[Risk factors associated with adherence to medical oncology treatment in pediatrics]. / Factores de riesgos asociados a la adherencia al tratamiento médico oncológico en pediatría.

In Chile, between 450 and 500 cases of cancer are diagnosed annually in children and adolescents. Treatment is financed by the state, but there are non-financial elements that could condition adherence to treatment. OBJECTIVE: to explore family, socioeconomic, housing, and support network risk factors that could affect adherence to medical treatment in children and adolescents diagnosed with cancer. PATIENTS AND METHOD: Descriptive observational study in pediatric oncology hospitals of a national cancer program. Through a "Social Care Form" applied to 104 caregivers of children and adolescents, between August 2019 and March 2020, socioeconomic data of children diagnosed with cancer were recorded in four dimensions: i) Individual/family/health; ii) Work/education/socioeconomic; iii) Housing/environment; and iv) Participation/support networks. RESULTS: 99% of the children and adolescents were registered in the public health system; 69% belonged to the lowest income brackets. Care for children and adolescents was mainly provided by the mother (91%). 79% reported living in a house; 48% owned or were paying for their home. Housing quality was described as good (70%), with low levels of overcrowding. 56% of households had access to Wi-Fi internet connection, while 27% reported no access. The main support network reported was the family (84%). CONCLUSIONS: Family, socioeconomic, housing, and support network risk factors were observed in children and adolescents diagnosed with cancer; socioeconomic and gender aspects highlight the social inequalities in these families. Descriptive baseline results were obtained, so it is suggested to re-observe its evolution and thus measure its impact on adherence to treatment.

Hallazgos vestibulares y oculomotores en migraña vestibular: una revisión actualizada / Vestibular and Oculomotor findings in vestibular migraine: an updated review

La migraña vestibular es una de las etiologías más frecuentes del síndrome vestibular episódico a nivel mundial. Presenta varias hipótesis de patofisiología, principalmente a nivel de sistema vestibular central y genético. Su diagnóstico es fundamentalmente clínico, pero se han observado alteraciones a nivel de la función vestibular y de las pruebas oculomotoras. Los hallazgos clínicos no solo están presentes en el momento de la crisis, sino también se han observado en intervalos asintomáticos. La paresia unilateral en la prueba calórica suele ser más frecuente que una ganancia baja del reflejo vestíbulo-ocular del canal lateral en la videonistagmografía, sin embargo, existe una tasa elevada de discordancia entre ambas pruebas. Respecto a la prueba de estudio del movimiento ocular, se han observado alteraciones en el seguimiento pendular, movimiento sacádico, nistagmo optocinético, nistagmo evocado por la mirada, nistagmo espontáneo y nistagmo posicional. Es frecuente observar que el nistagmo provocado por cambios posicionales presenta características centrales durante la crisis de migraña vestibular, pero también se pueden presentar en periodos libres de síntomas en este grupo de pacientes.

Vestibular migraine is one of the most frequent etiologies of episodic vestibular syndrome worldwide. It presents several pathophysiology hypotheses, mainly at the central vestibular system and genetic level. Its diagnosis is fundamentally clinical, but changes in vestibular function and oculomotor tests have been observed. Clinical findings are present not only during the crisis, but also have been seen in the symptom-free interval. Unilateral paresis on caloric testing is usually more common than low gain of the vestibulo-ocular reflex in the lateral canal on videonystagmography, however, there is a high rate of discrepancy between these tests. Regarding the eye movement study test, alterations have been seen in pendulum tracking, saccadic movement, optokinetic nystagmus, gaze-evoked nystagmus, spontaneous nystagmus and positional nystagmus. It is common to observe that nystagmus caused by positional changes has central features during vestibular migraine attacks, but it can also be seen in the symptom-free interval in this group of patients.

Implantes cocleares ópticos: una herramienta promisoria de tratamiento para la hipoacusia / Optical cochlear implants: a promising treatment tool for hearing loss

La hipoacusia afecta a más de 1.500 millones de personas mundialmente. Los principales medios de rehabilitación usados son los audífonos e implantes cocleares (IC). El IC eléctrico convierte el sonido en impulsos eléctricos que estimulan, directamente, a las neuronas del ganglio espiral para proveer sensación auditiva. Tiene como desventaja una amplia dispersión espacial de la corriente, limitando la resolución espectral y el rango dinámico de codificación sonoro, lo que conduce a una mala comprensión del habla en entornos ruidosos y mala apreciación de la música. En los últimos años se ha estudiado utilizar estimulación óptica en vez de eléctrica, pues emite estímulos con mayor selectividad espacial. Se han descrito IC ópticos usando luz infrarroja y otros con métodos de optogenética, estos últimos requieren de la expresión de proteínas fotosensibles inducidas por virus adenoasociados. Se ha visto que la selectividad espectral de la estimulación optogenética es indistinguible de la acústica, y permitió tasas de disparo casi fisiológicas con buena precisión temporal hasta 250 Hz de estimulación. Estudios que compararon un sistema de IC óptico con uno eléctrico concluyen que el uso de optogenética permitiría una restauración de la audición con una selectividad espectral mejorada en comparación con un IC eléctrico.

