Abstract: For centuries, numerous treatments were used, of the most varied origins and based on the most unlikely foundations designed to hasten recovery and improve the survival of patients with whooping cough. In 1906, when the bacterial origin of whooping cough was identified, the hope for a potential treatment arose, however, only decades later, humanity would face a significant change with the con solidation of an effective vaccination. This article provides a historical review from the use of some of the most frequent treatments devised between the 18th-20th centuries for the cure of whooping cough. Some of the therapies offered in Chile in the first half of the last century are emphasized and detailed.

Resumen: Durante siglos fueron empleados numerosos tratamientos, de los más variados orígenes y basados en los más inverosímiles fundamentos, destinados a apresurar la recuperación y mejorar la sobrevida de los pacientes con coqueluche o tos convulsiva. En 1906 al identificarse el origen bacteriano de la coqueluche, surgió la esperanza de un potencial tratamiento, sin embargo, sólo décadas después la humanidad enfrentaría un cambio significativo con la consolidación de una vacunación efectiva. Este artículo entrega una mirada histórica del uso de algunos de los tratamientos más frecuentes ideados entre los siglos XVIII-XX para la cura de la tos convulsiva. Se enfatizan y detallan algunas de las tera pias ofrecidas en Chile en la primera mitad del siglo pasado.

Down syndrome is the most common chromosomal abnormality in newborns, with a high incidence in Chile. This condition presents unique physiological aspects that should be known, which can affect the child during their stay in an Intensive Care Unit, beyond the neonatal period This review is focused on the respiratory, cardiovascular, infectious and neurological disorders. Anesthetic management and postoperative analgesia considerations, weaning from mechanical ventilation, cervical spine instability and prognosis of the critically ill child with Down syndrome are also analyzed. The evaluation of these conditions should be performed when the patient is admitted to the intensive care unit. The purpose of this update is to update the knowledge of the diagnosis and treatment of potential complications of children with Down syndrome during their stay in the unit of critical patient.

El síndrome de Down es la alteración cromosómica más frecuente en los recién nacidos, con una alta incidencia en Chile. Esta condición presenta aspectos fisiológicos únicos, los cuales pueden afectar al niño durante su estadía en una Unidad de Cuidados Intensivos, posterior al período neonatal. En esta revisión abordamos aspectos actuales de la patología respiratoria, cardiovascular, infecciosa y neurológica, así como también consideraciones anestésicas y de analgesia postoperatoria, destete de la ventilación mecánica, inestabilidad columna cervical y pronóstico del niño críticamente enfermo portador de síndrome de Down. La evaluación de todas estas condiciones debe ser realizada cuando el paciente es ingresado a la Unidad de Cuidados Intensivos. El objetivo de la presente actualización es profundizar el conocimiento del diagnóstico y tratamiento de las potenciales complicaciones del niño con síndrome de Down durante su estadía en la unidad de paciente crítico.

Abstract: Respiratory monitoring plays an important role in the care of children with acute respiratory failure. Therefore, its proper use and correct interpretation (recognizing which signals and variables should be prioritized) should help to a better understanding of the pathophysiology of the disease and the effects of therapeutic interventions. In addition, ventilated patient monitoring, among other determinations, allows to evaluate various parameters of respiratory mechanics, know the status of the different components of the respiratory system and guide the adjustments of ventilatory therapy. In this update, the usefulness of several techniques of respiratory monitoring including conventional respiratory monitoring and more recent methods are described. Moreover, basic concepts of mechanical ventilation, their interpretation and how the appropriate analysis of the information obtained can cause an impact on the clinical management of the patient are defined.

Resumen: La monitorización respiratoria representa un importante rol en el cuidado del niño con falla respiratoria aguda. Por tanto, su apropiado uso y correcta interpretación (reconociendo qué señales y variables deben ser priorizadas) deberían ayudar a un mejor entendimiento de la fisiopatología de la enfermedad y de los efectos de las intervenciones terapéuticas. Asimismo, la monitorización del paciente ventilado permite, entre otras determinaciones, evaluar diversos parámetros de la mecánica respiratoria, conocer el estado de los diferentes componentes del sistema respiratorio y guiar los ajustes de la terapia ventilatoria. En esta actualización se describe la utilidad de diversas técnicas de monitorización respiratoria (incluyendo métodos convencionales y otros más recientes), se definen conceptos básicos de mecánica ventilatoria, su interpretación y cómo el adecuado análisis de la información puede ocasionar un impacto en el manejo clínico del paciente.

