Effectiveness of a Therapeutic Exercise Program to Improve the Symptoms of Peripheral Neuropathy during Chemotherapy: Systematic Review of Randomized Clinical Trials.

BACKGROUND: Therapeutic exercise has an important role to manage chemotherapy-induced peripheral neuropathy symptoms. However, there is little evidence of its effectiveness. OBJECTIVE: To synthesize the evidence regarding therapeutic exercise during chemotherapy to improve peripheral neuropathy symptoms. DATABASES: PubMed, CINAHL, Cochrane Library, PEDro, ScienceDirect, Scopus, Web of Science and BIREME. METHODOLOGY: Randomized clinical trials were included. GRADE was used to synthesize evidence and an inverse variance model for meta-analysis. RESULTS: Up to May 2022, 2172 references were analyzed and 14 studies that evaluated 1094 participants were included. The exercises were highly effective in improving pain threshold and moderately effective in improving peripheral neuropathy symptoms at the 8-week follow-up and the 4-24 weeks. Furthermore, the evidence was low in improving thermal threshold, tactile and vibratory sensitivity. CONCLUSION: Therapeutic exercise generates a significant reduction in peripheral neuropathy symptoms in patients in short- and long-term follow-up with a moderate level of evidence quality.

Effectiveness of Resistance Training on Fatigue in Patients Undergoing Cancer Treatment: A Meta-Analysis of Randomized Clinical Trials.

Objective: To assess the effectiveness of the resistance training to improve fatigue levels in people with cancer who are enrolled in adjuvant and/or neoadjuvant treatment. Methods: MEDLINE, Web of Science, Embase, SPORTDiscus, LILACS, CENTRAL, and CINAHL databases were searched from May to December 7, 2021. Randomized clinical trials (RCT) that evaluate the effects of resistance training on fatigue levels in people undergoing cancer treatment were included. The PEDro scale was considered to assess methodological quality of studies, and the evidence was summarized through the GRADE system. The standardized average differences, effect size, and inverse variance model for meta-analysis were calculated. Results: Fifteen RCT for qualitative synthesis and thirteen for meta-analysis were selected. A moderate to high level of evidence of resistance training was identified to improve fatigue in people undergoing cancer treatment. Meta-analysis showed a significant reduction in fatigue (SMD = -0.31, CI 95% = -0.58, -0.12, P = 0.001) after 10 to 35 sessions of resistance training. Conclusion: The 10 to 35 sessions of resistance training are effective in reducing fatigue level in cancer patients who are undergoing cancer treatment and have a moderate level of quality evidence.

Effects of resistance exercise training on redox homeostasis in older adults. A systematic review and meta-analysis.

BACKGROUND: Resistance exercise training (RET) has proven effective at reducing the risk of chronic disease in older populations, and it appears to regulate redox homeostasis. AIMS: To determine the effects of RET on redox homeostasis in older people. STUDY DESIGN: A systematic review and meta-analysis of randomized clinical trials identified by searching MEDLINE, Web of Science, EMBASE, Sportdiscus, LILACS, CENTRAL and CINAHL. We included studies of subjects aged 65 years or older, with or without pathologies, and including RET metrics with quantified molecular oxidation and antioxidant capacity outcomes. RESULTS: Fifteen studies were included in this review. Agreement between reviewers reached a kappa value of 0.725. There were a total of 614 participants, with an average age of 68.1 years. Five (for molecular oxidation markers) and three (for antioxidant capacity markers) studies included data that quantified the effects of RET on homeostasis redox. The results of the meta-analysis showed that there were no differences in the molecular oxidation markers (SMD = -0.26; 95% CI = -0.57 to 0.05; P = 0.10; I2 = 0%) and antioxidant capacity markers (SMD = 0.53; 95% CI = -0.20 to 1.26; P = 0.16; I2 = 71.5%) in healthy older people after a RET of 8-24 weeks compared to non-intervention. CONCLUSIONS: Based on a small number of studies of low methodological quality, this systematic review with meta-analysis suggests that RET is not effective at reducing molecular oxidation markers in healthy older people. More research is needed on the effects of RET on redox homeostasis in older people. PROSPERO REGISTRATION NUMBER: CRD42019121529.

