Resumen La enfermedad renal crónica (ERC) es de alta prevalencia en América Latina y en todo el mundo. Se estima que entre 10 y 20% de la población adulta es portadora de ERC y su prevalencia va en aumento. La ERC progresa en forma silenciosa. Su diagnóstico temprano y oportuno permite iniciar un tratamiento efectivo, en la mayoría de los casos, para detener la enfermedad. Desde hace mucho tiempo, el análisis de la creatininemia es la principal prueba utilizada para valorar la función renal, pero su confiabilidad es limitada. De acuerdo con las recomendaciones de las GUIAS KDOQI del año 2002 la tasa de filtración glomerular estimada (TFGe) obtenida a través de fórmulas, se estableció como una de las herramientas principales para detectar la enfermedad renal de manera precoz, ya que alerta de forma precisa al médico y al equipo de salud sobre el nivel de función renal del paciente. La detección de una TFGe disminuida (menor de 60 mL/min/1,73 m2) es clínicamente relevante, ya que permite establecer el diagnóstico de enfermedad renal en adultos. En el año 2022, en una encuesta realizada por SLANH y COLABIOCLI dirigida a los laboratorios de análisis clínicos de América Latina (n: 237), el 49% de los mismos no informaban la TFGe rutinariamente. En base a esta realidad SLANH y COLABIOCLI elaboraron estas recomendaciones de consenso en referencia al uso de la TFGe.

Resumo A doença renal crônica (DRC) é altamente prevalente na América Latina e em todo o mundo. Estima-se que entre 10 e 20% da população adulta seja portadora de DRC e sua prevalência esteja aumentando. A DRC progride silenciosamente. Seu diagnóstico precoce e oportuno permite iniciar um tratamento eficaz, na maioria dos casos, para estancar a doença. Faz muito tempo, a análise da creatinina tem sido o principal teste usado para avaliar a função renal mas sua confiabilidade é limitada. De acordo com as recomendações dos GUIAS KDOQI do ano de 2002, a estimativa da taxa de filtração glomerular (eGFR), obtida por meio de fórmulas, consolidou-se como uma das principais ferramentas para a detecção precoce da doença renal, visto que alerta com precisão ao médico e ao equipe de saúde sobre o nível de função renal do paciente. A detecção de uma eGFR diminuída (inferior a 60 mL/min/1,73 m2) é clinicamente relevante, pois permite estabelecer o diagnóstico de doença renal em adultos. No ano de 2022, em pesquisa realizada pela SLANH e COLABIOCLI dirigida a laboratórios de análises clínicas da América Latina (n: 237), 49% deles não relataram rotineiramente eGFR. Com base nessa realidade, SLANH e COLABIOCLI prepararam essas recomendações de consenso sobre o uso de eGFR.

Abstract Chronic kidney disease (CKD) has a high prevalence worldwide and in Latin America (10 to 20% of the adult population) and is increasing. CKD progresses silently. Opportune diagnosis and treatment are effective in most cases to improve outcomes. Serum creatinine was the main test to assess kidney function, but its reliability is limited. Through the KDOQI Guidelines 2002, the estimated glomerular filtration rate (eGFR) obtained from equations was established as one of the main tools for the early detection of kidney disease in clinical practice. The detection of a decreased eGFR (less than 60 mL/min/1.73 m2) is clinically relevant. This cut-off level establishes the diagnosis of kidney disease in adults. In 2022 SLANH and COLABIOCLI conducted a survey among the clinical laboratories from Latin America. The survey included 237 laboratories, 49% of which did not routinely report the eGFR. Based on this situation, SLANH and COLABIOCLI have elaborated the following consensus recommendations regarding the use of eGFR.

