[Reduction in Helicobacter pylori infection among patients referred for upper gastrointestinal endoscopy in Santiago, Chile, between 2010-2020]. / Reducción de la infección por Helicobacter pylori en pacientes derivados a endoscopia digestiva alta en Santiago de Chile entre 2010-2020.

Latin America presents a high prevalence of Helicobacter pylori(Hp) infection. Between1996-2003, the prevalence in Santiago, Chile, was 70%; recent studies indicate a decreasein this infection. Updating the frequency of Hp is crucial due to its associated health impact. OBJECTIVE: Our objective was to describe the trend in Hp infection in patients undergoingambulatory esophagogastroduodenoscopy (EGD) in a Chilean population. MATERIALS AND METHODS: A retrospective observational study was conducted on patients over 18 years old who attended a first EGD with a rapid urease test between 2010-2020. Time trendswere described through time series analysis. A Poisson model was constructed to estimatethe risk of infection, adjusted for age and gender. RESULTS: 11,355 patients were included[66.9% females; mean age 52 years; Hp 41.6%]. Male gender presented a higher frequencyof Hp infection [RR 1.13; (95% CI: 1.08-1.18)].Hp frequency infection decreased significantlyfrom 45.1% in 2010 to 29% in 2020, with a 36% lower probability of Hp infection in 2020 compared to 2010 [RR 0.64;(95% CI: 0.55-0.74)]. A progressive decline in Hp infectiontrend was projected, reaching values close to 25% by year 2025. CONCLUSION: A significantreduction in Hpinfection was observed between 2010-2020. This decrease could be explained by the implementation of public health policies in the last decade associated with socio-sanitary changes.

Clinical features and prognosis of malignant small bowel tumors: Experience from a university hospital in Chile.

BACKGROUND: Small bowel tumors (SBT) are infrequent and represent a small proportion of digestive neoplasms. There is scarce information about SBT in Latin America. AIM: To describe the epidemiology, clinical characteristics, diagnostic methods, and survival of malignant SBTs. METHODS: Retrospective observational study of adult patients with histopathological diagnosis of SBT between 2007 and 2021 in a university hospital in Chile. RESULTS: A total of 104 patients [51.9% men; mean age 57 years] with SBT. Histological type: neuroendocrine tumor (NET) (43.7%, n=38), gastrointestinal stromal tumors (GIST) (21.8%, n=19), lymphoma (17.2%, n=15) and adenocarcinoma (AC) (11.5%, n=10). GIST was more frequent in duodenum (50%; n=12) and NET in the ileum (65.8%; n=25). Metastasis was observed in 17 cases, most commonly from colon and melanoma. Nausea and vomiting were significantly more often observed in AC (p=0.035), as well as gastrointestinal bleeding in GIST (p=0.007). The most common diagnostic tools were CT and CT enteroclysis with an elevated diagnostic yield (86% and 94% respectively). The 5-year survival of GIST, NET, lymphoma and AC were 94.7% (95%CI: 68.1-99.2), 82.2% (95%CI: 57.6-93.3), 40.0% (95%CI: 16.5-82.8) and 25.9% (95%CI: 4.5-55.7%), respectively. NET (HR 6.1; 95%CI: 2.1-17.2) and GIST (HR 24.4; 95%CI: 3.0-19.8) were independently associated with higher survival compared to AC, adjusted for age and sex. CONCLUSIONS: Malignant SBT are rare conditions and NETs are the most common histological subtype. Clinical presentation at diagnosis, location or complications may suggest a more probable diagnosis. GIST and NET are associated with better survival compared to other malignant subtypes.

Reducción de la infección por Helicobacter pylori en pacientes derivados a endoscopia digestiva alta en Santiago de Chile entre 2010-2020 / Reduction in Helicobacter pylori infection among patients referred for upper gastrointestinal endoscopy in Santiago, Chile, between 2010-2020

