[Ability of qSOFA1-lactate to predict 30-day mortality in patients seen for infection in the Emergency Department]. / Capacidad del qSOFA1-lactato para predecir mortalidad a 30 días en los pacientes atendidos por infección en urgencias.

OBJECTIVE: To evaluate lactate and the Quick Sepsis-Related Organ Failure Assessment (qSOFA) and compare their ability to predict 30-day mortality in patients treated for infection in emergency departments (ED). METHODS: Prospective multicenter observational cohort study. We enrolled a convenience sample of patients aged 18 years or older attended in 71 Spanish ED from October 1, 2019, to March 31, 2020. Each model's predictive power was analyzed with the area under the receiver operating characteristic curve (AUC), and its values of sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative (NPV). RESULTS: A total of 4439 patients with a mean (SD) age of 18 years were studied; 2648 (59.7%) were men and 459 (10.3%) died within 30 days. For 30-day mortality, the AUC-COR obtained with the qSOFA = 1 model plus 2 mmol/l lactate was 0.66 (95% CI, 0.63-0.69) with Se: 68%, Es: 70% and NPV:92%, while qSOFA = 1 obtained AUC-COR of 0.52 (95% CI, 0.49-0.55) with a Se:42%, Es:64% and NPV:90%. CONCLUSIONS: To predict 30-day mortality in patients presenting to the ED due to an episode of infection, the qSOFA =1 + lactate≥2 mmol/L model significantly improves the predictive power achieved individually by qSOFA1 and becomes very similar to qSOFA≥2.

Utilidad del modelo 5MPB-Toledo para predecir bacteriemia en el paciente con infección del tracto urinario en el servicio de urgencias / Usefulness of the 5MPB-Toledo model to predict bacteremia in patients with urinary tract infections in the emergency department

Objetivo: Analizar la utilidad de un nuevo modelo predictivo de bacteriemia (5MPB-Toledo) en pacientes atendidos por infección del tracto urinario (ITU) en los servicios de urgencias (SU). Métodos: Estudio observacional, prospectivo y multicéntrico de los hemocultivos (HC) obtenidos en pacientes mayores de 18 años atendidos por ITU en 65SU desde el 1 de octubre de 2019 hasta el 30 de abril de 2020. Se analizó la capacidad predictiva del modelo con el área bajo la curva (ABC) de la característica operativa del receptor (COR) y se calculó el rendimiento diagnóstico del punto de corte elegido con su sensibilidad, especificidad, valor predictivo positivo y valor predictivo negativo. Resultados: Se incluyeron 1.499 episodios de HC extraídos. De ellos se consideraron como bacteriemias verdaderas 277 (18,5%) y como HC negativos 1.222 (81,5%). Entre los negativos 94 (6,3%) se consideraron contaminados. El ABC-COR del modelo fue de 0,937 (IC 95%: 0,926-0,949). El rendimiento diagnóstico del modelo con un PC≥5 puntos consigue una sensibilidad de 97,47% (IC 95%: 94,64-98,89), especificidad de 76,68% (IC 95%: 74,18-79,00), un valor predictivo positivo de 48,65% (IC 95%: 44,42-52,89) y un valor predictivo negativo de 99,26% (IC 95%: 98,41-99,67). Conclusión: El modelo 5MPB-Toledo podría ser útil para predecir bacteriemia en los pacientes adultos atendidos en el SU por un episodio de ITU (AU)

Objective: To analyze the usefulness of a new predictive model of bacteremia (5MPB-Toledo) in patients treated for urinary tract infection (UTI) in the emergency department (ED). Methods: Prospective and multicenter observational cohort study of the blood cultures (BC) ordered for patients with UTIs in 65 Spanish ED from October 1, 2019, to April 30, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The diagnostic performance was calculated with the chosen cut-off point for sensitivity, specificity, positive predictive value, and negative predictive value. Results A total of 1,499 blood cultures were evaluated. True cases of bacteremia were confirmed in 277 (18.5%). The remaining 1,222 cultures (81.5%) were negative. Ninety-four (6.3%) were considered contaminated. The model's area under the ROC curve was 0.937 (95% CI, 0.926-0.949). The prognostic performance with a model's cut-off value of≥5 points achieved 97.47% (95% CI, 94.64-98.89) sensitivity, 76.68% (95% CI, 74.18-79.00) specificity, 48.65% (95% CI, 44.42-52.89) positive predictive value and 99.26% (95% CI, 98.41-99.67) negative predictive value. Conclusion: The 5MPB-Toledo score is useful for predicting bacteremia in patients with UTIs who visit the ED (AU)

Computational modeling of the effect of five mutations on the structure of the ACE2 receptor and their correlation with infectivity and virulence of some emerged variants of SARS-CoV-2 suggests mechanisms of binding affinity dysregulation.

