Abstract Background/Objective: There is controversy regarding the need to use advanced imaging to select candidates for thrombectomy in late window acute ischemic stroke (AIS). Hypoattenuation on CT angiography source images (CTA-SI) in arterial phase has been shown to be more sensitive than Alberta Stroke Program Early CT Score (ASPECTS) of brain parenchyma to determine tissue at risk of ischemia. Our hypothesis is that the addition of a second acquisition at 35-50 seconds could complement the assessment of hypoperfused tissue that fails to receive flow through pial vessels. Methods: Patients with large vessel occlusion and 6-24 hours from symptom onset, admitted between August 2019 and July 2023, were evaluated with dual-phase CT angiography (CTA) and CT-Perfusion. A vascular neurologist estimated CTA-SI ASPECTS in both phases at the time of data entry into the RECCA registry. In contrast, the post-processing of CT-Perfusion images was performed in an automated way through RAPID© software. The association between automated CT-perfusion values and dual-phase CTA-SI ASPECTS was assessed through a correlation coefficient. Results: Pearson’s coefficient demonstrated a high correlation between ischemic core volume and delayed phase CTA (CTA-DP) ASPECTS with an inverse association of −0.93 and between Tmax ≥ 6 sec volume and arterial phase CTA (CTA-AP) ASPECTS with a value of −0.88. Conclusions: CTA-derived source images (CTA-SI) in two phases may be useful in the selection of patients with AIS presenting beyond the 6-hour window.

Resumen Introducción/Objetivo: La recomendación actual es realizar el tamizaje de pacientes con ataque cerebrovascular ACV y oclusión de grades vasos LVO (por sus siglas en ingles) potencialmente candidatos a trombectomía mecánica en ventana extendida a través de un estudio de TC perfusión con post procesamiento automatizado. El acceso a TC perfusión no está ampliamente disponible en el mundo, por lo que existe controversia en relación a que sea una herramienta imprescindible. Métodos: Este es un estudio prospectivo de un registro retrospectivo unicéntrico con pacientes con ACV de circulación anterior, LVO y un tiempo entre 6-24 horas desde el inicio de los síntomas hasta la realización del estudio imagenológico. A todos los pacientes se les realizó un AngioTC en 2 fases, con evaluación de sus imágenes fuentes CTA-SI (por sus siglas en ingles) y un estudio de perfusión con post procesamiento por software RAPID. Resultados: El coeficiente de Pearson’s mostró una alta correlación entre el volumen de núcleo isquémico medido por FSC < 30% y el valor CTA-SI ASPECTS en fase tardía, con una asociación inversa de −0.93. Conclusión: La interpretación de CTA-SI ASPECTS en 2 fases entrega información congruentes con los resultados automatizados de los mapas de TC perfusión.

