Venous Thromboembolism Risk and Adherence to Pharmacological Thromboprophylaxis in Hospitalized Patients in Uruguay: First Nationwide Study.

INTRODUCTION: Venous thromboembolism (VTE) is a serious, frequent, and preventable medical complication in hospitalized patients. Although the efficacy of prophylaxis (pharmacological and/or mechanical) has been demonstrated, compliance with prophylaxis is poor at international and national levels. AIM: To determine the indication and use of pharmacological thromboprophylaxis in hospitalized patients in Uruguay. METHODS: An observational, descriptive, cross-sectional, multicentre study involving 31 nationwide healthcare facilities was conducted. Baseline characteristics associated with hospital admission, the percentage of the population with an indication for thromboprophylaxis, and the percentage of patients receiving pharmacological thromboprophylaxis were assessed. The VTE risk was determined using the Padua score for medical patients; the Caprini score for surgical patients; the Royal College of Obstetricians and Gynaecologists (RCOG) guidelines for pregnant-postpartum patients. RESULTS: 1925 patients were included, representing 26% of hospitalized patients in Uruguay. 71.9% of all patients were at risk of VTE. Of all patients at risk of VTE, 58.6% received pharmacological thromboprophylaxis. The reasons for not receiving thromboprophylaxis were prescribing omissions in 16.1% of cases, contraindication in 15.9% and 9.4% of patients were already anticoagulated for other reasons. Overall, just 68% of patients were "protected" against VTE. Recommendations of major thromboprophylaxis guidelines were followed in 70.1% of patients at risk. CONCLUSIONS: Despite the progress made in adherence to thromboprophylaxis indications, nonadherence remains a problem, affecting one in six patients at risk of VTE in Uruguay.

Intra-amniotic Candida albicans Infection Treated With Liposomal Amphotericin B With a Successful Neonatal Outcome.

Intra-amniotic infection with Candida species is an uncommon but severe condition with high fetal morbimortality and no established clinical guidelines for its management. We report a Candida albicans intra-amniotic infection diagnosed in a 25-week pregnant woman, successfully treated with high-dose liposomal amphotericin B. Pregnancy was prolonged until 30 weeks, and despite persistently positive Candida cultures in amniotic fluid, a healthy newborn was delivered without evidence of systemic infection. Amphotericin concentration was determined at birth, revealing levels over 30 times higher in mother's and cord blood than in the amniotic fluid, probably explaining the clinical protection despite failure in obtaining fungal clearance.

Manejo de embarazos únicos con diagnóstico antenatal de vasa previa / Management of singleton pregnancies with prenatal diagnosis of vasa previa

Introducción: vasa previa (VP) corresponde al paso de los vasos umbilicales por las membranas amnióticas, sin protección de gelatina de Wharton o placenta, antes de la presentación fetal, sobre el orificio cervical interno. Pese a su baja incidencia, el diagnóstico prenatal es relevante por las graves consecuencias que puede tener esta patología en caso de no ser diagnosticada. El objetivo de esta revisión es presentar la evidencia disponible para el manejo de embarazadas con diagnóstico antenatal de VP. Materiales y métodos: analizamos todos los estudios publicados (prospectivos, retrospectivos y reporte de casos) entre los años 1999 y 2023, con diagnóstico VP en embarazo único, reportando la edad gestacional de interrupción y el resultado neonatal. Resultados: incluimos 19 investigaciones (18 en la búsqueda primera y una adicional por relevancia). Las pacientes con manejo intrahospitalario desde las 34 semanas tuvieron mayor latencia al parto, mejores resultados neonatales y menor tasa de cesárea de urgencia que las pacientes con manejo ambulatorio. La edad gestacional de interrupción es variable entre los estudios, sin embargo, no se evidenció beneficio de interrupción a las 34 semanas comparado con manejo expectante hasta las 37 semanas de edad gestacional. Conclusión: existiría beneficio de hospitalización entre las 32-34 semanas en mujeres con diagnóstico de VP, siendo razonable la interrupción cercana a las 37 semanas por cesárea electiva.

Introduction: vasa previa (VP) corresponds to the passage of the umbilical vessels through the amniotic membranes, without the protection of Wharton's gelatin or placenta, in front of the fetal presentation, over the internal cervical os. Despite its low incidence, prenatal diagnosis is relevant due to the severe consequences of this pathology if the diagnosis is missed. This review presents the available evidence for pregnant women's management with an antenatal diagnosis of VP. Materials and methods: we analyzed all the studies published (prospective, retrospective, and case reports) between 1999 and 2023, with a diagnosis of VP in a single pregnancy, reporting gestational age at delivery and neonatal outcome. Results: We included 19 investigations (18 in the first search and another for relevance). Patients with in-hospital management from 34 weeks had a more extended latency period until delivery, better neonatal outcomes, and a lower rate of emergency cesarean section than patients with outpatient management. The gestational age at birth is variable between the studies; however, no benefit of delivery at 34 weeks was evidenced compared with expectant management until 37 weeks of gestational age. Conclusion: there would be a benefit of hospitalization between 32-34 weeks in women diagnosed with VP, being reasonable to schedule the delivery close to 37 weeks by elective cesarean section.