Hearing loss affects more than 1.5 billion people worldwide. The main means of rehabilitation used are hearing aids and cochlear implants (CI). The electrical CI converts sound into electrical impulses that directly stimulate neurons in the spiral ganglion to provide auditory sensation; it has the disadvantage of a wide spatial dispersion of the current, limiting the spectral resolution and the dynamic range of sound coding, which leads to a poor understanding of speech in noisy environments and a poor appreciation of music. In recent years, the use of optical stimulation instead of electrical stimulation have been studied since it emits stimuli with greater spatial selectivity. Optical CIs have been described using infrared light and others using optogenetic methods, the latter requiring the expression of photosensitive proteins induced by adeno-associated viruses. The spectral selectivity of optogenetic stimulation has been found to be indistinguishable from acoustic stimulation and allowed near-physiological firing rates with good temporal accuracy up to 250 Hz stimulation. Studies comparing an optical and an electrical CI system conclude that the use of optogenetics would allow hearing restoration with improved spectral selectivity compared to an electrical CI.

Rinoplastia en nariz mestiza, un desafío quirúrgico / Rhinoplasty in mestizo nose, a surgical challenge

Las características anatómicas de pacientes con nariz mestiza, generalmente, incluyen una nariz aparentemente grande, un dorso convexo con radix bajo y una base nasal ancha. La longitud de la columela y punta nasal se ve disminuida debido a que los cartílagos alares son cortos, débiles y delgados, proporcionando un soporte estructural insuficiente, mala definición y proyección de la punta nasal. La principal dificultad al manejar este tipo de narices es un marco osteocartilaginoso mal estructurado y débil. En los últimos años se han desarrollado técnicas quirúrgicas para mejorar los resultados estéticos y funcionales de la rinoplastía en estos pacientes. Se realizó una revisión exhaustiva de la literatura describiendo las técnicas quirúrgicas utilizadas en este tipo de nariz.

The anatomical characteristics of patients with mestizo nose usually include an apparently large nose, a convex dorsum with a deep radix, and a wide nasal base. The length of the nasal columella and tip is decreased because the alar cartilages are short, weak and thin, providing insufficient structural support, poor definition and nasal tip projection. The main difficulty in managing this type of noses is a poorly structured and weak osteocartilaginous framework. In recent years, surgical techniques have been developed to improve the aesthetic and functional results of rhinoplasty in these patients. A comprehensive literature review was conducted describing the surgical techniques used in this type of nose.

Modelos de simulación para entrenamiento en cirugía de hueso temporal / Temporal bone surgery simulation-training models

El fresado de hueso temporal (HT) es un desafío para los otorrinolaringólogos. Este procedimiento requiere un conocimiento detallado de esta zona anatómicamente compleja y un dominio de la técnica quirúrgica. La exposición a una mastoidectomía simple o mastoidectomía radical varía entre residentes y distintos programas de especialidad y, frecuentemente, no se cumple el número requerido para la curva de aprendizaje durante la formación. Por lo anterior, surge la necesidad de realizar simulación quirúrgica de fresado de HT. El gold standard para su entrenamiento son los modelos cadavéricos, sin embargo, su costo y baja disponibilidad representan una limitación importante. Los modelos de simulación no cadavéricos podrían jugar un rol importante en el entrenamiento de esta cirugía. Se realizó una revisión exhaustiva de la literatura sobre los modelos de simulación disponibles en fresado de HT. Se encontraron estudios sobre modelos cadavéricos, basados en impresión 3D, realidad virtual y de bajo costo. Los modelos de impresión 3D y realidad virtual han sido evaluados favorablemente en cuanto a adquisición de habilidades, aprendizaje de anatomía, similitud con modelos cadavéricos y sensación táctil. Los modelos de impresión 3D presentan mayor fidelidad anatómica y física, pero tienen un mayor costo. En suma, se han desarrollado modelos de fresado de HT no cadavéricos que cuentan, principalmente, con validez de apariencia y contenido, y solo algunos con validez de constructo. Se necesitan más estudios para evaluar su validez predictiva y transferencia de habilidades al paciente real.

