Background: The rate of survival to hospital discharge is less than 10% for out-of-hospital cardiac arrest (OHCA). Aim: To develop and implement a Chilean prospective, standardized cardiac arrest registry following the Utstein criteria. Material and Methods: We conducted a prospective registry for patients presenting at an urban, academic, high complexity emergency department (ED) after having an OHCA. The facility serves approximately 10% of the national population. Data were registered and analyzed following the Utstein criteria for reporting OHCA. Results: For three years, 289 patients aged 59 ± 19 years (63% men) were included. Fifty seven percent of patients were taken to a health care facility for the first medical assessment by relatives or witnesses and 34% was assisted and transferred by prehospital personnel. In the subgroup of non-traumatic OHCA, 28% (n = 54) received bystander cardiopulmonary resuscitation (CPR). The registered cardiac rhythms were asystole (61%), pulseless electrical activity (PEA) (25%) and ventricular tachycardia (VT) or ventricular fibrillation (VF) (11%). The overall survival rate to discharge from the hospital was 10%, while survival with mRankin score 0-1 was 5%. The median hospitalization length of stay was 18 days among those who survived, compared with five days for the group of patients that died during the hospital stay. Conclusions: OHCA is an important cause of death in Chile. The development of a national registry that follows the International Liaison Committee on Resuscitation guidelines is the first step to assess the profile of OHCA in the region. It will provide crucial information to identify prognostic factors and variables that can help develop standards of care and set up the basis to optimize cardiac arrest management within our country and region.

Abstract Background: The COVID-19 pandemic has affected millions of people around the world. Part of control strategies is testing a large proportion of the population to identify and isolate the infected subjects. Aim: To evaluate the SARS-CoV-2 detection by the performance of a reverse transcription and quantitative polymerase chain reaction (RT-qPCR) against SARS-CoV-2, using saliva as a matrix compared to a nasopharyngeal swab (NPS) to simplify obtaining a diagnostic sample. Methods: Adults in outpatient care were recruited, 95% of them symptomatic. We studied 530 paired saliva and NPS samples by SARS-CoV-2 RT-qPCR. Results: Fifty-nine individuals tested positive in NPS and 54 in saliva samples. Sensitivity for saliva sample was 91%, specificity 100%, positive predictive value (PPV) 100%, negative predictive value (NPV) 98%. The Kappa index was 0.95 and LR-0.08. On average, the cycle threshold (CT) of saliva was 3.99 points higher than those of NPS (p < 0.0001) showing that viral load (VL) is lower in saliva than in NPS. Viral load in both decreased over the time after onset of symptoms. Saliva sampling was preferred by subjects instead of NPS. Conclusion: This study demonstrates that SARS-CoV-2 RT-qPCR using saliva, even with lower VL, is suitable for the diagnosis of COVID-19 in outpatient adults, especially at early stage of symptoms.

Resumen Introducción: La pandemia de COVID-19 ha afectado a millones de personas en todo el mundo. La identificación de sujetos infectados ha sido importante para el control. Objetivo: Evaluar el rendimiento de una reacción de polimerasa en cadena (RPC) cuantitativa en tiempo real (en inglés: RT-qPCR) para SARS-CoV-2, utilizando saliva como matriz en comparación con un hisopado nasofaríngeo (HNF). Metodología: Se reclutaron adultos en atención ambulatoria, la mayoría sintomáticos. Fueron estudiadas 530 muestras pareadas de saliva e HNF con RT-qPCR. Resultados: Fueron positivas 59 muestras de HNF y 54 de saliva. La sensibilidad con saliva fue 91%, especificidad 100%, el valor predictor positivo (VPP) 100%, valor predictor negativo (VPN) 98%. El índice Kappa fue de 0,95 y LR-0,08. En promedio, el umbral de ciclo (en inglés cycle threshold-CT) de la saliva fue 3,99 puntos más alto que los de HNF (p < 0,0001) mostrando que la carga viral (CV) es menor en saliva. La carga viral en ambas disminuyó con el tiempo después del inicio de los síntomas. El muestreo de saliva fue preferido por los sujetos en lugar de HNF. Conclusión: Este estudio demuestra que la RPC para SARS-CoV-2 utilizando saliva, es adecuada para el diagnóstico de COVID-19 en adultos ambulatorios, especialmente en la etapa temprana de los síntomas.

