Caracterización clínica y sociodemográfica del intento suicida en la Región de Los Ríos, Chile

Introducción: El intento suicida es uno de los factores de riesgo suicida más relevantes, conocer variables asociadas y estrategias de seguimiento post-intento suicida contribuye a prevenir el suicidio. Objetivos: el objetivo de este trabajo fue describir características clínico-sociodemográfica de las personas que presentan intento de suicidio, y dar a conocer una estrategia de vigilancia clínicoepidemiológica que se activa posterior al intento suicida. Método: Se utilizó un diseño transversal, participaron 170 personas de 15 y más años ingresados a la Unidad para Personas con Intento suicida entre los años 2015 al 2018 en la Región De Los Ríos, Chile. Se evaluaron estadísticamente datos de carácter sociodemográfico y clínicos, previos y posterior al intento suicida. Resultado: Los resultados sociodemográficos muestran predominancia de intentos de mujeres, con una muestra que tiene su lugar de residencia principalmente en sectores urbanos. Además, se observó que la pertenencia religiosa católica o evangélica, podría asociarse a mayor riesgo de reintento suicida (p=0,014). Conclusiones: Los factores clínicos muestran que presentar intentos suicidas previos, depresión en curso al momento del intento suicida y los conflictos de pareja son factores relevantes a considerar. La frecuencia de suicidio y los reintentos suicida en vigilancia fue baja, por lo que fortalecer la continuidad de cuidados podría tener un rol preventivo en el fenómeno suicida.

Introduction: Suicidal attempt is one of the most relevant suicide risk factors, knowing associated variables and post-suicide attempt follow-up strategies contributes to preventing suicide. Objective: the objective of this work was to describe the clinical-sociodemographic characteristics of people who present a suicide attempt, and to present a strategy of clinical-epidemiological surveillance that is activated after the suicide attempt. Methods: A cross-sectional design was carried out, involving 170 subjects aged 15 and over admitted to the Unit for People with a suicide attempt between 2015 and 2018 in the Los Ríos region, Chile. Sociodemographic and clinical data, before and after the suicide attempt, were statistically evaluated. Results: The sociodemographic results show a predominance of attempts by women, with a sample that has its place of residence mainly in urban areas. In addition, it was observed that Catholic or evangelical religious affiliation could be associated with a higher risk of suicidal retry (p = 0.014). Conclusions: The clinical factors show that having previous suicide attempts, ongoing depression at the time of the suicide attempt, and partner conflicts are relevant factors to consider. The frequency of suicide and suicide retries in surveillance was low, so strengthening the continuity of care could play a preventive role in the suicide phenomenon.

Servicio de preparación de sistemas personalizados de reacondicionamiento de medicamentos (SPD): oportunidades para la mejora de la adherencia en pandemia / Personalised drug repackaging system (DPS) preparation service: opportunities for adherence improvement in pandemics

JUSTIFICACIÓN: a pesar de que el 88,3 % de los hipertensos diagnosticados tienen prescrita medicación para controlar su HTA, solo el 30 % tiene la presión arterial controlada, posiblemente por una falta de adherencia al tratamiento. Esta baja adherencia genera un alto coste, tanto en términos de salud, ya que puede comportar problemas de salud asociados como un mayor riesgo de ingreso hospitalario y mortalidad; como en términos económicos y sociales. En este aspecto, se estima que en España la no adherencia supone un coste de 10.500 millones de euros y 10.000 muertes evitables. La situación provocada por la pandemia ocasionada por el COVID-19 ha reducido la movilidad de los ciudadanos y ha establecido diversas medidas profilácticas con el fin de reducir el contagio del virus. Todo esto ha podido impactar en la adherencia a los tratamientos farmacológicos crónicos. Los SPD han podido reducir el impacto de la pandemia sobre la reducción de la adherencia a tratamientos crónicos ambulatorios seguidos en farmacia comunitaria.OBJETIVO: evaluar el impacto de la pandemia y el confinamiento en el nivel de adherencia de los usuarios ambulatorios del servicio SPD en farmacia comunitaria con patología cardiovascular o diabetes en comparación con la población general equivalente (no usuaria de SPD) mediante un estudio de cohortes basado bases de datos de la práctica real o Real World Data (RWD). Se constituirá un grupo intervención que serán pacientes usuarios del SPD no institucionalizados y un grupo control que no lo serán (pacientes polimedicados con tratamientos crónicos para patología cardiovascular o diabetes, mayores de 65 años), 200 pacientes por grupo. (AU)

Biomineralization of lithium nanoparticles by Li-resistant Pseudomonas rodhesiae isolated from the Atacama salt flat.

