RESUMO A partir de experiências de pesquisa realizadas desde o ano de 2008 até o momento, problematiza-se a relação entre sofrimento ambiental e territórios sustentáveis. A incerteza que acompanha o sofrimento ambiental, somada à falta de evidência e às dificuldades de levantar informações científicas sobre a saúde do território costeiro e insular, configura um espaço residual propício para a baixa regulamentação das indústrias e a intensificação de seus impactos sobre os territórios e seus habitantes. Nesse sentido, investigar as experiências de sofrimento ambiental permite aproximar-se das desigualdades socioecológicas da zona marinho-costeira da Patagônia chilena e das estratégias de seus habitantes para propor e mobilizar seus territórios rumo à sustentabilidade. 200 momento problematizase problematiza se sustentáveis insular sentido aproximarse aproximar marinhocosteira marinho costeira sustentabilidade 20 2

ABSTRACT From research experiences carried out from 2018 to the present, the relationship between environmental suffering and sustainable territories is problematized. The uncertainty that environmental suffering entails, added to the lack of evidence and the difficulties to gather scientific information on the health of the coastal and insular territory, configures a residual space conducive to the low regulation of industries and the deepening of their effects on the territories and their inhabitants. From there, inquiring into the experiences of environmental suffering allows us to approach the socio-ecological inequalities of the coastal marine zone of Chilean Patagonia and the strategies of its inhabitants to propose and mobilize their territories to sustainability. 201 present problematized entails territory there socioecological socio ecological sustainability 20 2

RESUMEN Desde experiencias de investigación realizadas desde el año 2018 hasta la actualidad, se problematiza la relación entre sufrimiento ambiental y territorios sustentables. La incertidumbre que conlleva el sufrimiento ambiental, sumado a la falta de evidencia y las dificultades de levantar información científica acerca de la salud del territorio costero e insular, configura un espacio residual propicio para la baja regulación de las industrias y la profundización de sus afectaciones sobre los territorios y sus habitantes. Desde ahí que indagar en las experiencias de sufrimiento ambiental permite aproximarse a las desigualdades socio-ecológicas de la zona marino-costera de la Patagonia chilena y a las estrategias de sus habitantes para proponer y movilizar sus territorios a la sustentabilidad. 201 actualidad sustentables insular socioecológicas socio ecológicas marinocostera marino costera sustentabilidad 20 2

RESUMEN Desde experiencias de investigación realizadas desde el año 2018 hasta la actualidad, se problematiza la relación entre sufrimiento ambiental y territorios sustentables. La incertidumbre que conlleva el sufrimiento ambiental, sumado a la falta de evidencia y las dificultades de levantar información científica acerca de la salud del territorio costero e insular, configura un espacio residual propicio para la baja regulación de las industrias y la profundización de sus afectaciones sobre los territorios y sus habitantes. Desde ahí que indagar en las experiencias de sufrimiento ambiental permite aproximarse a las desigualdades socio-ecológicas de la zona marino-costera de la Patagonia chilena y a las estrategias de sus habitantes para proponer y movilizar sus territorios a la sustentabilidad.

RESUMO A partir de experiências de pesquisa realizadas desde o ano de 2008 até o momento, problematiza-se a relação entre sofrimento ambiental e territórios sustentáveis. A incerteza que acompanha o sofrimento ambiental, somada à falta de evidência e às dificuldades de levantar informações científicas sobre a saúde do território costeiro e insular, configura um espaço residual propício para a baixa regulamentação das indústrias e a intensificação de seus impactos sobre os territórios e seus habitantes. Nesse sentido, investigar as experiências de sofrimento ambiental permite aproximar-se das desigualdades socioecológicas da zona marinho-costeira da Patagônia chilena e das estratégias de seus habitantes para propor e mobilizar seus territórios rumo à sustentabilidade.

ABSTRACT From research experiences carried out from 2018 to the present, the relationship between environmental suffering and sustainable territories is problematized. The uncertainty that environmental suffering entails, added to the lack of evidence and the difficulties to gather scientific information on the health of the coastal and insular territory, configures a residual space conducive to the low regulation of industries and the deepening of their effects on the territories and their inhabitants. From there, inquiring into the experiences of environmental suffering allows us to approach the socio-ecological inequalities of the coastal marine zone of Chilean Patagonia and the strategies of its inhabitants to propose and mobilize their territories to sustainability.