Acute Chagas Disease Outbreak among Military Personnel, Colombia, 2021.

We report an acute Chagas disease outbreak among soldiers in Colombia. Trypanosoma cruzi infection was confirmed through parasitology, serology, and molecular methods. Among 9 affected soldiers, 2 died; 7 were hospitalized and received benznidazole treatment, which produced favorable outcomes. Personnel patrolling rural areas in Colombia could be at increased risk for Chagas disease.

Description of changes in clinical outcomes following the implementation of an antibiotic stewardship program in a level IV hospital / Descripción del cambio en desenlaces clínicos posteriores a la implementación de un programa de gestión de antibióticos en un hospital de cuarto nivel de atención en salud.

INTRODUCTION: Inadequate prescription of antibiotics has been recognized as a public health problem by the World Health Organization. In this context, antibiotic stewardship programs have been implemented as a tool to mitigate its impact. OBJETIVE: To describe the changes in clinical outcomes after the implementation of an antibiotic stewardship program in a level IV hospital. MATERIALS AND METHODS: We conducted a unique cohort study of patients hospitalized for infectious pathologies that were treated with antibiotics in an advanced medical facility. We collected the clinical history before the implementation of the antibiotic stewardship program (2013 to 2015) and then we compared it to the records from 2018 to 2019 collected after the implementation of the program. We evaluated changes in clinical outcomes such as overall mortality, and hospital stay, among others. RESULTS: We analyzed 1,066 patients: 266 from the preimplementation group and 800 from the post-implementation group. The average age was 59.2 years and 62% of the population was male. Statistically significant differences were found in overall mortality (29% vs 15%; p<0.001), mortality due to infectious causes (25% vs 9%; p<0.001), and average hospital stay (45 days vs 21 days; p<0.001); we also observed a tendency to decrease hospital readmission at 30 days for infectious causes (14% vs 10%; p=0.085). CONCLUSIONS: The antibiotic stewardship program implemented was associated with a decrease in overall mortality and mortality due to infectious causes, as well as in average hospital stay. Our results evidenced the importance of interventions aimed at mitigating the impact of inadequate prescription of antibiotics.

Introducción: La inadecuada prescripción de antibióticos es un problema de salud pública, reconocido por la Organización Mundial de la Salud. Los programas de gestión de antibióticos son implementados como una herramienta para mitigar su impacto. Objetivo: Describir los cambios observados en los desenlaces clínicos después de la implementación de un programa de gestión de antibióticos en un hospital de IV nivel de atención. Materiales y métodos. Se llevó a cabo un estudio de cohorte única de pacientes hospitalizados por patologías infecciosas y tratados con antibióticos en una institución médica de alta complejidad. Inicialmente, se recolectaron las historias clínicas anteriores a a la implementación del programa de gestión de antibióticos (2013 a 2015) y luego se compararon con los datos obtenidos después de la implementación del programa de gestión de antibióticos de 2018 a 2019. Se evaluaron los cambios en los desenlaces clínicos como mortalidad y estancia hospitalaria, entre otros. Materiales y métodos: Se llevó a cabo un estudio de cohorte única de pacientes hospitalizados por patologías infecciosas y tratados con antibióticos en una institución médica de alta complejidad. Inicialmente, se recolectaron las historias clínicas anteriores a a la implementación del programa de gestión de antibióticos (2013 a 2015) y luego se compararon con los datos obtenidos después de la implementación del programa de gestión de antibióticos de 2018 a 2019. Se evaluaron los cambios en los desenlaces clínicos como mortalidad y estancia hospitalaria, entre otros. Resultados: Se analizaron las historias clínicas de 1.066 pacientes: 266 con historia previa a la implementación del programa y 800 con historia posterior a la implementación. El promedio de edad fue 59,2 años y 62 % de la población era masculina. Se encontraron diferencias estadísticamente significativas en mortalidad global (29 Vs. 15 %; p<0,001), mortalidad por causa infecciosa (25 % Vs. 9 %; p<0,001) y promedio de estancia hospitalaria (45 Vs.21 días; p<0,001), con tendencia a disminuir nuevas hospitalizaciones en 30 días por patología infecciosa (14 Vs.10 %; p=0,085). Conclusiones: El desarrollo del programa de gestión de antibióticos se asoció con a una disminución en la mortalidad global, la mortalidad por causa infecciosa y la estancia hospitalaria. Esto demuestra la importancia de desarrollar intervenciones dirigidas a mitigar el impacto de la prescripción inadecuada de antibióticos.