Abstract Background The efficacy of intravenous thrombolysis (IVT) is time-dependent. Objective To compare the door-to-needle (DTN) time of stroke neurologists (SNs) versus non-stroke neurologists (NSNs) and emergency room physicians (EPs). Additionally, we aimed to determine elements associated with DTN ≤ 20 minutes. Methods Prospective study of patients with IVT treated at Clínica Alemana between June 2016 and September 2021. Results A total of 301 patients underwent treatment for IVT. The mean DTN time was 43.3 ± 23.6 minutes. One hundred seventy-three (57.4%) patients were evaluated by SNs, 122 (40.5%) by NSNs, and 6 (2.1%) by EPs. The mean DTN times were 40.8 ± 23, 46 ± 24.7, and 58 ± 22.5 minutes, respectively. Door-to-needle time ≤ 20 minutes occurred more frequently when patients were treated by SNs compared to NSNs and EPs: 15%, 4%, and 0%, respectively (odds ratio [OR]: 4.3, 95% confidence interval [95%CI]: 1.66–11.5, p = 0.004). In univariate analysis DTN time ≤ 20 minutes was associated with treatment by a SN (p = 0.002), coronavirus disease 2019 pandemic period (p = 0.21), time to emergency room (ER) (p = 0.21), presence of diabetes (p = 0.142), hypercholesterolemia (p = 0.007), atrial fibrillation (p < 0.09), score on the National Institutes of Health Stroke Scale (NIHSS) (p = 0.001), lower systolic (p = 0.143) and diastolic (p = 0.21) blood pressures, the Alberta Stroke Program Early CT Score (ASPECTS; p = 0.09), vessel occlusion (p = 0.05), use of tenecteplase (p = 0.18), thrombectomy (p = 0.13), and years of experience of the physician (p < 0.001). After multivariate analysis, being treated by a SN (OR: 3.95; 95%CI: 1.44–10.8; p = 0.007), NIHSS (OR: 1.07; 95%CI: 1.02–1.12; p < 0.002) and lower systolic blood pressure (OR: 0.98; 95%CI: 0.96–0.99; p < 0.003) remained significant. Conclusions Treatment by a SN resulted in a higher probability of treating the patient in a DTN time within 20 minutes. (IVT timedependent. timedependent dependent. dependent time-dependent doortoneedle door needle (DTN (SNs nonstroke non (NSNs EPs . (EPs) Additionally 2 201 2021 30 433 43 3 43. 236 23 23. seventythree seventy three 57.4% 574 57 4 (57.4% 12 40.5% 405 40 5 (40.5% 2.1% 21 1 (2.1% 408 8 40. 247 24 7 24.7 225 22 22. Doortoneedle Door 15 15% 4% 0 0% odds OR [OR] 4.3 95 95%CI 95CI CI [95%CI] 166115 66 11 1.66–11.5 0.004. 0004 0.004 004 0.004) 0.002, 0002 0.002 , 002 0.21, 021 0.21 ER (ER 0.142, 0142 0.142 142 0.142) 0.007, 0007 0.007 007 0.007) 0.09, 009 0.09 09 0.09) (NIHSS 0.001, 0001 0.001 001 0.001) 0.143 0143 143 pressures ASPECTS (ASPECTS 0.05, 005 0.05 05 0.05) 0.18, 018 0.18 18 0.18) 0.13, 013 0.13 13 0.13) 0.001. (OR 3.95 395 1.44–10.8 144108 44 10 1.07 107 07 1.02–1.12 102112 02 0.98 098 98 0.96–0.99 096099 96 99 0.003 0003 003 significant (EPs 202 57.4 (57.4 40.5 (40.5 2.1 (2.1 24. [OR 4. 9 [95%CI 16611 1.66–11. 000 0.00 00 0.2 014 0.14 14 0.0 01 0.1 3.9 39 1.44–10. 14410 1.0 1.02–1.1 10211 0.9 0.96–0.9 09609 57. (57. (40. 2. (2. 1661 1.66–11 0. 3. 1.44–10 1441 1. 1.02–1. 1021 0.96–0. 0960 (57 (40 (2 166 1.66–1 1.44–1 144 1.02–1 102 0.96–0 096 (5 (4 ( 16 1.66– 1.44– 1.02– 0.96– 1.66 1.44 1.02 0.96 1.6 1.4