Interactions between the human angiotensin-converting enzyme 2 (ACE2) and the RBD region of the SARS-CoV-2 Spike protein are critical for virus entry into the host cell. The objective of this work was to identify some of the most relevant SARS-CoV-2 Spike variants that emerged during the pandemic and evaluate their binding affinity with human variants of ACE2 since some ACE2 variants can enhance or reduce the affinity of the interaction between the ACE2 and S proteins. However, no information has been sought to extrapolate to different variants of SARS-CoV-2. Therefore, to understand the impact on the affinity of the interaction between ACE2 protein variants and SARS-CoV-2 protein S variants, molecular docking was used in this study to predict the effects of five mutations of ACE2 when they interact with Alpha, Beta, Delta, Omicron variants and a hypothetical variant, which present mutations in the RBD region of the SARS-CoV-2 Spike protein. Our results suggest that these variants could alter the interaction of the Spike and the human ACE2 protein, losing or creating new inter-protein contacts, enhancing viral fitness by improving binding affinity, and leading to an increase in infectivity, virulence, and transmission. This investigation highlighted that the S19P mutation of ACE2 decreases the binding affinity between the ACE2 and Spike proteins in the presence of the Beta variant and the wild-type variant of SARS-CoV-2 isolated in Wuhan-2019. The R115Q mutation of ACE2 lowers the binding affinity of these two proteins in the presence of the Beta and Delta variants. Similarly, the K26R mutation lowers the affinity of the interaction between the ACE2 and Spike proteins in the presence of the Alpha variant. This decrease in binding affinity is probably due to the lack of interaction between some of the key residues of the interaction complex between the ACE2 protein and the RBD region of the SARS-CoV-2 Spike protein. Therefore, ACE2 mutations appear in the presence of these variants, they could suggest an intrinsic resistance to COVID-19 disease. On the other hand, our results suggested that the K26R, M332L, and K341R mutations of ACE2 expressively showed the affinity between the ACE2 and Spike proteins in the Alpha, Beta, and Delta variants. Consequently, these ACE2 mutations in the presence of the Alpha, Beta, and delta variants of SARS-CoV-2 could be more infectious and virulent in human cells compared to the SARS-CoV-2 isolated in Wuhan-2019 and it could have a negative prognosis of the disease. Finally, the Omicron variant in interaction with ACE2 WT, S19P, R115Q, M332L, and K341R mutations of ACE2 showed a significant decrease in binding affinity. This could be consistent that the Omicron variant causes less severe symptoms than previous variants. On the other hand, our results suggested Omicron in the complex with K26R, the binding affinity is increased between ACE2/RBD, which could indicate a negative prognosis of the disease in people with these allelic conditions.

Usefulness of the 5MPB-Toledo model to predict bacteremia in patients with urinary tract infections in the emergency department.

OBJECTIVE: To analyze the usefulness of a new predictive model of bacteremia (5MPB-Toledo) in patients treated for urinary tract infection (UTI) in the emergency department (ED). METHODS: Prospective and multicenter observational cohort study of the blood cultures (BC) ordered for patients with UTIs in 65 Spanish ED from November 1, 2019, to March 31, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The diagnostic performance was calculated with the chosen cut-off point for sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS: A total of 1,499 blood cultures were evaluated. True cases of bacteremia were confirmed in 277 (18.5%). The remaining 1,222 cultures (81.5%) were negative. Ninety-four (6.3%) were considered contaminated. The model's area under the ROC curve was 0.937 (95% CI, 0.926-0.949). The prognostic performance with a model's cut-off value of ≥5 points achieved 97.47% (95% CI, 94.64-98.89) sensitivity, 76.68% (95% CI, 74.18-79.00) specificity, 48.65% (95% CI, 44.42-52.89) positive predictive value and 99.26% (95% CI, 98.41-99.67) negative predictive value. CONCLUSION: The 5MPB-Toledo score is useful for predicting bacteremia in patients with UTIs who visit the ED.

Development of 3D-QSAR and pharmacophoric models to design new anti-Trypanosoma cruzi agents based on 2-aryloxynaphthoquinone scaffold.

In this work we have collected a set of 30 trypanosomicidal naphthoquinones and developed pharmacophoric and 3D-QSAR models as tools for the design of new potential anti-Chagasic compounds. Firstly, qualitative information was obtained from SAR and pharmacophoric models identifying some fragments around the 2-aryloxynaphthoquinone scaffold important for the antiparasitic activity. Then, 3D-QSAR CoMFA and CoMSIA models were developed. The models showed adequate statistical parameters where the steric, electrostatic, and hydrophobic features explain the trypanosomicidal effect. Therefore, to validate our models, we carried out the design, synthesis, and biological evaluation on T. cruzi epimastigotes of five new compounds (33a-e). According to CoMFA model, three out of five compounds showed pIC50 values within one logarithmic unit of deviation. The two compounds that did not fit the predictions were those with high lipophilicity, which agreed with the SAR and pharmacophore models. Docking and molecular dynamic studies were performed on T. cruzi trypanothione reductase, in a proposed binding site for this type of naphthoquinone. Interestingly, 33a-e showed the same interaction pattern as a naphthoquinone inhibitor (2). Finally, predicted drug-likeness properties indicated that 33a-e have optimal oral bioavailability. Thus, this study provides new in silico models for obtaining novel trypanosomicidal compounds.

[Usefulness of the 5MPB-Toledo model to predict bacteremia in patients with community-acquired pneumonia in the Emergency Department]. / Utilidad del modelo 5MPB-Toledo para predecir bacteriemia en el paciente con neumonía adquirida en la comunidad en el Servicio de Urgencias.

OBJECTIVE: To analyse a new risk score to predict bacteremia in the patients with Community-acquired Pneumonia (CAP) in the emergency departments. METHODS: Prospective and multicenter observational cohort study of the blood cultures ordered in 74 Spanish emergency departments for patients with CAP seen from November 1, 2019, to March 31, 2020. The predictive ability of the model was analyzed with the area under the Receiver Operating Characteristic curve (AUC-ROC). The prognostic performance for true bacteremia was calculated with the chosen cut-off for getting the sensitivity, specificity, positive predictive value and negative predictive value. RESULTS: A total of 1,020 blood samples wered cultured. True cases of bacteremia were confirmed in 162 (15.9%). The remaining 858 cultures (84.1%) wered negative. And, 59 (5.8%) were judged to be contaminated. The model´s area under the receiver operating characteristic curve was 0.915 (95% CI, 0.898-0.933). The prognostic performance with a model´s cut-off value of ≥ 5 points achieved 97.5% (95% CI, 95.1-99.9) sensitivity, 73.2% (95% CI, 70.2-76.2) specificity, 40.9% (95% CI, 36.4-45.1) positive predictive value and 99.4% (95% CI, 99.1-99.8) negative predictive value. CONCLUSIONS: The 5MPB-Toledo score is useful for predicting bacteremia in the patients with CAP seen in the emergency departments.

