[Clinical and epidemiological differences and similarities of viral pneumonias in two pandemics]. / Diferencias y similitudes clínicas y epidemiológicas de la neumonía viral en dos pandemias.

BACKGROUND: In a decade, we faced two pandemic viruses, influenza A H1N1pdm09 and SARS CoV-2, whose most serious manifestation is pneumonia. AIM: To compare the clinical, epidemiological and management aspects of pneumonias caused by each pandemic virus in adults requiring hospitalization. MATERIAL AND METHODS: Comparative, observational study carried out at a regional Chilean hospital, including 75 patients with influenza A H1N1pdm09 prospectively studied in 2009 and 142 patients with SARS-CoV-2 studied in 2020. RESULTS: Patients with SARS-CoV-2 pneumonia were older (56 and 39.7 years respectively, p < 0.01) and had significantly more comorbidities. Cough, fever and myalgias were more frequent in influenza. Dyspnea was more frequent in COVID-19. Patients with COVID-19 had more extensive lung involvement and a longer hospitalization (13.6 and 8.6 days respectively, p = 0.01). There was no difference on ICU admission requirements and mortality attributable to pneumonia. Patients with influenza had greater APACHE scores and a higher frequency of a PaO2/FiO2 ratio ≤ 200. During COVID-19pandemic chest sean replaced x-ray examination. Also high-flow nasal cannulas and awake prone position ventilation were added as treatments. CONCLUSIONS: COVID-19 patients were older, had fewer classic flu symptoms but more dyspnea and longer hospitalization periods than patients with influenza.

[Features of patients admitted with COVID-19 to a Chilean regional hospital during the first stages of the pandemic]. / COVID-19 en adultos en el Hospital de Puerto Montt en la primera etapa de la pandemia.

BACKGROUND: The COVID-19 pandemic posed a great strain in health services. AIM: To describe the epidemiological and clinical features of patients with SARS-CoV-2 admitted to a regional hospital in southern Chile between April and August 2020. MATERIAL AND METHODS: Clinical records of all hospitalized patients with RT-PCR (+) for SARS-CoV-2 were retrospectively analyzed. RESULTS: During the study period 226 patients aged 55 ± 18 years (55% men) were admitted. The main comorbidities were high blood pressure in 45%, diabetes in 31% and obesity in 21%. The main symptoms were dyspnea in 70%, cough in 69%, fever in 62% and myalgia in 47%. Pneumonia was the main cause of admission in 66%. Images on admission were compatible with pneumonia in 81%, and with a typical COVID-19 pattern in 84%. In 76% there was five-lobe involvement. Eighty-seven cases (39%) were admitted to critical care, with an APACHE score of 10.9 ± 7.1. Invasive mechanical ventilation was used in 16%, 30% required prone position and 13%, a high-flow nasal cannula. The mean stay in critical care was 13.3 days. The mean duration of invasive mechanical ventilation was 14.1 days. Antimicrobials were used in 55% and dexamethasone in 36%. Twenty-two (9.7%) patients aged 71.7 ± 14 died. A Charlson comorbidity index > 3, heart failure and connection to invasive mechanical ventilation were independent risk factors for death. An age > 65 years alone and other comorbidities were not risk factors. CONCLUSIONS: Viral pneumonia is the main cause of hospitalization for COVID-19, usually extensive and bilateral. The greater severity and poor prognosis of these patients are mainly related to comorbidities.

COVID-19 en adultos en el Hospital de Puerto Montt en la primera etapa de la pandemia / Features of patients admitted with COVID-19 to a Chilean regional hospital during the first stages of the pandemic