Resumen Se problematiza la enunciación 'otros-que-humanos' en torno a implementación de la ley Lafkenche (ley 20.249) y la producción de narrativas favorables y desfavorables a la implementación de Espacios Costeros Marinos de los Pueblos Originarios (ECMPO). A partir de enfoques poshumanistas y del giro ontológico en la antropología, el presente artículo explora teóricamente las manifestaciones ontológicas de las relaciones entre seres humanos y 'otros-que-humanos' en la implementación de la Ley: por una parte, Pueblos indígenas que afirman una relación equitativa y afectiva entre ambos mundos; y por otra parte, la posición de otros actores territoriales, quienes imponen narrativas que instrumentalizan y fragmentan esta relación. El desencuentro de estas ontologías es la base de desentendimientos y tensiones en la implementación de la Ley Lafkenche, definiendo, muchas veces, el futuro de los ECMPO y la adhesión o rechazo hacia esta política pública.

Abstract The enunciation 'other-than-humans' is problematized around the implementation of the Lafkenche law (law 20.249) and the production of favorable and unfavorable narratives for the implementation of Coastal and Marine Spaces of Indigenous Peoples (ECMPO). Based on post-humanist approaches and the ontological turn in anthropology, this article explores theoretically the ontological manifestations of the relation of human and ‘other-than-humans’ in the implementation of the Law: on the one hand, Indigenous Peoples who affirm an equitable and affective relationship between the both worlds; and on the other hand, the position of other territorial actors involved in the process, who impose narratives that instrumentalize and fragment this relationship. The disagreement of these ontologies is the basis of misunderstandings and tensions in the implementation of the Lafkenche Law, and often defines the future of the ECMPO and the adhesion or rejection of this public policy.

Background: The incorporation of novel drugs, such as proteasome inhibitors and immunomodulators, improved considerably the survival of patients with multiple myeloma. Aim: To evaluate the effect on survival of proteasome inhibitors and immunomodulators in patients with multiple myeloma in two national hospitals. Material and Methods: Review of clinical records from two hospitals of Santiago. Epidemiological, clinical, laboratory and therapeutic data was obtained from 144 patients with multiple myeloma diagnosed between 2002 and 2016. Results: Information was retrieved from 78 patients at one center and from 66 at the other center. The mean age at diagnosis was 58 and 62 years, the proportion of males was 53% and 52%, and presentation at stage III was 34% and 46%, respectively. The use of novel drugs, mainly bortezomib, was 90% in one of the centers and 3% in the other one. The use of autologous stem-cell transplantation was 47% and 3% respectively. The median overall survival of patients from the centers with and without access to novel drugs was 117 and 71 months respectively (p < 0.05). The five-year overall survival was 93 and 43% respectively (p < 0.05). Conclusions: The use of novel drugs, especially bortezomib, and autologous stem-cell transplantation significantly improved the survival of multiple myeloma patients treated in national hospitals. It is necessary to include them as a first line treatment.

Abstract Indigenous Marine Areas (ECMPO in Spanish) are the main institutional arrangement for the protection of the indigenous people's livelihoods and the promotion of marine sustainability of southern Chile. This article analyzes the contributions of ECMPO to the human well-being of indigenous communities. Through qualitative research conducted in the coastal town of. Carelmapu, Municipality of Maullín, Region de Los Lagos, we present potential human well-being indicators associated with the creation and implementation of ECMPO. The analysis shows that biodiversity conservation and the environmental quality of marine-coastal ecosystems promoted by ECMPO are essential components for the human well-being of indigenous communities, whose degradation might influence the capacity of the ecosystems to provide environmental services that sustain the life in the locality.

Resumen Los Espacios Costeros Marinos para Pueblos Originarios (ECMPOs) se han transformado en el principal mecanismo para el resguardo de los modos de vida de los pueblos indígenas y promoción de la sustentabilidad marino-costera del sur de Chile. El artículo analiza las contribuciones de los ECMPOs al bienestar humano de las comunidades indígenas. A través de una investigación de carácter cualitativo, desarrollada en la localidad de Carelmapu, Comuna de Maullín, Región de los Lagos, se presentan potenciales indicadores de bienestar humano asociados a la creación e implementación del ECMPO. El análisis demuestra que la conservación de la biodiversidad y el resguardo de la calidad ambiental de los ecosistemas marino-costeros promovidos por los ECMPOs son componentes esenciales para el bienestar humano, cuya degradación influiría en la capacidad de los ecosistemas de generar los servicios ambientales que sustentan la vida en la localidad.

