Randomized Evaluation of a Remote Management Program to Improve Guideline-Directed Medical Therapy: The DRIVE Trial.

BACKGROUND: Several SGLT2i (sodium-glucose transport protein 2 inhibitors) and GLP1-RA (glucagon-like peptide-1 receptor agonists) reduce cardiovascular events and improve kidney outcomes in patients with type 2 diabetes; however, utilization remains low despite guideline recommendations. METHODS: A randomized, remote implementation trial in the Mass General Brigham network enrolled patients with type 2 diabetes with increased cardiovascular or kidney risk. Patients eligible for, but not prescribed, SGLT2i or GLP1-RA were randomly assigned to simultaneous virtual patient education with concurrent prescription of SGLT2i or GLP1-RA (ie, Simultaneous) or 2 months of virtual education followed by medication prescription (ie, Education-First) delivered by a multidisciplinary team driven by nonlicensed navigators and clinical pharmacists who prescribed SGLT2i or GLP1-RA using a standardized treatment algorithm. The primary outcome was the proportion of patients with prescriptions for either SGLT2i or GLP1-RA by 6 months. RESULTS: Between March 2021 and December 2022, 200 patients were randomized. The mean age was 66.5 years; 36.5% were female, and 22.0% were non-White. Overall, 30.0% had cardiovascular disease, 5.0% had cerebrovascular disease, and 1.5% had both. Mean estimated glomerular filtration rate was 77.9 mL/(min‧1.73 m2), and mean urine/albumin creatinine ratio was 88.6 mg/g. After 2 months, 69 of 200 (34.5%) patients received a new prescription for either SGLT2i or GLP1-RA: 53.4% of patients in the Simultaneous arm and 8.3% of patients in the Education-First arm (P<0.001). After 6 months, 128 of 200 (64.0%) received a new prescription: 69.8% of patients in the Simultaneous arm and 56.0% of patients in Education-First (P<0.001). Patient self-report of taking SGLT2i or GLP1-RA within 6 months of trial entry was similarly greater in the Simultaneous versus Education-First arm (69 of 116 [59.5%] versus 37 of 84 [44.0%]; P<0.001) Median time to first prescription was 24 (interquartile range [IQR], 13-50) versus 85 days (IQR, 65-106), respectively (P<0.001). CONCLUSIONS: In this randomized trial, a remote, team-based program identifies patients with type 2 diabetes and high cardiovascular or kidney risk, provides virtual education, prescribes SGLT2i or GLP1-RA, and improves guideline-directed medical therapy. These findings support greater utilization of virtual team-based approaches to optimize chronic disease management. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT06046560.

Rapid turnover of a pea aphid superclone mediated by thermal endurance in central Chile.

Global change drivers are imposing novel conditions on Earth's ecosystems at an unprecedented rate. Among them, biological invasions and climate change are of critical concern. It is generally thought that strictly asexual populations will be more susceptible to rapid environmental alterations due to their lack of genetic variability and, thus, of adaptive responses. In this study, we evaluated the persistence of a widely distributed asexual lineage of the alfalfa race of the pea aphid, Acyrthosiphon pisum, along a latitudinal transect of approximately 600 km in central Chile after facing environmental change for a decade. Based on microsatellite markers, we found an almost total replacement of the original aphid superclone by a new variant. Considering the unprecedented warming that this region has experienced in recent years, we experimentally evaluated the reproductive performance of these two A. pisum lineages at different thermal regimes. The new variant exhibits higher rates of population increase at warmer temperatures, and computer simulations employing a representative temperature dataset suggest that it might competitively displace the original superclone. These results support the idea of a superclone turnover mediated by differential reproductive performance under changing temperatures.

Growth of long bones in European and Japanese quail from the 13th day of incubation to day 35 post-hatch.