The main objective of this study was to asses the temporal variation (1999 trough 2008) of air quality in Rome, focusing on airborn concentration of selected pollutants (PM10 and PM2.5 mass concentration and particle number concentration, PNC, carbon monoxide, CO, nitrogen oxides, NO and NO2) used for health effects assessment in epidemiological analyses. Time series analysis using Seasonal Kendall test has been applied. A statistically significant decreasing trend was found for primary gaseous pollutants and total particle number concentrations. Moreover a decreasing trend was assessed for PM10, PM2.5 and NO2 measured at traffic oriented sites even if the estimated reduction was lower compared with NO, CO and PNC. The urban background PM10 and NO2 concentrations seem to be practically unchanged since 1999 as no statistically significant trends were found. All the pollutants show higher slope of the estimated trend line at traffic oriented sites compared with those observed at the urban background. Thus a reduction of the intra-city concentration variability throughout the years occurred.

Il principale obiettivo di questo lavoro è stato quello di valutare la variazione nel tempo (dal 1999 al 2008) della qualità dell'aria a Roma, con particolare riferimento alle concentrazioni di alcuni inquinanti aerodispersi (concentrazione di massa del PM10 e del PM2.5, concentrazione numerica delle particelle, PNC, monossido di carbonio, CO, ossidi di azoto, NO e NO2) usate negli studi epidemiologici per valutare gli effetti sulla salute correlati all'esposizione. La stima dei trend è stata eseguita usando il test non parametrico di Kendall corretto per la stagionalità. È stato individuato un trend statisticamente significativo di riduzione delle concentrazioni degli inquinanti gassosi primari (NO, CO) e del numero di particelle (PNC). Un trend statisticamente significativo di riduzione è stato individuato anche per PM10, PM2.5 e NO2 limitatamente ai siti di monitoraggio orientati al traffico, sebbene meno rilevante rispetto a quanto osservato per NO, CO e PNC. I livelli di concentrazione di PM10 e NO2 nel sito di fondo urbano sembrano invece rimanere praticamente invariati dal 1999 e non è possibile individuare alcun trend statisticamente significativo. Poiché per tutti gli inquinanti è stata evidenziata una pendenza maggiore della linea di tendenza stimata nelle stazioni di traffico rispetto a quella di fondo, è possibile concludere che nel corso degli anni si è verificata una riduzione della variabilità spaziale dell'esposizione all'interno della città.

The objective of this study was to evaluate and compare the results of microbiological and physical-chemical analyses of untreated and treated water from the Sanitation Company of Paraná (SANEPAR) of Maringá, Paraná, with literature data relating to the relation between these parameters and the presence of Cryptosporidium sp. and Giardia sp. We collected 186 water samples, 93 of treated water and 93 of untreated water. The microbiological analyses (total and thermotolerant coliforms) and physical-chemical analyses (turbidity, pH, iron, fluorides, color and chlorine) were carried out in accordance with the methodology described in the Standard Methods for the Examination of Water and Wastewater. The results of these analyses met in compliance with legislation; however, comparing these results with those found in literature does not eliminate the possibility of the occurrence of these protozoans. The present study supports the recommendation for the continuation of research of indicators for Cryptosporidium sp and Giardia sp, as well as methodologies that are simple, sensible, efficient and affordable for the research of these protozoans in water supplies.