BACKGROUND: The COVID-19 pandemic posed a great strain in health services. AIM: To describe the epidemiological and clinical features of patients with SARS-CoV-2 admitted to a regional hospital in southern Chile between April and August 2020. MATERIAL AND METHODS: Clinical records of all hospitalized patients with RT-PCR (+) for SARS-CoV-2 were retrospectively analyzed. RESULTS: During the study period 226 patients aged 55 ± 18 years (55% men) were admitted. The main comorbidities were high blood pressure in 45%, diabetes in 31% and obesity in 21%. The main symptoms were dyspnea in 70%, cough in 69%, fever in 62% and myalgia in 47%. Pneumonia was the main cause of admission in 66%. Images on admission were compatible with pneumonia in 81%, and with a typical COVID-19 pattern in 84%. In 76% there was five-lobe involvement. Eighty-seven cases (39%) were admitted to critical care, with an APACHE score of 10.9 ± 7.1. Invasive mechanical ventilation was used in 16%, 30% required prone position and 13%, a high-flow nasal cannula. The mean stay in critical care was 13.3 days. The mean duration of invasive mechanical ventilation was 14.1 days. Antimicrobials were used in 55% and dexamethasone in 36%. Twenty-two (9.7%) patients aged 71.7 ± 14 died. A Charlson comorbidity index > 3, heart failure and connection to invasive mechanical ventilation were independent risk factors for death. An age > 65 years alone and other comorbidities were not risk factors. CONCLUSIONS: Viral pneumonia is the main cause of hospitalization for COVID-19, usually extensive and bilateral. The greater severity and poor prognosis of these patients are mainly related to comorbidities.

Diferencias y similitudes clínicas y epidemiológicas de la neumonía viral en dos pandemias / Clinical and epidemiological differences and similarities of viral pneumonias in two pandemics

BACKGROUND: In a decade, we faced two pandemic viruses, influenza A H1N1pdm09 and SARS CoV-2, whose most serious manifestation is pneumonia. AIM: To compare the clinical, epidemiological and management aspects of pneumonias caused by each pandemic virus in adults requiring hospitalization. Material and Methods: Comparative, observational study carried out at a regional Chilean hospital, including 75 patients with influenza A H1N1pdm09 prospectively studied in 2009 and 142 patients with SARS-CoV-2 studied in 2020. RESULTS: Patients with SARS-CoV-2 pneumonia were older (56 and 39.7 years respectively, p < 0.01) and had significantly more comorbidities. Cough, fever and myalgias were more frequent in influenza. Dyspnea was more frequent in COVID-19. Patients with COVID-19 had more extensive lung involvement and a longer hospitalization (13.6 and 8.6 days respectively, p = 0.01). There was no difference on ICU admission requirements and mortality attributable to pneumonia. Patients with influenza had greater APACHE scores and a higher frequency of a PaO2/FiO2 ratio ≤ 200. During COVID-19pandemic chest sean replaced x-ray examination. Also high-flow nasal cannulas and awake prone position ventilation were added as treatments. Conclusions: COVID-19 patients were older, had fewer classic flu symptoms but more dyspnea and longer hospitalization periods than patients with influenza.

Percepción de escolares chilenos de distinto nivel socioeconómico sobre la regulación de la publicidad de alimentos / Perception of Chilean schoolchildren from different socioeconomic status on food advertising regulation

El objetivo del estudio fue analizar la percepción de escolares de 8 a 12 años, de ambos sexos, distinto nivel socioeconómico (NSE) y estado nutricional, sobre la regulación de la publicidad de alimentos y bebidas azucaradas. En un estudio de corte transversal, se aplicó una encuesta previamente validada a 812 escolares (399 niños y 413 niñas) de NSE alto y bajo en 3 ciudades del país. Los datos se analizaron según NSE y estado nutricional. La obesidad fue más prevalente en los niños de NSE bajo, quienes veían más comerciales de alimentos y bebidas en televisión y los de NSE alto en Internet y celulares. Sobre el 65% de los escolares en ambos NSE llevaba dinero para comprar alimentos en el horario escolar. En los primeros meses de entrada en vigencia de la Ley 20.606, el 80% de los niños indicaron que les gustaba ser informados de lo que contenían los alimentos y los sellos Alto en Calorías, Alto en Grasas Saturadas y Alto en Sodio fueron significativamente más importantes para los de NSE alto. El sello Alto en Azúcares fue igualmente importante en ambos NSE. Estos resultados permitirán apoyar intervenciones de educación en nutrición y marketing social que motiven la alimentación saludable en niños, padres y profesores(AU)

The objective of this study was to analyze the perception of schoolchildren, 8 to 12 years, both sex, of different socioeconomic status (SES) and nutritional status, on food and sugary beverages advertising regulation. A cross-sectional study that used a previously validated survey to 812 schoolchildren (399 boys and 413 girls) of high and low SES in 3 Chilean cities was performed. The data was analyzed according to NSE and nutritional status. Obesity was more prevalent in low-SES children. These children watched significantly more food and beverages TV ads while high SES children do it more through Internet and cell phones. Over 65% of children of both SES brought money to school to buy food. In the first months after the 20.606 Law was implemented, 80% of the children indicated that they like to be informed on food content. On the other hand, the symbols "High in Calories", "High in Saturated Fats", and "High in Sodium", were significantly more relevant for children of high SES. The symbol "High in Sugars" was equally important for children of both SES. These results will support the design of nutrition education and social marketing interventions that promote healthy eating in children, parents and teachers(AU)

Controversies over the use of GnRH agonists for reduction of chemotherapy-induced gonadotoxicity.