This study described the growth, morphometric, biomechanical, and chemical properties of the femur, tibiotarsus, and tarsometatarsus of European and Japanese quail. Analyses were performed at 13 and 15 days of incubation, at hatch, and at 4, 7, 10, 14, 21, 28, and 35 days post-hatch (n=6/subspecies/period). Bone specimens were analyzed by cone-beam computed tomography, biomechanical assays, chemical analyses, and histomorphometry. Variables were fitted by the Gompertz function and its derivative or assessed using the analysis of variance. Analysis of the derivative of Gompertz curves showed that the growth behavior of the tarsometatarsal bone was similar between quail subspecies, and the femur and tibiotarsus of European quail increased first in width and then in length, whereas the opposite occurred in Japanese quail. There was an interaction between quail subspecies and days of growth on femoral, tarsometatarsal, and tibiotarsal bone densities. Femoral and tibiotarsal cross-sectional areas were influenced by the interaction of quail subspecies and day of growth. Interaction effects were significant for breaking strength and phosphorus percentage. European and Japanese quail have different femoral and tibiotarsal growth patterns, especially in the first few days after hatching, whereas tarsometatarsal growth is similar between subspecies.

Facultative endosymbionts modulate the aphid reproductive performance on wheat cultivars differing in contents of benzoxazinoids.

BACKGROUND: Facultative bacterial endosymbionts have the potential to influence the interactions between aphids, their natural enemies, and host plants. Among the facultative symbionts found in populations of the grain aphid Sitobion avenae in central Chile, the bacterium Regiella insecticola is the most prevalent. In this study, we aimed to investigate whether infected and cured aphid lineages exhibit differential responses to wheat cultivars containing varying levels of the benzoxazinoid DIMBOA (2,4-dihydroxy-7-methoxy-2H-1,4-benzoxazin-3(4H)-one), which is a xenobiotic compound produced by plants. Specifically, we examined the reproductive performance responses of the most frequently encountered genotypes of Sitobion avenae when reared on wheat seedlings expressing low, medium, and high concentrations of DIMBOA. RESULTS: Our findings reveal that the intrinsic rate of population increase (rm ) in cured lineages of Sitobion avenae genotypes exhibits a biphasic pattern, characterized by the lowest rm and an extended time to first reproduction on wheat seedlings with medium levels of DIMBOA. In contrast, the aphid genotypes harbouring Regiella insecticola display idiosyncratic responses, with the two most prevalent genotypes demonstrating improved performance on seedlings featuring an intermediate content of DIMBOA compared to their cured counterparts. CONCLUSION: This study represents the first investigation into the mediating impact of facultative endosymbionts on aphid performance in plants exhibiting varying DIMBOA contents. These findings present exciting prospects for identifying novel targets for aphid control by manipulating the presence of aphid symbionts. © 2023 Society of Chemical Industry.

Growth of breast muscles in European and Japanese quail raised in meat production system: a morphological analysis.

Growth curves have been described in the quail but with no attention to the muscle composing of the breast. The description of the characteristics of growth curves to body weight and to breast muscle was the aim of this study. Morphological development of Musculus supracoracoideus and Musculus pectoralis in European and Japanese quail was assessed from the final incubation of to 35 days. Gompertz models were adjusted with maximum growth rates to body weight, breast weight, and Musculus pectoralis and supracoracoideus weight at 17.6; 22.2; 23.5, and 21.4 days. The European quail had a higher body and breast weight at maturity. Musculus supracoracoideus developed faster in both subspecies but with larger Musculus pectoralis. Both musculus had a greater number of fibers type IIA and largest fibers IIB, with quadratically increasing in fiber diameter with age in both subspecies and muscles. At 35 days, results of meat quality indicated similarity between genders and subspecies, with darker and redness breast meat in Japanese quail. In conclusion, breast weight gain was a result of type IIA and IIB fiber hypertrophy in both muscles and, despite the difference in size and aptitude, Japanese and European quail showed similar body and muscle growth patterns.

Productive performance, breast growth and digestive system development in European quail subjected to post-hatch fasting for different periods.

This study assessed the effect of different periods of post-hatch fasting on animal performance and breast and digestive system growth in European quail. Quail chicks were distributed in a completely randomized design, with four fasting periods (0, 24, 36, and 48 hs) and four replications of 40 birds per treatment. In 1 to 14-day-old chicks, weight gain decreased with increasing fasting time. Compensatory gain was observed from 15 days of age onward. Fasted quail had a lower length and relative weight of the digestive system than fed animals for up to 14 days. Histologically, the duodenal villus height was significantly lower in 3-day-old quail fasted for 36 hs than in those fasted for 48 hs, but this effect was not observed at 7 days. Scanning electron microscopy showed no differences in the small intestinal mucosa between fasted and fed birds at 3 days of age. Post-hatch fasting reduced the relative weight of the breast in quail aged 1 to 14 days but did not affect type IIa and IIb fiber diameter at 35 days. On the basis of these results, it is recommended that European quail raised for meat should not be fasted for more than 48 hs post-hatch.

