[Association between weight status and motor competence in schoolchildren from Chilean Patagonia]. / Asociación entre el estado nutricional y la competencia motriz en escolares de la Patagonia chilena.

BACKGROUND: the prevalence of overweight and obesity in the child population is a global public health problem, with measures such as the promotion of physical activity being necessary. One of the recognized factors for this is the development of motor competence, due to its dynamic interaction with physical activity, so it is necessary to understand its relationship with weight status. OBJECTIVE: the aims of this study are to determine whether there are differences in the levels of motor competence of schoolchildren in Chilean Patagonia according to their nutritional status, as well as to determine the association between body mass index (BMI) and the levels of motor competence in these schoolchildren. MATERIAL AND METHODS: we evaluated 295 boys and girls in 5th and 6th grade of primary school, from educational centres in Coyhaique and Punta Arenas. We used the MOBAK 5-6 test to assess their motor competence. RESULTS: schoolchildren with normal weight status presented higher values of motor competence in self-movement (M = 3.1; SD = 1.84) compared to overweight (M = 2.7; SD = 1.68) and obese schoolchildren (M = 1.7; SD = 1.57), presenting significant differences between all groups (p < 0.001). In object control, no differences were found between the groups. In addition, there was an inverse association of object control with gender (ß: 1.49; p < 0.001) and BMI (ß: -0.05; p = 0.026), while self-movement had an inverse association with BMI (ß: -0.11; 95 % CI: -0.15 -0.07; p < 0.001). CONCLUSION: weight status and motor competence are associated. Schoolchildren with higher BMI values tend to perform lower in self-movement. These results underline the importance of addressing motor competence in efforts to combat overweight and obesity in children.

Active alcohol consumption is associated with acute-on-chronic liver failure in Hispanic patients.

BACKGROUND: Acute-on-chronic liver failure (ACLF) is a severe clinical entity associated with elevated short-term mortality. We aimed to characterize patients with decompensated cirrhosis according to presence of ACLF, their association with active alcohol intake, and long-term survival in Latin America. METHODS: Retrospective cohort study of decompensated cirrhotic in three Chilean university centers (2017-2019). ACLF was diagnosed according EASL-CLIF criteria. We assessed survival using competing-risk and time-to-event analyses. We evaluated the time to death using accelerated failure time (AFT) models. RESULTS: We included 320 patients, median age of 65.3±11.7 years old, and 48.4% were women. 92 (28.7%) patients met ACLF criteria (ACLF-1: 29.3%, ACLF-2: 27.1%, and ACLF-3: 43.4%). The most common precipitants were infections (39.1%), and the leading organ failure was kidney (59.8%). Active alcohol consumption was frequent (27.7%), even in patients with a prior diagnosis of non-alcoholic fatty liver disease (NAFLD) (16.2%). Ninety-two (28.7%) patients had ACLF (ACLF-1: 8.4%, ACLF-2: 7.8%, and ACLF-3: 12.5%). ACLF patients had a higher MELD-Na score at admission (27 [22-31] versus 16 [12-21], p<0.0001), a higher frequency of alcohol-associated liver disease (36.7% versus 24.9%, p=0.039), and a more frequent active alcohol intake (37.2% versus 23.8%, p=0.019). In a multivariate model, ACLF was associated with higher mortality (subdistribution hazard ratio 1.735, 95%CI: 1.153-2.609; p<0.008). In the AFT models, the presence of ACLF during hospitalization correlated with a shorter time to death: ACLF-1 shortens the time to death by 4.7 times (time ratio [TR] 0.214, 95%CI: 0.075-0.615; p<0.004), ACLF-2 by 4.4 times (TR 0.224, 95%CI: 0.070-0.713; p<0.011), and ACLF-3 by 37 times (TR 0.027, 95%CI: 0.006-0.129; p<0.001). CONCLUSIONS: Patients with decompensated cirrhosis and ACLF exhibited a high frequency ofactive alcohol consumption. Patients with ACLF showed higher mortality and shorter time todeath than those without ACLF.

An elevated HScore is associated with poor clinical outcomes in COVID-19.