[Delayed administration of thrombolytic therapy in minor stroke]. / Retraso en la administración de tratamiento trombolítico en el ictus minor.

INTRODUCTION: Minor strokes are considered to be those that present with few symptoms, although up to 40% of them entail long-term disability. The rate of thrombolysis in these patients is also lower than in other strokes. The aim of this study is to explore whether there are any differences in intravenous thrombolysis care times in minor strokes. PATIENTS AND METHODS: We conducted a retrospective review of strokes treated with intravenous thrombolysis at our centre and a comparative analysis of the care times in minor strokes and in the other types. RESULTS: Longer times were found in minor strokes in terms of door-to-CT scan and door-to-needle time. This was not the case, however, for the time from the onset of symptoms to arrival at the hospital. CONCLUSIONS: The presence of few symptoms in minor strokes can make them difficult to recognise and could be a reason for delaying treatment. Training among staff caring for these patients is essential to improve this aspect.

TITLE: Retraso en la administración de tratamiento trombolítico en el ictus minor.Introducción. Se considera ictus minor a aquel que se presenta con escasos síntomas; sin embargo, hasta un 40% presenta discapacidad a largo plazo. La tasa de trombólisis en estos pacientes también es inferior a la del resto de ictus. En este estudio se pretende explorar si existen diferencias en los tiempos de atención en la trombólisis intravenosa en los pacientes con ictus minor. Material y métodos. Revisión retrospectiva de los ictus tratados con trombólisis intravenosa en nuestro centro y análisis comparativo de los tiempos de asistencia entre ictus minor y el resto. Resultados. Se encontraron tiempos más alargados en los casos de ictus minor en cuanto al tiempo puerta-tomografía computarizada y puerta-aguja. No fue así, sin embargo, para el tiempo desde el inicio de los síntomas hasta la llegada al hospital. Conclusiones. La presencia de escasos síntomas en el ictus minor puede hacer difícil su reconocimiento y podría ser un motivo de retraso en el tratamiento. La formación entre el personal que atiende a estos pacientes es fundamental para mejorar este aspecto.

Genotypic diversity of Salmonella ser. Abortusequi isolates from Argentina.

BACKGROUND: Salmonella enterica subsp. enterica serovar Abortusequi (S. Abortusequi) is a serotype restricted to equines, which produces abortion outbreaks. Nowadays the disease is being reported in different countries including Argentina thus generating an important impact in the equine industry. Molecular characterization of the 95 kb virulence plasmid and the spvC gene of S. Abortusequi demonstrated their importance in the pathogenicity of the serotype. In the last decades, high clonality of S. Abortusequi was identified in Japan, Mongolia and Croatia. OBJECTIVES: The aim of this work was to characterize S. Abortusequi isolates obtained in Argentina between 2011 and 2016 by virulence-gene profiling and pulsed-field gel electrophoresis. STUDY DESIGN: Case report. METHODS: S. Abortusequi isolates were studied by virulence-gene profiling and pulsed-field gel electrophoresis. RESULTS: Four virulence profiles and nine pulsed-field gel electrophoresis pulsotypes were identified among the 27 isolates included in the study. Different strains were found in the same outbreak and/or farm suggesting the presence of different sources of infection or mutation of isolates. MAIN LIMITATIONS: The number of related and nonrelated strains. More isolates may be necessary for a more intensive study. CONCLUSIONS: Most strains presented the same virulence profile, being positive for all the studied genes except gipA and sopE1, which are involved in intestinal virulence. Only few isolates showed different results in the same outbreak or farm. Unlike other studies, our results demonstrate a considerable diversity of S. Abortusequi pulsed-field gel electrophoresis pulsotypes, which suggests that different sources of infection may be involved within the same outbreak.

Anillo vascular completo por doble arco aórtico simétrico, una malformación cardiovascular infrecuente / Complete vascular ring by double symmetrical aortic arch, an infrequent cardiovascular malformation

Resumen Introducción: El doble arco aórtico (DAA) es una malformación cardiovascular infrecuente caracterizada por la persistencia de ambos arcos aórticos posterior al nacimiento. Puede presentarse con rama derecha dominante (70-73%), izquierda o simétrica. Su forma anatómica produce compresión de estructuras mediastínicas como la tráquea y esófago. Caso clínico: Lactante menor hombre de 3 meses, con antecedente de estridor desde nacimiento. Ingresó a nuestro centro por neumonía grave con necesidad de ventilación mecánica prolongada. Evaluado por otorrinolaringología, se realizó revisión de vía aérea, observando estenosis en los últimos 5 anillos traqueales con colapso dinámico de la tráquea. La tomografía computada de tórax demostró DAA completo con emergencias de troncos supraaórticos de ambos arcos de forma simétrica. Se decidió tratamiento quirúrgico a la brevedad. Se abordó por toracotomía anterolateral izquierda, se realizó control vascular y sección del arco aórtico izquierdo distal a emergencia de subclavia, con plastía de aorta y arteria subclavia izquierda, liberado el arco aórtico se realizó pexia y disección de tejido fibrótico que rodeaba tráquea y esófago. Paciente evolucionó favorablemente, con resolución de cuadro respiratorio y ausencia estridor. Fibrobroncoscopía posoperatoria no observó compresión traqueal. El alta hospitalaria fue al 14° día posoperatorio. Actualmente, a seis meses de seguimiento, se encuentra asintomático respiratorio y cardiovascular. Discusión: El DAA puede afectar al 0,03% de la población pediátrica. Usualmente es sintomático con manifestaciones obstructivas como estridor o disfagia por compresión de estructuras mediastínicas, por lo que requiere alta sospecha clínica para su confirmación imagenológica y posterior tratamiento quirúrgico.

