Neutralizing antibodies induced by homologous and heterologous boosters in CoronaVac vaccines in Chile.

OBJECTIVES: To determine the impact of a booster dose on the humoral response in individuals inoculated with a complete schedule of any SARS-CoV-2 vaccine, we evaluated the neutralizing antibody (NAb) titres of homologous or heterologous booster doses over a 90-days period in CoronaVac vaccinees from 3 centres in Santiago, Chile. METHODS: Individuals previously inoculated with 2 doses of CoronaVac (N = 523) were recruited in the context of the REFUERZO clinical trial (NCT04992182) and received either placebo (N = 129), or a booster dose of CoronaVac (N = 134), BNT162b2 (N = 133), or ChAdOx1 (N = 127). Pseudovirus neutralizing antibody titres (pVNT) were determined at baseline (day 0) as well as at days 14, 30, 60, and 90 after booster dose administration. RESULTS: Inoculating a booster dose increases the pVNTs titres at days 14 and 30 in all groups, (13.5- and 12.0-fold increase for the CoronaVac group; 247.0- and 212.3-fold increase for the BTN162b2 group; and 89.1- and 128.1-fold increase for ChAdOx1 at each time point, respectively) with a decline observed at days 60 and 90. However, although pVNTs remained significantly higher for the BTN162b2 and ChAdOx1 groups at days 60 and 90, NAb titres reached baseline levels in the CoronaVac group at 90 days after inoculation. DISCUSSION: A single heterologous booster (BTN162b2 or ChAdOx1) in individuals who completed the CoronaVac primary series resulted in an important increase in NAb titres remaining significantly higher at least for 90 days. These data may directly impact middle- and low-income countries currently using CoronaVac as the main vaccination strategy.

The Genome of the Marine Alga Ulva compressa (Chlorophyta) Reveals Protein-Coding Genes with Similarity to Plants and Green Microalgae, but Also to Animal, Bacterial, and Fungal Genes.

The genome of the marine alga Ulva compressa was assembled using long and short reads. The genome assembly was 80.8 Mb in size and encoded 19,207 protein-coding genes. Several genes encoding antioxidant enzymes and a few genes encoding enzymes that synthesize ascorbate and glutathione were identified, showing similarity to plant and bacterial enzymes. Additionally, several genes encoding signal transduction protein kinases, such as MAPKs, CDPKS, CBLPKs, and CaMKs, were also detected, showing similarity to plants, green microalgae, and bacterial proteins. Regulatory transcription factors, such as ethylene- and ABA-responsive factors, MYB, WRKY, and HSTF, were also present and showed similarity to plant and green microalgae transcription factors. Genes encoding enzymes that synthesize ACC and ABA-aldehyde were also identified, but oxidases that synthesize ethylene and ABA, as well as enzymes that synthesize other plant hormones, were absent. Interestingly, genes involved in plant cell wall synthesis and proteins related to animal extracellular matrix were also detected. Genes encoding cyclins and CDKs were also found, and CDKs showed similarity to animal and fungal CDKs. Few genes encoding voltage-dependent calcium channels and ionotropic glutamate receptors were identified as showing similarity to animal channels. Genes encoding Transient Receptor Potential (TRP) channels were not identified, even though TRPs have been experimentally detected, indicating that the genome is not yet complete. Thus, protein-coding genes present in the genome of U. compressa showed similarity to plant and green microalgae, but also to animal, bacterial, and fungal genes.

