Impact of the institutional model on psychiatric patients in Chile from the 19th to 21st centuries: a scoping review.

Introduction: Various mental health hospital models have been tested in Chile since its foundation. The institutional model with the Asylum and the Madhouse prevailed during the nineteenth century and much of the twentieth. But is deinstitutionalizing all psychiatric patients the solution? Evidence acquisition: A PubMed, Epistemonikos, Lilacs, and Google Scholar Scoping Review was carried out in the last 5 years using the PRISMA-P method and the Scoping review search strategy. The MeSH terms ("Psychiatry/history" AND "Chile") OR ("Mental disorders" AND "therapy") were used during the search. Finally, papers focused on clinical trial therapy evaluation were excluded, and we emphasized the effects of historical evidence. Evidence synthesis: We identified 35 primary studies, and we counted the number of articles included in the review that potentially met our inclusion criteria and noted how many studies had been missed by our search. We analyzed 10 primary studies and 10 primary historical resources that were included in this study. Conclusion: The state must become a guarantor and be responsible for its psychiatric patients and provide professional and humanitarian support to its patients, be it through community psychiatry, day hospitals, devices such as mental health clinics, or psychiatric institutes dedicated to teaching and research. Patients should not be left to the free will of their direct relatives, but rather the state should strengthen the primary care system.

Update on the diagnosis, management and treatment of fever of unknown origin: review article and case report / Actualización en el diagnóstico, manejo y tratamiento de la fiebre de origen desconocido: artículo de revisión y reporte de caso

INTRODUCTION Actually, there are more than 200 different causes of unknown fever, it is necessary for the doctor to identify the most prevalent causes of unknown fever in our Clinical boar. PRESENTATION A 52-year-old male patient with no history of chronic diseases, which was received in the Emergency Service of the Hospital San Pablo, Coquimbo, on 02/03/20 began a clinical picture characterized by fever up to 39 ºC associated with diaphoresis, evaluated several times in primary health care without response to symptomatic treatment. He denies dyspnea, cough, sputum production, headache, muscle weakness, myalgia, fainting, decreased visual acuity, nausea, vomiting, chest pain, abdominal pain, diarrhea, constipation, altered bowel movements, weight loss, dysuria, bladder tenesmus, pain lumbar, skin lesions. As relevant information, the patient reports having taken amoxicillin/clavulanate for 2 days on his own account. DISCUSSION Physicians should be aware of the rare extent of an unusual presentation of knowledge origin fever, probably associated with Still disease, as well as medical options for treatment. The literature does not conclude on a gold standard for the method of approach. CONCLUSION In our case, the etiological agent that could cause Fever of unknown origin (FUO) was Sars cov-2 given the presence of elevated inflammatory factors and acute phase proteins and the presence of neutrophilic infiltration

Ley 21331: nuevos desafíos de la Ley del reconocimiento y protección de los derechos de las personas en la atención de salud mental / Law 21331: new challenges of the law of recognition and protection of people's rights in mental health care

Since the dawn of the Republic, the question regarding the diagnosis, management and treatment of mental illnesses has been an unresolved issue to this day. Since before the time of the colony, at the time of the conquest, mental illnesses abounded, both in the Mapuche population - autochthonous indigenous - and in the Spanish. The presence in the river basins of heavy metals and minerals toxic for human consumption, as was originally the Mapocho River, whose waters were not drinkable and were only used for crops adopted from the Inca culture, were consumed by the population of the Spanish conquerors, who manifested various types of mental disorders, either due to the consumption of polluted water and the neurological damage that it caused them, the high levels of stress due to the same occupation and the isolation in which they found themselves and the diseases venereal that they carried, which they progressively transmitted to the aboriginal population. (1) On the other hand, the Mapuche population had magical-ritual treatments and methods to treat these and other diseases based on herbalism, phytotherapy and rituals (2) for the evil of melancholy (depression), anxiety disorders, panic attacks and schizophrenia. (3) Centuries later, when medicine and hard science are presented in society giving way to the scientific method, key people make their appearance within mental health studies, who made their way into the national and world panorama, and who, despite the dark past and the tortuous evolution of this branch of medicine, stand out figures who were pioneers and who gave rise to a reality that today continues in constant development and debate. Today mental health is an issue on the table, and Law 21331, promulgated on April 23, 2021 (4) is a response to changes in the perception that society currently has of the concept of disease, which is contrasted to the thinking and management that existed for years, decades and centuries ago around mental health