[Statement of the Advisory Immunization Committee of the Chilean Society of Infectious Diseases on the emergence of serotype 19A pneumococcal infection and the use of pneumococcal conjugated vaccine in Chilean children]. / Opinión del Comité Consultivo de Inmunizaciones Sociedad Chilena de Infectología: Vacuna neumocóccica conjugada en niños y la emergencia de serotipo 19A.

Inclusion of the 10-valent pneumococcal conjugated vaccine (PCV10) in the Chilean infant vaccination Program in 2011 was followed by a reduction of hospital admissions and pneumonia-related deaths in this age group. However, a progressive increase of serotype 19A pneumococcal isolates (not included in PCV10) has been observed. According to the analysis of pneumococcal strains performed by the national reference laboratory of the Institute of Public Health as part of a national surveillance on invasive pneumococcal infections, the relative proportion of serotype 19A isolates increased from <5% before 2010 to 12-23% in years 2014-2015. Serotype 19A represented 4-8% of the isolates in the pre-vaccine era among children less than 2 years, increasing to 25% during 2014. This increase has been documented in two-thirds of the national territory. Aimong children <5 years of age, 25% of 19A serotype isolates from non-meningeal infections were penicillin resistant wheras from meningeal infections near 100% were penicillin resistant. Genetic analysis indicates that 48% of these 19A strains belong to clonal complex 320, recognized for its pandemic potential and high antimicrobial resistance. Among children, most invasive infections secondary to serotype 19A have occurred in patients fully vaccinated with PCV10. These epidemiological changes indicate an increase in invasive pneumococcal infections by serotype 19A in Chile and the need to control this problem by changing the current PCV10 for the PCV13 vaccine containing serotype 19A.

Opinión del Comité Consultivo de Inmunizaciones Sociedad Chilena de Infectología: Vacuna neumocóccica conjugada en niños y la emergencia de serotipo 19A / Statement of the Advisory Immunization Committee of the Chilean Society of Infectious Diseases on the emergence of serotype 19A pneumococcal infection and the use of pneumococcal conjugated vaccine in Chilean children

La incorporación de la vacuna conjugada antineumocóc-cica 10 valente (PCV10) en lactantes en Chile el año 2011 ha permitido reducir las hospitalizaciones y muertes por neumonía en este grupo etario. Sin embargo, se ha observado desde entonces un aumento progresivo de los aislados de Streptococcus pneumoniae del serotipo 19A no incluido en la vacuna en uso (de < 5% del total de cepas recibidas en el Laboratorio de Referencia Nacional del Instituto de Salud Pública para vigilancia de infecciones invasores causadas por S. pneumoniae hasta el año 2010, a 12-23% en los años 2014-2015). En lactantes, el serotipo 19A representaba 4 a 8% de los aislados en la era pre vacuna, porcentaje que se incrementa a 25% el 2014. Este aumento ha ocurrido en dos terceras partes de las regiones administrativas del país. Cepas del serotipo 19A de pacientes menores de 5 años, muestran 25% de resistencia a penicilina para aislados extra-meníngeos y casi 100% para aislados de meningitis. El análisis genético de las cepas del serotipo 19A ha demostrado que 48% pertenecen al complejo clonal 320 de carácter pandémico y asociado a resistencia antimicrobiana. Además, casi todas las infecciones invasoras por serotipo 19A en niños se han dado en pacientes con esquema completo de vacunación PCV10. Los cambios epidemiológicos presentados indican la emergencia de infecciones invasoras por el serotipo 19A y la necesidad de controlar este problema con el cambio de la vacuna PCV10 a la vacuna PCV13 que contiene el serotipo 19A.