Tromboembolismo pulmonar masivo en covid-19: reporte de caso clínico / Massive pulmonary thromboembolism in covid-19: Clinical case report

La pandemia de COVID-19 actualmente ha demostrado la importancia de una evaluación y un manejo agresivos, al considerar su exposición como una enfermedad viral muy trasmisible que tiene efectos multisistémicos y una alta tasa de mortalidad. Es así que el diagnóstico y el tratamiento de la embolia pulmonar, son desafiantes en circunstancias habituales. Objetivo: Describir un caso clínico de tromboembolismo pulmonar masivo en covid-19. Reporte de Caso: Paciente de sexo masculino 42 años con antecedentes patológico personales de hipertensión arterial con prueba rápida para SARS COV-2 IGG e IGM positivo. Resultados: Se estima que cada año hay 900.000 casos de tromboembolismo venoso (TEV) en los Estados Unidos, 150.000 a 250.000 hospitalizaciones relacionadas con la embolia pulmonar (EP) y 60.000 a 100.000 muertes, lo que la convierte en la tercera causa más común de enfermedades cardiovasculares. Conclusión: Una vez que se diagnostica una embolia pulmonar, es necesaria la estratificación del riesgo para definir el manejo adecuado. Los tratamientos disponibles al momento pueden variar desde anticoagulación sola, trombólisis dirigida por catéter, trombólisis sistémica de dosis completa, embolectomía con catéter, embolectomía quirúrgica y soporte circulatorio mecánico como oxigenación por membrana extracorpórea (ECMO)(AU)

The COVID-19 pandemic has currently demonstrated the importance of aggressive evaluation and management, considering its exposure as a highly transmissible viral disease that has multisystem effects and a high mortality rate. Thus, the diagnosis and treatment of pulmonary embolism are challenging under usual circumstances. Objective: To describe a clinical case of massive pulmonary thromboembolism in covid-19. Case Report: A 42-year-old male patient with a personal pathological history of arterial hypertension with a positive rapid test for SARS COV-2 IGG and IGM. Results: There are an estimated 900,000 cases of venous thromboembolism (VTE) in the United States each year, 150,000 to 250,000 pulmonary embolism (PE)-related hospitalizations, and 60,000 to 100,000 deaths, making it the third most common cause of pulmonary embolism. cardiovascular diseases. Conclusion: Once a pulmonary embolism is diagnosed, risk stratification is necessary to define the appropriate management. Currently available treatments may range from anticoagulation alone, catheter-directed thrombolysis, full-dose systemic thrombolysis, catheter embolectomy, surgical embolectomy, and mechanical circulatory support such as extracorporeal membrane oxygenation (ECMO)(AU)

Ulva compressa from Copper-Polluted Sites Exhibits Intracellular Copper Accumulation, Increased Expression of Metallothioneins and Copper-Containing Nanoparticles in Chloroplasts.

In order to analyze the mechanisms involved in copper accumulation in Ulva compressa, algae were collected at control sites of central and northern Chile, and at two copper-polluted sites of northern Chile. The level of intracellular copper, reduced glutathione (GSH), phytochelatins (PCs), PC2 and PC4, and transcripts encoding metallothioneins (MTs) of U. compressa, UcMT1, UcMT2 and UcMT3, were determined. Algae of control sites contained around 20 µg of copper g-1 of dry tissue (DT) whereas algae of copper-polluted sites contained 260 and 272 µg of copper g-1 of DT. Algae of control sites and copper-polluted sites did not show detectable amounts of GSH, the level of PC2 did not change among sites whereas PC4 was increased in one of the copper-polluted sites. The level of transcripts of UcMT1 and UcMT2 were increased in algae of copper-polluted sites, but the level of UcMT3 did not change. Algae of a control site and a copper-polluted site were visualized by transmission electron microscopy (TEM) and the existence of copper in electrodense particles was analyzed using energy dispersive x-ray spectroscopy (EDXS). Algae of copper-polluted sites showed electrodense nanoparticles containing copper in the chloroplasts, whereas algae of control sites did not. Algae of a control site, Cachagua, were cultivated without copper (control) and with 10 µM copper for 5 days and they were analyzed by TEM-EDXS. Algae cultivated with copper showed copper-containing nanoparticles in the chloroplast whereas control algae did not. Thus, U. compressa from copper-polluted sites exhibits intracellular copper accumulation, an increase in the level of PC4 and expression of UcMTs, and the accumulation of copper-containing particles in chloroplasts.

Computer-assisted planning with 3D printing for mandibular reconstruction caused by a mandibular fracture with secondary osteomyelitis: A Case Report.

