LBDNet interlaboratory comparison for the dicentric chromosome assay by digitized image analysis applying weighted robust statistical methods.

PURPOSE: This interlaboratory comparison was conducted to evaluate the performance of the Latin-American Biodosimetry Network (LBDNet) in analyzing digitized images for scoring dicentric chromosomes from in vitro irradiated blood samples. The exercise also assessed the use of weighted robust algorithms to compensate the uneven expertise among the participating laboratories. METHODS: Three sets of coded images obtained through the dicentric chromosome assay from blood samples irradiated at 1.5 Gy (sample A) and 4 Gy (sample B), as well as a non-irradiated whole blood sample (sample C), were shared among LBDNet laboratories. The images were captured using the Metafer4 platform coupled with the AutoCapt module. The laboratories were requested to perform triage scoring, conventional scoring, and dose estimation. The dose estimation was carried out using either their laboratory calibration curve or a common calibration curve. A comparative statistical analysis was conducted using a weighted robust Hampel algorithm and z score to compensate for uneven expertise in dicentric analysis and dose assessment among all laboratories. RESULTS: Out of twelve laboratories, one had unsatisfactory estimated doses at 0 Gy, and two had unsatisfactory estimated doses at 1.5 Gy when using their own calibration curve and triage scoring mode. However, all doses were satisfactory at 4 Gy. Six laboratories had estimated doses within 95% uncertainty limits at 0 Gy, seven at 1.5 Gy, and four at 4 Gy. While the mean dose for sample C was significantly biased using robust algorithms, applying weights to compensate for the laboratory's analysis expertise reduced the bias by half. The bias from delivered doses was only notable for sample C. Using the common calibration curve for dose estimation reduced the standard deviation (s*) estimated by robust methods for all three samples. CONCLUSIONS: The results underscore the significance of performing interlaboratory comparison exercises that involve digitized and electronically transmitted images, even when analyzing non-irradiated samples. In situations where the participating laboratories possess different levels of proficiency, it may prove essential to employ weighted robust algorithms to achieve precise outcomes.

Specific cognitive and psychological alterations are more strongly linked to increased migraine disability than chronic migraine diagnosis.

INTRODUCTION: The efficiency of The International Classification of Headache Disorders (ICHD-3) in reflecting patients' disability has recently been questioned. This prompts consideration that clinical features beyond pain may more accurately indicate the extent of underlying brain impairment than the mere frequency of headache days. Important cognitive dysfunctions and psychological impairment have been reported in burdensome cases of migraine, and the presence of these alterations has been associated with biological changes in the nervous system. This study aimed to compare migraine-related disability within a specific patient group, classified using ICHD-3 criteria or classified based on findings from a neuropsychological evaluation using machine learning. Additionally, a complementary voxel-based morphometry (VBM) comparison was conducted to explore potential neuroanatomical differences between the resulting groups. PATIENTS AND METHODS: The study included episodic and chronic migraine patients seeking consultation at a specialized headache department. A neuropsychological evaluation protocol, encompassing validated standardized tests for cognition, anxiety, depression, perceived stress, and headache-related impact (HIT-6) and disability (MIDAS), was administered. Results from this evaluation were input into an automated K-means clustering algorithm, with a predefined K=2 for comparative purposes. A supplementary Voxel-based Morphometry (VBM) evaluation was conducted to investigate neuroanatomical contrasts between the two distinct grouping configurations. RESULTS: The study involved 111 participants, with 49 having chronic migraine and 62 having episodic migraine. Seventy-four patients were assigned to cluster one, and 37 patients were assigned to cluster two. Cluster two exhibited significantly higher levels of depression, anxiety, and perceived stress, and performed worse in alternating and focalized attention tests. Differences in HIT-6 and MIDAS scores between episodic and chronic migraine patients did not reach statistical significance (HIT-6: 64.39 (±7,31) vs 62.92 (±11,61); p= 0. 42 / MIDAS: 73.63 (±68,61) vs 84.33 (±63,62); p=0.40). In contrast, patients in cluster two exhibited significantly higher HIT-6 (62.32 (±10,11) vs 66.57 (±7,21); p=0.03) and MIDAS (68.69 (±62,58) vs 97.68 (±70,31); p=0.03) scores than patients in cluster one. Furthermore, significant differences in grey matter volume between the two clusters were noted, particularly involving the precuneus, while differences between chronic and episodic migraine patients did not withstand correction for multiple comparisons. CONCLUSIONS: The classification of migraine patients based on neuropsychological characteristics demonstrates a more effective separation of groups in terms of disability compared to categorizing them based on the chronic or episodic diagnosis of ICHD-3. These findings could reveal biological changes that might explain differences in treatment responses among apparently similar patients.