BACKGROUND: The Atacama salt flat is located in northern Chile, at 2300 m above sea level, and has a high concentration of lithium, being one of the main extraction sites in the world. The effect of lithium on microorganism communities inhabiting environments with high concentrations of this metal has been scarcely studied. A few works have studied the microorganisms present in lithium-rich salt flats (Uyuni and Hombre Muerto in Bolivia and Argentina, respectively). Nanocrystals formation through biological mineralization has been described as an alternative for microorganisms living in metal-rich environments to cope with metal ions. However, bacterial lithium biomineralization of lithium nanostructures has not been published to date. In the present work, we studied lithium-rich soils of the Atacama salt flat and reported for the first time the biological synthesis of Li nanoparticles. RESULTS:  Bacterial communities were evaluated and a high abundance of Cellulomonas, Arcticibacter, Mucilaginibacter, and Pseudomonas were determined. Three lithium resistant strains corresponding to Pseudomonas rodhesiae, Planomicrobium koreense, and Pseudomonas sp. were isolated (MIC > 700 mM). High levels of S2- were detected in the headspace of P. rodhesiae and Pseudomonas sp. cultures exposed to cysteine. Accordingly, biomineralization of lithium sulfide-containing nanomaterials was determined in P. rodhesiae exposed to lithium salts and cysteine. Transmission electron microscopy (TEM) analysis of ultrathin sections of P. rodhesiae cells biomineralizing lithium revealed the presence of nanometric materials. Lithium sulfide-containing nanomaterials were purified, and their size and shape determined by dynamic light scattering and TEM. Spherical nanoparticles with an average size < 40 nm and a hydrodynamic size ~ 44.62 nm were determined. CONCLUSIONS: We characterized the bacterial communities inhabiting Li-rich extreme environments and reported for the first time the biomineralization of Li-containing nanomaterials by Li-resistant bacteria. The biosynthesis method described in this report could be used to recover lithium from waste batteries and thus provide a solution to the accumulation of batteries.

Biomineralization of lithium nanoparticles by Li-resistant Pseudomonas rodhesiae isolated from the Atacama salt flat

BACKGROUND: The Atacama salt flat is located in northern Chile, at 2300 m above sea level, and has a high concentration of lithium, being one of the main extraction sites in the world. The effect of lithium on microorganism communities inhabiting environments with high concentrations of this metal has been scarcely studied. A few works have studied the microorganisms present in lithium-rich salt flats (Uyuni and Hombre Muerto in Bolivia and Argentina, respectively). Nanocrystals formation through biological mineralization has been described as an alternative for microorganisms living in metal-rich environments to cope with metal ions. However, bacterial lithium biomineralization of lithium nanostructures has not been published to date. In the present work, we studied lithium-rich soils of the Atacama salt flat and reported for the first time the biological synthesis of Li nanoparticles. RESULTS: Bacterial communities were evaluated and a high abundance of Cellulomonas, Arcticibacter, Mucilaginibacter, and Pseudomonas were determined. Three lithium resistant strains corresponding to Pseudomonas rodhesiae, Planomicrobium koreense, and Pseudomonas sp. were isolated (MIC > 700 mM). High levels of S2− were detected in the headspace of P. rodhesiae and Pseudomonas sp. cultures exposed to cysteine. Accordingly, biomineralization of lithium sulfide-containing nanomaterials was determined in P. rodhesiae exposed to lithium salts and cysteine. Transmission electron microscopy (TEM) analysis of ultrathin sections of P. rodhesiae cells biomineralizing lithium revealed the presence of nanometric materials. Lithium sulfide-containing nanomaterials were purified, and their size and shape determined by dynamic light scattering and TEM. Spherical nanoparticles with an average size < 40 nm and a hydro-dynamic size ~ 44.62 nm were determined. CONCLUSIONS: We characterized the bacterial communities inhabiting Li-rich extreme environments and reported for the first time the biomineralization of Li-containing nanomaterials by Li-resistant bacteria. The biosynthesis method described in this report could be used to recover lithium from waste batteries and thus provide a solution to the accumulation of batteries.