Resumen El Cambio Climático y la gestión del recurso hídrico son elementos que impactan en la disponibilidad de agua en una amplia gama de territorios. En este trabajo se analiza el comportamiento de la variabilidad pluviométrica y fluviométrica en la cuenca del río Maule, Chile una de las principales y de mayor envergadura a nivel nacional con un área correspondiente a 20.300 km2, y en donde predomina la actividad silvoagropecuaria. Se realizó un análisis clúster basado en los datos disponibles para las precipitaciones (periodo 2000-2019) y caudales (periodo 2003-2019) cuyo vínculo entre este último y el primero se asocia a la magnitud de la escorrentía. El comportamiento de estos muestra una tendencia a la disminución, presumiblemente producto de la mega sequía y variaciones en el comportamiento climático de meso escala. El análisis de datos permite suponer una relación entre el comportamiento pluviométrico y la disminución del caudal medio de canales y ríos, acarreando consecuencias negativas a las actividades socioeconómicas vinculadas al uso del agua y demandando nuevas formas de gestión hídrica en los territorios.

Abstract Climate change and the management of water resources are elements that impact the availability of water in the territories. This work analyzes the behavior of the pluviometric and fluviometric variabilities in the Maule river basin, Chile, one of the main and largest at the national level with an area corresponding to 20,300 km2, and where silvo-agricultural activity predominates. A cluster analysis was performed based on the data available for rainfall (period 2000-2019) and flows (period 2003-2019) whose link between the latter and the former is associated with the magnitude of runoff. The behavior of these shows that an attention to the decrease, presumably due to the mega drought and variations in the mesoscale climatic behavior. The data analysis allows us to suppose a relationship between the rainfall behavior and the decrease in the average flow of channels and rivers, causing negative consequences to the socio-economic activities related to the use of water and demanding new forms of water management in the territories.

Abstract: The establishment of the Indigenous Marine Areas (IMAs or ECMPOS in Spanish) highlights the disputes over the common pool resources, which are rooted in interactions between users who have divergent stakes over the marine and coastal zone. Based on the analytical proposal of the New Institutional Political Ecology and the frame analysis, the article explores the institutional construction process related to the recovery of the commons through the creation and implementation of IMAs in southern Chile. In this process, the positions of the stakeholders are legitimized through discourses and narratives where the vision of the IMAs as a limit of the local and regional development is contrasted with the vision that supports them as a key tool for the protection of the commons and the territory.

Resumen: La creación de los Espacios Costeros Marinos para Pueblos Originarios (ECMPOs) pone de manifiesto las disputas por los recursos comunes arraigadas en interacciones entre usuarios que mantienen intereses divergentes sobre la zona marino-costera. Aplicando la propuesta analítica de la Ecología política neo-institucionalista y el análisis de encuadre o frame, el artículo analiza el proceso de construcción institucional para la recuperación de los comunes mediante la creación e implementación de ECMPOs en el sur-austral de Chile. En este proceso las posiciones de los grupos de interés son legitimadas a través de discursos y narrativas donde se contrapone la visión de los espacios costeros como limitantes del desarrollo local y regional, y aquella visión que los respalda como herramienta clave para el resguardo de los comunes y del territorio.

Resumo: A criação dos Espaços Costeiros Marinhos para Povos Indígenas (ECMPOs) visibiliza as disputas pelos recursos comuns, baseadas nas interações entre usuários com interesses divergentes sobre a zona marinha e costeira. Com base no marco teórico da Ecologia política neo-institucionalista (Haller, 2019) e dos frames, o artigo analisa o processo de construção institucional para a recuperação dos bens comuns, através da criação e implementação de ECMPOs no sul austral do Chile. Neste processo, as posições dos grupos de interesses são legitimadas através de discursos e narrativas onde a visão dos espaços costeiros como limitantes do desenvolvimento local e regional se opõe àquela visão que os coloca como uma ferramenta chave para a proteção dos bens comuns e do território.