Temporal bone (TB) dissection is a challenging procedure for otolaryngologists. It requires a detailed knowledge of this anatomically complex area and mastery of the surgical technique. Exposure to a simple or radical mastoidectomy may vary among residents and specialty programs, frequently not complying with the required number of surgeries to complete the learning curve during residency. Hence, TB dissection simulation is of great importance. The gold standard for simulated training are cadaveric models, nevertheless, the associated high cost and low availability represent a major limitation for this modality. Non-cadaveric simulation models could play a key role in simulated training for this surgery. A comprehensive review of the literature regarding the available simulation models for TB dissection was conducted. Articles for cadaveric, 3D-printed, virtual reality and low-cost models were identified. 3D-printed and virtual reality models have been favorably evaluated in terms of skill acquisition, anatomy learning, similarity to cadaveric models, and tactile sensation. 3D-printed models present superior anatomic and physical fidelity, but are more expensive. In sum, the current non-cadaveric models for TB dissection mostly present face and content validity, while few models count with construct validity. Further studies are required to assess predictive validity and skill transfer to the real patient.

Uso de profilaxis antibiótica en el taponamiento nasal, una revisión actualizada

Resumen El uso de profilaxis antibiótica en el taponamiento nasal es una práctica ampliamente usada por el eventual riesgo de síndrome de shock tóxico o complicaciones infecciosas locales. En los últimos años, se ha cuestionado su real impacto tomando en cuenta los riesgos asociados al uso de antibióticos y la baja o casi nula incidencia de las complicaciones infecciosas. Se realizó una revisión exhaustiva de la literatura sobre el uso de profilaxis antibiótica en taponamiento nasal. Se observó que no existían diferencias estadísticamente significativas en la incidencia de complicaciones infecciosas y no hubo reportes de síndrome de shock tóxico en ninguno de los grupos con y sin profilaxis antibiótica. No hubo diferencias significativas en los cultivos de los pacientes con o sin antibióticos en taponamiento nasal por epistaxis. El uso de profilaxis antibiótica en taponamiento nasal es una práctica cuestionable y se requieren más estudios al respecto.

Abstract Antibiotic prophylaxis in nasal packing is a widely used practice due to the possible risk of toxic shock syndrome and infectious complications. Lately, its real impact has been questioned due to the associated risks with antibiotic use and low incidence of infectious complications. A comprehensive review of the literature on the use of antibiotic prophylaxis in nasal packing was performed. No statistically significant differences in the incidence of infectious complications and no reports of toxic shock syndrome were reported in any of the groups with and without antibiotic prophylaxis. There were no significant differences in the antibiotic cultures of patients with or without prophylactic antibiotics in nasal packing due to epistaxis. The use of antibiotic prophylaxis in nasal packing is a questionable practice and further studies are required.

Deficiencia de vitamina D y de hierro en niños y adolescentes con parálisis cerebral / Vitamin D and iron deficiencies in children and adolescents with cerebral palsy

INTRODUCCIÓN: Los niños y adolescentes con parálisis cerebral (PC) tienen mayor riesgo de desnutrición y deficiencias de micronutrientes. Dos de los que podemos estudiar y tratar son la vitamina D (VD) y el hierro. No disponemos de estudios que describan estas deficiencias en Chile. OBJETIVO: Describir el estado de ambos micronutrientes y evaluar la asociación con algunos factores que favorecen su déficit. Pacientes y método: Estudio descriptivo, corte transversal. Se estudiaron 69 sujetos, de entre 2 a 21años de edad, de dos hospitales públicos. Se obtuvieron datos demográficos, función motora, uso de sonda de alimentación y fármacos en uso. Se realizó evaluación nutricional según patrones para PC, y se determinó 25-hidroxivitaminaD (25OHD), ferritinemia y albuminemia. RESULTADOS: Edad promedio 11,1 ± 4,9 años, 43 (62,3%) varones, 56 (81,2%) tenían PC moderada-severa. Utilizaban sonda nasogástrica y/o gastrostomía 35 (50,7%), el 15,4% estaban con peso bajo y el 73,8% eutróficos, todos con talla normal. Recibían suplementación de VD 20 (29%), y de hierro, 4 (6,1%). La albuminemia fue normal en todos. El promedio de 25OHD fue 24,3 ± 8,8 ng/ml, 33 (47,8%) presentaron insuficiencia y 21 (30,4%) deficiencia. Tuvieron ferritina baja 36 (52,2%). No se encontró asociación entre 25OHD y variables estudiadas. Se encontró asociación entre ferritina baja y mayor edad (p = 0,03), ser hombre (p = 0,006) y uso de sonda de alimentación (p = 0,006). CONCLUSIONES: El grupo estudiado fue principalmente PC moderada-severa, con alta frecuencia de valores subóptimos de VD y baja ferritina plasmática, además de escasa suplementación de ambos. Sugerimos realizar seguimiento de 25OHD y ferritina, por su alta frecuencia de deficiencia y por contar con fármacos para su tratamiento en los hospitales públicos

