severe gastroenteritis was implemented in public and private hospitals of Viña del Mar and Valparaiso (Region V) and of Chiguayante, Concepción, Penco, San Pedro de la Paz, Talcahuano and Tomé (Region VIII). All children <3 years of age residing in the districts, who consulted for severe gastroenteritis requiring oral or intravenous rehydration (equivalent to WHO plan B or C), or who were admitted to the hospital, were enrolled. Demographic and clinical information and a stool sample were obtained. Rotavirus was detected by ELISA and positive samples were serotyped by ELISA or real time PCR. Results: Between January 23 and June 30, 2003, a total of 760 children were recruited. Among these, 343 (45 percent) were admitted to the hospital. Stool samples were collected from 433 children. Among these, 214 were positive for rotavirus (49.4 percent). Overall, monthly disease incidence rates were 124/100,000 in V Region, and 114/100,000 in VIIIRegion. The predominant serotype was G4. Conclusions: Rotavirus was responsible for nearly half of the severe gastroenteritis episodes among children <3 years, during a predominantly G4 serotype season. Every year, approximately one every 70 children <3 years will have a severe rotavirus gastroenteritis episode.

Evaluaciónde costo-efectividad de la vacuna anti-rotavirus en Chile / Potential cost effectiveness of a rotavirus vaccine in Chile

Background:Cost effectiveness studies are essential to assess the real value of interventions with preventive or therapeutic objectives. Aim: To assess the theoretical cost-effectiveness of a vaccine against rotavirus in Chilean children of less than five years of age. Material and methods: An economic model was developed based on information on disease incidence, health care costs associated with treatment and the effectiveness and costs of vaccination. Net disease and vaccination costs were estimated from the health system perspective and were compared with life years and disability-adjusted life-years (DALYs) gained using a 3% discount rate. Local administrative and accounting hospital data and vaccine efficacy data were used to estimate healthcare costs and cost-effectiveness of vaccination. Results: A rotavirus vaccination program would prevent 10 deaths due to rotavirus gastroenteritis, 6,245 related hospitalizations and 41,962 outpatient visits during the first five years of life, per vaccinated cohort. For every 1,000 children born, the healthcare service spends US$15,077 on treatment of gastroenteritis. From the healthcare perspective, vaccination would yield a cost-effectiveness ratio of US$11,261 per DALY when the price of the vaccine is US$24 per course. Conclusions: Rotavirus vaccine can effectively reduce the disease burden and healthcare costs of rotavirus gastroenteritis and can be a cost-effective investment compared to other options.

Análise da eficácia no alívio dos sintomas climatéricos e da aceitabilidade de um gel contendo 1 mg de 17-beta estradiol (Sandrena gel) em mulheres climatéricas / Evaluation of the efficay and acceptability of a gel containing 17-beta estradiol 1 mg in relieving climacteric symptoms in menopausal womem

Avaliar a eficácia e a aceitabilidade de um gel de aplicaçäo transdérmica (Sandrena gel), contendo 1 mg de 17-beta estradiol, em pacientes climatéricas. Estudo prospectivo, aberto, näo controlado, pós-comercializaçäo. 459 pacientes foram tratadas com 1 mg de 17-beta estradiol em gel por dia por quatro meses. A intensidade dos sintomas climatéricos foi avaliada antes, durante e ao término do uso da medicaçäo. Ao final do estudo, foi pedido também que a paciente desse uma opiniäo sobre o tratamento. Os resultados de eficácia mostraram uma rápida e efetiva resposta observada em torno de 80 por cento das pacientes após 4 meses de tratamento, com poucos eventos adversos sistêmicos. Irritaçäo de pele ocorreu em raros casos (< 1 por cento) e a aceitabilidade ao tratamento relatada pelas pacientes foi elevada (86 por cento), durante o período do estudo. Apesar de seu valor limitado, devido aos múltiplos vieses inerentes a este tipo de desenho de estudo, a via percutânea de administraçäo de estradiol parece ser eficiente no alívio dos sintomas climatéricos, preenchendo as expectativas de uma via de reposiçäo hormonal com maior tolerância e alta aceitabilidade durante o período de observaçäo.