Rehabilitación domiciliara de pacientes con síndrome post UCI por COVID-19 / Home rehabilitation of patients with post ICU síndrome due to COVID-19

Objetivo: En marzo del año 2020, se declaró pandemia la enfermedad producida por el coro-navirus SARS-CoV-2 (COVID 19). Se estimaba inicialmente que el 5% de la población afectada por COVID-19 requeriría ingreso a unidades de cuidados intensivos con soporte de ventilación mecánica invasiva, pudiendo desarrollar secue-las a partir de la hospitalización. El equipo de rehabilitación domiciliaria se propone el desafío de realizar una serie de evaluaciones con la fi-nalidad de poder valorar la rehabilitación en el ámbito domiciliario.Método: Ensayo clínico no controlado de pa-cientes de la unidad de hospitalización domici-liaria que hayan sufrido COVID-19 con uso de VMI, entre junio 2020 y junio 2021. Ingresaron 193 pacientes, a los cuales se le realizó eva-luaciones al inicio y al final del proceso de re-habilitación por un equipo multidisciplinar en el domicilio del paciente.Resultados: Prevalencia de comorbilidades de hipertensión arterial y obesidad. en la forma grave de dicha enfermedad. Diferencia significa en todas las evaluaciones P (Wilcoxon)<0,001 entre el estado inicial y posterior a la rehabilita-ción, presencia de mayor deterioro en extremi-dades superiores.Conclusión: Pacientes con múltiples secuelas que requieren de la evaluación e intervención precoz de un equipo multidisciplinario, siendo la hospitalización domiciliaria una alternativa segura, eficiente y eficaz. Se logró el restable-cimiento de la deambulación segura e indepen-diente, la prevención de caídas, alimentación segura, recuperación de las destrezas cogniti-vas-comunicativas, y el empoderamiento de la familia en un contexto domiciliario. (AU)

Objective: In March 2020, the disease caused by the coronavirus SARS-CoV-2 (COVID-19) was declared a pandemic. It was initially esti-mated that 5% of the population affected by COVID-19 required admission to intensive care units with invasive mechanical ventilation sup-port, and may develop sequelae from hospitali-zation. The home rehabilitation team proposes the challenge of carrying out a series of evalua-tions in order to be able to assess rehabilitation in the home environment.Method: Uncontrolled clinical trial of patients from the home hospitalization unit who have suf-fered from COVID-19 with the use of IMV, be-tween June 2020 and June 2021. 193 patients were admitted, who underwent surgery at the beginning and at the end of the rehabilitation process for a multidisciplinary team at the pa-tient’s home.Results: Prevalence of comorbidities of arterial hypertension and obesity. in the severe form of this disease. Mean difference in all P (Wilcoxon) scores <0.001 between baseline and post-reha-bilitation status, presence of greater impairment in upper extremities.Conclusions: Patients with multiple sequelae that require early evaluation and intervention by a multidisciplinary team, home hospitalization being a safe, efficient and effective alternative. The restoration of safe and independent ambu-lation, the prevention of falls, safe eating, recov-ery of cognitive-communicative skills, and the empowerment of the family in a home context were achieved. (AU)

Neuro-Behcet's syndrome: Case report and literature review.

Behcet's disease (BD) is a multisystem, autoimmune vasculitis disorder affecting small, medium, and large blood vessels, with poorly understood pathogenesis. It commonly presents with recurrent aphthous ulcers, genital ulcers, skin lesions, and bilateral uveitis. Neurological symptoms are present in less than 10% of cases and develop, on average, 5-6 years after the first non-neurological symptoms. This presentation, known as Neuro-Behcet's disease (NBD), is associated with a worse prognosis of BD. Treatment for NBD is dependent on the severity of symptoms and the presence of other systemic manifestations but often initially involves glucocorticoids and a disease-modifying agent. This case report presents a 44-year-old female patient, previously diagnosed with BD, who presented with neurological symptoms and MRI findings consistent with NBD.

A mutation increases the specificity to plant compounds in an insect chemosensory protein.