INTRODUCTION: Children and adolescents with cerebral palsy (CP) are at a greater risk of malnutrition and micronutrient deficiencies. Two deficiencies that we can study and treat are vitamin D (VD) and iron deficiencies; however, no studies have described these deficiencies in Chile. OBJECTIVE: To describe the status of VD and iron in patients with CP and evaluate the relationship with certain factors associated with deficiencies of these micronutrients. PATIENTS AND METHOD: We performed a descriptive, cross-sectional study including 69 patients aged between 2 and 21 years, from two public hospitals. Data were obtained on demographic variables, motor function, use of feeding tube, and pharmacological treatment. We performed a nutritional assessment according to patterns of CP and determined 25-hydroxyvitamin D (25[OH]D) ferritin, and albumin levels. RESULTS: Patients' mean age was 11.1 ± 4.9 years; 43 (62.3%) were male; and 56 (81.2%) had moderate-to-severe CP. Thirty-five (50.7%) used a nasogastric tube and/or gastrostomy; 15.4% were underweight and 73.8% were eutrophic, all with normal height. Twenty (29%) and 4 patients (6.2%) received VD and iron supplementation, respectively. Albuminaemia was normal in all patients. Mean 25(OH)D level was 24.3 ± 8.8 ng/mL; 33 patients (47.8%) had insufficiency and 21 (30.4%) deficiency; 36 patients (52.2%) had low ferritin levels. There was no association between 25(OH)D level and the other variables studied. Low ferritin levels were found to be associated with older age (P = .03), being male (P = .006), and feeding tube use (P = .006). CONCLUSIONS: The patients studied mainly had moderate-to-severe CP, with a high frequency of suboptimal VD values and low plasma ferritin; few patients received VD and/or iron supplementation. We suggest monitoring 25(OH)D and ferritin levels due to the high rate of deficiency of these nutrients; public hospitals should be equipped with drugs to treat these deficiencies

Pilot-scale phycoremediation using Muriellopsis sp. for wastewater reclamation in the Atacama Desert: microalgae biomass production and pigment recovery.

Municipal wastewater phycoremediation represents a promising circular economy-based process for wastewater reclamation used to recover water and produce biomass. This study aimed to evaluate a pilot-scale phycoremediation system, using the most efficient strain of microalgae for wastewater reclamation in the Atacama Desert. Nitrogen and phosphorus removal, as well as biomass growth, were compared in different microalgae treatments, namely Muriellopsis sp., Scenedesmus almeriensis, Chlamydomonas segnis, Chlorella pyrenoidosa and Chlorella vulgaris. The most efficient treatments, Muriellopsis sp. and S. almeriensis, were scaled up to 20-L bubble column reactors to evaluate nutrient removal and biomass biochemical profile for potential biotechnological application. Finally, Muriellopsis sp. was selected for a pilot-scale phycoremediation experiment (800-L raceway), which removed 84% of nitrogen, 93% of phosphorus and other chemical compounds after 4 days of treatment to meet most of the Chilean standards for irrigation water (NCh. 1333. DS. MOP No. 867/78). Faecal coliforms count was reduced by 99.9%. Furthermore, biomass productivity reached 104.25 mg·L-1·day-1 value with 51% protein, and pigment content of 0.6% carotenoid, with 0.3% lutein. These results indicate the potential of wastewater phycoremediation at an industrial scale for the production of irrigation water and carotenoid using Muriellopsis sp.

Vitamin D and iron deficiencies in children and adolescents with cerebral palsy. / Deficiencia de vitamina D y de hierro en niños y adolescentes con parálisis cerebral.

INTRODUCTION: Children and adolescents with cerebral palsy (CP) are at a greater risk of malnutrition and micronutrient deficiencies. Two deficiencies that we can study and treat are vitaminD (VD) and iron deficiencies; however, no studies have described these deficiencies in Chile. OBJECTIVE: To describe the status of VD and iron in patients with CP and evaluate the relationship with certain factors associated with deficiencies of these micronutrients. PATIENTS AND METHOD: We performed a descriptive, cross-sectional study including 69 patients aged between 2 and 21years, from two public hospitals. Data were obtained on demographic variables, motor function, use of feeding tube, and pharmacological treatment. We performed a nutritional assessment according to patterns of CP and determined 25-hydroxyvitaminD (25[OH]D) ferritin, and albumin levels. RESULTS: Patients' mean age was 11.1±4.9years; 43 (62.3%) were male; and 56 (81.2%) had moderate-to-severe CP. Thirty-five (50.7%) used a nasogastric tube and/or gastrostomy; 15.4% were underweight and 73.8% were eutrophic, all with normal height. Twenty (29%) and 4 patients (6.2%) received VD and iron supplementation, respectively. Albuminaemia was normal in all patients. Mean 25(OH)D level was 24.3±8.8ng/mL; 33 patients (47.8%) had insufficiency and 21 (30.4%) deficiency; 36 patients (52.2%) had low ferritin levels. There was no association between 25(OH)D level and the other variables studied. Low ferritin levels were found to be associated with older age (P=.03), being male (P=.006), and feeding tube use (P=.006). CONCLUSIONS: The patients studied mainly had moderate-to-severe CP, with a high frequency of suboptimal VD values and low plasma ferritin; few patients received VD and/or iron supplementation. We suggest monitoring 25(OH)D and ferritin levels due to the high rate of deficiency of these nutrients; public hospitals should be equipped with drugs to treat these deficiencies.