Introduction: The double aortic arch (DAA) is an uncommon cardiovascular malformation, characterized by the persistence of both aortic arches after birth. It can be presented with right dominant branch (70-73%), left or symmetrical. It's anatomical shape produces compression of mediastinal structures such as the trachea and esophagus. Clinic case: Infant man 3 months old, with a history of stridor since birth. He was admitted to our center due to severe pneumonia with the need for prolonged mechanical ventilation. Evaluated by otorhinolaryngology, who performed airway revision observing stenosis in the last 5 tracheal rings with dynamic trachea collapse. Chest computed tomography showed complete DAA with emergence of supraaortic trunks of both arches symmetrically. Surgical treatment was decided as soon as possible. It was approached by left anterolateral thoracotomy, vascular control and left aortic arch section distal to subclavian emergency was performed, with aortic and left subclavian artery plasty, aortic arch was released to perform pexia and dissection of fibrotic tissue surrounding the trachea and esophagus. Patient evolved favorably, with resolution of respiratory symptoms and absence of stridor. Postoperative fiberoptic bronchoscopy did not observe tracheal compression. He was discharged on the 14th postoperative day. Currently at six months of follow-up, he is asymptomatic respiratory and cardiovascular. Discussion: AAD can affect 0.03% of the pediatric population. It is usually symptomatic with obstructive manifestations such as stridor or dysphagia due to compression of mediastinal structures, which requires high clinical suspicion for its imaging confirmation and subsequent surgical treatment.

Diet and body shape changes of paroko Kelloggella disalvoi (Gobiidae) from intertidal pools of Easter Island.

This study assesses seasonal variation in the morphology and diet of juveniles and adults of the Easter Island endemic goby Kelloggella disalvoi from intertidal pools during September-October 2015 (spring) and June-July 2016 (winter), utilizing geometric morphometric and gut-content analyses. A set of 16 landmarks was digitized in 128 individuals. Shape changes related to size changes (i.e. allometry) were low (18·6%) and were seasonally similar. Body shape changes were mainly dorsoventral (44·2% of variance) and comprised posteroventral displacement of the premaxilla and bending of the body. The latter included vertical displacement of the anterior portion of the first and second dorsal fins and the entire base of the caudal fin. Diets mainly comprised developmental stages of harpacticoid copepods (from eggs to adults), ostracods, isopods, gastropods and bivalves. Also, trophic niche breadth remained constant throughout development and did not vary between seasons. Nonetheless, significant dietary differences were detected in specimens collected during spring (main prey items: harpacticoid copepods and copepod eggs) and winter (harpacticoid copepods and copepod nauplii). Finally, there was weak but significant covariation between diet and morphology: molluscivores were characterized by having an inferior mouth gape, whereas planktivores had an anteriorly directed premaxilla.

Prognostic accuracy of SIRS criteria, qSOFA score and GYM score for 30-day-mortality in older non-severely dependent infected patients attended in the emergency department.

The aim of this study was to determine the accuracy of systemic inflammatory response syndrome (SIRS), quick Sepsis-related Organ Failure Assessment (qSOFA) score and GYM score to predict 30-day mortality in older non-severely dependent patients attended for an episode of infection in the emergency department (ED). We performed an analytical, observational, prospective cohort study including patients 75 years of age or older, without severe functional dependence, attended for an infectious process in 69 Spanish EDs for 2-day three-seasonal periods. Demographic, clinical and analytical data were collected. The primary outcome was 30-day mortality after the index event. We included 1071 patients, with a mean age of 83.6 [standard deviation (SD) 5.6] years; 544 (50.8%) were men. Seventy-two patients (6.5%) died within 30 days. SIRS criteria ≥ 2 had a sensitivity of 65% [95% confidence interval (CI) 53.1-75.9] and a specificity of 49% (95% CI 46.0-52.3), a qSOFA score ≥ 2 had a sensitivity of 28% (95% CI 18.2-39.8) and a specificity of 94% (95% CI 91.9-95.1), and a GYM score ≥ 1 had a sensitivity of 81% (95% CI 69.2-88.6) and a specificity of 45% (95% CI 41.6-47.9). A GYM score ≥ 1 and a qSOFA score ≥ 2 were the cut-offs with the highest sensitivity (p < 0.001) and specificity (p < 0.001), respectively. The area under the curve (AUC) was 0.73 (95% CI 0.66-0.79; p < 0.001) for the GYM score, 0.69 (95% CI 0.61-0.76; p < 0.001) for the qSOFA score and 0.65 (95% CI 0.59-0.72; p < 0.001) for SIRS. A GYM score ≥ 1 may be the most sensitive score and a qSOFA score ≥ 2 the most specific score to predict 30-day mortality in non-severely dependent older patients attended for acute infection in EDs.