Background: The impact of donor quality on post-kidney transplant survival may vary by candidate condition. Objective: Analyzing the combined use of the Kidney Donor Profile Index (KDPI) and the estimated post-transplant survival (EPTS) scale and their correlation with the estimated glomerular filtration rate (eGFR) decline in deceased-donor kidney recipients (DDKR). Methods: This was a retrospective, observational cohort study. We included DDKRs between 2015 and 2017 at a national third-level hospital. Results: We analyzed 68 DDKR. The mean age at transplant was 41 ± 14 years, 47 (69%) had sensitization events, 18 (26%) had delayed graft function, and 16 (23%) acute rejection. The graft survival at 12 and 36 months was 98.1% (95% CI 94-100) and 83.7% (95% CI 65-100), respectively. The Pearson correlation coefficient between the percentage reduction in the annual eGFR and the sum of EPTS and KDPI scales was r = 0.61, p < 0.001. The correlation coefficient between the percentage reduction in the annual eGFR and the EPTS and KDPI scales separately was r = 0.55, p < 0.001, and r = 0.53, p < 0.001, respectively. Conclusions: The sum of EPTS and KDPI scales can provide a better donor-recipient relationship and has a moderately positive correlation with the decrease in eGFR in DDKR.

RESUMEN Como resultado del debate sobre desarrollo rural ha habido un creciente interés por los enfoques territoriales que enfatizan la utilización y el desarrollo de recursos locales, así como la consideración de las demandas de distintos miembros de la comunidad. Este estudio evalúa el impacto de un programa de reducción de la pobreza sobre dos dimensiones de bienestar: ingresos y consumo en educación y salud. El análisis empírico utiliza una base de datos primaria de 2,234 hogares beneficiarios y no beneficiarios que residen en áreas rurales de México. Los resultados ofrecen información valiosa sobre cómo los programas de reducción de pobreza pueden mejorar el nivel de bienestar en comunidades rurales a través de intervenciones de desarrollo de capacidades vinculadas a inversiones en dos formas de capital territorial, a saber, capital humano y activos productivos.

ABSTRACT Within the rural development debate, there has been increasing call for a stronger territorial focus that emphasizes the utilization and development of local resources along with the demands of community members. This study evaluates the impact of a poverty reduction program on two well- being dimensions: income and consumption in education and health. The empirical analysis uses a primary dataset of 2,234 beneficiary and non-beneficiary households residing in rural areas of Mexico. The results offer valuable insights on how poverty reduction programs can improve the well-being level in the targeted communities through capability-building interventions linked to investments in two forms of territorial capital, namely human capital and productive assets.

ABSTRACT Objective: The discipline genre related problems faced by the students at the university reveal the need of figuring out the corresponding ways of inclusion in the new and complex academic culture. This article aims at examining the characteristic features of the discipline genre and the implications of its didactic transposition in learning contents and the foreign language. Methods: The didactic transposition theoretical framework construction was needed for determining, through the analysis and synthesis, the necessary elements to devise the didactic approach of mathematical contents related to discipline genres teaching and learning. Results: The main finding of the paper involved the description and foundations of the generic perspective and the implications of its didactic transposition in the field of learning contents and the foreign language. The paper also includes a full description of an assessment tool of a generic progressive character, focused on the learning of mathematics contents through oral interaction, reading comprehension and academic writing in the foreign language. These tasks include the recognition of mathematics objects from written sources (in English) and its representation in several semiotic systems, its corresponding comprehension, communication and translation to mathematics codes. Conclusions: The basic elements of generic perspective have contributed to install planning, organization and evaluation of disciplinary contents and linguistic-communicative aspects in accordance with socio-cultural factors in teaching and learning a unit, widening the potentials of the English Language Curricular Strategy based fostering the didactic transposition of contents and the foreign language.