Host plant recognition are highly dependent on chemosensory perception, which involves chemosensory proteins (CSPs) that bind key chemical compounds the host plants. In this work, we hypothesize that two closely related aphid taxa, which differ in diet breadth, also differ in their CSPs. We detected a non-synonymous difference (lysine for asparagine) between M. persicae sensu stricto (Mpp) and the subspecies M. p. nicotianae (Mpn) in the sequence of a CSP (CSP5). We modeled in silico the binding capacity of both CSP5s variants with 163 different potential ligands from their host plants (120 unique from tobacco, 29 unique from peach, and 14 common ligands). After docking analysis with all ligands, we selected the three best ligands for each variant to perform molecular dynamics (tobacco: 2-cyclopentene-1,4-dione, salicylaldehyde, and benzoic acid; peach: phenol, valeric acid, and benzonitrile). The binding energy of the MpnCSP5 model to the studied ligands was, in all cases, lower than with the MppCSP5 model. The ligands from the host plants showed more stable binding with MpnCSP5 than with MppCSP5. This result suggests that the set of CSPs studied among M. persicae s. str. and M. p. nicotianae are very similar, but focusing on the CSP5 protein, we found a single key mutation that increases affinities for host compounds for M. p. nicotianae, which might have contributed to the specialization to tobacco. This study provides new insights into an evolutionary trend toward specificity in a binding protein.

Descripción y manejo del paciente traqueostomizado en Hospitalización Domiciliaria: experiencia en el Complejo Asistencial Doctor Sótero del Río / Description and management of the tracheostomy patient in Hospital at Home: experience in the Doctor Sótero del Río Care Complex

Introducción: La traqueostomía (TQT) es uno de los procedimientos más antiguos y frecuentes realizados en los pacientes críticos. Se estima que 1 de cada 10 pacientes con apoyo de ventilación mecánica requerirán una TQT, siendo el manejo clínico en hospitalización domiciliaria (HD) muy similar de lo reportado en la literatura intrahospitalariaMétodo:Estudio descriptivo retrospectivo de los pacientes traqueostomizados ingresados a la Unidad de Hospitalización Domiciliaria del Complejo Asistencial Dr. Sótero del Río desde enero del año 2016 hasta abril del 2020. Para el análisis de datos se utilizó el programa estadístico IBM SPSS 24.Resultados:Un total de 96 pacientes traqueostomizados ingresaron al estudio, con una mediana de 64,5 (min. 16; máx. 88) años, el principal motivo de ingreso a HD fue por tratamiento de patologías respiratorias agudas (41,7%); los principales motivos por lo que estos pacientes poseían una TQT fue a causa de patologías neurológicas y debido a ventilación mecánica prolongada (40,6%). La mediana de uso de TQT previo al ingreso a HD fue de 90 (min. 2; máx. 3960) días y la mediana de estadía en HD fue de 22 (min. 2; máx. 150) días. En 87 (90.6%) usuarios se planteó el objetivo de manejo y educación en traqueotomía, y en 9 (9,3%) la rehabilitación para decanulación; teniendo éxito en 8 (88,8%) de ellos. Con relación a su manejo se basó en cuidados generales de TQT y estoma, educación, manejo de urgencias y decanulación.Conclusión:Resulta importante el abordaje multidisciplinario de los pacientes traqueostomizados en HD bajo el lineamiento de protocolos y estándares mínimos de atención, pudiéndose realizar procedimientos que antes se creían exclusivos de la atención intrahospitalaria (decanulación y cambios de cánula). Esto podría ser una alternativa viable en relación con el ahorro de la estancia hospitalaria y mejor gestión del recurso cama. (AU)