Catastrophic Streptococcus pyogenes Disease: A Personalized Approach Based on Phenotypes and Treatable Traits.

Streptococcal toxic shock syndrome (STTS) is a critical medical emergency marked by high morbidity and mortality, necessitating swift awareness, targeted treatment, and early source control due to its rapid symptom manifestation. This report focuses on a cohort of 13 patients admitted to Vall d'Hebron University Hospital Intensive Care Unit, Barcelona, from November 2022 to March 2023, exhibiting invasive Streptococcus pyogenes infections and meeting institutional sepsis code activation criteria. The primary infections were community-acquired pneumonia (61.5%) and skin/soft tissue infection (30.8%). All patients received prompt antibiotic treatment, with clinical source control through thoracic drainage (30.8%) or surgical means (23.1%). Organ support involved invasive mechanical ventilation, vasopressors, and continuous renal replacement therapy as per guidelines. Of note, 76.9% of patients experienced septic cardiomyopathy, and 53.8% required extracorporeal membrane oxygenation (ECMO). The study identified three distinct phenotypic profiles-hyperinflammatory, low perfusion, and hypogammaglobulinemic-which could guide personalized therapeutic approaches. STTS, with a mean SOFA score of 17 (5.7) and a 53.8% requiring ECMO, underscores the need for precision medicine-based rescue therapies and sepsis phenotype identification. Integrating these strategies with prompt antibiotics and efficient source control offers a potential avenue to mitigate organ failure, enhancing patient survival and recovery in the face of this severe clinical condition.

Hepatitis E Virus Infections in Free-Ranging and Captive Cetaceans, Spain, 2011-2022.

Epidemiologic surveillance of hepatitis E virus in over 300 free-ranging and captive cetaceans in waters off Spain revealed extensive exposure to this pathogen. We suggest the persistent and widespread presence of hepatitis E in the marine environment off the coast of Spain may be driven by terrestrial sources of contamination.

Case report: Cytokine hemoadsorption in a case of hemophagocytic lymphohistiocytosis secondary to extranodal NK/T-cell lymphoma.

We discuss a single case of Hemophagocytic lymphohistiocytosis (HLH) due to NK-type non-Hodgkin lymphoma and Epstein-Barr virus reactivation with multiorgan dysfunction and distributive shock in which we performed cytokine hemoadsorption with Cytosorb ®. A full microbiological panel was carried out, including screening for imported disease, standard serologies and cultures for bacterial and fungal infection. A liver biopsy and bone marrow aspirate were performed, confirming the diagnosis. The patients fulfilled the HLH-2004 diagnostic criteria, and according to the 2018 Consensus Statements by the HLH Steering Committee of the Histiocyte Society, dexamethasone and etoposide were started. There was an associated hypercytokinemia and, due to refractory distributive shock, rescue therapy with cytokine hemoadsorption was performed during 24 h (within day 2 and 3 from ICU admission). After starting this procedure, rapid hemodynamic control was achieved with a significant reduction in vasopressor support requirements. This case report highlights that cytokine hemoadsorption can be an effective since rapid decrease in IL-10 levels and a significant hemodynamic improvement was achieved.