The increase in cancer incidence in younger people and the significant improvement in long and permanent remission have brought concern about their reproductive future and quality of life. Up to two-thirds of adult female patients undergoing chemotherapy for malignancies eventually develop premature ovarian failure. This condition is related to many complaints including vasomotor symptoms, osteoporosis, increased risk of cardiovascular diseases, sexual dysfunction, and infertility. Therefore, protection against iatrogenic infertility and loss of endocrine ovarian function caused by chemotherapy is currently of high priority. Several options have been used for preserving ovarian function. Established methods include cryopreservation of embryos and/or ova, and ovarian transposition, while others such as ovarian tissue preservation are new, yet promising treatments for fertility preservation. The administration of gonadotropin releasing hormone (GnRH) agonistic analogs (GnRH-a) is still considered experimental. However, the recent evidence is strong to recommend the use of GnRH-a co-treatment during chemotherapy in young women with cancer to protect ovarian function, with promising results regarding fertility preservation. As the use of GnRH-a is non-invasive, highly available and without impact on cancer treatment outcomes, it should be offered to all young female cancer patients to preserve their ovarian function.

Actualización en displasia broncopulmonar / Bronchopulmonary displasia update

Bronchopulmonary dysplasia is one of the most common pediatric chronic lung diseases. In the recent decades the advances made in perinatal care and the increase survival of extreme preterm have shown an overall change in the characteristics of this disease giving rise to the concept of new dysplasia. In the development of the disease is essential the exposure of the immature lung to various factors such as nutritional deficiency, pre and post-natal infections, persistent ductus arteriosus, and genetic susceptibility. This article reviews the most important characteristics of this disease, treatment and follow-up.

La displasia broncopulmonar (DBP) es una de las enfermedades pulmonares crónicas frecuentes en pediatría. Los avances experimentados en las últimas décadas en cuidados perinatales y la sobrevida de prematuros cada vez más extremos han demostrado un cambio global en las características de esta enfermedad dando lugar al concepto de nueva displasia, en cuyo desarrollo son fundamentales la exposición del pulmón inmaduro a diversos factores como deficiencia nutricional, infecciones pre y post-natales, ductus arterioso persistente, y susceptibilidad genética. El presente articulo revisa las características más relevantes de esta patología, su enfrentamiento global, manejo y seguimiento ambulatorio.

Monitoring Pseudococcus calceolariae (Hemiptera: Pseudococcidae) in Fruit Crops Using Pheromone-Baited Traps.

The citrophilus mealybug, Pseudococcus calceolariae (Maskell), is an important pest of fruit crops in many regions of the world. Recently, its sex pheromone has been identified and synthesized. We carried out field experiments with the goal of developing monitoring protocols for P. calceolariae using pheromone-baited traps. Traps checked hourly for 24 hours showed a distinct diel pattern of male flight, between 18:00 and 21:00 h. The presence of unnatural stereoisomers did not affect trap captures, with isomeric mixtures capturing similar amounts of males as the biological active isomer. Dose of isomeric mixture pheromone (0-100 µg) had a nonlinear effect on male captures, with 10, 30, and 50 µg capturing similar amounts. The effective range of pheromone traps was determined by placing traps at different distances (15, 40, and 80 m) from an infested blueberry field, loaded with 0, 1 and 25 µg of the pheromone. For all distances, 25 µg dose captured more males, and was highly attractive up to 40 m. There was a significant effect of lure age on male captures (0-150 d), with similar amount of males captured up to 90-day-old lure, and lower captures in the 150-day-old lure compared with fresh ones. We found significant positive correlations between P. calceolariae males caught in pheromone traps with female abundance and fruit infestation at harvest. Our results show the usefulness of P. calceolariae pheromones for monitoring at field level and provide information for the design of monitoring protocols.

Methodological advances: using greenhouses to simulate climate change scenarios.