Introduction. Tracheostomy (TQT) is one of the oldest and most frequent procedures performed in critically ill patients. About 1 in 10 patients with mechanical ventilation support will require a TQT, with clinical management in hospital at home (HAH) being very similar to that reported in the in-hospital literature.Methods.Retrospective descriptive study of tracheostomized patients admitted to hospital at home Unit of Dr. Sótero del Río Care Complex from January 2016 to April 2020. The statistical program IBM SPSS 24 was used for data analysis.Results:A total of 96 tracheostomized patients entered the study, with a median of 64.5 (min. 16; max. 88) years of age, the main reason for admission to HAH was treatment of acute respiratory diseases (41.7%); the main reasons why these patients had TQT was due to neurological pathologies and due to prolonged mechanical ventilation (40.6%). The median used of TQT prior to admission to HD was 90 (min. 2; max. 3960) days and the median stay on HD was 22 (min. 2; max. 150) days. In 87 (90.6%) users the objective of tracheostomy management and education was set, and in 9 (9.3%) rehabilitation for decannulation; succeeding in 8 (88.8%) of them. In relation to its management, it was based on general TQT and stoma care, education, emergency management and decannulation.Conclusion:The multidisciplinary approach of tracheostomized patients on HAH is important under the guidelines of protocols and minimum standards of care, being able to perform procedures that were previously believed exclusive to in-hospital care (decannulation and cannula changes). This could be a viable alternative for decreasing hospital stay and optimize bed resource management. (AU)

Genome sequencing of a predominant clonal lineage of the grain aphid Sitobion avenae.

The English grain aphid, Sitobion avenae, is a cosmopolitan pest that feeds on cereals, provoking substantial yield losses by injuring plant tissue and by vectoring plant viruses. Here we report a highly complete, de novo draft genome of the grain aphid using long-read sequencing. We generated an assembly of 2740 contigs with a N50 of 450 kb. We compared this draft genome with that of other aphid species, inspecting gene family evolution, genome-wide positive selection, and searched for horizontal gene transfer events. In addition, we described a recent copy number variant expansion of gene families involving aconitase, ABC transporter, and esterase genes that could be associated with resistance to insecticides and plant chemical defenses. This S. avenae genome obtained from a predominant invasive genotype can provide a framework for studying the spatial-temporal success of these clonal lineages in invaded agroecosystems.

Target site mutations underlying insecticide resistance in Tunisian populations of Myzus persicae (Sulzer) on peach orchards and potato crops.

BACKGROUND: The massive use of synthetic insecticides strongly affects the level of insecticide resistance in populations of Myzus persicae worldwide. The selection of target site insensitivity-mutations is particularly worrying in areas where agro-industrial crops are vulnerable to the attacks of aphids that vector viruses, as in the case of Tunisia. Knowledge of the resistance mechanisms evolved locally in this aphid pest is a prerequisite to improving and retaining the sustainability of integrated pest management strategies. RESULTS: Target site mutations were surveyed in several populations of M. persicae collected from peach and potato crops between 2011 and 2017 in three Tunisian regions using real-time allele-specific PCR. The L1014F mutation (kdr locus) was found at a moderate frequency mostly in the heterozygous state and the homozygous resistant genotype was very uncommon. The M918T mutation (super-kdr locus) was present in a few heterozygous individuals, whereas the M918L mutation was detected for the first time in Tunisia and extreme North Africa. This latter mutation was shown to be widespread and well-established in Tunisia mainly as homozygous individuals, and was more abundant on peach than on potato crops. The S431F mutation (MACE) was found in a few heterozygous individuals. No individuals carrying the R81T mutation linked to neonicotinoid resistance were detected. CONCLUSION: This study points out a critical situation for the efficacy of pyrethroid insecticides to control M. persicae populations in Tunisia. It also confirms the rapid spread of the M918L mutation which has been detected in many different areas of the Mediterranean basin. © 2022 Society of Chemical Industry.

Sweet Syndrome in an Adolescent Patient With Differentiation Syndrome Secondary to Promyelocytic Leukemia Treatment With All-Trans Retinoic Acid.

Sweet syndrome (SS) is an acute febrile neutrophilic dermatosis that is histologically characterized by an infiltration of the dermis by neutrophils. A 12-year-old adolescent female patient recently diagnosed with acute promyelocytic leukemia presented with fever and was hospitalized for antibiotic management after 22 days of being treated with a treatment protocol based on daunorubicin, all-trans retinoic acid (ATRA), and prophylaxis with dexamethasone, the patient developed erythematous skin lesions located mostly on the extremities. Lesions evolved into painful subcutaneous nodules, and one lesion evolved into a 2.5-cm blister with a purple and necrotic base. A skin biopsy was performed and showed neutrophilic dermatosis which confirmed the diagnosis of SS. The patient's clinical features complied with criteria for differentiation syndrome complicated by shock. Two days after ATRA was suspended, the patient presented resolution of the fever and skin lesions. SS is a rare neutrophilic dermatosis secondary to an innate immune disorder classified into four categories: classical (idiopathic), para-inflammatory, paraneoplastic or pregnancy-related. SS has been described in patients with acute myeloid leukemia in adults secondary to the use of drugs such as ATRA or as a part of a paraneoplastic syndrome. SS can occur exceptionally in children with myeloid leukemia secondary to the use of drugs such as ATRA.