Desde los albores de la República, la cuestión referente al diagnóstico, manejo y tratamiento de las enfermedades mentales ha sido un tema sin resolver hasta nuestros días. Desde antes del tiempo de la colonia, en la época de la conquista, las enfermedades mentales abundaban, tanto en la población mapuche -indígena autóctona- como en la española. La presencia en las cuencas fluviales de metales pesados y minerales tóxicos para el consumo humano, como fue en su origen el río Mapocho, cuyas aguas no eran bebestibles y solo se utilizaban para los cultivos adoptados de la cultura inca, fueron consumidas por la población de los conquistadores españoles, los cuales manifestaron diversos tipos de trastornos mentales, ya fuese por el consumo de aguas contaminadas y el daño neurológico que les provocaba, los altos niveles de estrés debido a la misma ocupación y al aislamiento en el que se encontraban y las enfermedades venéreas que portaban, las cuales transmitieron progresivamente a la población aborigen. (1) Por otra parte, la población mapuche tenía tratamientos y métodos mágico-rituales para tratar estas y otras enfermedades basados en la herbolaria, la fitoterapia y los rituales (2) para el mal de la melancolía (depresión), trastornos ansiosos, crisis de pánico y la esquizofrenia.(3) Siglos más tarde, cuando la medicina y la ciencia dura se presentan en sociedad dando paso al método científico, hacen su aparición personas clave dentro de los estudios en salud mental, quienes se abrieron camino dentro del panorama nacional y mundial, y que, pese al pasado oscuro y a la evolución tortuosa de esta rama de la medicina, se destacan figuras que fueron pioneras y que dieron pie a una realidad que hoy en día continúa en constante desarrollo y debate. Hoy la salud mental es un tema sobre la mesa, y la Ley 21331, promulgada el 23 de abril del año 2021 (4) es una respuesta a los cambios en la percepción que la sociedad actualmente tiene frente al concepto de enfermedad, que se contrasta al pensamiento y manejo que durante años, décadas y siglos atrás existió en torno a la salud mental

Antibiotics for acute uncomplicated diverticulitis in hospitalized patients. / Antibióticos para diverticulitis aguda no complicada en pacientes hospitalizados.

INTRODUCTION: Acute diverticulitis is one of the complications of diverticular disease. Nowadays, there is a paradigm shift regarding the use of antibiotics to manage acute uncomplicated diverticulitis in hospitalized patients, with controversial information about it. METHODS: A search was done in Epistemonikos, the most comprehensive health-related systematic review database, maintained by screening multiple information sources including MEDLINE/PubMed, EMBASE, Cochrane, among others. Data were extracted from the identified systematic reviews, data from primary studies were analyzed, which in this work considered only randomized clinical trials, a meta-analysis was done, and a summary table of results was created using GRADE methodology. RESULTS AND CONCLUSIONS: Eleven systematic reviews were identified that included seven primary studies in total, of which two were randomized control trials. We concluded that the use of antibiotics in acute uncomplicated diverticulitis could slightly increase complications and result in a minor or no difference in the risk of recurrence and need for urgent surgery. However, the certainty of the evidence is low. Regarding hospital stay and readmission, it was not possible to evaluate the effect due to a low certainty of evidence.

INTRODUCCIÓN: La diverticulitis aguda es una de las complicaciones de la enfermedad diverticular. En la actualidad, ha habido un cambio de paradigma sobre el uso de antibióticos en el manejo de la diverticulitis aguda no complicada en pacientes hospitalizados, existiendo evidencia controversial al respecto. MÉTODOS: Se realizó una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el tamizaje de múltiples fuentes de información, incluyendo MEDLINE/PubMed, EMBASE, Cochrane, entre otras. Se extrajeron los datos desde las revisiones identificadas, se analizaron los datos de los estudios primarios, que en este trabajo consideraron solo ensayos clínicos aleatorizados, se realizó un metanálisis y se preparó una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Se identificaron 11 revisiones sistemáticas que en conjunto incluyeron siete estudios primarios, de los cuales dos correspondieron a ensayos aleatorizados. Se concluyó que el uso de antibióticos en la diverticulitis aguda no complicada podría aumentar levemente las complicaciones y podría resultar en nula o poca diferencia en el riesgo de recurrencia y la necesidad de cirugía de urgencia. Sin embargo, la certeza de la evidencia es baja. Respecto a la estadía hospitalaria y la readmisión no se pudo evaluar un efecto claro de esta intervención, dado que la certeza de la evidencia fue evaluada como muy baja.

Chagas' disease: study of congenital transmission in cases of acute maternal infection.

We studied three pregnant women with acute chagasic infection. Two patients, infected in the third trimester of pregnancy, had uninfected children. The third patient, infected earlier, had an infected newborn. These results encourage research on risk factors of transmission and on medical decisions concerning pregnant women with acute Chagas' disease.