Description of changes in clinical outcomes following the implementation of an antibiotic stewardship program in a level IV hospital / Descripción del cambio en desenlaces clínicos posteriores a la implementación de un programa de gestión de antibióticos en un hospital de cuarto nivel de atención en salud

Introduction. Inadequate prescription of antibiotics has been recognized as a public health problem by the World Health Organization. In this context, antibiotic stewardship programs have been implemented as a tool to mitigate its impact. Objective. To describe the changes in clinical outcomes after the implementation of an antibiotic stewardship program in a level IV hospital. Materials and methods. We conducted a unique cohort study of patients hospitalized for infectious pathologies that were treated with antibiotics in an advanced medical facility. We collected the clinical history before the implementation of the antibiotic stewardship program (2013 to 2015) and then we compared it to the records from 2018 to 2019 collected after the implementation of the program. We evaluated changes in clinical outcomes such as overall mortality, and hospital stay, among others. Results. We analyzed 1,066 patients: 266 from the preimplementation group and 800 from the post-implementation group. The average age was 59.2 years and 62% of the population was male. Statistically significant differences were found in overall mortality (29% vs 15%; p<0.001), mortality due to infectious causes (25% vs 9%; p<0.001), and average hospital stay (45 days vs 21 days; p<0.001); we also observed a tendency to decrease hospital re- admission at 30 days for infectious causes (14% vs 10%; p=0.085). Conclusions. The antibiotic stewardship program implemented was associated with a decrease in overall mortality and mortality due to infectious causes, as well as in average hospital stay. Our results evidenced the importance of interventions aimed at mitigating the impact of inadequate prescription of antibiotics.

Introducción. La inadecuada prescripción de antibióticos es un problema de salud pública, reconocido por la Organización Mundial de la Salud. Los programas de gestión de antibióticos son implementados como una herramienta para mitigar su impacto. Objetivo. Describir los cambios observados en los desenlaces clínicos después de la implementación de un programa de gestión de antibióticos en un hospital de IV nivel de atención. Materiales y métodos. Se llevó a cabo un estudio de cohorte única de pacientes hospitalizados por patologías infecciosas y tratados con antibióticos en una institución médica de alta complejidad. Inicialmente, se recolectaron las historias clínicas anteriores a la implementación del programa de gestión de antibióticos (2013 a 2015) y luego se compararon con los datos obtenidos después de la implementación del programa de gestión de antibióticos de 2018 a 2019. Se evaluaron los cambios en los desenlaces clínicos como mortalidad y estancia hospitalaria, entre otros. Resultados. Se analizaron las historias clínicas de 1.066 pacientes: 266 con historia previa a la implementación del programa y 800 con historia posterior a la implementación. El promedio de edad fue 59,2 años y 62 % de la población era masculina. Se encontraron diferencias estadísticamente significativas en mortalidad global (29 Vs. 15 %; p<0,001), mortalidad por causa infecciosa (25 % Vs. 9 %; p<0,001) y promedio de estancia hospitalaria (45 Vs.21 días; p<0,001), con tendencia a disminuir nuevas hospitalizaciones en 30 días por patología infecciosa (14 Vs.10 %; p=0,085). Conclusiones. El desarrollo del programa de gestión de antibióticos se asoció con a una disminución en la mortalidad global, la mortalidad por causa infecciosa y la estancia hospitalaria. Esto demuestra la importancia de desarrollar intervenciones dirigidas a mitigar el impacto de la prescripción inadecuada de antibióticos.

Inclusion in the university: Who assumes responsibility? A qualitative study.

Society challenges higher education institutions and their members to generate inclusive communities to enable the full development of all members. This study aims to analyze who is responsible for generating inclusion according to community members from a traditional Chilean University. We carried out qualitative research based on the Grounded Theory. We collected data through focus group and semi-structured Interviews, involving 14 undergraduate students, two post-graduate students, 17 faculty members, five non-teaching staff members, and nine executives officers. All of thembelonging to the three campuses of the University. We analyzed data using ATLAS.ti 7.5.7, using the constant comparison method and reaching an axial codification level. From the data analysis, 25 subcategories emerged, grouped into six categories. Later we organized them under the codification paradigm. Results highlighted the perception of the interaction and influence of the social, institutional, and personal fields in the inclusion phenomenon. Also, that inclusive practices must be a responsibility shared among different educational community members.

COVID-19 infection during blinatumomab therapy: Is safety a dilemma?

Patients with acute lymphoblastic leukemia may be particularly vulnerable to SARS-CoV-2 infection and severe illness. The mainstay of current treatment is the use of blinatumomab in patients with refractory or relapsed B-cell precursor acute lymphoblastic leukemia. We discuss the case of a patient with relapsed acute lymphoblastic leukemia who became positive for SARS-CoV-2 during blinatumomab therapy. There are no formal recommendations on the decision to continue, withhold, or delay blinatumomab treatment in these patients. More studies exploring this issue are warranted, as SARS-CoV-2 is expected to be here to stay.

Evaluating the feasibility of a group psychosocial intervention for migrant and host community women in Ecuador and Panamá: protocol for a multi-site feasibility cluster trial.