Changes in the genetic composition of Myzus persicae nicotianae populations in Chile and frequency of insecticide resistance mutations.

Myzus persicae is a cosmopolitan aphid that is highly polyphagous and an important agricultural pest. The subspecies M. persicae nicotianae has been described for highly specialized phenotypes adapted to tobacco (Nicotiana tabacum). In Chile, the population of M. persicae nicotianae was originally composed of a single red genotype that did not possess insecticide resistance mutations. However, in the last decade, variation in the colour of tobacco aphids has been observed in the field. To determine whether this variation stems from the presence of new genotypes, sampling was carried out across the entire distribution of tobacco cultivation regions in Chile. The aphids collected were genotyped, and the frequency of kdr (L1014F), super-kdr (M918T), modification of acetylcholinesterase (MACE) and nicotinic acetylcholine receptor ß subunit (nAChRß) mutations associated with insecticide resistance was determined. A total of 16 new genotypes of M. persicae nicotianae were detected in Chile: four of them possessed the MACE mutation, and none of them possessed the kdr, super-kdr or nAChRß mutation. The previously described red genotype was not detected in any of the sampled fields over two seasons. These results raise questions about the mechanisms underlying changes in the genetic structure of M. persicae nicotianae populations in Chile. Future research aimed at addressing these questions could provide new insight into aphid evolution and agricultural practices.

Global patterns in genomic diversity underpinning the evolution of insecticide resistance in the aphid crop pest Myzus persicae.

The aphid Myzus persicae is a destructive agricultural pest that displays an exceptional ability to develop resistance to both natural and synthetic insecticides. To investigate the evolution of resistance in this species we generated a chromosome-scale genome assembly and living panel of >110 fully sequenced globally sampled clonal lines. Our analyses reveal a remarkable diversity of resistance mutations segregating in global populations of M. persicae. We show that the emergence and spread of these mechanisms is influenced by host-plant associations, uncovering the widespread co-option of a host-plant adaptation that also offers resistance against synthetic insecticides. We identify both the repeated evolution of independent resistance mutations at the same locus, and multiple instances of the evolution of novel resistance mechanisms against key insecticides. Our findings provide fundamental insights into the genomic responses of global insect populations to strong selective forces, and hold practical relevance for the control of pests and parasites.

Sub-Lethal Effects of λ-Cyhalothrin on Behavior and Development of the Parasitoid Aphidius colemani (Hymenoptera: Braconidae) on kdr-Resistant and Susceptible Green Peach Aphid, Myzus persicae (Hemiptera: Aphididae).

The green peach aphid, Myzus persicae (Sulzer), is a pest mainly controlled with insecticides, and it can acquire resistance through different mechanisms. Pyrethroids can select the knock down resistance (kdr) mutation in M. persicae and can also produce lethal and sub-lethal effects on its main parasitoid, Aphidius colemani Viereck. However, kdr-resistant M. persicae exhibits a reduced response to alarm pheromone and increased vulnerability to natural enemies. To study the effects of sub-lethal concentrations of a pyrethroid on the aphid-parasitoid interaction, kdr-resistant and susceptible M. persicae were confronted with A. colemani with residual sub-lethal concentrations of λ-cyhalothrin. The behavior, survival, and development of parasitoids were evaluated after exposure to λ-cyhalothrin LC20 for adult parasitoids (0.52 mg/liter) for susceptible (Mp-SS, 0.56 mg/liter) and kdr-resistant M. persicae (Mp-RR, 12.15 mg/liter). The foraging and oviposition behaviors of the parasitoids were not affected by the lower parasitoid or Mp-SS LC20. Conversely, the higher Mp-RR LC20 significantly reduced parasitoid walking, the frequency of sting attempts, and successful stings, as well as aphid defensive behaviors, such as walking, kicking, and jerking. Therefore, the higher vulnerability of kdr-resistant M. persicae could not be capitalized by A. colemani parasitoids under a high concentration of λ-cyhalothrin. Similarly, the parasitism rate, survival of progeny, productivity, sex ratio (proportion of females), longevity, and adult body mass were reduced, and the development time increased with a higher Mp-RR LC20. Our results suggest that A. colemani could efficiently control kdr-resistant and susceptible M. persicae only at lower λ-cyhalothrin concentrations.