Chagas' disease: study of congenital transmission in cases of acute maternal infection

Se descrevem 3 gestantes com a doença de Chagas aguda. Duas gestantes infetadas no 3º trimestre de gestação não tiveram crianças infetadas. O 3º filho, doquella madre foi infetada no 1º trimestre, nasceu com doença de Chagas congénita. Estes resultados inducem a investigação sobre os fatores de riscos da transmição e sobre as desições médicas na conducção dos casos de gestantes com a doença de Chagas aguda.

Frequency of interferon- gamma -producing T cells specific for Trypanosoma cruzi inversely correlates with disease severity in chronic human Chagas disease.

This study sought to quantify CD8(+) T cell responses to Trypanosoma cruzi and to identify potential links between these responses and the severity of disease in humans. In the majority of patients with Chagas disease, staining with class I major histocompatibility complex tetramers and analysis of interferon (IFN)- gamma ELISPOT responses to a panel of known cytotoxic T lymphocyte target epitopes from T. cruzi failed to identify parasite-specific CD8(+) T cells. However, the frequency of individuals with positive ELISPOT responses was higher in areas of active transmission. Analysis of IFN- gamma ELISPOT responses to a parasite lysate revealed a very high frequency of responders among patients with mild clinical disease and a very low frequency of responders among those with the most severe form of the disease. These data suggest that the frequency of IFN- gamma -producing T cells in patients with chronic Chagas disease is associated with the history of recent exposure and with the clinical status of the patient.

Patterns of cytokines and soluble cellular receptors in the sera of children with acute chagas' disease.

Cytokines and soluble cellular receptors are involved in inflammatory processes and probably in the pathogenesis of parasite and bacterial diseases. In a previous study, we reported increased levels of soluble receptors of interleukin-2 (sIL2-R) in children with acute Chagas' disease, one of the main parasitic infections that is endemic in Latin America. We sought to analyze the pattern of different cytokines and soluble receptors in the sera of children with chagasic infection. Children with acute and indeterminate stages of Chagas' disease, as well as nonchagasic children, were studied. Sera were assayed by enzyme-linked immunosorbent assay to measure the levels of tumor necrosis factor alpha (TNF-alpha), IL-6, IL-2, IL-8, IL-12, sIL-2R, and the soluble receptors of CD8 and CD4 (sCD8 and sCD4). sIL-2R and sCD8 showed the highest levels in serum in acutely infected children, decreasing after specific antiparasite therapy. Chronic children showed a pattern similar to the one of nonchagasic children. Although they were not statistically significant, TNF-alpha, IL-6, and sCD4 showed a tendency to reach high levels in the acutely infected group, whereas IL-2, IL-8, and IL-12 did not reveal changes with respect to the noninfected children. In summary, we report here the patterns of cytokines and soluble receptors in in the sera of children infected with Trypanosoma cruzi; we found significantly increased levels of sIL-2R and sCD8 in acute infection that decreased after therapy, and high levels of TNF-alpha, IL-6, and sCD4 in some of the acute patients. The measurement of sIL-2R and sCD8 may provide a useful tool in the follow-up of children with Chagas' disease.

Leishmaniasis Tegumentaria Americana en la Provincia de Santiago del Estero, Argentina / American Tegumentary Leishmaniasis in the Province of Santiago del Estero, Argentina

Se estudiaron tres casos de Leishmaniasis Tegumentaria Americana (LTA) en pacientes con formas clínicas cutáneas en la provincia de Santiago del Estero, Argentina. Para el aislamiento de las cepas a partir de la lesión primaria se realizó: examen directo, cultivos e inoculación en animales receptivos. Para la tipificación de género y especie: biometría y utilización de anticuerpos monoclonales. Se realizaron exámenes serológicos de Inmunoglorescencia Indirecta y ELISA, como así mismo la aplicación de la Intradermorreacción de Montenegro (IRM), empleando antígenos diferentes. En los tres casos estudiados de cepa aislada por Leishmania Viannia braziliensis.

The autors describe a study of three patients with American Tegumentary Leishmaniasis (LTA) with cutaneous lesions in the providence of Santiago del Estero - Argenina. Direct examination, cultures and innoculation in receptive animals were performed in order to isolate the differents strains from the primary lesion, biometric studis and techniques with monoclonal antibodies in otder to know the genus and specific epithet. Serological indirect inmunofluorescence examination and ELISA, as well as the intradermal reaction of Montenegro (IRM) using different antigens. In the three examples studied the isolated strain was Leishmania Viannia braziliensis.