BACKGROUND: Community- and strengths-based psychosocial interventions are central to mental health and psychosocial support guidelines, but rigorous evidence regarding the effectiveness of these interventions is limited. The complexity and variability that is inherent to many community-based psychosocial interventions requires innovative strategies in order to facilitate the comparability and synthesis across research studies without compromising the fit and appropriateness of interventions to specific study populations and context. Entre Nosotras is a community-based psychosocial intervention developed for migrant and host community women that is designed to be flexible enough to enable integration of external intervention components and adaptable to diverse study contexts and populations. This protocol describes a study that aims to evaluate the appropriateness, acceptability, and feasibility of integrating a standardized stress management intervention into Entre Nosotras. METHODS: This study will evaluate the appropriateness, acceptability, feasibility, and safety of intervention and research procedures for a cluster randomized comparative effectiveness trial conducted in Ecuador and Panamá with migrant and host community women. In this feasibility trial, we will allocate communities nested within the three study sites to the integrated Entre Nosotras + stress management intervention versus Entre Nosotras alone through stratified randomization. Migrant and host community women residing in these study communities who report low to moderate levels of distress will be allocated to the intervention condition that their community is assigned (n = 220 total). We will collect quantitative measures of psychosocial wellbeing, psychological distress, coping, social support, and functioning from study participants. We will collect quantitative measures of fidelity and facilitator competencies through observation and facilitator self-assessment. Data on appropriateness, acceptability, feasibility, and safety will be gathered from participants and facilitators through quantitative assessments at 0, 5, and 10 weeks post-enrollment and qualitative interviews conducted with all facilitators and a subset of 70 study participants during the post-intervention follow-up period. DISCUSSION: Results from this feasibility trial will determine whether a multi-site cluster randomized comparative effectiveness trial of an adaptable community-based psychosocial intervention for migrant and host community women is relevant, acceptable, and feasible. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05130944 . Registered November 23, 2021-retrospectively registered.

Community-based participatory design of a psychosocial intervention for migrant women in Ecuador and Panama.

There is increasing evidence supporting the effectiveness of scalable mental health and psychosocial support (MHPSS) interventions delivered by non-specialists for improving wellbeing among migrant populations in humanitarian settings. Balancing fidelity in the implementation of evidence-based MHPSS interventions with their fit to the needs and preferences of new populations and contexts remains a challenge when introducing MHPSS interventions in new settings. This paper describes a community-based participatory approach to MHPSS intervention design incorporating processes to promote local adaptability and fit while maintaining standardized elements of existing MHPSS interventions. We conducted a mixed-methods study to design a community-based MHPSS intervention that fit the mental health and psychosocial needs of migrant women in three sites in Ecuador and Panama. Drawing from a set of community-based participatory research methods, we identified the priority mental health and psychosocial needs among migrant women, co-developed intervention mechanisms that aligned with those needs, matched mechanisms to existing psychosocial intervention components, and iteratively piloted and refined the intervention with community stakeholders. The resulting intervention was a five-session, lay facilitator-delivered group intervention titled, Entre Nosotras ('among/between us'). The intervention combined elements of individual and community problem solving, psychoeducation, stress management, and social support mobilization to address prioritized problems including psychological distress, safety, community connectedness, xenophobia and discrimination, and social support. This research outlines an emphasis on the social dimension of psychosocial support, as well as a process for balancing fit and fidelity in intervention design and implementation.

Psychopathological and Personality Pro file in Chronic Nononcologic Nociceptive and Neuropathic pain: Cross-sectional Comparative Study.

Introduction: Adaptation to chronic non-oncologic pain is associated with the development of psychopathology and personality disorders, creating severity, chronicity, poorer treatment response, and exacerbations in patients with neuropathy. Objective: To identify the psychopathological and personality profiles of patients with chronic nociceptive and neuropathic pain and their association with pain progression and intensity. Method: A cross-sectional, descriptive and comparative study was conducted in the Pain Treatment Unit of Hospital Universitari Sagrat Cor, with systematic randomized recruitment for 25 months; 115 patients were evaluated using the Hamilton Depression and Anxiety Rating Scale (HAM-D, HAM-A) and the Millon Clinical MultiaxialInventory-III (MCMI-III). Results: The neuropathic group achieved significantly higher scores for pain intensity and depressive and anxiety symptoms. With greater magnitude and frequency, the neuropathic group related pain intensity and progression with depressive/anxiety symptoms, clinical syndromes, and personality patterns. Both groups revealed tendencies towards a compulsive personality pattern, followed by narcissistic, histrionic, and schizoid patterns. Conclusions: When treating chronic pain, the presence of various psychopathological indicators requires an individualized strategy.