Concordancia entre los modelos de SCORE y ramingham y las ecuaciones AHA/ACC como evaluadores de riesgo cardiovascular / Concordance between the SCORE and Framingham models and ACC/AHA equations as cardiovascular risk indicators

Resumen Objetivo: Diferentes modelos de evaluación de riesgo cardiovascular están actualmente en uso en Colombia. El objetivo de este estudio es analizar la concordancia entre las ecuaciones AHA/ACC 2013, SCORE y Framingham ajustado, así como el impacto de usar una u otra en la cantidad de pacientes clasificados como de alto riesgo y en la cantidad de pacientes que requerirían manejo farmacológico. Métodos: Se evaluaron 800 pacientes entre 40 y 74 años, de la clínica de prevención primaria del Hospital militar Central en Bogotá (Colombia), libres de eventos cardiovasculares. Se estimaron el riesgo a 10 años de enfermedad arterioesclerótica cardiovascular según las ecuaciones propuestas por las guías AHA/ACC 2013, el riesgo de muerte cardiovascular según la función SCORE de la guía europea y el riesgo coronario según la función de Framingham ajustada, recomendada por la guía colombiana. Se consideró como indicación de manejo farmacológico un cálculo de riesgo AHA/ACC o Framingham ajustado > 7,5%. Un riesgo de Framingham > 20% o SCORE > 5% definía el riesgo alto. Resultados: Según el Framingham había un 5,9% de pacientes de alto riesgo, según las ecuaciones de SCORE para países de bajo riesgo un 18,7% y según las ecuaciones de SCORE para países de alto riesgo, un 31,2%. El coeficiente Kappa mostró baja concordancia entre Framingham ajustado y cada una de las ecuaciones de SCORE (0,28 y 0,22 respectivamente). Según las recomendaciones de la guía AHA/ACC, el tratamiento hipolipemiante estaría indicado en un 40,8% de los pacientes, frente a un 50,6% según la guía colombiana (Framingham ajustado). El coeficiente kappa fue de 0,5735. Conclusiones: En la actualidad existe pobre acuerdo entre las diferentes escalas de evaluación del riesgo cardiovascular usadas en Colombia, hecho que conlleva incertidumbre para la toma de decisiones terapéuticas. Los datos de este estudio demuestran la necesidad de validar los modelos de SCORE y AHA/ACC en Colombia y Latinoamérica.

Abstract Motivation: In Colombia, different models of cardiovascular risk assessment are currently being used. The motivation of this study is to analyse the concordance between the ACC/AHA 2013 equation, SCORE and adjusted Framingham, as well as the impact of using one or another in the amount of patients classified as high risk and the amount of patients requiring pharmacological management. Methods: 800 patients between 40 and 74 years old were assessed, from the primary prevention clinic of the Hospital Militar Central in Bogotá (Colombia), who were free of cardiovascular events. 10-year risk for atherosclerotic vascular disease was estimated according to the equations proposed by ACC/AHA 2013 guides, the risk of cardiovascular death according to the SCORE function of the European guide and the coronary risk according to the adjusted Framingham function recommended by the Colombian guide. The indication of pharmacological management was considered with an ACC/AHA or adjusted Framingham risk of > 7.5%. A >20% Framingham or a >5% SCORE risk were considered high risk. Results: According to Framingham there was a 5.9% of high-risk patients, according to SCORE equations for low-risk countries an 18.7% and according to SCORE equations for high-risk countries, a 31.2%. The Kappa coefficient showed a low concordance between adjusted Framingham and each of the SCORE equations (0.28 and 0.22 respectively). According to the ACC/AHA guide recommendations, hypolipidemic treatment would be indicated in 40.8% of patients, versus a 50.6% following the Colombian guide indications (adjusted Framingham). Kappa coefficient was 0.5735. Conclusions: Nowadays there is a poor agreement between the different cardiovascular risk assessment scales used in Colombia, thus generating uncertainty when it comes to making therapeutic choices. Data from this study show the need to validate the validate the SCORE and ACC/AHA models in Colombia and Latin America.

Membrane technology applied to acid mine drainage from copper mining.

The objective of this study is to evaluate the treatment of high-strength acid mine drainage (AMD) from copper mining by nanofiltration (NF) and reverse osmosis (RO) at pilot scale. The performances of two commercial spiral-wound membranes - NF99 and RO98pHt, both from Alfa Laval - were compared. The effects of pressure and feed flow on ion rejection and permeate flux were evaluated. The results showed high ion removal under optimum pressure conditions, which reached 92% for the NF99 membrane and 98% for the RO98pHt membrane. Sulfate removal reached 97% and 99% for NF99 and RO98pHt, respectively. In the case of copper, aluminum, iron and manganese, the removal percentage surpassed 95% in both membranes. Although concentration polarization limited NF performance at higher pressures, permeate fluxes observed in NF were five times greater than those obtained by RO, with only slightly lower divalent ion rejection rates, making it a promising option for the treatment of AMD.