BACKGROUND: Patients with Coronavirus Disease 2019 (COVID-19) frequently experience a hyperinflammatory syndrome leading to unfavorable outcomes. This condition resembles Secondary Hemophagocytic Lymphohistiocytosis (sHLH) described in neoplastic, rheumatic and other infectious diseases. A scoring system (HScore) that evaluates underlying immunosuppression, temperature, organomegaly, cytopenias, ferritin, triglycerides, fibrinogen and AST was validated for sHLH, and recently proposed to evaluate hyperinflammation in COVID-19. AIM: To assess the presence of sHLH among patients with COVID-19 admitted for hospitalization and to evaluate Hscore as a prognostic tool for poor outcomes. MATERIAL AND METHODS: One hundred forty-three patients aged 21-100 years (64% males) admitted because of COVID-19 were enrolled in a prospective study. HScore was calculated within 72 hours admission. The incidence of sHLH during hospitalization was evaluated. Additionally, the relationship between a HScore ≥ 130 points and either the requirement of mechanical ventilation or 60-days mortality was explored. RESULTS: The median HScore was 96 (33-169). A SHLH was diagnosed in one patient (incidence 0.7%), whose HScore was 169. After adjusting for age, sex, comorbidities and obesity, HScore ≥ 130 was independently associated with the composite clinical outcome (Hazard rartio 2.13, p = 0.022). CONCLUSIONS: sHLH is not frequent among COVID-19 patients. HScore can be useful to predict the risk for poor outcomes.

Ultraprecise Controller for Piezoelectric Actuators Based on Deep Learning and Model Predictive Control.

Piezoelectric actuators (PEA) are high-precision devices used in applications requiring micrometric displacements. However, PEAs present non-linearity phenomena that introduce drawbacks at high precision applications. One of these phenomena is hysteresis, which considerably reduces their performance. The introduction of appropriate control strategies may improve the accuracy of the PEAs. This paper presents a high precision control scheme to be used at PEAs based on the model-based predictive control (MPC) scheme. In this work, the model used to feed the MPC controller has been achieved by means of artificial neural networks (ANN). This approach simplifies the obtaining of the model, since the achievement of a precise mathematical model that reproduces the dynamics of the PEA is a complex task. The presented approach has been embedded over the dSPACE control platform and has been tested over a commercial PEA, supplied by Thorlabs, conducting experiments to demonstrate improvements of the MPC. In addition, the results of the MPC controller have been compared with a proportional-integral-derivative (PID) controller. The experimental results show that the MPC control strategy achieves higher accuracy at high precision PEA applications such as tracking periodic reference signals and sudden reference change.

An elevated HScore is associated with poor clinical outcomes in COVID-19 / Un HScore elevado se asocia a mal pronóstico en pacientes con COVID-19

BACKGROUND: Patients with Coronavirus Disease 2019 (COVID-19) frequently experience a hyperinflammatory syndrome leading to unfavorable outcomes. This condition resembles Secondary Hemophagocytic Lymphohistiocytosis (sHLH) described in neoplastic, rheumatic and other infectious diseases. A scoring system (HScore) that evaluates underlying immunosuppression, temperature, organomegaly, cytopenias, ferritin, triglycerides, fibrinogen and AST was validated for sHLH, and recently proposed to evaluate hyperinflammation in COVID-19. AIM: To assess the presence of sHLH among patients with COVID-19 admitted for hospitalization and to evaluate Hscore as a prognostic tool for poor outcomes. MATERIAL AND METHODS: One hundred forty-three patients aged 21-100 years (64% males) admitted because of COVID-19 were enrolled in a prospective study. HScore was calculated within 72 hours admission. The incidence of sHLH during hospitalization was evaluated. Additionally, the relationship between a HScore ≥ 130 points and either the requirement of mechanical ventilation or 60-days mortality was explored. RESULTS: The median HScore was 96 (33-169). A SHLH was diagnosed in one patient (incidence 0.7%), whose HScore was 169. After adjusting for age, sex, comorbidities and obesity, HScore ≥ 130 was independently associated with the composite clinical outcome (Hazard rartio 2.13, p = 0.022). CONCLUSIONS: sHLH is not frequent among COVID-19 patients. HScore can be useful to predict the risk for poor outcomes.