RESUMEN Latinoamérica presenta una alta prevalencia de infección por Helicobacter pylori (Hp). Entre 1996-2003 la prevalencia en Santiago de Chile fue del 70%; estudios recientes presentan una disminución en esta infección. Actualizar la frecuencia de Hp es fundamental debido a su impacto en la salud asociado. Objetivo: Nuestro objetivo fue describir la tendencia de la infección por Hp en pacientes que asisten a endoscopía digestiva alta (EDA) ambulatoria en una población chilena. Materiales y métodos: Se realizó un estudio observacional retrospectivo de pacientes mayores de 18 años que asistieron a una primera EDA con test rápido de ureasa entre 2010-2020. La tendencia en el tiempo fue descrita mediante análisis de series de tiempo. Se construyó un modelo Poisson para estimar el riesgo de infección, ajustado por edad y sexo. Resultados: Se incluyeron 11 355 pacientes [66,9% mujeres; edad media 52 años; Hp 41,6%]. El sexo masculino presentó una mayor frecuencia de infección por Hp [RR 1,13; (IC95%:1,08-1,18)]. La frecuencia de Hp disminuyó significativamente desde 45,1% en 2010 hasta 29% en 2020, con 36% menor probabilidad de presentar infección por Hp en 2020 con respecto al 2010 [RR 0,64; (IC95%:0,55-0,74)]. Se proyectó un descenso progresivo en la tendencia de infección por Hp hasta valores cercanos al 25% para el año 2025. Conclusión: Se observó una reducción significativa en la infección por Hp entre los años 2010-2020. Esta disminución pudiese ser explicada mediante la incorporación de políticas públicas de salud en la última década asociadas a cambios sociosanitarios.

ABSTRACT Latin America presents a high prevalence of Helicobacter pylori (Hp) infection. Between 1996-2003, the prevalence in Santiago, Chile, was 70%; recent studies indicate a decrease in this infection. Updating the frequency of Hp is crucial due to its associated health impact. Objective: Our objective was to describe the trend in Hp infection in patients undergoing ambulatory esophagogastroduodenoscopy (EGD) in a Chilean population. Materials and methods: A retrospective observational study was conducted on patients over 18 years old who attended a first EGD with a rapid urease test between 2010-2020. Time trends were described through time series analysis. A Poisson model was constructed to estimate the risk of infection, adjusted for age and gender. Results: 11,355 patients were included [66.9% females; mean age 52 years; Hp 41.6%]. Male gender presented a higher frequency of Hp infection [RR 1.13; (95% CI: 1.08-1.18)]. Hp frequency infection decreased significantly from 45.1% in 2010 to 29% in 2020, with a 36% lower probability of Hp infection in 2020 compared to 2010 [RR 0.64; (95% CI: 0.55-0.74)]. A progressive decline in Hp infection trend was projected, reaching values close to 25% by year 2025. Conclusion: A significant reduction in Hp infection was observed between 2010-2020. This decrease could be explained by the implementation of public health policies in the last decade associated with socio-sanitary changes.

Implementation of the updated Sydney system biopsy protocol improves the diagnostic yield of gastric preneoplastic conditions: Results from a real-world study.

BACKGROUND: The updated Sydney system biopsy protocol (USSBP) standardizes the sampling of gastric biopsies for the detection of preneoplastic conditions (e.g., gastric intestinal metaplasia [GIM]), but the real-world diagnostic yield is not well-described. AIM: To determine whether regular application of USSBP is associated with higher detection of chronic atrophic gastritis (CAG), GIM and autoimmune gastritis (AIG). METHODS: We performed a real-world retrospective study at an academic urban tertiary hospital in Chile. We manually reviewed medical records from consecutive patients undergoing esophagogastroduodenoscopy (EGD) from January to December 2017. Seven endoscopists who performed EGDs were categorized into two groups (USSBP 'regular' and USSBP 'infrequent') based on USSBP adherence, using minimum 20% adherence as the prespecified threshold. Multivariable logistic regression models were used to estimate the odds ratios (aOR) and 95% confidence intervals (CI) for the association between endoscopist groups and the likelihood of diagnosing CAG, GIM or AIG. RESULTS: 1206 patients were included in the study (mean age: 58.5; 65.3% female). The USSBP regular group demonstrated a higher likelihood of detecting CAG (20% vs. 5.3%; aOR 4.03, 95%CI: 2.69-6.03), GIM (12.2% vs. 3.4%; aOR 3.91, 95%CI: 2.39-6.42) and AIG (2.9% vs. 0.8%; aOR 6.52, 95%CI: 1.87-22.74) compared to infrequent group. Detection of advanced-stage CAG (Operative Link for Gastritis Assessment stage III/IV) was significantly higher in the USSBP regular vs. infrequent group (aOR 5.84, 95%CI: 2.23-15.31). CONCLUSIONS: Routine adherence to USSBP increases the detection rates of preneoplastic conditions, including CAG, GIM and AIG. Standardized implementation of USSBP should be considered in high gastric cancer risk populations.