RESUMEN Objetivo: Los problemas que ocasionan los géneros disciplinares que los estudiantes encuentran en la universidad dan cuenta de la necesidad de buscar vías que posibiliten la inserción progresiva a esta nueva y compleja cultura académica. Al respecto, el objetivo de este trabajo es examinar algunas características del género disciplinar y las implicaciones de la transposición didáctica del mismo en el marco del aprendizaje de contenidos y lengua extranjera. Métodos: Para el desarrollo del trabajo se emplearon como métodos de investigación fundamentales la sistematización teórica acerca del proceso de transposición didáctica para determinar, a través del análisis y síntesis, los elementos necesarios para encauzar el trabajo didáctico de los saberes emanados del género disciplinar, básicamente de la Matemática y su enseñanza en el marco del aprendizaje de contenidos y lengua extranjera. Resultado: El resultado principal del trabajo consistió en la fundamentación y descripción de la perspectiva genérica disciplinar y las implicaciones de la transposición didáctica de la misma en el marco del aprendizaje de contenidos y lengua extranjera. Se ilustra el empleo de un instrumento de evaluación de progresividad genérica del estudiante desde etapas iniciales, focalizado en el aprendizaje de contenidos académicos y lengua a través de prácticas de interacción oral, comprensión de lectura y escritura académica de la Matemática en la lengua extranjera (inglés), con acciones de reconocimiento de objetos matemáticos obtenidos de fuentes escritas en inglés y su representación en diferentes sistemas semióticos, la comprensión y exploración de textos académicos sencillos de la ciencia Matemática escritos en inglés, la verbalización de contenidos matemáticos, la traducción a códigos matemáticos de la información recibida por la vía de interacciones, enunciados y materiales de diferente tipo en inglés y español, entre otras. Conclusiones: Los elementos que fundamentan la perspectiva del género disciplinar esgrimidos han contribuido a situar la planificación, organización y evaluación de contenidos disciplinares y elementos lingüístico-comunicativos en consonancia con los elementos socio-culturales en una sola unidad de diseño de la enseñanza y el aprendizaje, lo que enriquece la concepción didáctica de la Estrategia Curricular de Inglés sobre el género disciplinar y las implicaciones de la transposición didáctica del mismo en el marco del aprendizaje progresivo de los contenidos y la lengua extranjera.

Background: The incidence of out of hospital cardiac arrest (OHCA) is approximately 20 to 140 per 100.000 inhabitants. International registries, based on Utstein criteria have allowed standardized reporting of OHCA profiles and outcomes in different countries. We proposed to create a local OHCA registry. Aim: To assess the quality of the information about OHCA currently recorded in medical records according to Utstein guidelines. Material and Methods: A retrospective analysis of medical records of patients arriving in the emergency room of a public hospital with OHCA during a 3-year period. Data regarding the patient characteristics, event and outcomes were analyzed. Results: During the revision period, 317 patients arrived with an OHCA. None of the medical records had complete data on items that are considered a minimum requirement by Utstein guidelines. Mean age of patients was 63 years old, 60% were men, the most common arrest rhythm was asystole (43%) and 8% of patients were discharged alive. Conclusions: Data recorded in medical records is insufficient to inform the profile of OHCA. A prospective registry is currently being implemented based on the information provided by this study. This registry should optimize reporting and data analysis.

This paper deals with the improvement of the didactic management of Applied Mathematics in Civil Engineering major, in the interaction of teaching and learning mathematics. The study, by means of applying methods and procedures of research-in-action, attempts to provide an active and professional approach to mathematics in a practical context of civil engineering that contributes to develop a reflexive learning and leads the students to fulfill the objective of integral education. The authors highlight the didactic management of the subject Mathematics I, based on human and professional values as a component of learning content and not only merely learning mathematics. This is expressed in the approach followed, characterized by moving from social to individual issues to achieve a level of command of mathematics satisfying the demands of society.

El artículo se aborda el perfeccionamiento de la gestión didáctica de la Matemática Aplicada en la carrera Ingeniería Civil, en la interacción de la enseñanza con la obtención de conocimientos matemáticos de los estudiantes. En este estudio, mediante la aplicación de procedimientos y técnicas de la investigación-acción, se describen de acciones didácticas de la Matemática I a partir de situaciones de la práctica de la Ingeniería Civil, se orienta la enseñanza de la asignatura en un sentido profesional que contribuye al desarrollo de la reflexión del aprendizaje de los estudiantes en el cumplimiento de los objetivos de su formación integral. La postura que asumen los autores destaca la gestión didáctica de la Matemática I basada en los valores humanos y profesionales como parte fundamental del contenido y no solo el conocimiento matemático, lo que se manifiesta en el enfoque asumido, al transitar de lo social a lo individual hasta alcanzar un nivel de preparación matemática del profesional en formación que satisface la demanda la sociedad.