Resumen Antecedentes La respuesta a la trombólisis intravenosa (TIV) es dependiente del tiempo. Objetivo Comparar los tiempo puerta-aguja (TPAs) de neurólogos vasculares (NVs) contra los de neurólogos no vasculares (NNVs) y médicos emergencistas (MEs), y determinar los elementos asociados a un PTA ≤ 20 minutos. Métodos Análisis observacional prospectivo de pacientes con TIV tratados en Clínica Alemana entre junio de 2016 y septiembre de 2021. Resultados En total, 301 pacientes con TIV fueron tratados. El TPA promedio fue de 43,3 ± 23,6 minutos. Un total de 173 (57,4%) pacientes fueron evaluados por NVs, 122 (40,5%), por NNVs, y 6 (2,1%), por MEs; los TPAs promedios fueron de 40,8 ± 23; 46 ± 24,7 y 58 ± 22,5 minutos, respectivamente. Los TPAs ≤ 20 minutos fueron más frecuentes en pacientes tratados por NVs versus NNVs y MEs: 15%, 4% y 0%, respectivamente (odds ratio [OR]: 4,3; intervalo de confianza del 95% [IC95%]: 1,66–11,5; p = 0,004). El análisis univariado demostró que TPA ≤ 20 minutos se asoció con: tratamiento por NVs (p = 0,002), periodo de la pandemia de enfermedad por coronavirus 2019 (COVID-19; p = 0,21), tiempo a urgencia (p = 0,21), diabetes (p = 0,142), hipercolesterolemia (p = 0,007), fibrilación auricular (p < 0,09), puntaje en la National Institutes of Health Stroke Scale [NIHSS] (p = 0,001), presión arterial sistólica (p = 0,143) y diastólica menores (p = 0,21), Alberta Stroke Program Early CT Score (ASPECTS ; p = 0,09), oclusión de vasos cerebrales (p =0,05), uso de tecneteplase (p = 0,18), trombectomía (p = 0,13) y años de experiencia del médico (p < 0,001). El análisis multivariado demostró que ser tratado por NVs (OR: 3,95; IC95%: 1,44–10,8; p = 0,007), el puntaje en la NIHSS (OR: 1,07; IC95%: 1,02–1,12; p < 0,002) y la presión arterial sistólica (OR: 0,98; IC95%: 0,96–0,99; p < 0,003) se asociaron a TPA ≤ 20 minutos. Conclusões El tratamiento por NVs resultó en un TPA menor y en una mayor probabilidad de tratamiento ≤ 20 minutos. (TIV puertaaguja puerta aguja (TPAs (NVs (NNVs MEs, MEs , (MEs) 2 201 2021 30 433 43 3 43, 236 23 23, 17 57,4% 574 57 4 (57,4% 12 40,5%, 405 40,5% 40 5 (40,5%) 2,1%, 21 2,1% 1 (2,1%) 408 8 40, 247 24 7 24, 225 22 22, 15 15% 0 0% odds OR [OR] 4,3 95 IC95% IC95 IC [IC95%] 1,66–11,5 166115 66 11 0,004. 0004 0,004 . 004 0,004) 0,002, 0002 0,002 002 COVID19 COVID 19 (COVID-19 0,21, 021 0,21 0,21) 0,142, 0142 0,142 142 0,142) 0,007, 0007 0,007 007 0,007) 0,09, 009 0,09 09 0,09) [NIHSS 0,001, 0001 0,001 001 0,001) 0,143 0143 143 ASPECTS =0,05, 005 =0,05 05 =0,05) 0,18, 018 0,18 18 0,18) 0,13 013 13 0,001. (OR 3,95 395 1,44–10,8 144108 44 10 1,07 107 07 1,02–1,12 102112 02 0,98 098 98 0,96–0,99 096099 96 99 0,003 0003 003 (MEs 202 57,4 (57,4 40,5 (40,5% 2,1 (2,1% [OR 4, 9 IC9 [IC95% 1,66–11, 16611 000 0,00 00 COVID1 (COVID-1 0,2 014 0,14 14 0,0 =0,0 01 0,1 3,9 39 1,44–10, 14410 1,0 1,02–1,1 10211 0,9 0,96–0,9 09609 57, (57, (40,5 2, (2,1 [IC95 1,66–11 1661 (COVID- 0, =0, 3, 1,44–10 1441 1, 1,02–1, 1021 0,96–0, 0960 (57 (40, (2, [IC9 1,66–1 166 (COVID =0 1,44–1 144 1,02–1 102 0,96–0 096 (5 (40 (2 [IC 1,66– 16 1,44– 1,02– 0,96– ( (4 1,66 1,44 1,02 0,96 1,6 1,4

Resumen: El recién nacido (RN) sano experimenta un descenso de peso fisiológico en los primeros días de nacido. El identificar la pérdida de peso normal en este período es relevante, ya que permite al clíni co tomar conductas en relación con la necesidad de complementar la lactancia materna. Objetivo: Determinar las curvas que muestren la gráfica del descenso de peso que experimentan los RN sanos alimentados con leche materna exclusiva durante las primeras 48 horas de nacido. Pacientes y Méto do: Estudio retrospectivo de RN de término sanos durante su permanencia en sala cuna, alimentados exclusivamente al pecho materno y con alimentación mixta. Se recopilaron los pesos al nacimiento, el primer y segundo día de vida. Se utilizó un polinomio cuadrático para modelar los pesos relativos. Se estimaron los percentiles de las variaciones de pérdida de peso. Resultados: La muestra se compuso de 4331 RN con edad gestacional promedio 38,84 semanas. De estos 56,45% fueron partos vaginales y 43,55% cesáreas. La distribución por género fue de 49,37% masculino y 50,63% femenino. De ellos, 82,96% fueron adecuados para la edad gestacional, 6,33% pequeños para la edad gestacional y 10,71% grandes para la edad gestacional. La mayor baja de peso se observó en las primeras 12 horas de vida. Conclusiones: Se obtiene la gráfica de baja de peso de los RN las primeras 48 horas de vida, que representan la pérdida de peso por hora para los RN de término sanos alimentados al pecho exclusivo. Estas curvas pueden ser usadas como herramienta de decisión al permitir categorizar la pérdida de peso del RN y ayudar en la toma de decisiones en lo que respecta a la indicación de adi cionar lactancia artificial.