Mandibular reconstructions are complex clinical pictures that require careful planning for functional and aesthetic outcomes. Virtual surgical planning and 3D printing are ideal to achieve a predictable result. Through "hybrid techniques" (prebending plates with 3D-models) and free software, this goal is within reach for clinics with limited financial resources.

[Seasonal influenza campaign 2020 in the context of SARS-CoV-2 pandemic: an unprecedented public health experience in Chile]. / Campaña influenza 2020 en contexto de pandemia por SARS-CoV-2: una experiencia inédita de salud pública en Chile.

In Chile, the Immunization Department of the Ministry of Health has carried out the seasonal influenza vaccination campaign annually since 1982 in collaboration with the national health services, regional health offices, and primary health care centres. With the aim of preventing deaths and serious morbidity in high-risk groups and preserving the integrity of health services, the seasonal influenza campaign had been the largest implemented in Chile until 2020, since in 2021 the vaccination campaign against SARS-CoV-2 is expected to become the largest ever implemented. In response to local demographic and epidemiological changes, and taking into account the new scientific evidence on the safety and immunogenicity of vaccines, the influenza vaccines available in Chile would increase annually as a result of campaign planning. In 2020, the influenza campaign had to be re-planned while in progress due to the addition of new high-risk groups to be vaccinated in accordance with the SARS-CoV-2 pandemic health alert modification of March 6th, 2020. Over the course of three weeks, the Immunization Department managed to increase the doses of available influenza vaccines from 6,799,800 previously agreed upon to 8,480,325 and thus serve high-risk groups, guaranteeing their access to state funded influenza vaccination.

Anthracene induces oxidative stress and activation of antioxidant and detoxification enzymes in Ulva lactuca (Chlorophyta).

In order to analyze whether the marine macroalga Ulva lactuca can absorb and metabolize anthracene (ANT), the alga was cultivated with 5 µM ANT for 0-72 h, and the level of ANT was detected in the culture medium, and in the alga. The level of ANT rapidly decreased in the culture medium reaching a minimal level at 6 h, and rapidly increased in the alga reaching a maximal level at 12 h and then decreased to reach a minimal level at 48 h of culture. In addition, ANT induced an increase in hydrogen peroxide that remained until 72 h and a higher increase in superoxide anions that reach a maximal level at 24 h and remained unchanged until 72 h, indicating that ANT induced an oxidative stress condition. ANT induced an increase in lipoperoxides that reached a maximal level at 24 h and decreased at 48 h indicating that oxidative stress caused membrane damage. The activity of antioxidant enzymes SOD, CAT, AP, GR and GP increased in the alga treated with ANT whereas DHAR remained unchanged. The level of transcripts encoding these antioxidant enzymes increased and those encoding DHAR did not change. Inhibitors of monooxygenases, dioxygenases, polyphenol oxidases, glutathione-S-transferases and sulfotransferases induced an increase in the level of ANT in the alga cultivated for 24 h. These results strongly suggest that ANT is rapidly absorbed and metabolized in U. lactuca and the latter involves Phase I and II metabolizing enzymes.

Campaña influenza 2020 en contexto de pandemia por SARS-CoV-2: una experiencia inédita de salud pública en Chile / Seasonal influenza campaign 2020 in the context of SARS-CoV-2 pandemic: an unprecedented public health experience in Chile