ANTECEDENTES: Los pacientes con Enfermedad por Coronavirus 2019 (COVID-19), experimentan frecuentemente un síndrome hiperinflamatorio que lleva a resultados desfavorables. Esta situación se asemeja al Síndrome Hemofagocítico Secundario (sHLH) descrito en enfermedades neoplásicas, reumatológicas y por otros agentes infecciosos. Un sistema simple de puntaje (HScore) que evalúa inmunosupresión, temperatura organomegalia, citopenias, ferritina, triglicéridos, fibrinógeno y AST ha sido validado para el diagnóstico de sHLH y ha sido propuesto recientemente para evaluar la hiperinflamación en COVID-19. OBJETIVO: Medir la frecuencia de sHLH entre pacientes con COVID-19 hospitalizados, y evaluar a HScore como una herramienta pronóstica. MATERIAL Y MÉTODOS: Ciento cuarenta y tres pacientes de 21 a 100 años (64% hombres) fueron ingresados en este estudio de cohorte prospectivo, unicéntrico. Se calculó HScore dentro de las primeras 72 horas desde el ingreso, y se midió la incidencia de sHLH durante la hospitalización. Adicionalmente, se evaluó la relación entre HScore ≥ 130 puntos y un desenlace compuesto de ventilación mecánica o muerte a los 60 días. RESULTADOS: La mediana de HScore fue 96 (33-169) puntos. Un paciente fue diagnosticado con sHLH (incidencia 0,7%). Luego de ajustar por edad, sexo, comorbilidades y obesidad, un HScore ≥ 130 se asoció de manera independiente con el desenlace compuesto. CONCLUSIONES: El sHLH no es frecuente en los pacientes con COVID-19. El uso de HScore puede ser útil para predecir el riesgo de desenlaces clínicos desfavorables.

Infección por citomegalovirus en pacientes reumatológicos: análisis de un caso y revisión de la literatura / Cytomegalovirus infection in rheumatologic patients: a case report and literature review

El Citomegalovirus es un microorganismo capaz de generar infecciones severas en pacientes inmunosuprimidos. Existe abundante información respecto a la infección en pacientes inmunosuprimidos por VIH o en relación a trasplante de órganos sólidos o hematopoyéticos. No ocurre lo mismo con los pacientes portadores de enfermedades autoinmunes. Si bien la clínica puede ser inespecífica y dificultar la sospecha diagnóstica, la clave está en determinar al paciente de riesgo para la infección y así realizar un diagnóstico precoz. Se presenta el caso de una mujer de 56 años, portadora de una polimiositis de difícil tratamiento, que en un contexto de terapia en base a corticoides e inmunosupresores (azatioprina y metotrexato), desarrolla cuadro febril asociado a fatiga, cuyo estudio concluyó una infección por Citomegalovirus, tratado exitosamente con Valganciclovir.

Cytomegalovirus is a microorganism associated with severe infections in immunosuppressed patients. There is abundant information regarding infection in HIV immunosuppressed patients or in relation to solid or hematopoietic organ transplantation. The same does not happen with patients with rheumatic diseases. Although the clinic can be nonspecific and hinder diagnostic suspicion, the key is to determine the patient at risk for the infection and thus make an early diagnosis. We present a case of a 56-year-old woman with a difficult-to-treat polymyositis, who, in a context of corticosteroid and immunosuppressive agents (azathioprine and methotrexate), develops a fever associated with fatigue, whose study con-cluded an infection due to Cytomegalovirus, successfully treated with Valganci-clovir.