RESUMEN: Este trabajo incursiona en la pregunta relativa al fundamento normativo u obligatoriedad moral del contrato. Ante esta pregunta, se presentan dos puntos de vista. El primero entiende que el contrato realiza un valor en sí mismo, cuyo fundamento se encuentra en el principio de autonomía (justificación intrínseca); el segundo, que la justificación del contrato pende de la realización de un valor social por su intermedio, como un ideal de eficiencia o justicia material (justificación extrínseca). El artículo intenta una defensa de la primera posición, enfatizando que al ser un valor que se desenvuelve dentro de una práctica social compartida como es el contrato, la autonomía necesariamente coexiste con reglas heterónomas o no contractuales que, en vez de socavarla, la hacen posible.

ABSTRACT: This work explores the question about the normative foundation or the moral obligatoriness of contract. Faced with this question, two points of view are presented. The first understands that contract realizes a value itself, the foundations of which derive from the principle of autonomy (intrinsic justification); the second, that the justification of the contract depends on the realization of a social value through it, as some notion of efficiency or material justice (extrinsic justification). The article attempts a defence of the first approach, emphasizing that being a value that unfolds within a shared social practice such as contract, autonomy necessarily coexists with heteronomous or non-contractual rules that, instead of undermining it, make it possible.

Abstract In this article, we analyze the intrinsically variable and unforeseen behavior of the Chilean electricity market regarding power purchase agree ments, emphasizing the transformation caused by the massive influx of non-conventional renewable energies since 2015. In this vein, on behalf of the unforeseen events theory and price adjustment or revision clauses, we study the parties possibilities to readjust their agreements in light of the new circumstances that arise after its conclusion.

Resumen En este trabajo analizaremos el comportamiento intrínsicamente variable e imprevisto del mercado eléctrico chileno con relación a los contratos de suministro eléctrico, haciendo hincapié en la transformación que ha causado la entrada masiva de energías renovables no convencionales desde el año 2015. En este sentido, al alero de la teoría de la imprevisión y de las cláusulas de ajuste o revisión de precios, estudiaremos las posibilidades que tienen las partes contratantes de reajustar sus pactos conforme a las nuevas circunstancias sobrevinientes a su celebración.

Crop evapotranspiration (ETc) is essential for irrigation scheduling. The amount of water consumed can be estimated by multiplying the reference evapotranspiration (ET0) by a crop coefficient (Kc); the value of Kc is usually obtained from FAO Paper nr 56. In table grapes (Vitis vinifera L.), Kc are obtained from experiments in vines trained on trellis systems; however in Chile, the most used is the overhead trellis system (parronal). Therefore, the objective was to determine water requirements and Kc values of a table grape orchard cv. Thompson Seedless trained on an overhead trellis system in Calle Larga (32°52’40" S, 70°37’45" W, 795 m a.s.l.), Aconcagua Valley, Chile, using the Eddy covariance method. During the 2008/2009 and 2009/2010 seasons, the instruments required for ET0 and ETc measurement were installed on a 4 m tower above the soil (2 m above vine canopy). The ET0 was estimated according to the FAO Penman-Monteith equation and ETc by the Eddy covariance method. The Kc was obtained by ratio between ETc and ET0. The maximum ETc was 7 mm d-1 and total water consumption was 810 mm. The season maximum Kc value of 1.2 was obtained near harvest during the first season, and 20 d before veraison in the second season. The Kc increased linearly with the percentage of intercepted solar radiation (IRS) by the vine canopy at noon, suggesting that an equation to convert the IRS to Kc is more useful than Kc tabulated according to phenology. The equation obtained in this experiment was Kc = 0.012 IRS - 0.1029, R² = 0.85.