La transición epidemiológica observada en las últimas décadas ha implicado un aumento creciente de enfermedades crónicas, fenómeno asociados con el estilo de vida de la población, al modelo alimentario y al sedentarismo, lo que predispone a la obesidad y a la resistencia a la insulina, condicionando patologías cardio metabólicas como la hipertensión arterial y la dislipidemia, favoreciendo el desarrollo del síndrome metabólico. El tratamiento consiste en el manejo farmacológico, mejoras en los hábitos alimentarios y la incorporación de la actividad física a la rutina diaria. Tradicionalmente los programas de ejercicio están orientados a un método aeróbico para mejorar los parámetros alterados. Sin embargo, actualmente han surgido nuevas estrategias de intervención como el entrenamiento interválico de alta intensidad, que ha evolucionado como un modelo de intervención eficaz, con real impacto en el estado de salud de la población. El objetivo de esta revisión es entregar una mirada histórica y actualizada del ejercicio interválico de alta intensidad, de su impacto en la población y de las adaptaciones fisiológicas que respaldan su uso como herramienta terapéutica.

The epidemiological transition observed in recent decades has led to a continuous increase in chronic non communicable diseases, phenomenon associated with the lifestyle of the population, the dietary pattern and physical inactivity, which predisposes to obesity and insulin resistance, conditioning cardiometabolic disease such as hypertension and dyslipidemia, allowing the development of metabolic syndrome. The treatment consists of pharmacological management, improving dietary habits and the incorporation of physical activity into the daily routine. Traditionally exercise programs are oriented to aerobic methods for improving altered parameters. New intervention strategies such as high-intensity interval training have been developed, which has evolved as a model of effective action, with a real positive impact on the health status of the population. The objective of this review is to provide a historical and updated look of high-intensity interval exercise, its impact on the population and physiological adaptations that support its use as a therapeutic tool.

The need for critical care services is increasing in Chile. Critical care beds and specialists in this area are scarce. In this article we discuss some aspects that hamper the care of critically ill patients from their arrival to the emergency department to their transfer to the ICU. Special emphasis is given to system saturation and its multiple causes. The benefits of an integrative approach between emergency medicine and critical care specialists are highlighted and some solutions are proposed to strengthen this partnership.

Objetivo: O transtorno de déficit de atenção com hiperatividade (TDAH) se associa a comprometimento funcional em diferentes domínios. Resiliência, o modo como indivíduos enfrentam e superam dificuldades, não foi investigada de modo suficiente no TDAH e poderia sugerir potenciais novas estratégias terapêuticas. Entretanto, sendo o TDAH frequentemente comórbido com outras condições clinicas, é necessário entender se ele compromete a resiliência de modo independente de outras variáveis. Este estudo piloto é o primeiro a investigar a correlação entre medidas quantitativas de resiliência e TDAH diagnosticado de modo estrito controlando-a por variáveis clínicas.Método: Os níveis de resiliência de 12 adolescentes diagnosticados com TDAH de acordo com os critérios do sistema Manual Diagnóstico e Estatístico de Transtornos Mentais, 4ª edição (DSM-IV) através de entrevista semiestruturada foram comparados aos de 12 adolescentes com desenvolvimento típico, em uma análise controlada por níveis de ansiedade e depressão, status socioeconômico e inteligência.Resultados: O grupo TDAH apresentou menor resiliência do que o grupo controle (p < 0,01). Não houve correlação entre resiliência e depressão ou ansiedade, idade, inteligência ou nível socioeconômico.Conclusões: TDAH parece estar associado a baixos níveis de resiliência que não podem ser justificados por depressão, ansiedade, inteligência, idade ou condição socioeconômica.

Objective: Attention deficit hyperactivity disorder (ADHD) is associated with impaired daily functioning in a wide range of domains. Resilience, the ability to overcome and recover from challenges, has been scarcely investigated in ADHD and could potentially provide novel strategies for treatment. However, since ADHD is often comorbid with other clinical conditions, it is necessary to better understand if it impairs resilience levels when controlled for other variables. This pilot study is the first to investigate the correlation between quantitative measures of resilience and ADHD using strict diagnostic criteria by controlling this correlation for comorbid conditions.Methods:Twelve adolescents diagnosed with ADHD via semi-structured interview using Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) were compared to 12 adolescents exhibiting typical development, regarding resilience, in an analysis controlled for anxiety and depression levels, socioeconomic status, and intelligence quotient (IQ).Results: The ADHD group was less resilient than the control group (p < 0.01). Importantly, resilience in the ADHD group was not correlated with depression or anxiety, age, intelligence level, and socioeconomic status.Conclusions:ADHD seems to be associated with lower resilience, which cannot be explained by depression, anxiety, intelligence level, age, or socioeconomic status.