Infección por adenovirus en el Hospital de niños Roberto del Río 2016 / Adenovirus infection at the Roberto del Río children's Hospital 2016

En los meses de invierno, las enfermedades respiratorias representan la primera causa de hospitalización en hospitales pediátricos. La mayoría de estas enfermedades son causadas por virus, dentro de los cuales se encuentra el adenovirus (AdV), el cual puede generar infecciones diseminadas graves, secuelantes e incluso letales y se caracteriza por tener una rápida transmisión entre pacientes, generando brotes intrahospitalarios. Se identificó a 54 pacientes hospitalizados con infección por adenovirus en el periodo de marzo-julio del 2016 con una edad promedio de 18,3 meses, de los cuales 23 casos fueron infecciones asociadas a la atención de salud (IIAS) y 2 tuvieron desenlace fatal. Los casos de IIAS, se asociaron a una mayor tasa de hospitalización prolongada (p= <0.01), ingreso a UPC (p= <0.01) y uso de ventilación mecánica (p= <0.01). No se encontró asociación entre la presencia de antecedentes mórbidos con el desarrollo de IIAS. Las IIAS por adenovirus se asocia a una hospitalización prolongada, ingreso de unidades de alta complejidad y necesidad de uso de ventilación mecánica. Dado que el adenovirus se transmite a través de contactos directo, aerosoles y fómites, las medidas básicas de precaución de contacto y de aislamiento permiten reducir los contagios nosocomiales, recayendo la responsabilidad en todo el equipo de salud a cargo.

Respiratorio deseases are frequent in winter times. being the main cause of hospital admissions. Viral infecciones are the main etiology, and adenovirus infección clould lead to severe disease, with cross infections. We identified 54 patients admitted to the Roberto del Río Childrens hospital in 2016, with a mean age of 18,3 months old; 23 cases where nosocomial infection, and 2 were fatal. Hospital acquired adenovirus infection were associated to long hospital stay (p= <0.01), intensive care admission (p= <0.01) and ventilatory support (p= <0.01). We did not find previous illness conditions. Adenovirus hospital acquired infection is associated with longer hospital stay and dead. Adenovirus is transmitted with direct contact, aerosols and fomites, therefore basic contact precautions are important.

Diagnóstico final de pacientes con sospecha de accidente cerebrovascular descartado. Experiencia del Hospital de Chillán, chile / Final diagnosis of patients with suspect of ruled out stroke. experience of the Hospital of Chillán, Chile

INTRODUCCIÓN: El accidente cerebrovascular (ACV) es una lesión neurológica aguda con dos subtipos clásicos (isquémico y hemorrágico); siendo un importante problema de salud púbica en Chile. Existen patologías que imitan su presentación, sin embargo, una historia clínica y examen físico orientado permiten discriminar en un alto número de casos entre estas patologías evitando la derivación a especialista y solicitud de exámenes imagenológicos, disminuyendo así, los costos derivados en un gran número de pacientes. MATERIAL Y MÉTODO: Estudio transversal a partir de las fichas clínicas de pacientes ingresados con sospecha de ACV durante febrero y marzo del 2016 en Hospital Clínico Herminda Martín de Chillán para su confirmación diagnóstica por el Servicio de Neurología. RESULTADOS: Se obtuvieron 304 fichas clínicas con sospecha de ACV de las cuales un 26,9% no correspondieron a ACV. De estos, 45,9% eran patologías de especialidades no neurológicas siendo las más frecuentes las derivadas de Medicina Interna. DISCUSIÓN: El ACV es una entidad neurológica clásicamente descrita en base a la ubicación de la lesión vascular. Pese a que su presentación semiológica es conocida, existen muchas patologías que son clínicamente similares, o bien, las características singulares de los pacientes hacen que el patrón clínico sea confuso. Este fenómeno se refleja en una tasa de falsos ACV relativamente similar entre diferentes centros de salud. La tasa de error en diagnóstico de ACV en el estudio es de 26,9%, similar a otras experiencias. Pareciera ser que existe un número basal de falsos ACV, cuyo margen de error clínico, resulta difícil reducir aún con buenas escalas y protocolos estandarizados de atención.

INTRODUCTION: Stroke is an acute neurological lesion with two classic subtypes (ischemic and hemorrhagic), being an important public health problem in Chile. There are pathologies that mimic its presentation, however, a clinical history and oriented physical examination allow to discriminate in a high number of cases between these pathologies avoiding the referral to specialist and request of imaging examinations, thus reducing, the costs derived in a large number of patients. MATERIAL AND METHOD: Cross-sectional study from the clinical records of patients admitted with suspected stroke during February and March of 2016 at Herminda Martin Clinic Hospital from Chile for diagnostic confirmation by the Neurology Service. RESULTS: A total of 304 clinical files were obtained with suspected stroke, of which 26,9% did not correspond to stroke. Of these, 45,9% were pathologies of non-neurological specialties, the most frequent being those derived from internal medicine. DISCUSSION: Stroke is a neurological entity classically described based on the location of the vascular lesion. Although its semiologic presentation is known, there are many pathologies that are clinically similar, or the unique characteristics of the patients make the clinical pattern confusing. This phenomenon is reflected in a relatively similar false stroke rate among different health centers. The error rate in diagnosis of stroke of this study is 26,9%, similar to other experiences. It appears that there is a basal number of false stroke, whose clinical margin of error is difficult to reduce even with good scales and standardized care protocols.

[Characteristics and epidemiological changes for patients with urinary tract infection in the emergency department]. / Características y cambios epidemiológicos de los pacientes coninfección del tracto urinario en los servicios de urgencias hospitalarios.