Objetivo: Describir los hábitos higiénicos íntimos femeninos de algunas mujeres de Latinoamérica durante 2008. Métodos: Se aplicó una encuesta piloto, previamente diseñada, a un total de mil mujeres que acudieron a la consulta de un grupo de ginecólogos de Latinoamérica durante 2008 y aceptaron contestar voluntariamente la encuesta. Ambiente: Los países participantes fueron: Colombia, Costa Rica, Ecuador, Guatemala, Honduras, México, Panamá, Perú, República Dominicana y Venezuela. Resultados: El 95,4 % de las mujeres refirió realizar aseo corporal una o más veces al día y 2,8 %, una o dos veces por semana. El 71 % realiza aseo del área genital de adelante hacia atrás (de vulva a ano). El tipo de jabón más comúnmente usado es el jabón en barra, seguido de la presentación líquida. Se evidenció un porcentaje de 66,9 % de mujeres que depilan su área genital. El área circunscrita al bikini es la más depilada con 32,8 % y la depilación del área genital en su totalidad es de 28,8 %. El material de la ropa interior en la región vulvar más utilizado por las mujeres latinoamericanas encuestadas es el algodón (65,5 %), que sumado a 20,2 % de las mujeres que utilizan ropa interior de cualquier material con algodón fue cercano al 86 %. En relación con el uso de elementos de aseo genital durante las relaciones sexuales, 29,7 % de las mujeres encuestadas refiere utilizar duchas vaginales; de las cuales 42 % refirió su uso siempre que tiene relaciones sexuales y 43 %, ocasionalmente. A la costumbre de orinar antes y después de tener relaciones sexuales se encontró que 37,9 % de las mujeres orina después del coito; 17 %, antes y 11,8 % orina antes y después. Conclusiones: Las mujeres realizan en un gran porcentaje lavado de manos después de orinar o defecar, pero el hábito de lavarse las manos antes, sigue siendo bajo. En cuanto a la técnica de aseo genital, el porcentaje de técnica inadecuada sorprende por estar alrededor de 28 %. Es necesario reforzar las capacitaciones, mejorar las estrategias de divulgación y las campañas de salud pública.

Objective: To describe the intimate hygienic feminine habits of some women of Latin-America during 2008. Methods: A previously designed pilot survey was applied to a total of one thousand women who assisted to the office of a group of gynecologists of Latin America during 2008 and agreed to voluntarily answer the survey. Setting: The participant countries were: Colombia, Costa Rica, Ecuador, Guatemala, Honduras, Mexico, Panama, Peru, Dominican Republic and Venezuela. Results: 95.4 % of these women practiced corporal hygiene at least once daily and 2.8 %, once or twice a week. 71.% cleaned their genital area backwards (from vulva to anus). The type of soap most commonly used is the bar soap followed by liquid body wash. Evidence showed that 66.9 % of women depilate their genital area. The bikini surrounding area is the most depilated one, with a 32.8 % and the total depilation of the genital area is 28.8 %. Cotton is the most commonly used material for underwear on the vulvar area by surveyed Latin American women (65.5 %), which added to a 20.2 % of women who use underwear of any material with cotton was nearly 86 %. When the use of genital hygiene devices during sexual intercourse is questioned, 29.7 % of the surveyed women opted to use vaginal showers; of which 42 % used it every time they had sexual intercourse and 43 % just occasionally. In relation to the habit of urinating before and after having sexual intercourse it was established that 37.9 % of women urinate after the coitus; 17 % before it, and 11.8 % urinates before and after. Conclusions: Women, in a great percentage, wash their hands after urinating or defecating, but the habit of washing their hands before is still not as frequent. Regarding the genital (feminine) hygiene technique, the percentage of "inadequate" hygiene technique is surprisingly as low as about 28 % (percent). With this in mind, it is fundamental to reinforce training, improve information strategies and public health campaigns.

The design and the on-chip integration of planar microelectronic array and the read-out circuit implemented by 0.6 µm CMOS process (Complementary Metal-Oxide-Semiconductor), is presented. The design includes a shielding ring around the microelectrode array and a control for a tunable low pass filter, which are made with a CMOS transmission gate operating in subthreshold region. This is achieved by varying the gate voltage in a range from 400 to 800 mV for a frequency range of 1 to 1KHz. The performance of the circuit with a voltage supply ± 1.5 V was 40dB gain, 44 dB PSRR (power supply rejection ratio) and 87 dB CMRR (common-mode rejection ratio), in an area of 0.014mm², showing that the system is a good alternative for biological applications.