Perceived Resources and Satisfaction With Food-Related Life Among Ecuadorian Elderly.

OBJECTIVE: To identify variables that explain satisfaction with food-related life in Ecuadorian elderly people. DESIGN: Stratified random sampling with proportional affixation within each retirement home was conducted based on the rate of rurality, gender, age, and living circumstances. SETTING: Retirement homes in Guayaquil, Ecuador. PARTICIPANTS: The sample consisted of 817 elderly people of both genders (47.5% women; mean age 73.7 years; SD 7.45 years; range 60-101 years) registered in retirement homes located in Guayaquil, Ecuador. MAIN OUTCOME MEASURES: Satisfaction With Life scale, satisfaction with food-related life (SWFL), and 22 food-related perceived resources. ANALYSIS: Generalized linear models. RESULTS: Gender, food consumption expenditure, satisfaction with economic situation, unhealthy days, family importance, food-related lifestyles, food neophobia, and the sum of 22 resources were found to be associated with SWFL. In addition, the Pearson bivariate correlation between the Satisfaction With Life scale and SWFL was .38 (P < .01). CONCLUSIONS: Perceived resources contributed to SWFL and the greatest satisfaction with life was observed among older adults who were more satisfied with their food.

Analysis of the characteristics and components for the frailty syndrome in older adults from central Chile. The PIEI-ES study.

OBJECTIVE: To determine the prevalence and to characterize frailty in elderly subjects in four urban provincial capitals and two rural communes from Maule Region in Chile. DESIGN: Cross-sectional study. PARTICIPANTS: 1205 participants aged 65 and older. METHODS: The dataset was obtained from the PIEI-ES Study. Frailty syndrome was determined according to the criteria proposed by Fried. Data collection included questionnaires. RESULTS: The study sample included 1205 individuals, of which 68% were females. Mean age was 73 years. The overall prevalence of frailty was 24.6%. Increase prevalence of frailty was observed in people 80 years old and older, both in women and men. Using adjusted logistic regression, advanced frailty state was more likely to occur in subjects with cognitive impairment. CONCLUSION: This study provides evidence that frailty may be related with cognitive functioning, educational level and nutritional status in older adults.

Nitrogen and potassium variation on contaminant removal for a vertical subsurface flow lab scale constructed wetland.

Lab scale constructed wetlands were used to evaluate organic load removal efficiency. Bioreactors were fed with synthetic wastewater (SW) with varying concentrations of nitrogen and potassium. Reactors were planted with species Phragmites australis. Fed theoretic COD was adjusted to 240.0mg-O(2)L(-1), nitrogen levels were 10 and 40 mg-NL(-1) (ammonium sulfate), potassium levels were 5 and 31 mg-KL(-1) (potassium monobasic phosphate). The higher biomass yield, for 0.5 and 0.775 N:K ratios, was related with higher organic load removal. The ratio N:K showed significant differences for organic load abatement, when 1:0.5 and 1:0.775 N:K ratios were applied, 96.8% efficiency was obtained, whereas N:K ratio of 1:0.125 had efficiency of 92.1% and N:K ratio of 1:3.1 showed an efficiency of 90.5%. For planted bioreactor E(H) decreased in 162.7 mV from sample port to 5 cm down to 35 cm depth, while for the bioreactor without plant showed an E(H) decrement of only 17.7 mV.

Apoptosis is directly related to intracellular amyloid accumulation in a cell line derived from the cerebral cortex of a trisomy 16 mouse, an animal model of Down syndrome.