Mediastinitis descendente en el contexto de la angina de Ludwig. Artículo de revisión / Descending mediastinitis in the context of Ludwig's Angina. Article review

Introducción: la mediastinitis se define como el proceso inflamatorio usualmente infeccioso del tejido conectivo mediastinal y los órganos que este rodea. Específicamente, la mediastinitis descendente corresponde a una complicación rara por infección de los espacios profundos del cuello, la orofaringe o la cavidad oral, que se extiende a través de los espacios fasciales del cuello y los diseca. De forma infrecuente, esta patología puede originarse a partir de la parotiditis, las infecciones de la piel del cuello o la epiglotitis. También, de manera menos frecuente, puede generarse en el contexto de un traumatismo del cuello o la cavidad oral. En este estudio se pretende llamar la atención, en particular, sobre los aspectos que involucran al especialista otorrinolaringólogo en el manejo de los pacientes con infecciones profundas del cuello y su rol en el diagnóstico y tratamiento eficaz de la mediastinitis descendente, como la principal causa de mortalidad en estos casos. Metodología: se llevó a cabo una búsqueda con las palabras clave "Airway" "Ludwig's angina" en PubMed, no se efectuó filtración por fecha ni tipo de estudio. Se encontró un total de 147 artículos. Se realizó lectura de los resúmenes por los autores y se seleccionaron 50. Se realizó lectura crítica del texto completo de los 50 artículos resultantes de la búsqueda y se extrajo la información relevante. Conclusión: esta patología de marcada severidad conlleva a un aumento significativo de la mortalidad. Su tratamiento, aunque permanece controversial en ciertas circunstancias, debe ser agresivo y oportuno, con un enfoque en el rol del otorrinolaringólogo en 4 pilares de tratamiento: el drenaje quirúrgico, la antibioticoterapia de amplio espectro, el soporte hemodinámico y la seguridad de la vía aérea.

Introduction: Mediastinitis is defined as the usually infectious inflammatory process of the mediastinal connective tissue and the organs it surrounds. Specifically, descending mediastinitis corresponds to a rare complication, an infection of deep spaces of the neck, oropharynx, or oral cavity, which extends through the facial spaces of the neck, dissecting. Less frequent, this pathology can originate from parotiditis, skin infections of the neck or epiglottitis. Also, less frequent it can be generated in the context of trauma to the neck or oral cavity. This study intends to draw attention to the aspects that involve the ENT specialist in the management of patients with deep neck infections and their role in the diagnosis and effective treatment of descending mediastinitis as the main cause of mortality in these patients. Methodology: A search was carried out with the keywords "Airway" "Ludwig's angina" in PubMed, no filtering was performed by date or type of study, finding a total of 147 articles, abstracts were read by the authors, selecting 50. A critical reading of the 50 articles full texts is carried out and the relevant information is extracted. Conclusion: This pathology of marked severity, carries a significant increase in mortality and its treatment, although it remains controversial in certain circumstances, it must be aggressive and timely, focusing the role of the otorhinolaryngologist on 4 pillars of treatment: surgical drainage, antibiotic therapy, hemodynamic support, and airway safety.

Valor de la 18F-FDG PET/TC en el diagnóstico de corea-acantocitosis / Value of 18F-FDG PET/CT in the diagnosis of chorea-acanthocytosis

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Anti-HLA Antibodies After Precocious Transplantectomy by Vascular Thrombosis.

BACKGROUND: Our objective in this study was to determine the effects of early renal transplantectomy on patients and the production of anti-human leukocyte antigen (anti-HLA) antibodies. METHODS: Between January 2003 and May 2017, we analyzed a group of patients for the presence of specific HLA class I and/or II donor-specific antibodies (DSA), their panel-reactive antibodies (PRA), and the time period in which the antibodies were still detectable after transplantectomy. RESULTS: Anti-HLA antibodies were detected in 60.8% of patients, 60.8% and 52.2% of those patients had anti-class I and anti-class II antibodies, respectively. DSA were detected in 91.7% of the anti-HLA class I patients. Class II DSA were detected all of the patients with anti-HLA class II antibodies. The average (mean ± SD) PRA levels in our patients after transplantectomy was 60 ± 34% in class I and 63 ± 36% in class II. CONCLUSION: Anti-HLA antibodies can be detected well after transplantectomy. Even if the kidney allograft had been transplanted for only a short time, when the intensity of immunosuppression was the highest, many patients developed anti-HLA antibodies. The patients who continued with immunosuppression after transplantectomy did not develop anti-HLA antibodies.