Introducción: La adaptación al dolor crónico no oncológico se asocia al desarrollo de psicopatología y afectaciones de la personalidad, generando severidad, cronicidad, menor respuesta al tratamiento y agravándose ante la neuropatía. Objetivo: Identificar perfiles psicopatológicos y de personalidad en pacientes con dolor crónico nociceptivo y neuropático, y su relación con la evolución e intensidad del dolor. Método: Estudio transversal, descriptivo y comparativo, realizado en la Unidad de Tratamiento del Dolor del Hospital Universitari Sagrat Cor, con reclutamiento aleatorio sistemático durante 25 meses; 115 pacientes fueron evaluados mediante la Escala de Hamilton para la Depresión y Ansiedad (HAM-D, HAM-A) y el Inventario Clínico Multiaxialde Millon III (MCMI-III). Resultados: El grupo neuropático obtuvo puntuaciones significativamente mayores en intensidad del dolor, sintomatología depresiva y ansiosa. Con más magnitud y frecuencia, relacionó la intensidad y evolución del dolor con sintomatología depresiva, ansiosa, síndromes clínicos y patrones de la personalidad. Ambos grupos revelaron tendencia al patrón de personalidad compulsiva, seguido del narcisista, histriónico y esquizoide. Conclusiones: En el tratamiento del dolor crónico, la presencia de distintos indicadores psicopatológicos requiere una estrategia individualizada.

Encefalopatia neonatal por COVID-19 con estatus convulsivo / COVID-19 neonatal encephalopathy and convulsive status

We present a patient with laboratory-confirmed coronavirus disease who subsequently developed encephalopathy. The patient was brought to a primary care center due to slight symptoms, however the patient presented a seizure with generalized tonic-clonic movements with respiratory depression and reversible cardiorespiratory arrest, requiring orotracheal intubation and midazolam. After that the patient was transferred to the NICU where he was admitted with signs of dehydration, and he presented another reversible cardiac arrest. Given an inadequate response to weaning from mechanical ventilation, troponin increasing and chest X-ray suggestive of a pneumonic process, ampicillin sulbactam was considered. and took a tracheal secretion cultures and COVID-19 test, finding and methicillin sensitive , as well as a COVID-19 positive PCR test antibiotic management for bacterial pneumonia was started. It is to highlight the importance of recognizing that acute encephalitis is one of the most serious complications of pediatric viral infections, since it can lead to motor and intellectual sequelae, and even epilepsy in some cases.

Presentamos el caso de un paciente de 6 meses que presentó cuadro clínico de emesis, convulsiones tónico-clónicas generalizadas y dos paradas cardiorrespiratorias, requiriendo intubación orotraqueal y soporte inotrópico en la UCIN. Se obtuvo prueba de PCR COVID-19 positiva, se realizó el diagnóstico de encefalitis viral aguda y se inició manejo con antiepiléptico intravenoso, sedoanalgesia, soporte inotrópico, corticoide intravenoso, inmunoglobulina humana, N-acetilcisteína y tromboprofilaxis. Debido a la instauración atípica de la infección por COVID-19 en este grupo de edad, discutimos el espectro de presentación de la encefalitis viral en pediatría y su manejo desafiante.

Enfoque perioperatorio de la insuficiencia suprarrenal en el contexto de un paciente con síndrome poliglandular: Reporte de caso / Adrenal Insufficiency in a patient with polyglandular syndrome perioperative management

Adrenal insufficiency is a deficiency in the secretion of steroid hormones, mainly glucocorticoids from the adrenal gland. It can be classified in primary when the alteration occurs at the level of the adrenal gland; or secondary, due to a central defect that compromises corticotropin (ACTH) or corticotropin-releasing hormone (CRH) secretion. Adrenergic suppression and compromised response to stress characteristic of patients with adrenal deficiency constitute a potentially fatal clinical condition, especially in operating rooms, where it becomes a challenge for the entire surgical team, particularly the anesthesiologist, where is essential to carry out a comprehensive pre-anesthetic assessment, creating an anesthetic plan focused on correct adrenergic substitution, which is decisive in the patient's prognosis.

La insuficiencia suprarrenal es una entidad caracterizada por una deficiencia en la secreción de hormonas esteroideas, principalmente glucocorticoides desde la glándula adrenal. Se puede clasificar en primaria cuando la alteración se produce a nivel de la glándula adrenal; o secundaria, debido a un defecto central que compromete la secreción de corticotropina (ACTH), o de hormona liberadora de corticotropina (CRH). La supresión adrenérgica y el compromiso en la respuesta ante el estrés característica en los pacientes con déficit adrenal, constituye una condición clínica potencialmente mortal, especialmente en salas de cirugía, donde se convierte en un desafío para todo el equipo quirúrgico en particular el anestesiólogo, donde es imprescindible realizar una valoración preanestésica integral creando un plan anestésico enfocado en la correcta suplencia adrenérgica que es determinante en el pronóstico del paciente.