Evaluación de satisfacción en la implementación de un nuevo sistema de telemedicina en el Servicio de Otorrinolaringología del Complejo Asistencial Dr. Sótero del Río (CASR) durante la pandemia de COVID-19

Resumen Introducción: Debido a la pandemia por SARS-CoV-2, las consultas presenciales y cirugías electivas fueron suspendidas o disminuidas para evitar la propagación viral hacia pacientes y personal de salud. En nuestro país se ha implementado la telemedicina como canal alternativo de atención. Debido a su reciente implementación en nuestra especialidad a nivel nacional, es importante conocer la percepción del paciente y proveedor sobre ella, con el fin de evaluar su factibilidad como nueva modalidad de atención en el futuro. Objetivo: Evaluar la satisfacción del paciente y del proveedor sobre el uso de telemedicina en Otorrinolaringología en nuestro hospital. Material y Método: Estudio prospectivo observacional. Se adaptaron dos instrumentos de evaluación de satisfacción reportados en la literatura, para el paciente y proveedor de salud. Las encuestas fueron administradas luego de la consulta de telemedicina a través de correo electrónico para el paciente, y como parte de la plataforma de telemedicina para el proveedor y respondidas en forma voluntaria. Las respuestas fueron analizadas utilizando medidas de frecuencia (porcentajes). Resultados: Se recopilaron 51 encuestas de pacientes y 69 de proveedores. En los pacientes, en un 98% la telemedicina facilitó el acceso a atención, siendo del mismo nivel que una presencial (91%). Un 98% volvería a usarla y la recomendaría a familiares o amigos. En los proveedores, el 98% estuvo satisfecho con la teleconsulta y 89% con la plataforma. Conclusión: La atención por telemedicina es satisfactoria para usuario y proveedor en nuestro hospital. Esta es una herramienta valiosa para complementar la atención clínica otorrinolaringológica.

Abstract Introduction: Due to the SARS-CoV-2 pandemic, clinical consults and elective surgeries were suspended or decreased to avoid spreading the disease to patients and health personnel. In our country telemedicine has been implemented as an alternate way to obtain medical attention. Given that this attention paradigm has only been recently implemented in our specialty at the national level, it is important to know the perception of the patient and health care provider in order to evaluate its feasibility as a new modality of care in the future. Aim: To assess the patients and healthcare providers satisfaction regarding the use of telemedicine in the Otorhinolaryngology Department. Material and Method: Prospective observational study. Two satisfaction surveys previously reported in the literature were adapted for the patient and health provider. The surveys were sent after each telemedicine consultation via email to the patient, and as part of the telemedicine platform for the provider and answered voluntarily. The responses were analyzed using proportions. Results: answered surveys were obtained from 51 patients and 69 healthcare providers. In 98% of patient's telemedicine facilitated access to care, which was found to be as good as a clinical consult in 91% of the telehealth visits. 98% would use it again and recommend it to family or friends. In 98% of providers were satisfied with the teleconsultation and 89% with the platform. Conclusion: teleconsultation is satisfactory for both patients and providers in our hospital. This new attention modality is a valuable tool to complement the standard otolaryngologist clinical assessment.

Analysis of bacterial communities of infected primary teeth in a Mexican population.

BACKGROUND: The objective of this study was to describe the bacterial communities associated with pediatric patients with endodontic infections of temporal teeth by targeting the 16S rRNA gene using pyrosequencing. MATERIAL AND METHODS: Microbiological samples were obtained from the lower primary molars of thirteen 13 pediatric patients with dental infections. An aspiration method for microbiological sampling was used. The identification of microbiota employing the pyrosequencing method by targeting the 16S gene was performed. RESULTS: Ribosomal 16S RNA gene sequences were amplified, obtaining a total of 16,182 sequences from 13 primary infected molars (13 different individuals) by pyrosequencing. Bacteroidetes phyla (35.15%) were the most abundant followed by Firmicutes (33.3%) and Fusobacteria (10.05%); the presence of specific pathogenic bacteria was determined as well. CONCLUSIONS: The infected root canal of primary teeth contains a high diversity of anaerobic bacteria, and Bacteroidetes, Firmicutes, and Fusobacteria phyla were the most abundant; Prevotella and Streptococcus genera were the most prevalent.