Abstract: The healthy newborn (NB) experiences physiological weight loss in her/his first days of life. Identifying normal weight loss in this period is relevant since it allows the clinician to make decisions in relation to the need to supplement breastfeeding. Objectives: To determine the curves that graph the weight loss experienced by healthy newborns exclusively breastfed during the first 48 hours after birth. Patients and Method: Retrospective and analytical descriptive study in healthy full-term NBs during their stay in the nursery, exclusively breastfed, and with mixed feeding. Weights were recorded at birth and on the first and second day of life. A quadratic polynomial was used to model the relative weights. The percentiles of the variations in weight loss were estimated. Results: The sample consists of 4331 NBs with an average gestational age of 38.84 weeks. Of these, 56.45% were vaginal deliveries and 43.55% cesarean sections. The distribution by sex was 49.37% male and 50.63% female. Regarding adequacy, 82.96% were adequate for gestational age, 6.33% were small for gestational age, and 10.71% were large for gestational age. The greatest weight loss was observed in the first 12 hours of life. Conclusions: A weight loss graph is obtained for the first 48 hours of life, representing the weight loss per hour for healthy term NB exclusively breastfed. These curves can be used as a decision-making tool to categorize the weight loss of the NB and help in decision making regarding the indication to add artificial feeding.

Abstract Background: Topographic patterns may correlate with causes of ischemic stroke. Objective: To investigate the association between diffusion-weighted imaging (DWI) and Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification. Methods: We included 1019 ischemic stroke patients. DWI were classified as: i) negative; ii) DWI single lesion (cortico-subcortical, cortical, subcortical ≥20 mm, or subcortical <20 mm); iii) scattered lesions in one territory (small scattered lesions or confluent with additional lesions); and iv) multiple lesions (multiple unilateral anterior circulation [MAC], multiple posterior circulation [MPC], multiple bilateral anterior circulation [MBAC], and multiple anterior and posterior circulations [MAP]). Results: There was a relationship between DWI patterns and TOAST classification (p<0.001). Large artery atherosclerosis was associated with small, scattered lesions in one vascular territory (Odds Ratio [OR] 4.22, 95% confidence interval [95%CI] 2.61–6.8), MPC (OR 3.52; 95%CI 1.54–8.03), and subcortical lesions <20 mm (OR 3.47; 95%CI 1.76–6.85). Cardioembolic strokes correlated with MAP (OR 4.3; 95%CI 1.64–11.2), cortico-subcortical lesions (OR 3.24; 95%CI 1.9–5.5) and negative DWI (OR 2.46; 95%CI 1.1–5.49). Cryptogenic strokes correlated with negative DWI (OR 4.1; 95%CI 1,84–8.69), cortical strokes (OR 3.3; 95%CI 1.25–8.8), MAP (OR 3.33; 95%CI 1.25–8.81) and subcortical lesion ≥20 mm (OR 2.44; 95%CI 1,04–5.73). Lacunar strokes correlated with subcortical lesions diameter <20 mm (OR 42.9; 95%CI 22.7–81.1) and negative DWI (OR 8.87; 95%CI 4.03–19.5). Finally, MBAC (OR 9.25; 95%CI 1.12–76.2), MAP (OR 5.54; 95%CI 1.94–15.1), and MPC (OR 3.61; 95%CI 1.5–8.7) correlated with stroke of other etiologies. Conclusions: A relationship exists between DWI and stroke subtype.