Resumen Desde 1982, cada año el Departamento de Inmunizaciones del Ministerio de Salud de Chile lleva a cabo la campaña de vacunación contra influenza junto con las Secretarías Regionales Ministeriales-SEREMI, Servicios de Salud y centros de atención primaria de salud. Con los objetivos de prevenir mortalidad y morbilidad grave en grupos de mayor riesgo y de preservar la integridad de los servicios de salud, hasta el 2020 las campañas de vacunación contra influenza serían las más grandes implementadas en Chile, para dar paso, el 2021, a la vacunación contra SARS-CoV-2. Obedeciendo a cambios demográficos y epidemiológicos locales y acogiendo los avances científicos sobre seguridad e inmunogenicidad de la vacuna, el incremento de las vacunas influenza disponibles en Chile forma parte de la planificación anual de la campaña. El 2020, sin embargo, la Campaña Influenza tuvo que ser re-planificada en curso como consecuencia de la incorporación de nuevos grupos a vacunar según dispuso la modificación de la alerta sanitaria por brote de SARS-CoV-2 del 6 de marzo de 2020. Así, de 6.799.800 de dosis, el Departamento de Inmunizaciones logró en menos de dos meses aumentar la disponibilidad a 8.480.325, y cumplir con el compromiso de garantizar el acceso de los grupos de riesgo al beneficio de la vacunación estatal gratuita.

Abstract In Chile, the Immunization Department of the Ministry of Health has carried out the seasonal influenza vaccination campaign annually since 1982 in collaboration with the national health services, regional health offices, and primary health care centres. With the aim of preventing deaths and serious morbidity in high-risk groups and preserving the integrity of health services, the seasonal influenza campaign had been the largest implemented in Chile until 2020, since in 2021 the vaccination campaign against SARS-CoV-2 is expected to become the largest ever implemented. In response to local demographic and epidemiological changes, and taking into account the new scientific evidence on the safety and immunogenicity of vaccines, the influenza vaccines available in Chile would increase annually as a result of campaign planning. In 2020, the influenza campaign had to be re-planned while in progress due to the addition of new high-risk groups to be vaccinated in accordance with the SARS-CoV-2 pandemic health alert modification of March 6th, 2020. Over the course of three weeks, the Immunization Department managed to increase the doses of available influenza vaccines from 6,799,800 previously agreed upon to 8,480,325 and thus serve high-risk groups, guaranteeing their access to state funded influenza vaccination.

Benzopyrene induces oxidative stress and increases expression and activities of antioxidant enzymes, and CYP450 and GST metabolizing enzymes in Ulva lactuca (Chlorophyta).

MAIN CONCLUSION: Benzopyrene is rapidly incorporated and metabolized, and induces oxidative stress and activation of antioxidant enzymes, and CYP450 and GST metabolizing enzymes in Ulva lactuca. To analyze absorption and metabolism of benzo[a]pyrene (BaP) in Ulva lactuca, the alga was cultivated with 5 µM of BaP for 72 h. In the culture medium, BaP level rapidly decreased reaching a minimal level at 12 h and, in the alga, BaP level increased until 6 h, remained stable until 24 h, and decreased until 72 h indicating that BaP is being metabolized in U. lactuca. In addition, BaP induced an initial increase in hydrogen peroxide decreasing until 24 h, superoxide anions level that remained high until 72 h, and lipoperoxides that initially increased and decreased until 72 h, showing that BaP induced oxidative stress. Activities of antioxidant enzymes superoxide dismutase (SOD), catalase (CAT), ascorbate peroxidase (AP), glutathione reductase (GR) and glutathione peroxidase (GP) were increased, whereas dehydroascorbate reductase (DHAR) activity was unchanged. The level of transcripts encoding these antioxidant enzymes was increased, but transcripts encoding DHAR remained unchanged. Interestingly, the activity of glutathione-S-transferase (GST) was also increased, and inhibitors of cytochrome P450 (CYP450) and GST activities enhanced the level of BaP in algal tissue, suggesting that these enzymes participate in BaP metabolism.

Microbiota Modulates the Immunomodulatory Effects of Filifolinone on Atlantic Salmon.