Diaphragm pacing in a pediatric patient with Acquired Central Hypoventilation syndrome. / Marcapasos diafragmático en paciente pediátrico con síndrome de Hipoventilación Central Adquirido.

INTRODUCTION: Diaphragmatic pacemaker is a device that reduces or eliminates the need of mechanical ventilation in patients with chronic respiratory failure who keep the phrenic nerve-diaphragm axis intact, as long as they do not present intrinsic lung disease. Although its implantation has been practiced for deca des, its use is not widespread and to date, there is little published literature about it, mostly related to high spinal cord injury and congenital central hypoventilation syndrome. OBJECTIVE: To describe an experience of diaphragmatic pacemaker implantation in a pediatric patient with acquired cen tral hypoventilation syndrome. CLINICAL CASE: Female patient with central hypoventilation syndrome secondary to ischemic brainstem lesion as a result of ventriculoperitoneal shunt malfunction. For this reason, for 5 years she was supported by inpatient mechanical ventilation. At 7 years of age, a diaphragmatic pacemaker was implanted by thoracoscopic surgery, which allowed, after a period of rehabilitation and respiratory conditioning, mechanical ventilation withdrawal, and hospital dischar ge. CONCLUSIONS: Diaphragmatic pacemaker is a feasible, potentially safe, and cost-effective option for decreasing or eliminating mechanical ventilation dependence and improve life quality in patients with acquired central hypoventilation syndrome.

Anosmia y enfermedad por Coronavirus 2019 (COVID-19): ¿Qué debemos saber? / Anosmia and coronavirus disease 2019 (COVID-19): ¿What should we know?

Nos enfrentamos actualmente a una pandemia mundial de gran impacto, como resultado de la rápida propagación de un nuevo coronavirus, SARS-CoV-2, causante de la enfermedad COVID-19. Todavía nos falta entender la fisiopatología de esta enfermedad, y la variedad de signos y síntomas que puede generar. Se ha descrito un porcentaje no menor de pacientes que desarrollan alteraciones del olfato y del gusto. La comunidad científica y médica está constantemente publicando sus observaciones sobre este tema, un proceso dinámico con abundante información. Se realizó una revisión exhaustiva de la literatura sobre las alteraciones del olfato y del gusto en los pacientes con COVID-19. Se observó una variabilidad importante en la incidencia de hiposmia/anosmia, de 5,1% hasta 85,7%, y de alteraciones del gusto de 5,6% hasta 88,8%. Esto se debe a que la mayoría de los estudios son principalmente retrospectivos, y varios ocuparon encuestas sin evaluación objetiva del olfato o gusto, limitando establecer con claridad la incidencia de estas alteraciones. Se observó que las alteraciones del olfato y del gusto son en general, frecuentes en estos pacientes, y presentan un buen pronóstico.

We are currently facing a global pandemic of great impact, as a result of the rapid spread of a new coronavirus, SARS-CoV-2, which causes coronavirus disease (COVID-19). We have yet to understand the pathophysiology of this disease, as well as the variety of signs and symptoms it can cause. The scientific and medical communities are constantly publishing their observations on this subject, a dynamic process with a wealth of information. An exhaustive review of the literature on smell and taste alterations in patients with COVID-19 was carried out. A significant variability was observed in the incidence of hyposmia/anosmia, from 5.1% to 85.7%, and of taste alterations ranging from 5.6% to 88.8%. This is due to the fact that most of the studies were mainly retrospective, and several occupied surveys without objective evaluation of smell or taste, limiting to establish clearly the incidence of these alterations. It was observed that alterations of smell and taste are in general frequent in these patients, and that they present a good prognosis.

Anterior column reconstruction of the thoracolumbar spine with a new modular PEEK vertebral body replacement device: retrospective clinical and radiologic cohort analysis of 48 cases with 1.7-years follow-up.