Protecting Women's and Newborns' Rights in a Public Maternity Unit During the COVID-19 Outbreak: The Case of Dra. Eloísa Díaz - La Florida Hospital in Santiago, Chile.

The Maternity in Dra. Eloísa Díaz' hospital, located in the municipality of La Florida and city of Santiago, Chile, opened its doors in 2014, and has integrated a humanistic model of care called the "Safe Model of Personalized Childbirth" since 2016. With around 3,000 births per year, it has been recognized as an example of excellence in maternity care in the country. The COVID-19 outbreak presented a big challenge to this Maternity: to maintain its quality of care standards despite the health crisis. This article presents the Maternity's responses to the pandemic from March to July 2020, describing the strategies that were deployed and the obstetric outcomes achieved. Semi-structured interviews with midwives and OB-GYNs, and a retrospective review of the childbirth standards of care and outcomes of the 55 women who tested positive for SARS-CoV-2, were carried out. The results show how the Maternity's staff responded in order to avoid a significant negative impact on the rights of women and newborns. Protocols to reestablish the companion during labor and childbirth and skin-to-skin contact, which were suspended for almost three weeks at the beginning of the outbreak, and the creation of an Instagram account to communicate with the external community were some of the measures taken. After some initial weeks of adjustment, the standards of care for all women, included for those diagnosed with COVID-19, were reestablished almost to pre-pandemic levels. This case shows that quality of care can be maintained and the rights of women and newborns can be respected during health crisis such as the COVID-19 pandemic.

Kinesiología en las unidades de hospitalización domiciliaria en Chile / Kinesiology in hospital at home units in Chile

INTRODUCCIÓN: La hospitalización domiciliaria nace con el objetivo de ser una alternativa a la hospitalización tradicional, similar en recursos y complejidad. Dentro de las prestaciones que se puede entregar, se encuentra la kinesiología. Sin embargo, no existen información específica sobre el perfil ni el quehacer de estos profesionales en dichas unidades. Por lo que se busca con este trabajo, describir y caracterizar el trabajo de los kinesiólogos/as que se desempeñan en unidades de hospitalización domiciliaria en hospitales públicos de Chile. Materiales y MÉTODO: Estudio descriptivo transversal realizado mediante una encuesta a kinesiólogos/as que trabajan en unidades de hospitalización a domicilio en hospitales públicos de Chile. Realizada entre marzo y agosto de 2019. Para el análisis estadístico se utilizó el software Rstudio. RESULTADOS: De 82 hospitales encuestados, 59 cuentan con hospitalización domiciliaria, de estos, 45 cuentan con kinesiología. Dentro de las áreas más desarrolladas en adultos, son la kinesiología respiratoria (95,3%), la kinesiología motora (93,4%), y la neurorrehabilitación (90,1%). En pediatría es la kinesiología respiratoria (28,1%). El 32% de las unidades cuenta con un coordinador/a de profesión kinesiólogo/a. CONCLUSIONES: La kinesiología permite entregar diferentes prestaciones en domicilio tanto a adultos como niños. Sin embargo, esto surge según la necesidad de cada hospital y no está definido a nivel nacional, por lo que se propone avanzar hacia lineamientos que permitan la estandarizar la incorporación de esta profesión a todas las unidades de hospitalización domiciliaria

INTRODUCTION: Home hospitalization was created with the aim of being an alternative to traditional hospitalization, similar in resources and complexity. Among the attentions that can be delivered, is kinesiology. However, there is no specific information on the profile or work of these professionals in these units. Therefore, this work seeks to describe and characterize the work of kinesiologists who work in home hospitalization units in public hospitals in Chile. MATERIALS AND METHOD: Cross-sectional descriptive study carried out by means of a survey of kinesiologists who work in home hospitalization units in public hospitals in Chile between March and August 2019. The Rstudio software was used for the statistical analysis. RESULTS: Of 82 hospitals surveyed, 59 have home hospitalization, of these, 45 have kinesiology. Among the most developed areas in adults are respiratory kinesiology (95.3%), motor kinesiology (93.4%), and neurorehabilitation (90.1%). In pediatrics it is respiratory kinesiology (28.1%). 32% of the units have a coordinator by profession kinesiologist. CONCLUSIONS: Kinesiology allows delivering different benefits at home to both adults and children. However, this arises according to the need of each hospital and is not defined at the national level, so it is proposed to move towards guidelines that allow the standardization of the incorporation of this profession to all home hospitalization units