Se presenta el diseño e integración en el mismo substrato, de un arreglo de microelectrodos planares y el circuito de lectura implementado en un proceso comercial estándar CMOS (Semiconductor Complementario Metal-Oxido), de 0.6 µm. El diseño incluye el blindaje alrededor del arreglo de microelectrodos y el control del filtro pasabanda a través de la compuerta de transmisión CMOS operando en la región de subumbral. Esto se logra variando el voltaje de compuerta en un rango de 400 a 800 mV para un rango de frecuencia de corte bajo de 1 hasta 1 KHz. El funcionamiento del circuito con polarización de ± 1.5 V dio una ganancia de 40 dB, PSRR (razón de rechazo de la potencia aplicada) de 44 dB y CMRR (razón de rechazo de señales comunes) de 87 dB en un área 0.014 mm² haciéndolo un buen prospecto para la aplicación biológica.

The key messages of these guidel ines on chronic kidney disease are: • Chronic kidney disease (CKD) is a public health problem due to its wide distribution, high rate of complications and cost. • CKD is a common condition, its prevalence being about 10%, and is treatable if it is detected on time. • A patient with CKD has a higher risk of cardiovascular mortality than of progression of its underlying renal disease. • A new definition of CKD, based on estimated Glomerular Filtration Rate (eGFR) and kidney damage, facilitates its detection and management. • CKD is detected with three simple tests: 1) Blood pressure measurement, 2) Detection of proteinuria or albuminuria in an isolated urine sample, and 3) Estimation of renal function (eGFR), based on serum creatinine, age, gender and race. • The CKD risk groups are individuáis with diabetes, hypertension and a family history of renal disease. • The most cost-effective measures are to detect and treat diabetic and hypertensive patients in the community. • Therapy must emphasize the maximal reduction of cardiovascular risk. • The complications of CKD such as anemia and renal osteodystrophy can be identified and treated on time. • Most patients with chronic kidney disease are detected in the community, therefore their initial care must be organized at the level of primary care, along with programs for hypertension and diabetes.

Botulinum toxin has been thoroughly studied as a potential tool in the treatment of several pain syndromes. Therefore, we assessed the clinical effects of botulinum toxin type A injections in 12 patients with otherwise unresponsive idiopathic trigeminal neuralgia. Patients were infiltrated with 20-50 units of botulinum toxin in trigger zones. Those who presented with mandibular involvement were also infiltrated in the masseter muscle. The patients were assessed on a weekly basis using the Visual Analogic Scale for pain. Ten of our patients reported a significant benefit from botulinum toxin injections, with reduction or even disappearance of pain, and remained pain free for as long as 60 days. Our findings suggest that botulinum toxin may represent a useful therapeutic tool in the management of patients with this entity.

La toxina botulínica ha sido estudiada en forma exhaustiva como una potencial herramienta en el tratamiento de múltiples síndromes dolorosos. Por lo tanto, evaluamos los efectos clínicos de la aplicación de toxina botulínica tipo A en 12 sujetos con neuralgia trigeminal idiopática resistente a manejo farmacológico. Se aplicaron en dichos sujetos entre 20 y 50 unidades de toxina botulínica tipo A en las zonas gatillo. Además se infiltró el músculo masetero en aquellos que presentaban involucro mandibular. Los sujetos fueron evaluados semanalmente con una escala visual análoga para dolor. Diez de los sujetos reportaron un beneficio significativo con el uso de toxina botulínica, con reducción e incluso desaparición del dolor, permaneciendo libres de dolor por un periodo de hasta 60 días. Nuestros hallazgos sugieren que la toxina botulínica puede representar una herramienta terapéutica útil en el manejo de pacientes con esta entidad.