Cardioembolic stroke: risk factors, clinical features, and early outcome in 956 consecutive patients

ABSTRACT Background: There is little information about the early clinical features of cardioembolic stroke before complementary examinations. Objective: The aim of this study was to identify risk factors, clinical features, and early outcomes of cardioembolic stroke. Methods: Retrospective study based on prospectively collected data available from a university medical center hospital-based stroke registry. Consecutive patients diagnosed with cardioembolic infarction were selected and compared to those diagnosed with an atherothrombotic stroke. Predictors of cardioembolic infarction were assessed by multivariate analysis. Results: From a cohort of 4597 consecutive patients, we studied 956 patients diagnosed with cardioembolic infarction (80 years [standard deviation (SD) 9.14]; 63% women) and 945 with atherothrombotic infarction (77.01 years [SD 9.75]; 49.8% women). The univariate comparative analysis reported that advanced age (≥ 85 years), female gender, atrial fibrillation (AF), ischemic heart disease, and congestive heart failure were significantly more frequent in the cardioembolic group, whereas hypertension, diabetes, peripheral vascular disease, heavy smoking, hyperlipidemia, and previous transient ischemic attack were significant in the atherothrombotic group. In the logistic regression model, AF (odds ratio [OR] 15.75, 95% confidence interval [CI]: 12.14-20.42), ischemic heart disease (OR 3.12, 95% CI: 2.16-4.5), female gender (OR 1.56, 95% CI: 1.22-2.00), and sudden-onset (OR 1.97, 95% CI: 1.54-2.51), were independent significant predictors of cardioembolic stroke. Conclusions: Potential cardioembolic stroke requires a comprehensive evaluation, since early classification and identification through predictors would improve effective management. (REV INVEST CLIN. 2021;73(1):23-30)

Epidemiology and molecular characterization of Carnivore protoparvovirus-1 infection in the wild felid Leopardus guigna in Chile.

Landscape anthropization has been identified as one of the main drivers of pathogen emergence worldwide, facilitating pathogen spillover between domestic species and wildlife. The present study investigated Carnivore protoparvovirus-1 infection using molecular methods in 98 free-ranging wild guignas (Leopardus guigna) and 262 co-occurring owned, free-roaming rural domestic cats. We also assessed landscape anthropization variables as potential drivers of infection. Protoparvovirus DNA was detected in guignas across their entire distribution range, with observed prevalence of 13.3% (real-time PCR) and 9% (conventional PCR) in guignas, and 6.1% (conventional PCR) in cats. Prevalence in guigna did not vary depending on age, sex, study area or landscape variables. Prevalence was higher in juvenile cats (16.7%) than in adults (4.4%). Molecular characterization of the virus by amplification and sequencing of almost the entire vp2 gene (1,746 bp) from one guigna and five domestic cats was achieved, showing genetic similarities to canine parvovirus 2c (CPV-2c) (one guigna and one cat), feline panleukopenia virus (FPV) (one cat), CPV-2 (no subtype identified) (two cats), CPV-2a (one cat). The CVP-2c-like sequence found in a guigna clustered together with domestic cat and dog CPV-2c sequences from South America, suggesting possible spillover from a domestic to a wild species as the origin of infection in guigna. No clinical signs of disease were found in PCR-positive animals except for a CPV-2c-infected guigna, which had haemorrhagic diarrhoea and died a few days after arrival at a wildlife rescue centre. Our findings reveal widespread presence of Carnivore protoparvovirus-1 across the guigna distribution in Chile and suggest that virus transmission potentially occurs from domestic to wild carnivores, causing severe disease and death in susceptible wild guignas.

Conocimiento de los niños, niñas y adolescentes del acoso escolar en una institución educativa de la localidad de ciudad Bolívar (Colombia). Un aporte desde enfermería para la reconciliación y reconstrucción de la paz / Children and adolescents' knowledge of acoso escolar in an educational institution in ciudad Bolívar (Colombia). A contribution from nursing for the reconciliation and reconstruction of peace

OBJETIVO: Describir los conocimientos que tienen los estudiantes entre los 12 y 17 años frente al acoso escolar, en una institución educativa de la localidad de Ciudad Bolívar (Colombia)en el segundo semestre del 2020. MATERIALES Y MÉTODOS: Se desarrolló un estudio cualitativo con enfoque descriptivo exploratorio, con el fin de comprender experiencias y percepciones de la niñez y adolescencia con respecto al acoso escolar. Se llevó a cabo una encuesta con 134 niños entre los 12 y 17 años y un grupo focal de 12 participantes de distintas edades, pertenecientes a la institución educativa. El análisis y la sistematización de la información y la codificación se realizó utilizando el software Nvivo V.12. RESULTADOS: luego del análisis cualitativo emergieron cuatro categorías: definiciones de acoso escolar, porqué se realiza el Acoso Escolar, reacciones frente al acoso escolar y lugares donde se realiza el acoso escolar. CONCLUSIONES: A pesar de reconocer a través de las categorías cómo se realiza el Acoso Escolar, dónde se realiza y sus principales efectos, se evidenció como la definición de acoso en este estudio al igual que en la literatura no es única, el aspecto común es que es una forma de agresión. Se sigue reconociendo como primera causa del acoso escolar el manejo del poder justificándose desde razones económicas, aspecto físico, el género y su desarrollo durante el colegio. Desde Enfermería es importante liderar programas para la promoción de convivencia en paz, prevención de la aparición de este fenómeno y su reconocimiento temprano, con el fin de disminuir consecuencias graves y aportar a nuestra sociedad en búsqueda de reconciliación que se reflejará en una convivencia pacífica en las aulas; aspecto que se reflejará en futuros ciudadanos respetuosos de las diferencias y tolerantes en búsqueda de un país mejor.