Molecular Characterization of Herpesviral Encephalitis in Cetaceans: Correlation with Histopathological and Immunohistochemical Findings.

Herpesviruses are causative agents of meningitis and encephalitis in cetaceans, which are among the main leading known natural causes of death in these species. Brain samples from 103 stranded cetaceans were retrospectively screened for the presence of herpesvirus DNA in the brain. Molecular detection of Cetacean Morbillivirus was performed in HV positive brain cases. Histopathologic evaluation of brain samples included the presence or absence of the following findings (n = 7): meningitis, perivascular cuffings, microgliosis, intranuclear inclusion bodies, malacia, neuronal necrosis and neurophagic nodules, and haemorrhages. Histological evidence of the involvement of other etiological agents led to complementary analysis. We detected the presence of alpha and gamma-HVs in 12 out of 103 (11.6%) brain samples from stranded cetaceans of five different species: one bottlenose dolphin, six striped dolphins, three Atlantic spotted dolphins, one Cuvier's beaked whale, and one common dolphin. Pathogenic factors such as viral strain, age, sex, and the presence of co-infections were analysed and correlated with the brain histopathological findings in each case. Herpesvirus was more prevalent in males, juveniles, and calves and a 41.6% incidence of co-infections in the brain was detected in our study: three with Dolphin Morbillivirus, one with Staphilococcus aureus septicaemia and one with Brucella spp.

Nocardiosis in Free-Ranging Cetaceans from the Central-Eastern Atlantic Ocean and Contiguous Mediterranean Sea.

We report the pathologic features of nocardiosis in five free-ranging delphinids from the Canary Islands and Andalusia, namely four striped dolphins (Stenella coerulealba) and one bottlenose dolphin (Tursiops truncatus). All animals had a multiorgan (disseminated) pattern of infection involving suppurative to pyogranulomatous and thromboembolic lesions in two or more organs. Most affected organs were (by decreasing order) lung, pulmonary lymph nodes, liver, kidney, adrenal glands, and central nervous system. Typical intralesional and intravascular branched and filamentous bacteria were highlighted by Grocott's methenamine silver and Gram stains. Bacterial analysis including 16S rRNA gene sequencing identified Nocardia farcinica in two striped dolphins and Nocardia otitidiscaviarum in one striped dolphin and the bottlenose dolphin. All dolphins tested (n = 4) for cetacean morbillivirus were negative; one dolphin had concurrent cutaneous herpesvirosis. These results provide the first record of N. otitidiscaviarum in cetaceans, the first account of N. farcinica in free-ranging dolphins, and confirmation of nocardiosis in central eastern Atlantic Ocean. These results expand the known geographic range of nocardiosis in cetaceans.

Experience in the treatment of hepatitis C with direct-acting antivirals in a foreign population at a high-immigration area.

INTRODUCTION: immigrants from areas of high endemicity for hepatitis C represent a relevant risk group. The goal of this study was to analyze the characteristics of these patients in a high-immigration health care area, and to analyze the impact of promoting diagnosis and referral by means of training sessions in the primary care setting. MATERIALS AND METHODS: a retrospective study in immigrant patients with HCV monoinfection treated with direct-acting antiviral agents in Almería between 2015 and 2020. Epidemiological and clinical variables were collected, as well as the impact of a micro-elimination approach. RESULTS: a total of 175 immigrant patients were enrolled, most of them from eastern Europe (52.5 %), followed by sub-Saharan Africa (21.1 %) and the Maghreb (14.8 %). Patients from sub-Saharan Africa and eastern Europe were younger (p = 0.002) and sub-Saharan subjects predominantly exhibited genotypes 2 and 3, whereas genotype 1 predominated in the rest of patients (p < 0.001). Of all the patients, 156 attained SVR (ITT-SVR, 89.1 %). The modified ITT rate was 96.9 %. Patients with SVR had spent more time in Spain (12.7 vs 6.1 years; p = 0.006). CONCLUSIONS: the immigrant population with HCV infection in our health care area exhibits homogeneous clinical and epidemiological characteristics. The efficacy of antiviral therapy is similar to that reported in the non-immigrant population, with higher rates of losses to follow-up and dosage errors, particularly in those who have been in the country for less time.

