Subphenotyping of Mexican Patients With COVID-19 at Preadmission To Anticipate Severity Stratification: Age-Sex Unbiased Meta-Clustering Technique.

BACKGROUND: The COVID-19 pandemic has led to an unprecedented global health care challenge for both medical institutions and researchers. Recognizing different COVID-19 subphenotypes-the division of populations of patients into more meaningful subgroups driven by clinical features-and their severity characterization may assist clinicians during the clinical course, the vaccination process, research efforts, the surveillance system, and the allocation of limited resources. OBJECTIVE: We aimed to discover age-sex unbiased COVID-19 patient subphenotypes based on easily available phenotypical data before admission, such as pre-existing comorbidities, lifestyle habits, and demographic features, to study the potential early severity stratification capabilities of the discovered subgroups through characterizing their severity patterns, including prognostic, intensive care unit (ICU), and morbimortality outcomes. METHODS: We used the Mexican Government COVID-19 open data, including 778,692 SARS-CoV-2 population-based patient-level data as of September 2020. We applied a meta-clustering technique that consists of a 2-stage clustering approach combining dimensionality reduction (ie, principal components analysis and multiple correspondence analysis) and hierarchical clustering using the Ward minimum variance method with Euclidean squared distance. RESULTS: In the independent age-sex clustering analyses, 56 clusters supported 11 clinically distinguishable meta-clusters (MCs). MCs 1-3 showed high recovery rates (90.27%-95.22%), including healthy patients of all ages, children with comorbidities and priority in receiving medical resources (ie, higher rates of hospitalization, intubation, and ICU admission) compared with other adult subgroups that have similar conditions, and young obese smokers. MCs 4-5 showed moderate recovery rates (81.30%-82.81%), including patients with hypertension or diabetes of all ages and obese patients with pneumonia, hypertension, and diabetes. MCs 6-11 showed low recovery rates (53.96%-66.94%), including immunosuppressed patients with high comorbidity rates, patients with chronic kidney disease with a poor survival length and probability of recovery, older smokers with chronic obstructive pulmonary disease, older adults with severe diabetes and hypertension, and the oldest obese smokers with chronic obstructive pulmonary disease and mild cardiovascular disease. Group outcomes conformed to the recent literature on dedicated age-sex groups. Mexican states and several types of clinical institutions showed relevant heterogeneity regarding severity, potentially linked to socioeconomic or health inequalities. CONCLUSIONS: The proposed 2-stage cluster analysis methodology produced a discriminative characterization of the sample and explainability over age and sex. These results can potentially help in understanding the clinical patient and their stratification for automated early triage before further tests and laboratory results are available and even in locations where additional tests are not available or to help decide resource allocation among vulnerable subgroups such as to prioritize vaccination or treatments.

Actitud hacia el consumo, ahorro y endeudamiento en titulados de una universidad pública del sur de Chile / Attitudes toward purchase, saving and indebtedness in university graduates from a public university of southern Chile

La presente investigación tiene por objeto comparar las actitudes hacia el ahorro, consumo y endeudamiento en titulados de una universidad pública del sur de Chile, a partir de su género, nivel socioeconómico y facultad de procedencia. Cuenta con un diseño cuantitativo, no experimental, ex post facto, de alcance descriptivo-correlacional y de tipo transversal. Se administraron la Escala de Actitudes hacia el Endeudamiento, la Escala de Actitudes hacia el Ahorro, la Escala de Actitudes hacia la Compra y la Escala de Evaluación del Nivel Socioeconómico ESOMAR. Además, se aplicó un cuestionario de preguntas de clasificación sociodemográfica, que fue respondido por 120 titulados universitarios de una universidad pública del sur de Chile contactados mediante el método bola de nieve. Se realizaron análisis descriptivos, pruebas de comparación de medias y medianas para dos muestras independientes para las comparaciones según género, nivel socioeconómico y facultad de procedencia (pruebas t para muestras independientes y pruebas U de Mann-Whitney),y pruebas de correlación r de Pearson para identificar posibles asociaciones entre las distintas escalas y subescalas. Los resultados permiten concluir un perfil esperable en cuanto a actitudes hacia el ahorro, endeudamiento y la compra, en titulados universitarios. En relación a las comparaciones, si bien se encontraron algunas diferencias significativas en cuanto a género y nivel socioeconómico de los participantes, resultaron más bien bajas. Finalmente, se hallaron asociaciones entre actitudes hacia el ahorro con austeridad y con racionalidad en la compra. También se encontraron asociaciones entre compulsividad en la compra con austeridad (inversamente) y con impulsividad en la compra, lo que apunta a una coherencia teórica de los constructos y sus dimensiones. Limitaciones del estudio incluyen el uso de medidas de autorreporte, lo que restringe la extrapolación de resultados a contextos fuera del presente estudio. Otra limitación corresponde al método de muestreo utilizado (bola de nieve) y tamaño muestral, lo que no permitiría generalizar los resultados a la población. A partir de los hallazgos y limitaciones, se realizan sugerencias para futuras investigaciones en alfabetización económica.