Abstract: During the first months of 2016, diverse ecological perturbations in the marine ecosystem arose in the Chiloé archipelago which caused one of the most severe socio-environmental crises of the last years in the southern Chile. Although it is possible to identify the specific limits of the crisis associated to the algal bloom, the research presented in this paper shows that the crisis is part of a broad process of socio-environmental transformation experienced in the archipelago with implications to the different social and ecological life dimensions of Chiloé. Based on anthropological research carried out over the last seven years, this paper presents, as an anthropological dialogue, the key elements that allow for the untangling of Chiloé&apos;s socio-environmental crisis: a history of the boom and the decline of the exploitation of natural resources, territorial conflicts and collective action strategies of local groups, the intra and extra-regional migration phenomena and the dynamics of archipelagic mobility. Taking into account these different dimensions and approaches, this paper discusses the intersections between research and public anthropology, identifying the main challenges that the socio-environmental crisis imposes over the discipline. In short, this article exposes the evidence of the unfolding of a transformation process, whose future, still uncertain, could represent the shifting point for a territorial recomposition of the Chiloé archipelago.

Resumen: Durante los primeros meses del año 2016 sucedieron en el archipiélago de Chiloé una serie de trastornos ecológicos en el ecosistema marino que provocaron una de las mayores crisis socioambientales del último tiempo en la zona sur austral de Chile. A pesar de que es posible identificar los contornos específicos de la crisis, referidos a la marea roja, las investigaciones que movilizan el debate presentado en este texto muestran que la crisis se inscribe en un amplio e histórico proceso de transformación socioambiental experimentado en el archipiélago, con implicancias en las diferentes esferas de la vida social y ecológica de Chiloé. Apoyándose en diversas investigaciones antropológicas realizadas en los últimos siete años el artículo entrega, a modo de diálogo antropológico, los elementos clave para descifrar la crisis socioambiental de Chiloé: una historia de auge y decadencia en la explotación de recursos naturales, los conflictos territoriales y las estrategias de acción de los grupos organizados, los fenómenos migratorios intra y extra-regionales y las dinámicas de movilidad archipelágica. Asumiendo las diferentes dimensiones y aproximaciones, el artículo discute las intersecciones entre las investigaciones y la antropología pública, identificando los principales desafíos que la crisis socioambiental coloca a la disciplina. En suma, al artículo expone las evidencias del despliegue de un proceso de transformación en curso, cuyo futuro, aún incierto, puede representar el punto de cambio para una recomposición territorial del archipiélago de Chiloé.

Background: Medical emergencies (ME) in hospitalized patients (cardiac and respiratory arrest, suffocation, asphyxia, seizures, unconsciousness) are associated with high morbidity and mortality. Most of these patients have signs of physiological deterioration prior to the appearance of the emergency. Early detection of warning signs by rapid response teams (RRT) may provide an opportunity for the prevention of major adverse events. Aim: To identify clinical signs predicting death, need for mechanical ventilation, or transfer to a more complex unit during the 72 hours prior to the activation of the ME code. To evaluate the association of each trigger with specific major adverse events. Patients and Methods: Medical records of 184 hospitalized adult patients in whom the ME code was activated between 2009 and 2014 were reviewed. Results: Seventy five percent patients who experienced a ME had predictive signs of poor clinical outcome. Polypnea and airway involvement were associated to mechanical ventilation. Hypotension and hypoxemia were associated with mortality. Conclusions: In the absence of RRT, special attention should be given to patients with polypnea, airway involvement, hypotension and desaturation, since these are associated with poor clinical outcomes.

RESUMEN La conservación marina se ha convertido en uno de los principales vectores de transformación de los océanos, reconfigurando los arreglos de poder que definen el devenir de los maritorios y movilizando diversos agentes durante el proceso de toma de decisiones. El artículo analiza la creación de Áreas Marinas Protegidas en el golfo de Corcovado, en la Patagonia Norte de Chile, revelando que: i) responde a un contencioso proceso de transformación territorial, tensionado por la expansión de la industria salmonera y la conservación de la biodiversidad; ii) emerge un ensamblaje conservacionista a través de un proceso de agenciamiento colectivo y su agregación en torno de una red de gobernanza multiagentes.

ABSTRACT Marine conservation has become one of the main factors in the transformation of oceans, reshaping the relations of power which define the future of such zones, with the participation of diverse agents in decision-making. This paper analyzes the creation of Marine Protected Areas in the Corcovado Gulf in Chilean Northern Patagonia. It reveals that these Marine Protected Areas are i) a response to a controversial process of territorial transformation, aggravated by the expansion of the salmon industry and calls for the conservation of biodiversity; ii) the emergence of a conservationist assemblage, based on the idea of collective efforts, and its involvement in a multi-agent network of governance.