Human activities are increasing atmospheric CO2 concentration and temperature. Related to this global warming, periods of low water availability are also expected to increase. Thus, CO2 concentration, temperature and water availability are three of the main factors related to climate change that potentially may influence crops and ecosystems. In this report, we describe the use of growth chamber - greenhouses (GCG) and temperature gradient greenhouses (TGG) to simulate climate change scenarios and to investigate possible plant responses. In the GCG, CO2 concentration, temperature and water availability are set to act simultaneously, enabling comparison of a current situation with a future one. Other characteristics of the GCG are a relative large space of work, fine control of the relative humidity, plant fertirrigation and the possibility of light supplementation, within the photosynthetic active radiation (PAR) region and/or with ultraviolet-B (UV-B) light. In the TGG, the three above-mentioned factors can act independently or in interaction, enabling more mechanistic studies aimed to elucidate the limiting factor(s) responsible for a given plant response. Examples of experiments, including some aimed to study photosynthetic acclimation, a phenomenon that leads to decreased photosynthetic capacity under long-term exposures to elevated CO2, using GCG and TGG are reported.

High levels of insecticide resistance in introduced horn fly (Diptera: Muscidae) populations and implications for management.

The horn fly, Haematobia irritans (L.) (Diptera: Muscidae), was introduced to Chile in the beginning of the 1990s. Since its introduction, farmers have controlled this pest almost exclusively with insecticides. To understand the consequences of different control strategies on the development of insecticide resistance and their persistence, a field survey was conducted at eight farms in the south of Chile to characterize insecticide resistance in field populations and resistance mechanisms. Horn fly samples were assayed to determine levels of resistance to pyrethroids and diazinon, genotyped for kdr and HialphaE7 mutations, and tested for general esterase activity. All field populations, including ones that were not treated with insecticides for the past 5 yr, showed high levels of cypermethrin resistance and high frequencies of the kdr mutation. None of the fly populations demonstrated resistance to diazinon and the HialphaE7 mutation was not detected in any of the fly samples. Esterase activities in all populations were comparable to those found in the susceptible reference strain. The findings of high frequencies of homozygous resistant and heterozygous individuals both in insecticide treated horn fly populations and in the untreated fly populations suggests complex interactions among field populations of the horn fly in Chile.

Olfactory response of Haematobia irritans (Diptera: Muscidae) to cattle-derived volatile compounds.

In Chile, the horn fly, Hematobia irritans (L., 1758), is a major pest of grazing cattle and affects livestock production during the summer. Previous studies in Europe and the United States have shown that cattle flies, including H. irritans, are differentially attracted to individual cattle within herds and that volatile semiochemicals are responsible for this phenomenon. This study provides evidence that similar differential attractiveness occurs for the interaction between Chilean Holstein-Friesian cattle herds and local H. irritans populations. Thus, Holstein-Friesian dairy cattle, Bos taurus, which were of similar age and physiological condition, were shown to possess an uneven distribution of H. irritans. Heifers h6904 and h8104 were defined as low-carrier heifers and h5804, h2304 and h1404 as high-carrier heifers. Gas chromatography (GC) and coupled GC-mass spectrometric (GC-MS) analysis of samples collected from heifers revealed the presence of compounds previously reported as semiochemicals for cattle flies, including meta- and para-cresol, methylketones (C8-C11), and 6-methyl-5-hepten-2-one. Other compounds identified included carboxylic acids (butanoic, 3-methylbutanoic, pentanoic, and hexanoic acids), 1-hexanol, and 3-octanone. In Y-tube olfactometer studies, both m- and p-cresol attracted H. irritans at the highest doses tested (10(-6) g), as did the positive control 1-octen-3-ol. Of the other compounds tested, only 2-decanone and 2-undecanone produced a behavioral response, with significantly more flies being recorded in the control arm when the former compound was tested (at 10(-6) and 10(-8) g), and more flies being recorded in the treated arm for the latter compound (at 10(-7) g). This demonstration of behavioral activity with the identified compounds represents a first step for research into the application of semiochemicals in monitoring and control of cattle flies in Chile.

Insecticide resistance in the horn fly: alternative control strategies.