Insights into immune evasion of human metapneumovirus: novel 180- and 111-nucleotide duplications within viral G gene throughout 2014-2017 seasons in Barcelona, Spain.

BACKGROUND: Human metapneumovirus (HMPV) is an important aetiologic agent of respiratory tract infection (RTI). This study aimed to describe its genetic diversity and clinical impact in patients attended at a tertiary university hospital in Barcelona from the 2014-2015 to the 2016-2017 seasons, focusing on the emerging duplications in G gene and their structural properties. METHODS: Laboratory-confirmed HMPV were characterised based on partial-coding F and G gene sequences with MEGA.v6.0. Computational analysis of disorder propensity, aggregation propensity and glycosylation sites in viral G predicted protein sequence were carried out. Clinical data was retrospectively reviewed and further associated to virological features. RESULTS: HMPV prevalence was 3%. The 180- and 111-nucleotide duplications occurred in A2c lineage G protein increased in prevalence throughout the study, in addition to short genetic changes observed in other HMPV lineages. The A2c G protein without duplications was calculated to protrude over F protein in 23% of cases and increased to a 39% and a 46% with the 111- and 180-nucleotide duplications, respectively. Children did not seem to be more affected by these mutant viruses, but there was a strong association of these variants to LRTI in adults. DISCUSSION: HMPV presents a high genetic diversity in all lineages. Novel variants carrying duplications might present an evolutionary advantage due to an improved steric shielding, which would have been responsible for the reported increasing prevalence and the association to LRTI in adults.

Study of Psychomotor Development and Environmental Quality at Shelter Homes for Children Aged 0 to 2 in the Department of Chuquisaca (Bolivia).

Children in situations of destitution who become institutionalized commonly display developmental disorders, including delayed growth. The aim was to evaluate the environmental quality of the casas cuna of the Department of Chuquisaca (Plurinational state of Bolivia) in children aged 0 to 2 years old after receiving an early stimulation program based on psychomotor therapy. Thirty-six children who were institutionalized at shelter homes in the Department of Chuquisaca were selected to receive sessions of psychomotricity over a five-month period. The Infant/Toddler Home Observation for Measurement of the Environment (IT-HOME) scale and the Attachment During Stress Scale (ADS) were used. The adult-child relationship with factors of responsiveness (-0.89; p = 0.037), acceptance (0.57; p = 0.024), organization (-1.03; p < 0.001), learning material (-2.57; p < 0.001) and involvement (-1.92; p < 0.001) scored below expectations, showing that environmental indicators are a poor stimulation for children growing up in shelter homes. Improvements were found in the children's development after receiving this therapy. In conclusion, an early stimulation program based on psychomotor therapy over five months provided favorable results for the acquisition of skills for communication, motor development and social skills, which positively affect the psychomotor development.

Cirugía de oberlin en parálisis braquial obstétrica. Nota técnica / Oberlin surgery in obstetric brachial palsy. Technical note