BACKGROUND: The aim of this paper is to determine both the prevalence of urinary tract infection (UTI) in the emergency department (ED) and the most relevant epidemiological changes in the last decade, as well as the profile and management of these patients. METHODS: Descriptive cross-sectional analysis at 49 Spanish ED during 12 months. All patients with infections and UTI diagnosis were included. All patients attended to in ED during the study were recorded as well. RESULTS: The study included 2,517 patients diagnosed with UTI, with a mean age of 55 (SD 23) years, 64.6%of whom were women. These patients represent 22%of infections in the ED and 3.2% of all patients in the ED. Thirty-six per cent were over 70 years old. Fifty one point nine per cent had some underlying disease (16.5%diabetes mellitus) and 32.7% had some risk factors for multi-resistant strains of bacteria. Eight point three percent met sepsis criteria. Seventy-one point nine percent of patients were directly discharged from the ED. CONCLUSIONS: UTI are very common infections in ED, with important associated comorbidities, high mean ages and a predominance in women. With respect to a decade before UTI has increased its prevalence (3.2%vs 2.1%) and the patients have a greater age [55.5 (SD 23) vs 52 (SD 22) years], more comorbidities (51.9% vs 40.6%) and clinical severity (8.3% vs 6.5%).

Características y cambios epidemiológicos de los pacientes con infección del tracto urinario en los servicios de urgencias hospitalarios / Characteristics and epidemiological changes for patients with urinary tract infection in the emergency department

Fundamento: El objetivo de este artículo es determinar la prevalencia y conocer los cambios epidemiológicos más relevantes en la última década en la infección del tracto urinario (ITU) en los servicios de urgencias (SU), así como el perfil y manejo de los pacientes. Métodos: Estudio descriptivo con análisis transversal, multicéntrico en 49 SU españoles durante 12 meses. Se incluyeron todos los pacientes con el diagnóstico de ITU y de infección. Se registraron todos los pacientes atendidos en los SU. Resultados: Se incluyeron 2.517 casos diagnosticados de ITU con una edad media de 55 ± 23 años, el 64,6% mujeres. Estos representan el 22% de las infecciones y el 3,2% de todos los pacientes del SU. El 36% de las ITU se registraron en pacientes con 70 o más años. El 51,9% tenían alguna enfermedad de base (16,5% diabetes mellitus) y el 32,7% alguno de los factores de riesgo de multirresistencia para bacterias. El 8,3% cumplían criterios de sepsis. El 71,9% de los pacientes recibieron el alta desde el SU. Conclusiones: Las ITU son infecciones muy frecuentes en los SU, con importante comorbilidad asociada, elevada edad media y predominio en mujeres. Respecto a una década anterior, las ITU han aumentado su prevalencia (3,2% frente a 2,1%) y el paciente tiene más edad [55,5 (DE 23) frente a 52 (DE 22) años], mayor comorbilidad (51,9% frente a 40,6%) y gravedad clínica (8,3% frente a 6,5%) (AU)

Background: The aim of this paper is to determine both the prevalence of urinary tract infection (UTI) in the emergency department (ED) and the most relevant epidemiological changes in the last decade, as well as the profile and management of these patients. Methods: Descriptive cross-sectional analysis at 49 Spanish ED during 12 months. All patients with infections and UTI diagnosis were included. All patients attended to in ED during the study were recorded as well. Results: The study included 2,517 patients diagnosed with UTI, with a mean age of 55 (SD 23) years, 64.6% of whom were women. These patients represent 22% of infections in the ED and 3.2% of all patients in the ED. Thirty-six per cent were over 70 years old. Fifty one point nine per cent had some underlying disease (16.5% diabetes mellitus) and 32.7% had some risk factors for multi-resistant strains of bacteria. Eight point three per cent met sepsis criteria. Seventy-one point nine per cent of patients were directly discharged from the ED. Conclusions: UTI are very common infections in ED, with important associated comorbidities, high mean ages and a predominance in women. With respect to a decade before UTI has increased its prevalence (3.2% vs 2.1%) and the patients have a greater age [55.5 (SD 23) vs 52 (SD 22) years], more comorbidities (51.9% vs 40.6%) and clinical severity (8.3% vs 6.5%) (AU)

Edible antimicrobial films based on microencapsulated lemongrass oil.

Edible films and coatings have been proposed as viable alternatives for the preservation of fresh food such as fruit, meat, fish and cheese. They can be designed to contain natural antioxidants, vitamins and antimicrobials in order to extend shelf life of the product keeping the natural sensorial properties. Essential oils have been targeted as potential active principles for edible films and coatings given their well-recognized antioxidant, antimicrobial and sensory properties. In the present work, lemongrass oil (LMO) microcapsules were prepared by the emulsification-separation method using sodium caseinate as wall material. Microcapsules had an average size of 22 µm and contained over 51 % oil in their nucleus. The release kinetics of the LMO components was studied for both, microcapsules and microcapsule containing films. Experimental data for the controlled release of LMO components showed good correlation with Peppas and Weibull models. The effect of the alginate matrix on the release parameters of the mathematical models could be detected by the modification of the b constant of the Weibull equation which changed from 0.167 for the microcapsules to 0.351 for the films. Films containing LMO at concentrations of 1250, 2500 and 5000 ppm were able to inhibit growth of Escherichia coli ATCC 25922 and Listeria monocytogenes ISP 65-08 in liquid cultures. A possible future application of these films for shelf life extension of fresh food is discussed.