OBJECTIVE: Describe the knowledge that students between 12 and 17 years of age have against bullying, in an educational institution in the town of Ciudad Bolívar (Colombia) in the second semester of 2020. MATERIALS AND METHOD: A qualitative study was developed with descriptive exploratory approach, in order to understand experiences and perceptions of childhood and adolescence regarding bullying. A survey was carried out with 134 children between 12 and 17 years old and a focus group of 12 participants of different ages, belonging to the educational institution. The analysis and systematization of the information and coding was carried out using the Nvivo V.12 software. RESULTS: after the qualitative analysis, four categories emerged: definitions of bullying, why bullying is carried out, reactions to bullying and places where bullying is carried out. CONCLUSIONS: Despite recognizing through the categories how bullying is carried out, where it is carried out and its main effects, it was evidenced that the definition of bullying in this study as in the literature is not unique, the common aspect is which is a form of aggression. The handling of power is still recognized as the main cause of bullying, justified from economic reasons, physical appearance, gender and its development during school. From Nursing it is important to lead programs for the promotion of peaceful coexistence, prevention of the appearance of this phenomenon and its early recognition, in order to reduce serious consequences and contribute to our society in search of reconciliation that will be reflected in a peaceful coexistence in the classrooms; an aspect that will be reflected in future citizens who are respectful of differences and tolerant in search of a better country.

Infections and systemic sclerosis: an emerging challenge / Infecciones y esclerosis sistémica: un desafío emergente

ABSTRACT Mounting evidence has shown non-systemic sclerosis (SSc) related complications as a rising cause of hospital admission and mortality, out of which infections are among the top-five causes. Patients with SSc are at an increased risk of infection due to several features of the treatment options and to the disease itself. For instance, lung involvement is associated with a higher frequency of respiratory infections, whereas the presence of digital ulcers or calcinosis may result in skin and soft tissue infections, and even osteomyelitis. On the other hand, the growing trend towards immunomodulation and immunosuppression in patients with autoimmune diseases will place SSc patients at a higher risk of infectious complications, including opportunistic infections. A low suspicion threshold and an increasing awareness among treating specialists, particularly rheumatologists, are warranted for prevention, early diagnosis and management of infectious complications. Nonetheless, data on risk management strategies in SSc, such as vaccination and antimicrobial prophylaxis, are scarce. A narrative non-systematic review was performed to provide an update of infectious complications in patients with SSc.

RESUMEN La evidencia creciente muestra que las complicaciones no asociadas a la esclerosis sistémica (ES) son una causa cada vez más frecuente de hospitalización y mortalidad, dentro de las cuales las infecciones se encuentran entre las primeras cinco causas. Los pacientes con ES presentan un riesgo elevado de infección asociado con las opciones terapéuticas y con la enfermedad misma. Por ejemplo, el compromiso pulmonar se asocia con una mayor frecuencia de infecciones respiratorias, mientras que la presencia de úlceras digitales o calcinosis pueden resultar en infecciones de piel y tejidos blandos, incluso en osteomielitis. Por otro lado, la tendencia creciente hacia la inmunomodulación y la inmunosupresión, como tratamiento de las enfermedades autoinmunes, pondrá a estos pacientes en un mayor riesgo de infecciones, incluidas las infecciones oportunistas. Son necesarios un umbral bajo de sospecha y un alto nivel de alerta entre las especialidades tratantes, particularmente los reumatólogos, para la prevención, el diagnóstico temprano y el manejo de las complicaciones infecciosas. Sin embargo, la información respecto a estrategias de gestión de riesgo en ES, como la vacunación o la profilaxis antibiótica, es escasa. Se realizó una revisión narrativa no sistemática que presenta una actualización sobre las complicaciones infecciosas en pacientes con ES.

Cardioembolic Stroke: Risk Factors, Clinical Features, and Early Outcome in 956 Consecutive Patients.