Uso de cánula nasal de alto flujo en usuarios con patologías respiratorias agudas en hospitalización domiciliaria / Use of High-Flow Nasal Cannula in Users with acute Respiratory Diseases Receiving Hospital at Home

Introducción: La Hospitalización Domiciliaria (HD) se posiciona como un servicio trascendental, demostrando una gran efectividad en el tratamiento de patologías respiratorias. Objetivos: Evaluar los efectos de las cánulas nasales de alto flujo (CNAF), describir la experiencia de pacientes tratados con esta terapia en HD y plantear un protocolo que estandarice la utilización de este equipo en contexto de patología respiratoria aguda en domicilio. Material y Métodos: Esto se llevó a cabo por medio de un estudio cuasiexperimental, con pacientes ingresados a HD entre los meses de mayo a septiembre del año 2019, para el análisis estadístico se utilizó el programa Minitab 17.0. Resultados: Cumplieron los criterios de inclusión 11 usuarios, el promedio de la edad fue 73 ± 7.8 años.El 100% (N = 11) fueron derivados con requerimientos de oxígeno, desde el servicio de urgencias. El 73,2% (N = 8) ingresaron con patologías clasificadascomo J15 y J44; el 18,1% (N = 2) ingreso con diagnóstico clasificado en J84 y J46 el 9% (N = 1) según CIE-10. El promedio de días de conexión fue de 7.5 ± 5.1 días. Se utilizó un flujo promedio de 35 ± 5.2 l/min, FiO2 de 33 ± 6,1% y una temperatura en Grados Celsius (°C) de 32.3 ± 5.1. Los signos clínicos que tuvieron cambios estadísticamente significativos (Kruskal Wallis, p < 0.05) BORG, el UMA, FR y el Índice de SAFI. Mientras que la SpO2 y la FC no mostraron diferencias estadísticamente significativas. Conclusión: Si bien el número de pacientes tratados fue bajo, hay efectos potencialmente significativos en parámetros de relevancia para este tipo de patologías, lo cual puede servir de base para futuros estudios

Use of High-Flow Nasal Cannula in Users with acute Respiratory Diseases Receiving Hospital at Home / Uso de cánula nasal de alto flujo en usuarios con patologías respiratorias agudas en hospitalizacion domiciliaria

Introduction: Hospital at Home (HAH) is considered an extremely important service, showing great efficacy in the treatment of respiratory diseases. Objectives: To evaluate the effects of high-flow nasal cannulas (HFNCs), describe the experience of patients treated with this therapy as HC and propose a protocol that standardizes the use of this equipment in the context of acute respiratory diseases as home care. Materials and Methods: This was done by means of a quasi-experimental study with patients admitted to HAH between May and September 2019. For the statistical analysis we used Minitab 17.0. Results: 11 subjects met the inclusion criteria, with a mean age of 73 ± 7.8 years. 100% of them (N = 11) had been referred from the emergency service with oxygen requirements. 73.2% (N = 8) were admitted with diseases classified as J15 and J44; 18.1% (N = 2) had diagnosis code J84 and 9% (N = 1) had diagnosis code J46, according to the ICD-10 (International Classification of DiseasesTenth Edition). The mean duration of the HFNC connection was 7.5 ± 5.1 days. We used a mean flow of 35 ± 5.2 L/min, FiO2 of 33 ± 6.1% and a temperature of 32.3 ± 5.1 Degrees Celsius (°C). The clinical signs with statistically significant changes were (Kruskal Wallis, p < 0.05) the BORG Scale, UAM, RR and the SAFI Index. The SpO2 and HR didn't show statistically significant differences. Conclusion: Despite the fact that the number of patients under treatment was low, there are potentially significant effects in parameters of relevance for this type of diseases, and this may serve as a basis for future studies.