The horn fly, Haematobia irritans (Linnaeus 1758) (Diptera: Muscidae) is one of the most widespread and economically important pests of cattle. Although insecticides have been used for fly control, success has been limited because of the development of insecticide resistance in all countries where the horn fly is found. This problem, along with public pressure for insecticide-free food and the prohibitive cost of developing new classes of compounds, has driven the investigation of alternative control methods that minimize or avoid the use of insecticides. This review provides details of the economic impact of horn flies, existing insecticides used for horn fly control and resistance mechanisms. Current research on new methods of horn fly control based on resistant cattle selection, semiochemicals, biological control and vaccines is also discussed.

Nutritional status, especially body mass index, from birth to adulthood and lung function in young adulthood.

OBJECTIVE: The study assessed the impact of body mass index (BMI) at birth, infancy, and adulthood, and waist circumference on lung function. METHODS: Using a longitudinal design 1221 Chilean young adults were studied. A standardized respiratory questionnaire was used. Forced expiratory volume in 1 s (FEV(1)), forced vital capacity (FVC), height, weight and waist circumference were measured. Data at birth and at 1 year were obtained from clinical notes. RESULTS: Males with a BMI > or = 30 and women with a BMI < 20 had a lower FEV(1) (-230 mL, 95% CI -363 to -98; -106 mL, 95% CI -211 to -0.18, respectively). In both sexes those with a BMI 20-25 had the highest FEV(1) and FVC. In males there was a negative association between waist circumference and FEV(1) and FVC while in women the middle tertile had the highest FEV(1) and FVC. There was an association between birthweight and BMI at birth, and FEV(1) in men, when unadjusted for other measurements. CONCLUSIONS: BMI and waist circumference in adulthood make a greater impact on lung function in adulthood than anthropometric measurements at birth and infancy. Proxy measures of fatness in adulthood reduce lung function, but the pattern between fatness and lung function by sex may be different.

Respiratory consequences of light and moderate smoking in young adults in Chile.

OBJECTIVE: To assess the association between smoking and respiratory symptoms, lung function and bronchial hyperresponsiveness (BHR) in young adults in Chile. SETTING: Selected sample of 1232 subjects aged 22-28 years. DESIGN: In this cross-sectional study, the outcome measures were: respiratory symptoms, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), forced expiratory flow between 25% and 75% (FEF25-75), FEV1/FVC and BHR. RESULTS: Among the 1232 subjects, 67.7% of the men and 49.4% of the women were smokers; the median cigarettes smoked per day was four for men and three for women. Smoking was associated with wheezing, waking up with a cough, breathlessness following exercise and persistent cough, with odds ratios (OR) between 1.94 (95% CI 1.41-2.66) and 3.12 (95% CI 2.21-4.40) among those smoking > or = 5 cigarettes per day, compared to non-smokers. Smoking < 5 cigarettes was significantly associated with wheezing and waking up with a cough. Smokers had a lower FEV1/FVC than non-smokers by approximately 0.8%. Smoking was not associated with FEV1, FEF25-75 or BHR status. CONCLUSIONS: This study highlights the early effects of smoking on respiratory symptoms. It could help governments in Latin America take vigorous action to deter young people from starting smoking.

Prevalence of asthma, atopy and bronchial hyperresponsiveness and their interrelation in a semi-rural area of Chile.

OBJECTIVE: To assess the prevalence of asthma symptoms and their association with sensitisation to eight allergens and bronchial hyperresponsiveness (BHR) to methacholine. SETTING: A random sample of 1232 adults, aged 22 to 28 years, studied in a Chilean semi-rural area. DESIGN: A cross-sectional design for the purpose of this analysis. RESULTS: The prevalence of wheeze was 27.4% (95%CI 24.9-29.9) and waking with breathlessness 13.7% (95%CI 11.8-15.6), higher than the results of a multi-centre European study. Only 7.8% (95%CI 6.3-9.3) had a positive BHR (< or =8 mg/ml) and 26.3% (95%CI 23.8-28.8) were atopic. The Youden index of asthma symptoms in non-atopic subjects varied from 0.184 to 0.259 when using BHR as gold standard for asthma, and increased from 0.379 to 0.504 among those with positive atopy. Only 4.5% reported asthma, and the Youden index was slightly higher in comparison to the asthma symptom groups. CONCLUSION: The prevalence of asthma symptoms in young adults was high, but only a small proportion of these were sensitised or had a positive BHR. We believe that aetiological studies of asthma should analyse subjects with asthma symptoms separately from those with positive atopic status or positive BHR.