Bacteriemias en pacientes oncológicos del Instituto del Cáncer SOLCA. Cuenca, 2011-2016 / Bacteriemia in cancer patients at the SOLCA Cancer Institute. Cuenca, 2011-2016

Objetivo: caracterizar los episodios de bacteriemias, los microorganismos causantes y sus patrones de sensibilidad, en pacientes atendidos en el Instituto del Cáncer SOLCA ­ Cuenca, Ecuador. Metodología: se utilizó un diseño descriptivo. El estudio se enfocó en to-dos los episodios de bacteriemias ocurridos en el periodo 2011-2016 ve-rificados mediante hemocultivos. Las variables estudiadas fueron edad y sexo de los pacientes en los que se produjo la bacteriemia; tipo de tumor, microorganismo, tiempo de positivización y perfil de resistencia. Resultados: se identificaron 318 episodios. El 66.8% de los microorganis-mos aislados fueron bacterias gramnegativas y el 33.2% grampositivas; los más prevalentes fueron Escherichia coli 37.3%, Staphylococcus au-reus 17.9%, Klebsiella.spp 9.3%, Estafilococos coagulasa negativa 7.2% y Pseudomonas aeruginosa 5.1%. En los cocos grampositivos, la meticilino resistencia fue de 40% en Staphylococcus aureus.y 67% en Staphylococ-cus coagulasa negativa; Escherichia coli y Klebsiella pneumoniae fueron resistentes a cefalosporinas de tercera generación en un 29% y 47%, res-pectivamente, compatibles con el fenotipo de beta-lactamasa de espectro extendido; la resistencia a quinolonas fue 35% y 50% respectivamente. Conclusiones: las bacterias gramnegativas fueron los microorganismos más prevalentes en este estudio, principalmente enterobacterias, con una importante resistencia a los antibióticos ensayados.

Objective: to characterize the episodes of bacteremia, the causative microorganisms and their patterns of sensitivity in patients treated at the Cancer Institute SOLCA - Cuenca, Ecuador.Methodology: a descriptive design was applied. The study focused on all episodes of bacteremia occurred in the period 2011-2016, they were verified by blood cultures. The variables studied were age and sex of the patients in whom the bacteremia occurred; type of tumor, microorganism, time of positivization and resistance profile.Results: a total of 318 episodes were identified. The 66.8% of the isolated microorganisms were gram-negative bacteria and 33.2% gram-positive; the most prevalent were Escherichia coli 37.3%, Staphylococcus aureus 17.9%, Klebsiella.spp 9.3%, Staphylococcus coagulase negative 7.2% and Pseudomonasaeruginosa 5.1%. In gram-positive cocci, methicillin resistance was 40% in Staphylococcus.aureus and 67% in coagulase-negative Staphylococcus; Escherichia.coli and Klebsiella pneumoniae were resistant to third-generation cephalosporins by 29% and 47% respectively, compatible with the extended-spectrum beta-lactamase phenotype; the resistance to quinolones was 35% and 50% respectively.Conclusions: the gram-negative bacteria were the most prevalent microorganisms in this study, mainly the enterobacteria, with an important resistance to the antibiotics tested.

Autonomic imbalance in cardiac surgery: A potential determinant of the failure in remote ischemic preconditioning.

Remote ischemic preconditioning (RIPC) is a cardioprotective strategy against myocardial damage by ischemia-reperfusion. Many in-vivo and ex-vivo animal researches have demonstrated that RIPC decreases significantly the ischemia-reperfusion myocardial damage, by up to 58% in isolated rat heart. Cardiac artery bypass graft surgery (CABG) is a clinical model of myocardial ischemia-reperfusion and a clinical potential application to RIPC. However, although RIPC has shown successful results in experimental studies, clinical trials on CABG have failed to demonstrate a benefit of RIPC in humans. Strikingly, the main proposed factors associated with this translational failure also impair the balance of the autonomic nervous system (ANS), which has shown to play a key role in RIPC cardioprotection in animal models. Comorbidities, chronic pharmacological treatment and anesthesic drugs - common conditions in CABG patients - cause an ANS imbalance through parasympathetic activity decrement. On the other hand, ANS and specially the parasympathetic branch are essentials to get cardioprotection by RIPC in animal models. Consequently, we propose that ANS imbalance in CABG patients would explain the failure of RIPC clinical trials. Whether our hypothesis is true, many patients could be benefited by RIPC: a cheap, simple and virtually broad-available cardioprotective maneuver. In this paper we discuss the evidence that support this hypothesis and its clinical implications.