BACKGROUND: There is little information about the early clinical features of cardioembolic stroke before complementary examinations. OBJECTIVE: The aim of this study was to identify risk factors, clinical features, and early outcomes of cardioembolic stroke. METHODS: Retrospective study based on prospectively collected data available from a university medical center hospitalbased stroke registry. Consecutive patients diagnosed with cardioembolic infarction were selected and compared to those diagnosed with an atherothrombotic stroke. Predictors of cardioembolic infarction were assessed by multivariate analysis. RESULTS: From a cohort of 4597 consecutive patients, we studied 956 patients diagnosed with cardioembolic infarction (80 years [standard deviation (SD) 9.14]; 63% women) and 945 with atherothrombotic infarction (77.01 years [SD 9.75]; 49.8% women). The univariate comparative analysis reported that advanced age (≥ 85 years), female gender, atrial fibrillation (AF), ischemic heart disease, and congestive heart failure were significantly more frequent in the cardioembolic group, whereas hypertension, diabetes, peripheral vascular disease, heavy smoking, hyperlipidemia, and previous transient ischemic attack were significant in the atherothrombotic group. In the logistic regression model, AF (odds ratio [OR] 15.75, 95% confidence interval [CI]: 12.14-20.42), ischemic heart disease (OR 3.12, 95% CI: 2.16-4.5), female gender (OR 1.56, 95% CI: 1.22-2.00), and sudden-onset (OR 1.97, 95% CI: 1.54-2.51), were independent significant predictors of cardioembolic stroke. CONCLUSIONS: Potential cardioembolic stroke requires a comprehensive evaluation, since early classification and identification through predictors would improve effective management.

Gastrointestinal and cardiorespiratory endoparasites in the wild felid guigna (Leopardus guigna) in Chile: Richness increases with latitude and first records for the host species.

Guignas (Leopardus guigna) are small felids closely associated with native forest habitats. In fragmented landscapes, they use vegetation corridors and forest remnants to move across the landscape. In these contexts, guignas may increase contact probabilities with domestic animals, being therefore relevant to assess their pathogens and parasites. The aim of this study was to characterize the helminth fauna in the gastrointestinal tract and cardiorespiratory system of guignas from central and southern Chile. Between 2015 and 2018, 33 dead free-ranging guignas were found road-killed or were collected from wildlife rescue centers. Thirty-two gastrointestinal tracts and 32 cardiorespiratory organs were analyzed through direct analysis and artificial digestion. We found 81.8% (27/33) guignas were positive for helminth endoparasites (84.4% (27/32) positive for gastrointestinal parasites, 37.5% (12/32) positive for cardiorespiratory parasites). Fourteen parasites were identified (7 at genus level and 7 at species level), with Angiostrongylus sp., Molineus sp., Oslerus sp. and Troglostrongylus sp. as first records in guignas. The most prevalent parasites were the species Toxascaris leonina, Toxocara cati and Uncinaria stenocephala. Uncinaria stenocephala showed the highest intensity of infection. Multiparasitism was observed in 76% of the animals. Significant differences in richness of endoparasites and prevalence of cardiorespiratory parasites were found between geographic zones; higher values in the southern zone are possibly due to favorable environmental characteristics for endoparasite development. There were no statistically significant differences between sexes. All the parasites found in this study have been previously reported in domestic cats. These results are valuable to understand parasite transmission at the domestic-wildlife interface; the possibility of endoparasite transmission between domestic cats and guignas should be clarified with molecular analysis.

Antibiotic resistance genes as landscape anthropization indicators: Using a wild felid as sentinel in Chile.

Antimicrobial resistance is a global emerging public health issue whose presence and impact in wildlife are widely unknown. Antimicrobial resistance genes (ARGs) are considered environmental contaminants, suitable to evaluate the degree of anthropic impact on wildlife and the environment. We used a wild felid, the guigna (Leopardus guigna), as a sentinel for the presence of ARGs in anthropized and pristine areas across their entire distribution range in Chile. We evaluated fecal samples from 51 wild guignas, collected between 2009 and 2018. Real-time PCR essays were employed to detect and quantify 22 selected ARGs in their fecal microbiome. All animals (100%) were positive for at least one ARG. The most prevalent ARG families were those that confer resistance to tetracycline (88.2%) and beta-lactamase (68.9%), with tet(Q) (60.8%), tet(W) (60.8%), and blaTEM (66.7%) as the most prevalent ARGs. Multi-resistance profiles were observed in 43% of the guignas. Statistically significant differences were found between anthropized and pristine areas for tet(Q) (p = 0.014), tet(W) (p = 0.0037), tetracycline family (p = 0.027), multi-resistance profile prevalence (p = 0.043) and tet(W) quantification (p = 0.004). Two animals from anthropized landscapes were positive for mecA, a gene associated with Staphylococcus aureus and other staphylococci resistant to methicillin, while three animals from anthropized areas were positive for blaCTX-M, that encodes class A extended-spectrum beta-lactamase. Both genes have been identified in bacteria causing relevant nosocomial infections worldwide. This is the first study on ARGs in wild felids from Chile and the first detection of mecA in South American wild felids. We observed an association between the degree of landscape anthropization and ARG prevalence, confirming that ARGs are important indicators of wildlife exposure to human activity/presence, with a widespread distribution.