PURPOSE: To evaluate whether a new PEEK vertebral body replacement can maintain the sagittal alignment as an anterior column reconstruction device in thoracic and lumbar spinal defects due to trauma or tumor. METHODS: Retrospective review of 48 patients who underwent a corpectomy between T5 and L5 due to trauma or tumor and were stabilized with the new PEEK vertebral body replacement, between 2013 and 2017. We excluded patients who underwent a corpectomy for infection or degenerative disease and patients without complete follow-up in our institution. The primary outcome was the bi-segmental kyphotic angle (BKA). Secondary outcomes were the assessment of pedicle screw loosening, cage height, and subsidence or tilting of the cage. The clinical outcomes were assessed through the COMI-Score, EuroQol-5D, and Karnofsky indexes. Bony fusion and complications were registered. RESULTS: After the surgery BKA decreased by 12.1° (p < 0.001). At the end of the follow-up, we observed a mean loss of reduction of 1.6° (p = 0.002). This was accompanied by an increase in subsidence of 2.1 mm (p < 0.001) and mean tilting of the cage of 1.4° (p = 0.003). The height of the cage and other parameters did not experience any changes. Clinically, the COMI-Score (p = 0.02) and the EuroQol-5D Index (p = 0.012) showed significant improvement, same as Karnofsky-Index (p = 0.015) at final follow-up. The fusion rate according to Bridwell was 92.1%. The 2% late complications were related to implant malpositioning. CONCLUSION: The new PEEK expandable vertebral body replacement is effective and safe in thoracic and lumbar anterior column reconstruction in tumor and trauma diseases.

Marcapasos diafragmático en paciente pediátrico con síndrome de Hipoventilación Central Adquirido / Diaphragm pacing in a pediatric patient with Acquired Central Hypoventilation syndrome

Resumen: Introducción: El marcapasos diafragmático permite reducir o eliminar la necesidad de ventilación mecánica en pacientes con insuficiencia respiratoria crónica que conservan el eje nervio frénico-diafragma in tacto, siempre que no presenten enfermedad pulmonar intrínseca. Aunque su implantación ha sido practicada por décadas, su uso no está ampliamente difundido, y existe poca literatura pu blicada al respecto, la mayoría relacionada con lesión medular alta y síndrome de hipoventilación central congénito. Objetivo: Describir una experiencia de implantación de marcapasos diafragmático en paciente pediátrico con síndrome de hipoventilación central adquirido. Caso Clínico: Pa ciente femenino con síndrome de hipoventilación central secundario a lesión isquémica de tronco cerebral como resultado de disfunción de válvula de derivación ventrículo peritoneal, motivo por el cual durante 5 años se mantuvo con asistencia de ventilación mecánica intrahospitalaria. A los 7 años de edad se implantó marcapasos diafragmático mediante cirugía toracoscópica, lo que per mitió posterior a un periodo de rehabilitación y acondicionamiento respiratorio el destete de la ventilación mecánica y el egreso hospitalario. Conclusiones: El marcapasos diafragmático es una opción factible, potencialmente segura y costo efectiva para disminuir o eliminar la dependencia de ventilación mecánica y mejorar la calidad de vida en pacientes con síndrome de hipoventilación central adquirido.

Abstract: Introduction: Diaphragmatic pacemaker is a device that reduces or eliminates the need of mechanical ventilation in patients with chronic respiratory failure who keep the phrenic nerve-diaphragm axis intact, as long as they do not present intrinsic lung disease. Although its implantation has been practiced for deca des, its use is not widespread and to date, there is little published literature about it, mostly related to high spinal cord injury and congenital central hypoventilation syndrome. Objective: To describe an experience of diaphragmatic pacemaker implantation in a pediatric patient with acquired cen tral hypoventilation syndrome. Clinical Case: Female patient with central hypoventilation syndrome secondary to ischemic brainstem lesion as a result of ventriculoperitoneal shunt malfunction. For this reason, for 5 years she was supported by inpatient mechanical ventilation. At 7 years of age, a diaphragmatic pacemaker was implanted by thoracoscopic surgery, which allowed, after a period of rehabilitation and respiratory conditioning, mechanical ventilation withdrawal, and hospital dischar ge. Conclusions: Diaphragmatic pacemaker is a feasible, potentially safe, and cost-effective option for decreasing or eliminating mechanical ventilation dependence and improve life quality in patients with acquired central hypoventilation syndrome.

Las mujeres en la medicina chilena: desde los tiempos de Eloísa Díaz a la actualidad / The presence of women in Chilean medicine: from the times of Eloísa Díaz to this day

Though the presence of many women in medicine goes unnoticed today, their incorporation to the field was slow and difficult. It took until the end of the nineteenth century for women to be finally allowed to study at the University in Chile, being Eloísa Díaz the first woman to become a medical doctor in 1887. In that century, only six women became medical doctors. However, throughout the twentieth century, this small proportion of women in medicine increased at a similar rate as tuition did in the schools of medicine, especially from the 1960's when limited quotas for women were abolished. At present, women doctors constitute 40% of the total pool of medical doctors in Chile, being present in all specialties, though preferably found as general practitioners, family doctors and pediatricians. While many women have stood out in academia and in politics, they have also successfully reached high positions in scientific societies (and other offices such in the Health Ministry, and even the country's presidency) their participation is still limited in these areas. It is only fair to conclude that the outstanding participation that women in Chilean medicine enjoy today is not solely due to their long-lasting efforts, but more importantly, to their tireless struggle to overcome prejudice, discrimination and misunderstanding; the latter being especially represented by pioneer women of medicine.