Inclusion of the 10-valent pneumococcal conjugated vaccine (PCV10) in the Chilean infant vaccination Program in 2011 was followed by a reduction of hospital admissions and pneumonia-related deaths in this age group. However, a progressive increase of serotype 19A pneumococcal isolates (not included in PCV10) has been observed. According to the analysis of pneumococcal strains performed by the national reference laboratory of the Institute of Public Health as part of a national surveillance on invasive pneumococcal infections, the relative proportion of serotype 19A isolates increased from <5% before 2010 to 12-23% in years 2014-2015. Serotype 19A represented 4-8% of the isolates in the pre-vaccine era among children less than 2 years, increasing to 25% during 2014. This increase has been documented in two-thirds of the national territory. Aimong children <5 years of age, 25% of 19A serotype isolates from non-meningeal infections were penicillin resistant wheras from meningeal infections near 100% were penicillin resistant. Genetic analysis indicates that 48% of these 19A strains belong to clonal complex 320, recognized for its pandemic potential and high antimicrobial resistance. Among children, most invasive infections secondary to serotype 19A have occurred in patients fully vaccinated with PCV10. These epidemiological changes indicate an increase in invasive pneumococcal infections by serotype 19A in Chile and the need to control this problem by changing the current PCV10 for the PCV13 vaccine containing serotype 19A.

[Modification of pertussis vaccination schedule in Chile, immunization of special groups and control strategies: Commentary from the Consultive Committee of Immunizations of The Chilean Society of Infectious Diseases]. / Modificación en el esquema de vacunación antipertussis en Chile, vacunación en grupos especiales y estrategias de control: Comentario del Comité Consultivo de Inmunizaciones (CCI) de la Sociedad Chilena de Infectología.

In Chile, an increased number of notifications of cases of whooping cough was detected at the beginning of October 2010, and maintained through 2012. Accumulated cases during 2011 were 2,581 (15.0 per 100,000), which is greater than the number of cases registered during the period 2008-2010 (2,460 cases). On the other hand, the local sanitary authority introduced a modification of pertussis vaccination schedule (starting 2012), which consists in the replacement of the second booster of pertussis vaccine (DTwP, administered to 4-year-old children) as well as diphtheria-tetanus toxoid (dT, administered to second grade scholars) for an acellular pertussis vaccine with reduced antigenic content (dTpa), which will be administrated to first grade scholars. The Consultive Committee of Immunizations considers that the modification is adequate, since it extends the age of protection, reducing at least in theory the infection in older scholars and adolescents -who are significant sources of transmission of Bordetella pertussis to infants- using an adequate vaccine formulation (acellular pertussis vaccine). The available evidence regarding vaccination in special groups (adolescents and adults, health-care workers and pregnant women) and cocooning strategy are commented.

Modificación en el esquema de vacunación antipertussis en Chile, vacunación en grupos especiales y estrategias de control: Comentario del Comité Consultivo de Inmunizaciones (CCI) de la Sociedad Chilena de Infectología / Modification of pertussis vaccination schedule in Chile, immunization of special groups and control strategies: Commentary from the Consultive Committee of Immunizations of The Chilean Society of Infectious Diseases

In Chile, an increased number of notifications of cases of whooping cough was detected at the beginning of October 2010, and maintained through 2012. Accumulated cases during 2011 were 2,581 (15.0 per 100,000), which is greater than the number of cases registered during the period 2008-2010 (2,460 cases). On the other hand, the local sanitary authority introduced a modification of pertussis vaccination schedule (starting 2012), which consists in the replacement of the second booster of pertussis vaccine (DTwP, administered to 4-year-old children) as well as diphtheria-tetanus toxoid (dT, administered to second grade scholars) for an acellular pertussis vaccine with reduced antigenic content (dTpa), which will be administrated to first grade scholars. The Consultive Committee of Immunizations considers that the modification is adequate, since it extends the age of protection, reducing at least in theory the infection in older scholars and adolescents -who are significant sources of transmission of Bordetella pertussis to infants- using an adequate vaccine formulation (acellular pertussis vaccine). The available evidence regarding vaccination in special groups (adolescents and adults, health-care workers and pregnant women) and cocooning strategy are commented.