Introducción: La parálisis braquial obstétrica (PBO) constituye una complicación poco frecuente del parto. La mayoría de los pacientes recuperan espontáneamente, sin embargo en algunos casos debe realizarse una neurocirugía para reinervar músculos y restablecer funciones. Las ramas mayoritariamente afectadas son C5-C6. Oberlin describió por primavera vez un tipo de trasferencia nerviosa en 4 pacientes adultos, utilizando fascículos del nervio ulnar para reanimar el músculo bíceps. El objetivo de este trabajo consiste en realizar una nota técnica sobre la cirugía de Oberlin, en el contexto de una PBO. Esta nota técnica surge del análisis de 4 cirugías pediátricas y de las disecciones de 14 miembros superiores fetales. Descripción técnica: Paciente en decúbito dorsal, con el brazo afectado extendido, en supinación y abducción de 90°. Se incide piel 4cm de extensión en cara interna del brazo, hasta identificar la fascia braquial. Posteriormente se diseca la rama motora del bíceps y fascículos del ulnar. Mediante magnificación se aproximan los cabos y se realiza la neurorrafia. Discusión: Existen múltiples técnicas descriptas de transferencia nerviosa, escasa es la bibliografía en pacientes pediátricos. La cirugía de Oberlin puede ser realizada en pediatría. Conclusión: Presentamos los pasos de la cirugía de transferencia nerviosa descripta por Oberlin, la misma es reproducible en pacientes lactantes en contexto de PBO, quedando expuestos los detalles técnicos y los reparos anatómicos para su realización.

Introduction: Obstetrical brachial plexus palsy (OBPP) is a rare complication of labor. Most patients recover spontaneously, however, in some cases neurosurgery must be perform to re innervate muscles and restore functions. The most frequent affected roots are C5-C6. Oberlin first described a type of nervous transfer in 4 adult patients, using fascicles of the ulnar nerve to reanimate the biceps muscle. The objective of this paper is to make a technical note about Oberlin's surgery regarding OBPP. This technical note emerges from the analysis of 4 pediatric surgeries and 14 fetal upper limbs dissections. Technical description: Patient was place in dorsal decubitus, with the compromised upper limb extended in supination and 90 ° abduction. Skin incision of 4 cm long is made along the medial aspect of the arm, until the brachial fascia is identified. Subsequently, the motor branch of the biceps muscle and fascicles of the ulnar nerve are dissect. Under microscopic magnification, both nerves are approached and the neurorrhaphy is performed. Discussion: There are multiple nerve transfer techniques described; but bibliography in pediatric patients is limited. Oberlin surgery can be performed in pediatrics. Conclusion: The steps of the nerve transfer surgery described by Oberlin presented can be applied in the case of obstetrical brachial plexus palsy, the technical details and the anatomical repairs for its realization are outlined

Stress cardiomyopathy in stranded cetaceans: a histological, histochemical and immunohistochemical study.

BACKGROUND: Free-living cetaceans are exposed to a wide variety of stressful situations, including live stranding and interaction with human beings (capture myopathy), vessel strikes, and fishing activities (bycatch), which affect their wellbeing and potentially lead to stress cardiomyopathy (SCMP). METHODS: Here, the authors aimed to characterise SCMP of stranded cetaceans as an injury resulting from extreme stress responses, based on pathological analyses (histological, histochemical and immunohistochemical). Specifically, the authors examined heart samples from 67 cetaceans found ashore (48 live strandings, seven dead from ship collision and 12 dead from bycatch) on the coast of Spain, more specifically in the Canary Islands from 2000 to 2016 and Andalusia from 2011 to 2014. RESULTS: The microscopic findings were characterised by vascular changes, acute or subacute cardiac degenerative necrotic lesions, interstitial myoglobin globules, and infiltration of inflammatory cells. Immunohistochemically, cardiac troponin I, cardiac troponin C and myoglobin were depleted, along with fibrinogen being expressed in the degenerated/necrotic cardiomyocytes. A perivascular pattern was also identified and described in the damaged cardiomyocytes. CONCLUSIONS: This study advances current knowledge about the pathologies of cetaceans and their implications on conserving this group of animals by reducing mortality and enhancing their treatment and subsequent rehabilitation to the marine environment.