Human Down syndrome (DS) represents the most frequent cause of mental retardation associated to a genetic condition. DS also exhibits a characteristic early onset of neuropathology indistinguishable from that observed in Alzheimer's disease (AD), namely the deposition of the beta-amyloid peptide. Early endosomal dysfunction has been described in individuals with DS and AD, suggesting an important role of this subcellular compartment in the onset and progression of the pathology. On the other hand, cholesterol activates the amyloidogenic processing pathway for the amyloid precursor protein, and the lipoprotein receptor-related peptide interacts with the beta-amyloid peptide. In the present work, using cell lines derived from the cortex of both normal and trisomy 16 mice (Ts16), an animal model of DS, we showed that the application of exogenous beta-amyloid has cytotoxic effects, expressed in decreased viability and increased apoptosis. Supplementation of the culture media with cholesterol associated to lipoprotein increased cell viability in both cell lines, but apoptosis decreased only in the normal cell line. Further, intracellular beta-amyloid content was elevated in trisomic cells following cholesterol treatment, with higher values in the trisomic cell line. Immunocytochemical detection showed intracellular accumulation of exogenous beta-amyloid in Rab4-positive compartments, which are known to be associated to endosomal recycling. The results suggest that the intracellular beta-amyloid pool plays a central role in apoptosis-mediated cell death in the trisomic condition.

The efficacy of monepantel, an amino-acetonitrile derivative, against gastrointestinal nematodes of sheep in three countries of southern Latin America.

The efficacy of the novel anthelmintic, monepantel (an amino-acetonitrile derivative), was investigated in sheep naturally infected with gastrointestinal nematodes in five studies in Argentina, Brazil, and Uruguay. Monepantel, administered at 2.5 mg/kg liveweight, was highly effective (>99.7%) against Haemonchus contortus, Teladorsagia (Ostertagia) circumcincta, Trichostrongylus axei, Trichostrongylus colubriformis, Cooperia curticei, Cooperia mcmasteri, Cooperia oncophora, Cooperia pectinata, Cooperia punctata, and Nematodirus spathiger, including strains resistant to the older broad-spectrum anthelmintics. Efficacy against C. mcmasteri, C. pectinata, and C. punctata is documented for the first time. The treatment with monepantel was well tolerated by the sheep.

La medicina familiar en el Perú: evolución y desafíos / Family medicine in Perú: evolution and challenges

La medicina familiar, disciplina que habilita a sus especialistas para desempeñarse adecuadamente en un contexto de atención primaria,ha venido recibiendo en los últimos años un número creciente de postulantes e ingresantes al residentado médico, conforme se abren nuevos programas formativos universitarios en el Perú. La expansión acelerada de esta especialidad es resultante de su progreso fructífero en diversos países desarrollados y en nuestros vecinos del continente americano, de su maduración en nuestro país a partir de experiencias universitarias aisladas, y la respuesta del sector formativo de recursos humanos a las políticas y directivas del sector al Modelo de Atención Integral de Salud (MAIS). Si bien esta situación representa oportunidades concretas para la especialidad, aparejadasa ellas se presentan desafíos impostergables como lograr un modelo de atención orientado hacia la atención primaria y basado en la medicina familiar, consolidar la formación masiva y diversificada de especialistas en medicina familiar, contar con adecuados servicios de salud familiar y con un apropiado sistema de certificación, evaluación y ajuste del desempeño, los cuales deberán abordarse para obtenerpleno provecho de esta especialidad.

Family medicine, a discipline that enables its specialist to adequately perform in the context of primary health care, has been receiving in recent years an increasing number of applicants and entrants to the medical residency, as they open new university training programs in Peru. The rapid expansion of this specialty is a result of their fruitful development in various developed countries and our neighbors inthe Americas; it has matured into our country from isolated academic experiences, and the response of the education sector of human resources to policies and directives of the sector to the Model of Integral Health Care. While this represents an specific opportunities for the specialty, accompanied them unpostponable challenges are presented as a model of attention oriented to primary care and family medicine-based, consolidated and diversified the mass training of specialists in family medicine, having adequate family health care and with an appropriate system of certification, evaluation and adjustment of performance, which should be addressed to get full benefit ofthis specialty.

Factores de riesgos presentes y su relación con los accidentes laborales en trabajadores del Hospital "Bertha Calderón Roque": Managua, enero - junio 2004

Tiene por objetivo identificar los factores de riesgo presentes y su relación con los accidentes laborales en trabajadores del hospital Bartha Calderón Roque.