Filifolinone is an aromatic geranyl derivative, a natural compound isolated from Heliotropum sclerocarpum, which has immunomodulatory effects on Atlantic salmon, upregulating cytokines involved in Th1-type responses through a mechanism that remains unknown. In this work, we determined whether the immunomodulatory effects of filifolinone depend on the host microbiotic composition. We evaluated the effect of filifolinone on immune genes and intestinal microbiotic composition of normal fish and fish previously treated with bacitracin/neomycin. Filifolinone induced the early expression of IFN-α1 and TGF-ß, followed by the induction of TNF-α, IL-1ß, and IFN-γ. A pre-treatment with antibiotics modified this effect, mainly changing the expression of IL-1ß and IFN-γ. The evaluation of microbial diversity shows that filifolinone modifies the composition of intestinal microbiota, increasing the abundance of immunostimulating organisms like yeast and firmicutes. We identified 69 operational taxonomic units (OTUs) associated with filifolinone-induced IFN-γ. Our results indicate that filifolinone stimulates the immune system in two ways, one dependent on fish microbiota and the other not. To our knowledge, this is the first report of microbiota-dependent immunostimulation in Salmonids.

Mechanisms of Copper Tolerance, Accumulation, and Detoxification in the Marine Macroalga Ulva compressa (Chlorophyta): 20 Years of Research.

Copper induces an oxidative stress condition in the marine alga Ulva compressa that is due to the production of superoxide anions and hydrogen peroxide, mainly in organelles. The increase in hydrogen peroxide is accompanied by increases in intracellular calcium and nitric oxide, and there is a crosstalk among these signals. The increase in intracellular calcium activates signaling pathways involving Calmodulin-dependent Protein Kinases (CaMKs) and Calcium-Dependent Protein Kinases (CDPKs), leading to activation of gene expression of antioxidant enzymes and enzymes involved in ascorbate (ASC) and glutathione (GSH) synthesis. It was recently shown that copper also activates Mitogen-Activated Protein Kinases (MAPKs) that participate in the increase in the expression of antioxidant enzymes. The increase in gene expression leads to enhanced activities of antioxidant enzymes and to enhanced levels of ASC and GSH. In addition, copper induces an increase in photosynthesis leading to an increase in the leve of Nicotinamide Adenine Dinucleotide Phosphate (NADPH). Copper also induces an increase in activities of enzymes involved in C, N, and S assimilation, allowing the replacement of proteins damaged by oxidative stress. The accumulation of copper in acute exposure involved increases in GSH, phytochelatins (PCs), and metallothioneins (MTs) whereas the accumulation of copper in chronic exposure involved only MTs. Acute and chronic copper exposure induced the accumulation of copper-containing particles in chloroplasts. On the other hand, copper is extruded from the alga with an equimolar amount of GSH. Thus, the increases in activities of antioxidant enzymes, in ASC, GSH, and NADPH levels, and in C, N, and S assimilation, the accumulation of copper-containing particles in chloroplasts, and the extrusion of copper ions from the alga constitute essential mechanisms that participate in the buffering of copper-induced oxidative stress in U. compressa.

Cytohistological correlation in patients with atypical glandular cells on Papanicolaou test in a Chilean population.

The standard screening test for detecting cervical lesions and cancers is a Papanicolaou (Pap) smear. While squamous cell abnormalities remain the most common positive Pap test result, cytologic findings of glandular cell abnormalities have become more frequent in recent decades. The 2014 Bethesda System for reporting cervical cytology includes the classification "atypical glandular cells" (AGC). AGC have morphological abnormalities that fall outside the range of reactive changes, but are insufficient for a diagnosis of invasive adenocarcinoma. In several histologic follow-up studies, most AGC cases were found to represent a benign condition. In the current study, we evaluate the significance of AGC cytology findings by analyzing the histologic follow-up results of a large number of patients with AGC. Most patients with AGC in this study were found to have a significant lesion on follow-up (63.9%), with negative histologic results in only 36.1% of patients. Among patients with significant lesions, the most common result was low-grade squamous intraepithelial lesion (26.6%), followed by high-grade squamous intraepithelial lesion (23.2%). This provides further evidence to support the Chilean Clinical Guidelines for Cervical Cancer, which recommends diagnostic follow-up studies in all women with AGC to minimize the chance of undetected serious cervical disease.