En Chile, a comienzos del mes de octubre de 2010 se detectó un aumento en la notiicación de casos de coqueluche, dinámica que se ha mantenido a la fecha (abril 2012). El número de casos acumulados durante 2011 ascendió a 2.581 (15,0/100.000 hab.), cifra superior al número de casos registrados durante el período 2008-2010 (2.460 casos). Por su parte, a partir de 2012 la autoridad sanitaria introdujo una modiicación en el esquema de vacunación anti-pertussis, consistente en el reemplazo del segundo refuerzo de vacuna antipertussis (DTwP, administrada a los 4 años) y del refuerzo de toxoide diftérico-tetánico (dT, administrado en segundo básico) por la vacuna anti-pertussis acelular de contenido antigénico reducido (dTpa), a ser administrada en primero básico. El Comité Consultivo de Inmunizaciones considera la modificación adecuada, por cuanto permite extender el tiempo de protección, reduciendo al menos en teoría la infección en escolares mayores y adolescentes -quienes son importantes fuente de contagio de Bordetella pertussis para los lactantes- utilizando una adecuada formulación de vacuna (vacuna antipertussis acelular). Se comenta la evidencia disponible sobre vacunación anti-pertussis en grupos especiales (adolescentes y adultos, funcionarios de la salud y mujeres embarazadas), y la estrategia de vacunación de capullo.

Aspectos epidemiológicos de las infecciones del torrente sanguíneo por levaduras. Confrontando nuestra realidad con el mundo / Epidemiological aspects of circulatory infections by yeasts. Our situation compared with global conditions

Blood stream infections caused by yeasts have undergone considerable increases since the 1980's, showing a change in dynamics of distribution of the agents beginning in the 1990's. This type of infection is primarily nosocomial, and fundamentally affects immunodeppressed individuals, and those within intensive care units. General and specific epidemiological data are reviewed in this study, including both national and global information related to clinical and diagnostic aspects of yeast fungemias. An updated overview of the topic is presented for professionals and specialists in health fields.

La infección del torrente sanguíneo, causada por levaduras, ha experimentado un aumento considerable desde la década de los 80, mostrando a partir de los 90 un cambio dinámico en la distribución de los agentes. Esta infección es mayoritariamente nosocomial y afecta fundamentalmente a pacientes inmunodeprimidos e internados en unidades críticas. En la presente revisión se muestran antecedentes epidemiológicos generales y específicos, tanto nacionales como extranjeros, relacionados con la clínica y el diagnóstico de fungemia por levaduras, entregando una visión actualizada del tema a los distintos profesionales y especialistas del área de la salud.

[Resistance to Streptococcus pneumoniae to penicillin and its association with clinical and epidemiological factors]. / Resistencia de Streptococcus pneumoniae a penicilina y su asociación con factores clínicos y epidemiológicos.

BACKGROUND: Penicillin and third generation cephalosporin resistant pneumococcal isolates have emerged in Chile, mainly in the pediatric population. These isolates complicate therapeutic alternatives, specially among patients with central nervous system infections. AIM: To assess the frequency of penicillin and third generation cephalosporin resistance among isolates obtained from pediatric patients with invasive pneumococcal infections, and to study serotypes and clinical risk factors associated with resistance. MATERIAL AND METHODS: Microbiological isolates obtained from children between April 1994 and May 1999 with pneumococcal invasive infections, were serotyped and analyzed according to their susceptibility to penicillin and cefotaxime by E-test and broth microdilution testing. Potential risk factors studied included patient's age, previous antibiotic use or admissions, comorbidity, and serotypes. RESULTS: Seventy eight patients were studied. Penicillin-resistant pneumococcal isolates were detected in 35.9% of cases (21.8% with intermediate and 14.1% with high level resistance) without significant variation among different clinical conditions. Most of the high level penicillin-resistant pneumoccocal isolates had MIC > or = 4 micrograms/mL (8 out of 11 strains). One third of penicillin-resistant isolates also expressed cefotaxime resistance. Multivariate analysis indicated an age < or = 36 months (OR = 6.8; IC 95%: 1.4 to 33.5) and serotype 14 (OR = 6.3; IC 95%: 1.7 to 23.3) as factors associated with penicillin resistance. CONCLUSIONS: One third of the invasive pneumococcal isolates obtained from pediatric patients were resistant to penicillin. Risk factors involved a younger age and pneumococcal isolates belonging to serotype 14.