Descompresión orbitaria endoscópica transnasal en orbitopatía tiroidea severa / Transnasal endoscopic orbital decompression in severe thyroid orbitopathy

RESUMEN La orbitopatía tiroidea es una enfermedad autoinmune, en la que una reacción inflamatoria genera aumento de la presión orbitaria con protrusión de su contenido. A menudo es autolimitada y sus síntomas más frecuentes son retracción palpebral, exoftalmo y diplopía. Existen casos severos con compromiso de la agudeza visual por compresión del nervio óptico. El diagnóstico es clínico, pero debe complementarse con una tomografía computarizada. Su tratamiento depende de la gravedad y actividad de la enfermedad, siendo los procedimientos quirúrgicos, como la descompresión orbitaria, de elección en exoftalmo y neuropatía óptica compresiva. El pilar de tratamiento en la orbitopatía tiroidea severa es la cirugía descompresiva. Se han descrito múltiples técnicas, pero con limitaciones. La descompresión endoscópica transnasal, es considerada actualmente el procedimiento de elección, ya que permite una buena visualización de la pared medial, con resultados comparables y menores complicaciones, respecto a métodos tradicionales. Describimos un caso de oftalmopatía tiroidea severa, con exoftalmo, diplopía y disminución de la agudeza visual, en la que se realizó una descompresión endoscópica con muy buenos resultados.

ABSTRACT Thyroid orbitopathy is an autoimmune disease in which an inflammatory reaction generates increased orbital pressure with protrusion of its contents. It is often self-limiting and its most frequent symptoms are eyelid retraction, exophthalmos and diplopia. There are severe cases with compromised visual acuity due to compression of the optic nerve. The diagnosis is clinical, but must be complemented with a computed tomography scan. Its treatment depends on the severity and activity of the disease and the surgicals procedures such as orbital decompression is the best choice in exophthalmos and compressive optic neuropathy. The treatment in severe thyroid orbitopathy is decompressive surgery. Multiple techniques have been described, but with limitations. The transnasal endoscopic decompression is currently considered the gold standard, since it allows a good visualization of the medial wall with comparable results and less complications, compared to traditional methods. We present a case of severe thyroid ophthalmopathy, with exophthalmos, diplopia and decreased visual acuity, in which a transnasal endoscopic decompression was performed with very good outcomes.

[The presence of women in Chilean medicine: from the times of Eloísa Díaz to this day]. / Las mujeres en la medicina chilena: Desde los tiempos de Eloísa Díaz a la actualidad.

Though the presence of many women in medicine goes unnoticed today, their incorporation to the field was slow and difficult. It took until the end of the nineteenth century for women to be finally allowed to study at the University in Chile, being Eloísa Díaz the first woman to become a medical doctor in 1887. In that century, only six women became medical doctors. However, throughout the twentieth century, this small proportion of women in medicine increased at a similar rate as tuition did in the schools of medicine, especially from the 1960's when limited quotas for women were abolished. At present, women doctors constitute 40% of the total pool of medical doctors in Chile, being present in all specialties, though preferably found as general practitioners, family doctors and pediatricians. While many women have stood out in academia and in politics, they have also successfully reached high positions in scientific societies (and other offices such in the Health Ministry, and even the country's presidency) their participation is still limited in these areas. It is only fair to conclude that the outstanding participation that women in Chilean medicine enjoy today is not solely due to their long-lasting efforts, but more importantly, to their tireless struggle to overcome prejudice, discrimination and misunderstanding; the latter being especially represented by pioneer women of medicine.

The cAMP/PKA Pathway Inhibits Beta-amyloid Peptide Release from Human Platelets.

The main component of Alzheimer's disease (AD) is the amyloid-beta peptide (Aß), the brain of these patients is characterized by deposits in the parenchyma and cerebral blood vessels known as cerebral amyloid angiopathy (CAA). On the other hand, the platelets are the major source of the Aß peptide in circulation and once secreted can activate the platelets and endothelial cells producing the secretion of several inflammatory mediators that finally end up unchaining the CAA and later AD. In the present study we demonstrate that cAMP/PKA pathway plays key roles in the regulation of calpain activation and secretion of Aß in human platelets. We confirmed that inhibition of platelet functionality occurred when platelets were incubated with forskolin (molecule that rapidly increased cAMP levels). In this sense we found that platelets pre-incubated with forskolin (20 µM) present a complete inhibition of calpain activity and this effect is reversed using an inhibitor of protein kinase A. Consequentially, when platelets were inhibited by forskolin a reduction in the processing of the APP with the consequent decrease in the Aß peptide secretion was observed. Therefore our study provides novel insight in relation to the mechanism of processing and release of the Aß peptide from human platelets.