Análisis del caso de Chile en el informe FAO: estado sobre la inseguridad alimentaria en el mundo, 2004 / Analysis of the Chilean case in the FAO report: state of food insecurity in the world, 2004

En la Cumbre Mundial sobre la Alimentación (CMA) del año 1996, los jefes de estado de 186 países acordaron para el año 2015, reducir al 50 por ciento la cantidad de personas que padecen subnutrición en el mundo. Con el propósito de monitorear el avance hacia el cumplimiento de esta meta, la FAO publica desde 1999 El estado de la inseguridad alimentaria en el mundo, informe que estima año a año la cifra de personas subnutridas, en base a una metodología aplicada con propósitos comparativos a todos los países sin excepción. La cifra resultante es una estimación y no pretende reemplazar la medición directa del consumo de alimentos provenientes de encuestas poblacionales, o la medición del estado nutricional de los habitantes de un país a partir de medidas antropométricas. En el caso de Chile, al usar esta metodología, el informe SOFI 2004 indica que la proporción de personas subnutridas alcanza un 4 por ciento de la población total, es decir, 600.000 personas. Esta cifra amerita un análisis complementario en virtud de que en este país existe información actualizada y representativa de su población, basada en indicadores socioeconómicos, de salud y de estado nutricional. En consecuencia el análisis de esta información nacional, muestra que la cifra de personas subnutridas es comparable al número de personas indigentes, las que evidentemente se encuentran en riesgo de inseguridad alimentaria. Sin embargo, resultados del estado nutricional de la población demuestran elevados índices de sobrepeso y obesidad en los diferentes grupos etareos, estando la subnutrición más asociada a una dieta inadecuada desde el punto de vista de calidad (adecuación de micronutrientes) y no de cantidad (aporte energético). La primera Encuesta Nacional en Salud (ENS 2003) indica que Chile tiene como mayor manifestación, la carga de enfermedades crónicas relacionadas con la nutrición derivadas del sobrepeso y obesidad, en una población adulta que ha estado sometida a desnutrición tempra...

At the World Food Conference (WFC) in 1996, 186 chief of states made the compromise to reduce by 50 percent the amount of people that suffer undernourishment in the world by the year 2015. In order to monitor the accomplishment of this goal, FAO published since 1999 The State of Food Insecurity in the World, a Report that estimates yearly the amount of undernourished people, based on a methodology applied with comparative purposes to all countries without exception. The value obtained is an estimation and does not pretend to replace the direct measurement of food consumption obtained from population surveys or analysis of nutritional status of the country population based on anthropometrical measurements. In the case of Chile, using this methodology, SOFI 2004 Report states that the proportion of undernourished population amounts to 4 percent of the total population or 600.000 people. This figure requires complementary analysis since the country has current information representative from its population, based on socio-economical, health and nutritional status indicators. As a consequence the analysis of these national data indicates that de estimation of undernourished people is comparable with the number of indigent population, who evidently are at risk of food insecurity. However, nutritional status of the population indicates high prevalence of overweight and obesity in all age groups. Undernourishment in Chile is more related to an unhealthy diet from the stand point of quality (nutrient adequacy) and not quantity (energy intake). The first Chilean National Health Survey (NHS 2003) showed that Chile presents mainly a nutrition related burden of chronic diseases. The prevalence of overweight and obesity in the adult population is highest in the groups that experienced early undernutrition, as evidenced by their low height...

Human leukocyte antigens in indigenous (mapuche) people in a regional renal transplantation program in chile.

An active regional transplantation program established in the southern region of Chile has allowed the incorporation of ethnic minorities particularly Mapuche living in this geographic area in the development of a histocompatibility database. To identify possible differences in the human leukocyte (HLA) antigen distribution in Chilean Mapuche compared with non-Mapuche, we reviewed 442 HLA tissue-typing studies. Seventy-eight of 309 recipients (25%) and 18 of 133 donors (13%) were Mapuche. Among recipients, Mapuche people showed a significantly higher frequency of the HLA antigens, A28, B16, DR4, and DR8, and a lower one for A19, B15, and DR1 (P < .05) compared with non-Mapuche individuals. A particularly higher frequency of the haplotype A28, -B16, -DR4 was also evidenced in Mapuche. Besides, these recipients showed a higher frequency of the allele -DR4 when compared with Mapuche donors. A greater frequency of some histocompatibility antigens in patients with chronic renal disease might be attributed to allelic concentration due to a high index of endogamy, but a possible association with the development of progressive renal disease cannot be ignored, especially when a higher prevalence of DR4 was observed among Mapuche recipients.