Noninvasive Liver Assessment in Adult Patients With Fontan Circulation Using Acoustic Radiation Force Impulse Elastography and Hepatic Magnetic Resonance Imaging.

BACKGROUND: Patients who have undergone the Fontan procedure are at risk of developing hepatic dysfunction. However, broad recommendations regarding liver monitoring are limited. The purpose of this study was to characterize the frequency of liver disease in adult Fontan patients using multimodality imaging (hepatic magnetic resonance imaging [MRI], acoustic radiation force impulse [ARFI] elastography, or hepatic ultrasound). METHODS: In a prospective cross-sectional analysis of adult patients palliated with a Fontan procedure, hepatic MRI, ARFI, and hepatic ultrasound were used to assess for liver disease. The protocol compared (1) varying prevalence of liver disease based on each imaging technique, (2) agreement between different techniques, and (3) association between noninvasive imaging diagnosis of liver disease and clinical variables, including specific liver disease biomarkers. RESULTS: Thirty-seven patients were enrolled. The ARFI results showed high wave propagation velocity in 35 patients (94.6%). All patients had some abnormality in the hepatic MRI. Specifically, 8 patients (21.6%) showed signs of chronic liver disease, 10 patients (27%) had significant liver fibrosis, and 27 patients (73%) had congestion. No correlation was found between liver stiffness measured as propagation velocity and hepatic MRI findings. Only 7 patients had an abnormal hepatic ultrasound study. CONCLUSIONS: There is an inherent liver injury in adult Fontan patients. Signs of liver disease were observed in most patients by both hepatic MRI and ARFI elastography but not by ultrasound imaging. Increased liver stiffness did not identify specific disease patterns from MRI, supporting the need for multimodality imaging to characterize liver disease in Fontan patients.

Tympanic membrane perforation impact on severity of injury and resource use in victims of explosion.

PURPOSE: Though tympanic membrane perforation (TMP) is a marker of barotrauma, relation to severity of injury has been contested based on previous observations that following an explosion many victims with significant injuries do not suffer from TMP while many victims with TMP do not suffer from significant injuries. The objective of this study was to reassess the relationship of TMP to severity of injury and resource demand in patients treated in multiple casualty incidents following terrorist bombings treated in one medical center. METHODS: Retrospective review. RESULTS: Most of the patients with TMP were mildly injured. Nevertheless, TMP was more prevalent in patients with moderate and severe injuries, 53.3 % compared to 13.6 % in mildly injured patients (p = 0.0009). Patients with TMP suffered from more body areas injured (p < 0.0001). They more often needed surgery (30.6 vs. 5.5 %; p < 0.0001), ICU hospitalization (16.1 vs. 1.3 %; p < 0.0001) and secondary transfer to a level I trauma center (12.9 vs. 1.0 %; p < 0.0001). They were hospitalized longer (p < 0.0001). Fifty-three (12.6 %) patients included in this study were not examined by the ENT service. Most of those not examined were either moderately or severely injured. CONCLUSIONS: Patients with TMP were more severely injured and more often needed surgery, ICU hospitalization and need for transfer to a level I trauma center. The observation that all those who died in hospital and most of those who were unstable were not examined by the ENT services suggests that impact of TMP as an indicator of severity may be underestimated.

ESTES guidelines: acute mesenteric ischaemia.

PURPOSE: Acute mesenteric ischaemia (AMI) accounts for about 1:1000 acute hospital admissions. Untreated, AMI will cause mesenteric infarction, intestinal necrosis, an overwhelming inflammatory response and death. Early intervention can halt and reverse this process leading to a full recovery, but the diagnosis of AMI is difficult and failure to recognize AMI before intestinal necrosis has developed is responsible for the high mortality of the disease. Early diagnosis and prompt treatment are the goals of modern therapy, but there are no randomized controlled trials to guide treatment and the published literature contains a high ratio of reviews to original data. Much of that data comes from case reports and often small, retrospective series with no clearly defined treatment criteria. METHODS: A study group of the European Society for Trauma and Emergency Surgery (ESTES) was formed in 2013 with the aim of developing guidelines for the management of AMI. A comprehensive literature search was performed using the Medical Subject Heading (MeSH) thesaurus keywords "mesenteric ischaemia", "bowel ischaemia" and "bowel infarction". The bibliographies of relevant articles were screened for additional publications. After an initial systematic review of the literature by the whole group, a steering group formulated questions using a modified Delphi process. The evidence was then reviewed to answer these questions, and recommendations formulated and agreed by the whole group. RESULTS: The resultant recommendations are presented in this paper. CONCLUSIONS: The aim of these guidelines is to provide recommendations for practice that will lead to improved outcomes for patients.