Since the decade of 1970 onward in Chile, there has been a substantial change in terms of economic behaviour, which stems mainly from the installation of a neoliberal socioeconomic model. The profound consequences of this change for the Chilean society can be seen to this day, 40 years later, and these consequences include: broader access to goods and services for segments of the population that were previously excluded and/or that were a privilege of the economic elites; the assignation of new meanings to the concepts of purchase; and saving and indebtedness. These are all key concepts for the development and comprehension the neoliberal model. Complementary, the study of university graduates' behaviour is especially relevant in this area, considering that higher education is often thought to play a substantial role in social mobility. In the Chilean context, the transformations of the educational system have favoured the expansion of the admission numbers up to the point that seven of ten Chileans that pursue a graduate degree are the first members of their family to reach this educational level. Considering the above, the present study aims to compare attitudes towards purchase, saving and indebtedness in graduates from a university in southern Chile, by gender, socioeconomic level and faculty. The study follows a quantitative, cross-sectional, non-experimental, ex-post-facto design, with a descriptive-correlational scope. A questionnaire was completed by 120 participants contacted via snowball method. The questionnaire included: the Attitudes toward Indebtedness Scale; Attitudes toward Saving Scale; and Attitudes toward Purchase Scale, a scale that evaluates the participants' socioeconomic level and other sociodemographic information to help describe the sample. Descriptive analyses were carried out, along with mean and median comparisons for gender, socioeconomic level and faculty (t tests for independent samples and Mann-Whitney U tests). Finally, correlation tests with Pearson's r test were carried out to test associations between the scales and subscales. Results showed a profile that is desirable in university graduates in terms of attitudes towards saving, indebtedness and purchase, that is: favourable attitudes toward saving, austerity (a subscale of attitudes toward indebtedness) and rationality (a subscale of attitudes toward purchase), as well as negative attitudes toward hedonism (a subscale of attitudes toward indebtedness), and compulsivity and impulsivity (subscales of attitudes toward purchase). In terms of comparison, differences were found when comparing participants by gender in terms of attitudes toward compulsivity, and by their socioeconomic level by attitudes toward austerity in the indebtedness. Both these differences, although significant, were low when considering their effect size. No differences were found when comparing the faculty to which participants belonged in terms of attitudes toward saving, indebtedness and purchase. Finally, results showed associations between attitudes toward saving and austerity and with rationality, and between compulsivity and austerity (inversely) and with impulsivity. These results highlight the need to strengthen the attitudinal aspect in higher education environments where economic literacy is carried out, aiming to prepare students for their insertion into the workforce and their role as active citizens. Limitations of this study include the subjective self-report measurements used, which are susceptible to the effect of social desirability. This limitation hinders the extrapolation of the results in terms of attitudes into actual behaviour in the real world. Another limitation comes from the sampling method used (snowball) and sample size, which does not allow to generalize the results to the population. Drawing from both findings and limitations, suggestions for future research in the subject of economic literacy and related issues are outlined.

Sarcoidosis como espondiloartropatía seronegativa / Sarcoidosis presenting as seronegative spondyloarthropathy

Presentamos dos casos de dolor lumbar de tipo inflamatorio y dolor alternante en nalgas, quedesarrollaron disnea progresiva con adenopatías mediastinales e hiliares y signos de enfermedad pulmonar intersticial a la tomografía de tórax. El diagnóstico de sarcoidosis se confirmó con biopsia cutánea en un caso y con biopsia pulmonar a cielo abierto en el otro. Se discute esta forma inusual de presentación de estas dos patologías y se revisan los casos similares de la literatura

[Sarcoidosis as seronegative spondyloarthropathy]. / Sarcoidosis como espondiloartropatía seronegativa.

Two cases were presented with initial symptoms of inflammatory low back pain and alternate buttock pain. They developed a progressive dyspnea with bilateral mediastinal and hiliar lymphadenopathy and pulmonary interstitial disease as visualized with chest CT scan. Sarcoidosis diagnosis was confirmed by biopsy in both cases--in one case by skin biopsy and in the other by open lung biopsy. These clinical forms of spondyloarthropathy and sarcoidosis were unusual and were compared with similar cases present in the literature.

Hospital del Trabajador de Concepción: programa de control de antimicrobianos / Hospital del Trabajador de Concepción: antibiotic control program

Se diseñó una estrategia para disminuir el consumo y gasto en antimicrobianos de última generación y alto costo a fin de mitigar el impacto económico, proteger la ecología bacteriana y contrarrestar la gran presión que existe para la aparición de cepas microbianas resistentes. Se estudió dos años consecutivos hasta agosto de 1997, se obtuvo una disminución en el consumo de estos medicamentos en un promedio de 41,75 por ciento y un menor gasto económico de 46,6 por ciento. Estas cifras comprenden dos factores: distinto número y tipos de infecciones y una mejor selección en la indicación de los antimicrobianos sometidos a control. No se logró la meta propuesta de mejorar la sensibilidad bacteriana de varios gérmenes a AB específicos, con resultados favorables parciales, pues se estima muy corto el tiempo para su logro. Nos parece que es necesario que los hospitales tengan programas bien definidos para el control de uso de estos antimicrobianos, ya que es evidente el beneficio económico y para el ambiente bacteriológico, elevando así el standard de calidad

Evaluación de la eficiencia de cuatro garrapaticidas usados por nuestros ganaderos para el control de la garrapata / Evaluations of the efficiency of four tick killers used by our cattle breeders for the tick control

Evalúa la eficiencia de 4 productos químicos frecuentemente utilizados en Panamá para el control de las garrapatas del ganado vacuno. Para el experimento se colectaron 100 garrapatas hembras que presentaban desove. Cada grupo de 100 se obtuvieron de 2 fincas, una en la provincia de Panamá y otra en la provincia de Los Santos. El estudio se presenta de la siguiente manera: 1. Aspectos generales de los garrapaticidas; 2. Materiales y procedimiento utilizados; 3. Conclusiones y Recomendaciones. Entre las conclusiones podemos destacar que de los 4 garrapaticidas solo el , un organofosforado, presentó mayor capacidad de inhibir la ovoposición en las garrapatas