Associação entre fatores de risco cardiovasculares e a presença de doença arterial coronariana / Association between cardiovascular risk factors and the presence of coronary artery disease

Objetivo: associar os fatores de risco e a presença da doença arterial coronariana em pacientes submetidos à cintilografia de perfusão de miocárdio. A doença arterial coronariana é uma das principais causas de morte no Brasil e no mundo por isso, detectá-la anteriormente às manifestações clínicas ou complicações é crucial para evitar a progressão da doença. Materiais e Métodos: foi realizado um estudo observacional, transversal e retrospectivo a partir da análise aleatória de 226 prontuários de pacientes submetidos a cintilografia de perfusão do miocárdio entre agosto de 2010 e agosto de 2015. Avaliou-se a razão de chances (Odds Ratio) dos seguintes fatores de risco: tabagismo, diabetes mellitus tipo II, hipertensão arterial sistêmica, dislipidemia, obesidade, sobrepeso, sedentarismo, estresse e antecedentes familiares. Foram calculados riscos atribuíveis ao Intervalo de Confiança 95%. Resultados: dentre os fatores analisados, o diabetes aparece como o principal fator de risco não evitável para a doença com razão de chances ajustada de 3,45 (Intervalo de confiança 95%). A dislipidemia com Odds Ratio ajustada de 2,45 (Intervalo de confiança 95%) e hipertensão com Odds Ratio ajustada de 1,97 (Intervalo de confiança 95%). Conclusões: o presente estudo permitiu associar os fatores de risco e a presença da doença arterial coronariana em pacientes submetidos à cintilografia de perfusão de miocárdio, sendo o diabetes o principal fator de risco não evitável para a doença. Dentre os fatores de risco evitáveis (tabagismo,sedentarismo, estresse, sobrepeso/obesidade e sobrepeso) nenhum apresentou associação significativa com a doença..(AU)

Objective: to associate the risk factors and presence of coronary artery disease in patients submitted to myocardial perfusion scintigraphy. Coronary artery disease is one of the leading causes of death in Brazil and around the world so detecting it prior to clinical manifestations or complications is crucial to prevent disease progression. Materials and Methods: an observational, cross-sectional and retrospective study was performed from a randomized analysis of 226 medical records of patients undergoing myocardial perfusion scintigraphy between August 2010 and August 2015. Odds Ratio (odds ratio) of the following risk factors: smoking, type II diabetes mellitus, systemic arterial hypertension, dyslipidemia, obesity, overweight, sedentary lifestyle, stress and family history. Risks attributable to the 95% Confidence Interval were calculated. Results:among the factors analyzed, diabetes appears as the main non-avoidable risk factor for the disease with an adjusted odds ratio of 3.45 (95% confidence interval). Dyslipidemia with adjusted Odds Ratio of 2.45 (Confidence Interval 95%) and hypertension with adjusted Odds Ratio of 1.97 (95% Confidence Interval). Conclusions:the present study allowed to associate the risk factors and the presence of coronary artery disease in patients submitted to myocardial perfusion scintigraphy, with diabetes being the main non-avoidable risk factor for the disease. Among the avoidable risk factors (smoking, sedentary lifestyle, stress, overweight / obesity and overweight) none of them had a significant association with the disease..(AU)

Dose response of prematurely condensed chromosome rings after gamma irradiation.

PURPOSE: This paper presents a calibration curve for prematurely condensed chromosome rings (PCC-ring) which are scarce in cytogenetic dosimetry; here we analyzed the behavior of the PCC-ring frequency and PCC index after gamma irradiation in the dose interval from 0 to 20 Gy. MATERIALS AND METHODS: PCC-rings were induced in lymphocytes with Calyculin A. A total of 5788 PCC cells in G1, G2/M, and M/A stages were analyzed. RESULTS: The best fitting curve between the frequency of PCC ring (Y) and the Dose (D) was obtained with the equation Y = (0.0308 ± 0.0012) D. The distribution of rings by cell followed a Poisson distribution. The PCC index was correlated with radiation dose and decreased in a dose-dependent manner. CONCLUSION: This PCC-ring dose-effect curve can be used in case of high dose accidental overexposure to gamma radiation, allowing a dose assessment in a reliable way in most of the simulated irradiation analyzed.