Encouraging intrinsic motivation in the clinical setting: teachers' perspectives from the self-determination theory.

INTRODUCTION: Self-determination theory postulates that the three basic psychological needs of autonomy, competence and relatedness have to be satisfied for students to achieve intrinsic motivation and internalisation of autonomous self-regulation towards academic activities. Consequently, the influence of the clinical teaching environment becomes crucial when satisfying these needs, particularly when promoting or diminishing students' intrinsic motivation. The aim of this study was to describe and understand how clinical teachers encourage intrinsic motivation in undergraduate dental students based on the three basic psychological needs described by the self-determination theory. METHODS: A qualitative case study approach was adopted, and data were collected through semistructured interviews with nine experienced undergraduate clinical teachers of one dental school in Santiago, Chile. Interview transcripts were analysed by two independent reviewers using a general inductive approach. FINDINGS: Several themes emerged outlining teaching strategies and behaviours. These themes included the control of external motivators; gradual transference of responsibility; identification and encouragement of personal interests; timely and constructive feedback; delivery of a vicarious learning experience; teamwork, team discussion, and presence of a safe environment, amongst others. Overall, teachers stressed the relevance of empowering, supporting and building a horizontal relationship with students. CONCLUSIONS: Our findings regarding dental education expand on the research outcomes from other health professions about how teachers may support students to internalise behaviours. An autonomy-supportive environment may lead students to value and engage in academic activities and eventually foster the use of an autonomy-supportive style to motivate their patients.

Circulation of a novel human respiratory syncytial virus Group B genotype during the 2014-2015 season in Catalonia (Spain).

Human respiratory syncytial virus (HRSV) is one of the most common viral aetiological agents in the youngest population. In the present study a novel HRSV-B BA genotype is first described based on the phylogenetic analysis of the coding hypervariable region 2 sequences of G protein from strains detected during the 2014-2015 season. Among all strains detected in the last season, 44% belonged to this new genotype. Therefore, it highlights the importance of a continuous HRSV surveillance to monitor the emergence and spread of new genotypes or variants with genetic changes that may affect antigenic and tropism features.

Caracterización del consumo de suplementos nutricionales en población físicamente activa de gimnasios del sur de Chile / Characterization of nutritional supplements consumption in physically active population in gyms of southern Chile

El consumo de suplementos nutricionales (SN) se ha investigado generalmente en relación al rendimiento deportivo. Menos información existe en relación a población no deportista pero físicamente activa. Objetivo y metodología: El objetivo fue conocer las características de los consumidores de SN en 412 usuarios (179 mujeres) de gimnasios de cuatro ciudades del sur de Chile. El instrumento utilizado para recolectar datos correspondió a un cuestionario previamente validado (1), estructurado con preguntas cerradas, alternativas y preguntas abiertas en relación al consumo de SN. Para su interpretación se utilizaron estadísticos descriptivos y de comparación (i.e. Chi cuadrado). El nivel de significancia estadística se estableció en p<0,05. Resultados: los resultados revelan que 22% de los usuarios consumen SN. De los hombres consumidores, 37% lo realiza para aumentar masa muscular y 36% para mejorar el rendimiento físico. Entre las mujeres, 32% los consume por motivos relacionados a salud. Los SN más consumidos fueron: proteínas (36%), vitaminas y minerales (11%), creatina (10%), aminoácidos y carbohidratos (8%). En cuanto al perfil del consumidor, está representado por jóvenes de entre 15 a 25 años, dedicados en su mayoría al estudio y al trabajo, con menos de un año de asistencia al gimnasio y una frecuencia de asistencia ≥ 3 sesiones/semana. Conclusión: un relativamente bajo consumo de SN fue observado,en comparación con deportistas, influenciado por la edad,el género y el uso de dieta o alimentación especial. Varones jóvenes (i.e. 15 a 25 años de edad) que trabajan, con una alta frecuencia de asistencia a gimnasios (≥ 3 sesiones/semana) son los principales consumidores de SN...