Immunostimulatory activity in mammalian cells of 3, 5-dihydroxy-7-methoxyflavanone ((-)-alpinone) isolated from Heliotropium huascoense resinous exudate / Actividad inmunoestimulante en células de mamífero de 3, 5-dihidroxi-7-metoxiflavanona ((-)-alpinona) aislada del exudado resinoso de Heliotropium huascoense

The flavonoid 3,5-dihydroxy-7-methoxyflavanone ((-)-alpinone) isolated from sticky resinous exudate of Heliotropium huascoense was evaluated as immunostimulatory in mammalian cells . Preliminary observations had showed that (-)-alpinone had increased the expression levels of pro-inflammatory cytokine transcripts in salmonid. Due to high morbidity and mortality that infectious diseases cause in humans, we evaluate the effect of (-)-alpinone as an immunostimulant in mammalian cells. Reactive oxygen species (ROS) are produced by macrophages activators for the destruction of pathogens; we evaluated (-)-alpinone effect in ROS generation and the proliferation of macrophages. The results showed that proliferation in Raw 264.7 cells treated with 10 and 25 µg/mL of (-)-alpinone had a significant increase in macrophage proliferation. In relation to ROS formation, cells treated with 1 and 5 µg/mL of (-)-alpinone, induce ROS formation in macrophages.

El flavonoide 3,5-dihidroxi-7-metoxiflavanona ((-)-alpinona) aislado del exudado resinoso de Heliotropium huascoense se evaluó como inmunoestimulador en células de mamíferos. Resultados preliminares habían demostrado que (-)-alpinona aumentaba los niveles de expresión de transcritos de citoquinas proinflamatorias en salmónidos. Debido a la alta morbilidad y mortalidad que causan las enfermedades infecciosas en los humanos, evaluamos el efecto de (-)-alpinona como inmunoestimulante en células de mamíferos. Dado que las especies de oxígeno reactivo (ROS) son producidas por macrófagos activados para la destrucción de patógenos, se evaluó el efecto de (- )-alpinona en la generación de ROS y la proliferación de macrófagos. Los resultados mostraron que la proliferación en células Raw264.7 tratadas con 10 y 25 µg / mL del flavonoíde tuvo un aumento significativo en la proliferación de macrófagos. En relación con la formación de ROS, las células tratadas con 1 y 5 µg/mL de (-)-alpinona, inducen la formación de ROS en los macrófagos.

Use of leukocyte and platelet-rich fibrin (L-PRF) in periodontally accelerated osteogenic orthodontics (PAOO): Clinical effects on edema and pain.

BACKGROUND: Demand for shorter treatment time is common in orthodontic patients. Periodontally Accelerated Osteogenic Orthodontics (PAOO) is a somewhat new surgical procedure which allows faster tooth movement via combining orthodontic forces with corticotomy and grafting of alveolar bone plates. Leukocyte and Platelet-Rich Fibrin (L-PRF) possess hard- and soft-tissue healing properties. Further, evidence of pain-inhibitory and anti-inflammatory potential is growing. Therefore, this study explores the feasibility, intra- and post-operative effects of using L-PRF in PAOO in terms of post-operative pain, inflammation, infection and post-orthodontic stability. MATERIAL AND METHODS: A pilot prospective observational study involving a cohort of 11 patients was carried out. A Wilcko's modified PAOO technique with L-PRF (incorporated into the graft and as covering membrane) was performed with informed consent. Post-surgical pain, inflammation and infection were recorded for 10 days post-operatively, while the overall orthodontic treatment and post-treatment stability were followed up to 2 years. RESULTS: Accelerated wound healing with no signs of infection or adverse reactions was evident. Post-surgical pain was either "mild" (45.5%) or "moderate" (54.5%). Immediate post-surgical inflammation was either "mild" (89.9%) or "moderate" (9.1%). Resolution began on day 4 where most patients experienced either "mild" or no inflammation (72.7% and 9.1%, respectively). Complete resolution was achieved in all patients by day 8. The average orthodontic treatment time was 9.3 months. All cases were deemed stable for 2 years. CONCLUSIONS: L-PRF is simple and safe to use in PAOO. Combination with traditional bone grafts potentially accelerates wound healing and reduces post-surgical pain, inflammation, infection without interfering with tooth movement and/or post-orthodontic stability, over a 2 years period; thus alleviating the need for analgesics and anti-inflammatory medications. KEY WORDS: Periodontally accelerated osteogenic orthodontics, leukocyte and platelet-rich fibrin, corticotomy, osteogenesis, grafts.