Dehydration of fructose over thiol- and sulfonic- modified alumina in a continuous reactor for 5-HMF production: Study of catalyst stability by NMR.

In the present study, the synthesis of an organic group-modified alumina by the sol-gel method is proposed. This material has shown to have an enhanced catalytic performance with grafted organic groups and showed an improved stability. The prepared material has shown to have several O - H groups and an enhanced surface acidity. The alumina acidity was improved by incorporating thiol groups by grafting method, which promotes the tautomerization of fructose to its furanose form. Furthermore, the grafting of sulfonic groups catalyzes its dehydration. The modified alumina was thermally treated up to 200 °C to improve the functional groups stability. After, this modified material was packed into a continuous reactor system, designed and built by this group, to obtain 5-hydroxymethylfurfural (5-HMF) from fructose dissolved in a single-phase solution of tetrahydrofuran (THF) and H2O (4:1 w/w). The catalytic activity of this material was evaluated by the reaction of fructose dehydration at different reaction temperatures (60, 70, 80 and 90 °C). Fructose conversion and selectivity toward 5-HMF were determined by high performance liquid chromatography (HPLC), obtaining 95% and 73% respectively for the highest temperature. The catalyst showed an efficient stability after 24 hours in continuous flow at 70 °C. The loss of sulfur content was 15%, but the fructose conversion yield and the selectivity to 5-HMF after 24 hours of continuous reaction did not undergo significant changes (less than 5%). The nuclear magnetic resonance (NMR) tests confirmed the presence of the thiol and sulfonic groups before and after 24 hours of reaction, as well as the conservation of the same structure, demonstrating the efficient catalytic performance of the material. The catalysts were characterized by nitrogen adsorption/desorption, X-ray diffraction and infrared (IR) spectroscopy. Also, before and after use by utilizing elemental analysis and   1 H - 13 C cross-polarization magic-angle spinning (CPMAS) and dynamic-nuclear polarization (DNP)-enhanced   1 H - 13 C and   1 H - 29 Si CPMAS as well as directly excited   29 Si magic-angle spinning (MAS) NMR methods in solid-state.

Formación y capacitación en salud mental / Education and training in mental health

Para adecuar la formación de RRHH a la Ley Nº 26.657 (LNSM), elaboraron recomendaciones señalando la necesidad de orientar integralmente contenidos de la formación de profesionales con énfasis en los ejes: enfoque de derechos, inclusión social, salud pública e interdisciplina como ejes transversales para la formación, extensión e investigación. OBJETIVO describir los obstáculos identificados en el cumplimiento de las Recomendaciones del Art. 33 de la LNSM en la formación universitaria y la capacitación en servicio de salud mental del Área Metropolitana de Buenos Aires (AMBA). Diseño exploratorio descriptivo para la caracterización de las capacitaciones en servicios y los planes de estudio vigentes (Enfermería, Medicina, Trabajo Social, Terapia Ocupacional y Psicología) de Universidades mediante observación sistemática de fuentes documentales (planes de estudio, programas, recomendaciones, lineamientos), y triangulación metodológica con programas de asignaturas y entrevistas a informantes claves. Se analizaron 39 planes, la mayoría no menciona la LNSM. Los contenidos y ejes de SM son abordados con diferente profundidad y a veces conceptualmente contradictorios con la ley. El eje de mayor cobertura es Interdisciplina incluido en todos los planes pero con diferentes abordajes. Los ejes Salud Pública e Inclusión Social tienen menos referencias. Sobre Enfoque de Derechos incluyen pocas normativas específicas. De los 293 programas de capacitación en servicio analizados los ejes con mayor cobertura son Salud Pública (46%) e Inclusión Social (24%). Sólo el 4% de los programas incluyen todos los ejes pero focalizando en algunos principios. Hay escasez de referencias explícitas a los requerimientos de la ley y presencia de contenidos, bibliografía o enfoques de difícil valoración respecto del marco normativo. Hay escasa articulación intersectorial e interjurisdiccional