Is there a causal relation between obesity and asthma? Evidence from Chile.

OBJECTIVE: An association between obesity and asthma symptoms has been reported in the literature, but such a relationship is inconsistent if atopic status or bronchial hyper responsiveness (BHR) is considered. The objective was to assess the association between obesity and asthma symptoms or BHR in adults. METHODS: A study was carried out in 1232 people born between 1974 and 1978 in Chile. The participants completed the European Community Health Survey questionnaire, were skin tested and subject to a BHR challenge to methacholine. MEASUREMENTS: Weight, height and waist circumference were measured and body mass index (BMI) was calculated. RESULTS: There was a positive association between wheeze and breathlessness following exercise and BMI (both with an OR 1.03, 95% CI 1.00-1.06), the associations with wheeze tended to disappear in women who did react at least to one allergen, and persisted in those who did not react to any allergens. BMI was negatively associated with BHR (OR 0.93, 95% CI 0.89-0.97). Waist circumference was not associated with asthma symptoms and it was negatively associated with BHR. CONCLUSION: Although there was an association between BMI and asthma symptoms, there were weaknesses in the evidence because waist circumference, a more direct measure of obesity than BMI, was not associated with asthma symptoms, and BMI and waist circumference were negatively associated with BHR.

[Food based approaches to improve vitamin and mineral nutrition adequacy]. / Enfoque alimentario para mejorar la adecuación nutricional de vitaminas y minerales.

This paper, using the nutrient density concept and the development of Food-Based Dietary Guidelines (FBDG), explores the nutritional adequacy of food patterns based on the main staples around the world--maize, wheat, rice and potato. The nutritional adequacy of the vitamins A, C, folates and the minerals iron, zinc and calcium in diets composed by these staples is analyzed. Projected diets modified by the addition of foods high in vitamins and minerals, based on food table composition information, are analyzed for changes in nutritional adequacy, in order to cover the nutritional requirements of all family members. This theoretical exercise shows that diets diversified by the addition of relatively small quantities (27-70 g) of foods like fruits, vegetables, legumes and meat improve substantially the nutritional adequacy of the vitamins A, C, folates, iron and zinc. In the case of calcium, the addition of a dairy source becomes essential. From the practical point of view, the implementation of the food based approach requires a national effort in order to support the production of nutrient rich foods and to promote consciousness of nutrient bioavailability, so that people may obtain all nutrient potential from foods. Simultaneously, the need of fortification programs at the national level is recognized. This is the case for critical nutrients, where requirements might be above the potential in available foods. A similar situation occurs in the case of vulnerable groups like pregnant women and infants, who need supplementation to ensure nutritional adequacy of their diets. In conclusion, the use of FBDG is a good alternative for improving the nutritional adequacy of diets based predominantly on staple foods. However, food fortification and supplementation programs directed to vulnerable groups are necessary and complementary practices to the FBDG implementation.

Bleomycin-induced chronic lung damage does not resemble human idiopathic pulmonary fibrosis.

Administration of bleomycin into the lungs of experimental animals has been utilized as a model to understand human pulmonary fibrosis. Most of the studies, however, have focused on early stages of the lung reaction. We hypothesized that chronic stages of the model may not mimic idiopathic pulmonary fibrosis, since in preliminary studies, lung volume and compliance were not decreased. Eight male Sprague-Dawley rats receiving intratracheal bleomycin (0.5 U/100 g body weight) underwent measurement of FRC, inspiratory capacity, and lung compliance 120 d later. Lung histologic changes were evaluated using light microscopy. Eight rats without intervention served as controls. Results show that our model, in early stages, has histologic changes no different from those previously described elsewhere. In chronic stages, however, the model does not behave as a restrictive syndrome: FRC is normal or increased, whereas lung compliance is normal. Focal peribronchiolar inflammation and fibrosis associated with paracicatricial emphysematous changes are the main histologic features of long-term lung remodeling after bleomycin. We conclude that while the chronic stages of the model may be informative in understanding mechanisms of fibrosis, care should be taken not to extrapolate to human idiopathic pulmonary fibrosis. We speculate that the model might resemble a particular subgroup of human interstitial lung disease, namely, those involving peribronchiolar structures.