Análisis del síndrome de dificultad respiratoria del recién nacido: hospital San José, Santiago 1991 / Analysis of respiratory distress syndrome of the newborn infant: San José hospital, Santiago 1991

En el año 1991 nacieron 7.772 RN vivos en el Hospital San José, de los cuales 135 evolucionaron con SDR obteniéndose una incidencia del 17,4 por mil RN vivoc. Las causas más frecuentes del SDR resultaron ser: SDRT (46,67 por ciento). SDRI (17,03 por ciento), y bronconeumonia (17,03 por ciento). Hubo predominio del sexo masculino (62,25 por ciento) y la vía del parto fue la cesárea en un 48,88 por ciento. Del total de RN con SDR se trasladó el 48,88 por ciento (66/135) a una Unidad de Cuidados Intensivos. El SDRI y la bronconeumonia fueron las enfermedades que motivaron mayor número de traslados. Permanecieron en el Hospital San José el 51,12 por ciento de los RN, correspondiendo a neonatos que evolucionaron con SDRT, SAM y bronconeumonia. Los promedios de peso y de edad gestacional de los neonatos con SDRT fue de 2.370 gramos y 34 semanas. Los del grupo con SDRI fueron 1.344 gramos y 29 semanas. El SAM predominó en el RN de término y se asoció a asfixia neonatal severa (APGAR al minuto=3). Un 36,29 por ciento de los neobnatos con SDR requirieron conexión a ventilación mecánica. La letalidad del SR resultó ser de un 23,7 por ciento. Las principales causas de muerte fueron: SDRI y bronconeumonia. La letalidad del grupo que permaneció en el Hospital San José fue de 4,48 por ciento. Se concluye que el SDRT resultó ser la causa mas frecuente del SDR. Se confirma que el SDRI es de alta letalidad. Se sugiere las siguientes estrategias para enfrentar el problema: 1. Cumplimiento de las normas de traslado del RN. 2. Creación de un Servicio de UCI neonatal en el Hospital San José. 3. Utilización del surfactante pulmonar exógeno en el tratamiento del SDRI

Enfermedad de Chagas aguda con signo de romaña-mazza en una lactante de zona hiperendémica / Acute Chagas disease with romaña-mazza sign in a suckling girl from hyperendemic zone

Se describe un caso de enfermedad de Chagas aguda adquirida, en una lactante menor procedente del área rural cercana a Combarbalá, en la IV Región de Chile, zona de alta endemia chagásica. El diagnóstico se sospecha por la presencia de complejo oftalmo-ganglionar o signo de Romaña-Mazza y se confirma con el hallazgo de tripomastigotes móviles de T. cruzi en el análisis microscópico de sangre al frasco. Es tratada con nifurtimox durante 60 días, más fenobarbital por 30 días, pero los exámenes de control -un mes después- indican persistencia de xenodiagnóstico positivo. Es tratada por segunda vez, con iguales drogas, por 30 días, y el control posterior revela que el xenodiagnóstico se ha vuelto negativo y la serología persiste positiva. No hubo reacción adversa al tratamiento en ninguna de las dos oportunidades. El cuadro infeccioso y el edema bipalpebral habían ya cedido con la primera cura, no obstante de que la paciente aún continuaba con parasistemia positiva. Este caso es presentado atendiendo a la rareza con que nuestro país son observados casos agudos de Enfermedad de Chagas adquirida, incluso dentro de las zonas de alta endemia

Enfermedad de Chagas en donantes de sangre del hospital de Combarbalá, IV Región, Chile / Chagas disease in blood donors of Combarbalá, IV Region, Chile

Se estudió serológicamentee la frecuencia de infección chagásica en 126 donantes del banco de sangre del Hospital de Combarbalá, zona de alta endemia, mediante reacción de hemaglutinación indirecta. Hubo 22 casos positivos (17,5), lo cual representa uno de los más altos porcentajes de infección por T. cruzi encontrados en dadores de sangre del país. A raíz de estos hallazgos se ha establecido un sistema de control sistemático de los donantes de sangre de ese Hospital, para descartar todas las sangres positivas