RESUMO A conservação marinha converteu-se em um dos principais vetores de transformação dos oceanos, reconfigurando os ajustes de poder que definem o futuro dos territórios marítimos e mobilizando diversos agentes durante o processo de tomada de decisões. Este artigo analisa a criação de áreas marinhas protegidas no golfo de Corcovado, na Patagônia Norte do Chile, revelando que: i) responde a um contencioso processo de transformação territorial, tensionado pela expansão da indústria de salmão e da conservação da biodiversidade; ii) emerge uma ensamblagem conservacionista por meio de um processo de agenciamento coletivo e sua agregação em torno de uma rede de governança multiagentes.

A implementação de Áreas Marinhas Protegidas intensificou-se nos últimos anos. Na América do Sul este fenômeno tem evidenciado a tensão entre o aumento da exploração pesqueira e a conservação da biodiversidade. No entanto, experiências recentes mostram alternativas locais de conservação que conseguem conciliar uso e proteção dos recursos naturais. O artigo tem como objetivo analisar o desenvolvimento de uma arena ambiental para a conservação marinha no Chile através da análise da trajetória institucional de exploração e manejo de recursos pesqueiros de pequena escala na Província de Cardenal Caro. Os resultados mostram que a implementação de uma Área Marinha Protegida na região insere-se em um contexto institucional baseado no uso sustentável dos recursos pesqueiros, em relações sociais de cooperação e conflito e na conformação de uma arena ambiental municipal.

In the last years the establishment of Marine Protected Areas has been intensified worldwide. In South America this phenomenon has highlighted the tension between the expansion of fishery production and the conservation of biodiversity. However, recent experiences have shown some local alternatives for marine conservation which are able to conciliate the use and protection of natural resources. Drawing on an empirical research this paper seeks to analyze the development of an environmental arena for marine conservation in Chile, and discusses the institutional trajectory of exploration and management of small-scale fisheries in Cardenal Caro Province. The results point out that the implementation of a Marine Protected Area in the studied region is part of an institutional framework based on sustainable use of fisheries, social relations of conflict and cooperation, and construction of a municipal environmental arena.

La implementación de Áreas Marinas Protegidas se ha intensificado en los últimos años. En América del Sur este fenómeno ha evidenciado la tensión entre el aumento de la producción pesquera y la conservación de la biodiversidad. Sin embargo, experiencias recientes muestran alternativas locales de conservación marina que logran conciliar uso y protección de los recursos naturales. De esta forma, el artículo busca analizar el desarrollo de una arena ambiental para la conservación marina en Chile, a través del análisis de la trayectoria institucional de explotación y manejo de recursos pesqueros de pequeña escala en la Provincia de Cardenal Caro. Los resultados muestran que la implementación de una área marina protegida en la región se inserta en un marco institucional basado en el uso sustentable de los recursos pesqueros, en relaciones sociales de cooperación y conflicto, y en la conformación de una arena ambiental municipal.

A Multiple Myeloma (MM), IgG-lambda stage III-A was diagnosed in a 41-year-old-man. After VAD cycles IgG decreased from 7.5 to 2.4 g/dL. were mobilized with cyclophosphamide and 10 µg/Kg G-CSF. Three days after the collection of peripheral stem cell, the patient had fever, nausea, vomiting, liquid stools, shoulder and knee arthralgia and dehydration. Upper GI endoscopy showed esophageal candidiasis and ulcerative necrotic lesions both in stomach and duodenum; the biopsy confirmed necrosis. Simultaneously, the appearance of purpura with maculopapular lesions of diverse sizes appeared in the feet progressing to the limbs and trunk. Hematuria and proteinuria were also observed. Skin biopsy showed leukocytoclastic vasculitis. Renal biopsy showed focal and segmental glomerulonephritis. Serum ANCA, cryoglobulins, anti-HCV and RF were negative, and serum monoclonal IgG was 1290 mg/dL. Daily treatment with iv methylprednisolone pulses for 3 days improved skin lesions and digestive involvement. Macroscopic hematuria and proteinuria improved after two months of steroid treatment (Rev Méd Chile 2000; 128: 1255-60)