Eficacia de la Clozapina (Refraxol) en el tratamiento de pacientes psicóticos / Efficiency of the Clozapine (Refraxol) in the treatment of psychotic patients

La importancia del estudio radica en la necesidad de evaluar terapias de eficacia reconocida, la clozapina siendo el primer antipsicótico atípico con reconocida eficacia en el manejo de los síntomas positivos y negativos de la esquizofrenia se muestra como una opción importante para el tratamiento a largo plazo de estos pacientes en nuestro medio. Se incluyeron en el estudio los primeros 100 pacientes que se presentan al consultorio de Psiquiatría de Antipsicóticos Atípicos del Hospital Edgardo Rebagliati desde Abril del 2004 a Noviembre del mismo año. La descripción del grupo muestra cifras dentro de los límites esperados para pacientes con diagnóstico de psicosis. Se comprobó que hubo aumento de peso significativo relacionado al uso de clozapina, no se comprueba variación significativa en la presión sanguínea (el valor de p es mayor que 0.05 para la comparación de los promedios de la primera y la tercera determinaciones de la presión arterial) ni en la glicemia (la diferencia de los promedios de la primera y segunda determinación de glucosa es de -1.6 con un p=0.5301 y la de los promedios de la primera y tercera es de 1.191 con un p=0.7521), se encontró 2 casos (2 por ciento) de leucopenia, sin embargo la diferencia entre el primer y segundo conteos de leucocitos dio en promedio una diferencia de -101.68 sin significancia estadística (p=0-749), en el tercer conteo se presentaron dos casos de leucopenia que arrojaron un promedio de 749.54 en la diferencia de los promedios. No se encontró disminución en los conteos de linfocitos ni variación en los de plaquetas. Los puntajes de la Escala Breve de Evaluación Psiquiátrica bajaron de manera significativa de un promedio de 18.49 a 13.87, mostrando una tendencia general a la mejoría (P= menor que 0.05). Los puntajes de la Escala de Efectos Secundarios Psiquiátricos bajan de un promedio de 9.9 a 6.87 de manera ...

The importance of the research is base don the need to evaluate therapies of recognized efficiency, Clozapine, the first atypical antipsychotic with a recognized efficiency in the treatment of positive and negative schizophrenic symptoms, is an important option for long-term treatment of these patients in our environment. This research included the first 100 patients assisted on the Psychiatrics external service of the Edgardo Rebagliati Hospital’s Atypical Antipsychotic Program from April to November, 2004. The group description shows values within the limits expected for patients diagnosed for psychosis. It was verified that there was a significant weight increase related to the use of clozapine, significant variation on blood pressue is not verified (p value is mayor que) 0.05 for the comparison of the average of the first and third determinations of the arterial pressute) either in glycemia (the difference of the averages of the first and second determination of glucose is of -1.6 with a p =0.5301 and that of the averages of first and third determination is of 1.191 with ap=0.7521). Two cases (2 per cent) of leucopenia were found; nevertheless, the difference between the first and the second counts of leukocytes resulted in average difference of -101.68 without statistics significance (p=0.749); on the third count two cases of leucopenia appeared sowing an average of 749.54 on the average difference. Nor decrease on lymphocyte counts neither variation on those of platelets was found. Values of Psychiatric Evaluation Brief Scale decreases in a significant way from an average of 18.49 to 13.87, showing a general trend to the improvement (P menor que 0.05). Values Psychiatric Side Effects Scale decrease from an average of 9.9 to 6.87 in a significant way (P menor que 0.05), which shows a significant decrease on the presentation of the side effects it evaluates.

Factores determinantes de hospitalización en 100 pacientes del Servico de Hospitalización Breve / Hospitalization determinant factors in 100 patients of short hospitalization

Se realizó un estudio con el propósito de identificar los factores determinantes de hospitalización. su adecuada valoración es indispensable para alcanzarlos objetivos de una hospitalización breve. se incluyo 100 pacientes (50 varones y 50 mujeres) hospitalizados durante los meses de agosto a octubre de 1990 en el Instituto Salud Mental del Hospital Nacional Edgardo Rebagliati. Se encontro que la mayoria de los casos de reagudización se encuentran relacionados con el abandono de la medicación. La influencia del medio familiar gravitó en el 68 por ciento de las hospitalizaciones. En función del estudio se sugieren medidas para disminuir o prevenir la hospitalización de estos pacientes