Fuentes de estrés percibidas y rendimiento académico de estudiantes de odontología chilenos / Perceived sources of stress and academic performance of Chilean dental students

Objetivo: Evaluar la influencia de distintas fuentes de estrés en el rendimiento académico de estudiantes de odontología de la Universidad de Chile. Sujetos y métodos: Se utilizó el cuestionario de estrés en el ambiente dental (DESQ) modificado de 25 preguntas, que se aplicó al 60% de los estudiantes de cada año. Se compararon distintas fuentes de estrés percibidas entre los cursos. La prueba r de Pearson se utilizó para determinar la influencia de las fuentes de estrés en el rendimiento académico. Resultados: Una muestra de 302 estudiantes respondió el cuestionario. Entre los resultados se identificó que las principales fuentes de estrés en todos los cursos eran las calificaciones y los exámenes, el miedo a fallar en un curso o un año y la falta de tiempo para relajarse. Un factor de estrés importante para los cursos superiores fue la atmósfera negativa creada por los supervisores clínicos. La carga de trabajo presentó una correlación negativa con el rendimiento académico, mientras que la práctica preclínica y clínica mostraron una correlación positiva. Conclusiones: El cuarto año parece ser el más estresante. El contacto temprano con los pacientes y una mejor planificación curricular y administración deben ponerse en práctica para evitar el aumento del estrés de la formación clínica

Aim: To assess the influence of perceived sources of stress amongst University of Chile dental students on their academic performance. Subjects and methods: In this research was used a modified Dental Environment Stress Questionnaire (DESQ) consisting of 25 questions was applied to 60% of students of each year. Tests were applied to compare perceived sources of stress between courses. The Pearson r test was used to determine the influence of stress sources on academic performance. Results: A sample of 302 students answered the questionnaire. In results, the main sources of stress in all courses were grades and examinations, fear of failing a course or a year and lack of time to relax. An important stressor for higher courses was the negative atmosphere created by clinical supervisors. Workload showed a negative correlation with academic performance, and preclinical and clinical training showed a positive correlation. Conclusions: The fourth year seems being the most stressful. Earlier contact with patients and an improvement in curriculum planning and administration should be put in practice to avoid the increased stress of the clinical training

Caso clínico: evaluación multimodal en medicina familiar / Clinic case: evaluation multimodal in family medicine

Se presenta el caso de una mujer de 43 años quien por trastornos del sueño y problemas de pareja. Al hacer la evaluación multimodal se encontró: a) área cognitiva: déficit cognitivo, operacional y afectivo, poca capacidad de insight; personalidad analógica media, dependiente sádica e histriónica. b) área afectiva: crisis de ansiedad, con depresión crónica, y poca tolerancia a las frustraciones. c) área somática: sobrepeso, trastornos del sueño. d) área interpersonal: relaciones de pareja conflictivas, poco apoyo familiar, relaciones sociales superficiales, e) área conductual: pocas habilidades de comunicación y de afrontamiento al estrés. Se estableció el siguiente plan terapéutico: a) área cognitiva: terapia cognitiva: explorar el modelo ABC, detección de creencias irracionales. d) área afectiva: ejercicio de la silla vacía, inducción de escenas cargadas afectivamente, y focalización posterior. e) área somática: ejercicios de relajación, indicaciones dietéticas y prescripción de ejercicios físicos, higiene del sueño. f) área interpersonal: orientación de pareja, con elaboración de contrato terapéutico y negación de los cambios y compromisos de cada uno. g) área conductual: entrenamiento asertivo, asignación de tareas para el hogar para mejorar habilidades de expresión, resolución de problemas y negación