Background: Heart rate variability analysis provides quantitative information about vagal and sympathetic modulation of cardiac function. Aim: To analyze the relationship between heart rate variability and insulin resistance in obese patients. Material and Methods: Male participants were studied, divided in 10 obese subjects aged 27 ± 2 years with a body mass index (BMI) of 31.2 ± 1.3 kg/m², 15 overweight subjects aged 24 ± 3 years with a BMI of 26.7 ± 1.5 kg/m² and 14 normal weight subjects aged 21 ± 2 years with a BMI of 22.5 ± 1.3 kg/m². Resting heart rate variability was measured in a period of 5 minutes. A spectral analysis was done measuring the low frequency/high frequency ratio (LF/HF). A non- linear analysis was carried out measuring the standard deviation of the instantaneous variation of RR intervals (SD1) and α-1 or a fractal analysis of RR interval complexity. A fasting blood sample was obtained to measure blood glucose and insulin and calculate the homeostasis model assessment for insulin resistance (HOMA-IR). Results: Among obese subjects HOMA-IR, LF/HF, α-1 and SD1 values were 2.6 ± 2.1, 2.4 ± 1.8, 1.2 ± 0.06 and 22.5 ± 10 respectively. The figures for normal weight subjects were 0.5 ± 0.1, 1.3 ± 0.2, 0.9 ± 0.3 and 26 ± 7.8 respectively. Conclusions: There is an association between spectral and fractal values of heart rate variability and HOMA-IR. These results may indicate a predominance of sympathetic control of heart rate among obese subjects.

This paper enters upon the problematic relationship between the claim for damages and the complaints for collapsing building, when who pretends to try one of this remedies is a neighbour of the building which suffers the collapse. For this purpose, we will develop an argument not based in the victim’s interest, but in the social incentives for the conservation of goods and the way how these valuations impose the existence of a real order of preference between these actions. Finally, with the purpose of being useful as a corrective to a strict interpretation of the legal rules analyzed, possibles jurisprudencial development’s guidelines are insinuated, destined to protect the neighbour who has satisfied his duties of self-care of analog way to the required by law.

El presente trabajo aborda la problemática relación existente entre la acción de indemnización de perjuicios y la querella de obra ruinosa, cuando quien pretenda intentar cada uno de estos remedios sea vecino de la edificación que sufre el colapso. Para tales efectos, se desarrollará una argumentación basada no en los intereses de la víctima, sino en los incentivos sociales existentes para la conservación de las cosas y la manera como estas valoraciones imponen la existencia de un verdadero orden de prelación entre las señaladas acciones. Finalmente, con el propósito de servir de correctivo a una interpretación estricta de las reglas legales analizadas, se insinúan posibles directrices de desarrollo jurisprudencial destinadas a amparar al vecino que ha satisfecho sus deberes de autocuidado de modo análogo al exigido por la ley.

Background: Chest pain (CT) constitutes an important cause of consultation and diagnostic dilemma in the emergency room, especially due to the possible presence of coronary disease. Its presentation, diagnosis and prognosis are different between men and women. Aim: To report a follow-up of patients attended at a Chest Pain Unit (CPU), evaluating gender differences. Material and Methods: Prospective evaluation of patients that consulted for chest pain in a period of 4 years. Baseline characteristics and the final diagnosis from CPU or hospitalization were registered. Telephonic follow-up was performed for at least one year. Mortality was determined using the national mortality registry. Results: A total of 1,168 patients aged 62 ± 23 years, 69 % men, were followed for a mean of 28 ± 20 months. A definitive diagnosis of coronary disease (CD) was done in 32 %. Mortality among women and men with CD was 28 and 14% respectively (p = 0,02). Predictor variables for mortality were the presence of a complete left branch block in the initial electrocardiogram, with an odds ratio (OR) of 12,5 (95% confi dence intervals (CI): 1,98-25,8), the presence of coronary disease with an OR of 3,98 (95% CI: 1,45-13,8) and elevated troponin I with an OR 2,12 (95% CI: 1,05-7,89). Female gender lost significance in the adjusted model. Conclusions: Complete left branch block, elevated troponin I and coronary etiology of CP are indicators of bad prognosis among patients that consult for CP. Women have twice the mortality of men after 28 months of follow-up.