Respuesta patológica completa en pacientes sometidos a neoadyuvancia en cáncer de recto / Pathologic complete response in patients with neoadjuvant chemoradiotherapy for rectal cancer

Background: the standard treatment of locally advanced rectal cancer (RC) of the middle and lower third of the rectum is neoadjuvant chemoradiotherapy (XRQT) follow by oncologic resection. After this treatment in 15-25 percent of the cases, the pathologist reports complete pathological response (pCR). Aim: to describe demographic, clinical and survival data of patients with pCR undergoing chemoradiotherapy and radical resection for RC. Material and Methods: historic cohort study. In a prospectively maintained database between 2000 and 2010, we identified patients with RC, who underwent neoadjuvant chemoradiotherapy according to protocol, followed by radical resection. The preoperative staging was obtained by clinical examination, endoscopy, rectal ultrasound, CT scan of chest, abdomen and pelvis and pelvic MRI. Demographic data, tumor location, time between the end of XRTQ and surgery, postoperative staging (according AJCC) and survival, were collected. Results: 119 patients received preoperative XRTQ, 65 percent male, with a mean age of 58 years. The most frequent tumor site was the lower third (63 percent). Surgery was performed 8 weeks after the end of XRTQ. Of 119 patients with XRTQ, 15.1 percent had a pCR. Overall survival was 75 percent, and cancer-specific survival was 80.4 percent at 5 years in patients without pCR. For patients with pCR, the 5 year survival estimates for overall and cancer specific survival was 100 percent. We did not identify factors associated with pCR. Conclusions: in this study, pCR was comparable to other larger series reported elsewhere. No factors associated with pCR were identified.

Introducción: el cáncer de recto (CR) de tercio medio e inferior localmente avanzado se trata con radio-quimioterapia (XRTQ) preoperatoria. Luego XRQT y resección quirúrgica, 15-25 por ciento presentan respuesta patológica completa (RPC) de la lesión. Objetivo: comparar características demográficas, clínicas y sobrevi da de pacientes con RPC y respuesta parcial sometidos XRTQ preoperatoria y resección radical. Materiales y Métodos: estudio cohorte concurrente. En la base de datos de pacientes con CR mantenida prospectivamente, entre 2000-2010, se identificaron pacientes con CR tercio medio e inferior, sometidos XRTQ preoperatoria según protocolo, seguidos de resección radical. Etapificación preoperatoria según: examen clínico, endoscopia, endosonografía rectal, TAC tórax abdomen pelvis y resonancia nuclear magnética de pelvis. Se registraron datos demográficos, localización tumoral, lapso entre término de XRTQ y cirugía, etapificación post operatoria (AJCC), seguimiento y sobrevida. Resultados: 119 pacientes recibieron XRTQ preoperatoria por CR, 65 por ciento hombres. Edad promedio: 58 años. Localización tumoral más frecuente: tercio inferior (63 por ciento). Cirugía se realizó 8 semanas después del término de XRTQ. Etapificación post operatoria: Etapa I 26,1 por ciento, II 34,5 por ciento, III 16,8 por ciento, IV 5 por ciento y RPC 15,1 por ciento. Sobrevida global 75 por ciento, sobrevida específica por cáncer 80,4 por ciento a 5 años. Sobrevida pacientes con RPC fue 100 por ciento a 5 años. No se identificaron factores asociados a RPC. Conclusiones: en este estudio no se logró reconocer factores asociados a RPC. Con las limitaciones que impone el número de pacientes y el seguimiento, se reproducen hallazgos vistos en series más extensas.

Aspergilosis necrotizante crónica: reporte de un caso / Chronic necrotizing aspergillosis: report a case

INTRODUCCIÓN: el Aspergillus fumigatus es un patógeno poco frecuente en la población general, que produce una infección en personas inmunodeprimidas cuando se inhalan sus esporas, las cuales se pueden depositar en senos paranasales, nasofaringe, en los pulmones y posteriormente comprometer incluso tejidos distintos a las de la vía aérea. Uno de los cuadros clínicos pulmonares es la aspergilosis necrotizante crónica (ANC), en donde se produce una invasión local del parénquima pulmonar con destrucción y formación de cavidades, sin invasión de vasos sanguíneos ni a otros órganos. PRESENTACIÓN DEL CASO: Paciente de 57 años, sexo femenino, quien tuvo múltiples consultas en la asistencia pública por síntomas respiratorios en el Hospital Clínico Regional de Concepción, se realizó una biopsia transbronquial del lóbulo superior derecho cuyo informe histopatológico informó la presencia de tejido necrótico, abundantes colonias con hifas y conidias consistentes con Aspergillus, por lo cual se diagnosticó ANC y se decidió tratar con itraconazol de 200 mg cada 12 horas por 26 semanas y prednisona 20 mg vía oral hasta completar tratamiento antifúngico. DISCUSIÓN: Si bien la ANCes una enfermedad que afecta a pacientes inmunodeprimidos también se debe considerar como una posibilidad diagnóstica a pesar de estar frente a un paciente inmunocompetente, ya que es una patología potencialmente fatal y que puede presentar complicaciones como compromiso de la pared torácica, plexo braquial y columna vertebral.

INTRODUCTION: Aspergillus fumigatus is a rare pathogen in the general population that produces an infection in depressed immune persons when inhaled spores, which can be deposited in sinuses, nasopharynx and lungs. One of pulmonar disease, is the Chronic Necrotizing Aspergillosis (CNA), where there is a local invasion on lung parenchyma with destruction and cavitation, without invasion of blood vessels or other organs. CASE REPORT: A 57 year old female who had multiple consultations on public assistance for respiratory symptoms in the Regional Hospital of Concepción, were taken a transbronchial biopsy was performed in the middle lobe, whose pathology report informed presence of necrotic tissue, abundant colonies with hyphae and conydias, that are consistent with Aspergillus and thus was diagnosed CNA and decided to deal with itraconazole 200 mg every 12 hours for 26 weeks and 20mg prednisone oral until complete antifungal treatment. DISCUSSION: Although the CNA is a disease that affects immune depressed patients should also be considered as a diagnostic possibility in spite of being an immune competent patient, since it is a potentially fatal disease that may present complications like chest wall involvement, brachial plexus and spine.