Prevalencia de queilitis actínica en pescadores artesanales,Valdivia, Chile / Prevalence of actinic cheilitis in artisanal fishermen, Valdivia, Chile

El objetivo de este trabajo consistió en determinar la prevalencia de Queilitis Actínica en pescadores artesanales de la ciudad de Valdivia, Chile. Se realizó un estudio observacional descriptivo de corte transversal durante los meses de noviembre 2014 a abril 2015. La muestra fueron 180 pescadores previamente seleccionados a través de una muestra aleatoria simple, quienes fueron evaluados mediante un examen clínico y además completaron un cuestionario referente a datos personales y hábitos de salud. El 38,8 % de los pescadores artesanales presentó Queilitis Actínica. El 64,4 % de los pescadores revisados no utiliza protección solar mientras trabaja y todos los casos se ubicaron en el labio inferior. Los pescadores artesanales de la ciudad de Valdivia presentaron una prevalencia de Queilitis Actínica superior a las reportadas a nivel nacional. Nuestros resultados sugieren la implementación de políticas de salud pública centrados en la prevención de Queilitis Actínica en pescadores artesanales de la ciudad de Valdivia.

The aim of this study was to determine the prevalence of actinic cheilitis in fishermen in the city of Valdivia, Chile 2015. A descriptive observational cross-sectional study was realized from November 2014 to April 2015. The sample included 180 fishermen, previously selected through a simple random sample. The subjects were evaluated by clinical examination and also completed a questionnaire on personal data and health habits. Of the total fishermen surveyed 38.8 % presented Actinic cheilitis. Furthermore, 64.4 % of the fishermen interviewed reported they do not use sun protection while working and all cases were located in the lower lip. The fishermen in Valdivia showed a higher prevalence of Actinic cheilitis than that found nationally. Our results suggest the implementation of public health policies focusing on the prevention of actinic cheilitis in artisanal fishermen in the city of Valdivia.

Prone positioning as a bridge to recovery from refractory hypoxaemia following lung transplantation.

OBJECTIVES: Refractory hypoxaemia is the leading cause of mortality in the postoperative period after lung transplantation. The role of prone positioning as a rescue therapy in this setting has not been assessed. We evaluated its effects in lung transplant recipients presenting refractory hypoxaemia following the surgery. METHODS: Prospectively collected data from 131 consecutive adult patients undergoing lung transplantation between January 2013 and December 2014 were evaluated. Twenty-two patients received prone position therapy. Indications, associated complications, time to initiation and duration of the manoeuvre were analysed and the effects of prone position on gas exchange were evaluated. Finally, outcomes in this cohort were compared against the rest of lung transplant recipients. RESULTS: Prone positioning was more frequently implemented within the first 72 h (68.2%) and its main indication was primary graft dysfunction. The manoeuvre was maintained during a median of 21 h. After prone position, the pressure of arterial oxygen/fraction of inspired oxygen ratio significantly increased from 81.0 mmHg [interquartile range (IQR) 71.5-104.0] to 220.0 (IQR 160.0-288.0) (P < 0.001). No complications related with the technique were reported. Patients who underwent the manoeuvre had longer hospital stay [50.0 days (IQR 36.0-67.0) vs 30.0 (IQR 23.0-56.0), P = 0.006] than the rest of the population. No differences were found comparing either 1-year mortality (9.1% vs 15.6%; P = 0.740) or 1-year graft function [forced expiratory volume in 1 second of 70.0 (IQR 53.0-83.0) vs 68.0 (IQR 53.5-80.5), P = 0.469]. CONCLUSIONS: Prone positioning is safe and significantly improves gas exchange in patients with refractory hypoxaemia after lung transplantation. It should be considered as a possible treatment in these patients.