El objetivo de este estudio fue evaluar y comparar los resultados de los análisis físico-químicas y microbiológicos del agua in natura y del agua tratada por la Compañía de Saneamiento del Paraná (SANEPAR), de Maringá, Paraná, con los datos de la literatura que se refieren a la relación entre esos parámetros y la presencia de Cryptosporidium sp. y Giardia sp. Fueron recogidas 186 muestras de agua, siendo 93 de agua tratada y 93 de agua in natura. Los análisis microbiológicos (coliformes totales y termotolerantes) y los físico-químicas (turbidez, pH, hierro, fluoruro, color y cloro) fueron realizadas de acuerdo con la metodología descrita por Standart Methods for the Examination of Water and Wastewater. Los resultados de estos análisis se encontraban en conformidad con la legislación, no obstante, comparando estos resultados con aquellos encontrados en la literatura, mismo el agua tratada obedeciendo a las normas establecidas por el Ministerio de la Salud, no elimina la posibilidad de ocurrencia de estos protozoarios. El actual estudio soporta la recomendación de que la investigación de los indicadores para el Cryptosporidium sp. y Giardia sp. y de las metodologías que sean simples, sensibles, eficientes y de bajo costo para la investigación de estos protozoarios en aguas de abastecimiento necesitan ser continuadas.

O objetivo deste estudo foi avaliar e comparar os resultados das análises microbiológicas e físico-químicas da água "in natura" e da água tratada pela Companhia de Saneamento do Paraná (SANEPAR), de Maringá, Paraná, com dados da literatura que se referem à relação entre esses parâmetros e a presença de Cryptosporidium sp. e Giardia sp. Foram coletadas 186 amostras de água, sendo 93 "in natura" e 93 de água tratada. As análises microbiológicas (coliformes totais e termotolerantes) e físico-químicas (turbidez, pH, ferro, fluoretos, cor e cloro) foram realizadas de acordo com a metodologia descrita pelo Standart Methods for the Examination of Water and Wastewater. Os resultados destas análises encontravam-se em conformidade com os requerimentos regulatórios, entretanto, comparando estes resultados com aqueles encontrados na literatura, mesmo a água tratada obedecendo às normas da Portaria estabelecida pelo Ministério da Saúde, não elimina a possibilidade de ocorrência desses protozoários. O presente estudo suporta a recomendação de que a pesquisa de indicadores para Cryptosporidium sp e Giardia sp e de metodologias que sejam simples, sensíveis, eficientes e de baixo custo para a pesquisa destes protozoários em águas de abastecimento precisam ser continuadas.

In this paper we present preliminary results obtained in an exploratory study about research practice effects on clinical practice; both activities are carried out by members of an university chair whose educational objective is tutoring of a psychoanalytic theory. The professional psychologists perform their activities as degree or posdegree teachers, as children psychotherapists in an welfare unit and also participate in an empirical investigation about psychic change in children and changes in the emotional support of their adults in charge, based on the clinical material gathered in the welfare unit. This is an heterogeneous working team regarding the teaching, assisting and research experience that includes both advanced students and recently graduated members of psychology and also professionals of long and recognized trajectory. We analyze the answers given to an open question asked to each teacher- psychotherapist-researcher with the aim of understanding their perception in respect to the effects of their research activity in their assisting practice. In the clinical practice, the teachers-psychotherapistsresearchers observe changes in the perception and in the organization of the clinical material and greater accuracy on their interventions.

Se presentan resultados preliminares de un estudio exploratorio acerca de los efectos de la práctica investigativa sobre la práctica clínica; ambas actividades son realizadas por integrantes de una cátedra universitaria cuyo objetivo docente es la enseñanza de una teoría psicoanalítica. Los profesionales psicólogos se desempeñan como docentes de grado y de postgrado, como psicoterapeutas de niños en una unidad asistencial y participan asimismo de una investigación empírica sobre cambio psíquico en niños y cambios en la contención emocional de sus adultos responsables, sobre la base de material clínico recogido en la unidad asistencial. Es un equipo heterogéneo respecto de la experiencia docente, asistencial e investigativa, que incluye estudiantes avanzados y graduados recientes de la carrera de Psicología y profesionales de larga y reconocida trayectoria. Se analizan las respuestas a una pregunta abierta formulada a cada docente-psicoterapeuta-investigador a fin de recabar su percepción respecto de los efectos de su actividad investigativa en su práctica asistencial. En la práctica clínica los docentes-psicoterapeutas-investigadores registran cambios en la percepción y en la organización del material clínico y mayor precisión en sus intervenciones.