RESUMEN Antecedentes: Los patrones topográficos pueden correlacionarse con las causas del accidente cerebrovascular isquémico. Objetivo: Investigar la asociación entre imágenes ponderadas por difusión por resonancia nuclear magnética (dRNM) y el ensayo de Org 10172 en la clasificación de tratamiento agudo de accidentes cerebrovasculares (TOAST). Métodos: Fueron incluidos 1.019 pacientes con accidente cerebrovascular isquémico. Las dRNM fueron clasificadas como: i) negativa; ii) dRNM lesión única (cortico-subcortical, cortical, subcortical ≥20 mm, o subcortical <20 mm); iii) lesiones disgregadas un territorio vascular (pequeñas lesiones dispersas o confluentes con lesiones adicionales); y iv) lesiones múltiples (unilaterales de circulación anterior [MAC], de circulación posterior [MPC], bilaterales de circulación anterior [MBAC] y de circulación anterior y posterior [MAP]). Resultados: Existió relación entre los patrones de dRNM y la clasificación TOAST (p<0,001). La aterosclerosis de las arterias grandes se asoció con lesiones pequeñas y disgregadas en un territorio vascular (Odds Ratio [OR] 4,22, intervalo de confianza del 95% [IC95%] 2,61–6,8), MPC (OR 3,52; IC95% 1,54–8,03), y lesiones subcorticales <20 mm (OR 3,47; IC95% 1,76–6,85). Cardioembolias se relacionaron con MAP (OR 4,3; IC95% 1,64–11,2), lesiones cortico-subcorticales (OR 3,24; IC95% 1,9–5,5) y dRNM negativas (OR 2,46; IC95% 1,1–5,49). Los accidentes cerebrovasculares criptogénicos se relacionaron con dRNM negativas (OR 4,1; IC95% 1,84–8,69), accidentes cerebrovasculares corticales (OR 3,3; IC95% 1,25–8,8), MAP (OR 3,33; IC95% 1,25–8,81) y lesiones subcorticales ≥20 mm (OR 2,44; IC95% 1,04–5,73). Los accidentes cerebrovasculares lacunares se correlacionaron con lesiones subcorticales de diámetro <20 mm (OR 42,9; IC95% 22,7–81,1) y dRNM negativas (OR 8,87; IC95% 4,03–19,5). Finalmente, MBAC (OR 9,25; IC95% 1,12–76,2), MAP (OR 5,54; IC95% 1,94–15,1) y MPC (OR 3,61; IC95% 1,5–8,7) se relacionaron con accidentes cerebrovasculares de otras etiologías. Conclusiones: Existe relación entre dRNM y subtipo de accidente cerebrovascular.

Background: Violence against women (VAW) is a violation of women's fundamental rights and special attention must be paid during the gestational and postpartum period. Aim: To determine the prevalence of violence against women attending antenatal and postpartum controls in Primary Health Centers. Material and Method: The Woman Abuse Screening Tool (WAST) for early detection of VAW was applied to 279 pregnant and 102 puerperal women attending five public primary health centers in metropolitan Santiago. Results: The prevalence ofviolence against pregnant and puerperal women was 5.7 and 5.9%, respectively. In both groups, the factors associated with a greater risk of violence were being immigrants, a history of domestic violence, not having a supportive partner and alcohol consumption by the partner. Conclusions: Violence against these women is a multifactorial, complex and structural phenomenon, which involves the victim, the abuser and the entire social system. Primary health care level and health professionals can be key elements applying early detection strategies, timely referral mechanisms and bringing emotional support for victims.

Abstract Background Postoperative Hyperlactatemia (PO-HL) is a frequent condition associated with poor prognosis. In recent years, there has been growing evidence that adrenergic stimulation may contribute to increased lactate levels. The use of adrenergic agonists for the control of intraoperative hypotension is frequent, and its impact on the development of PO-HL is unknown. Objective To evaluate whether the use of intraoperative adrenergic agents is associated with the occurrence of PO-HL. Methods This was a prospective observational study. The inclusion criteria were undergoing elective open colon surgery, being ≥60 years old and signing informed consent. The exclusion criteria were cognitive impairment, unplanned surgery, and anticipated need for postoperative mechanical ventilation. Baseline and intraoperative variables were collected, and arterial lactate data were collected at baseline and every 6 hours postoperatively for 24 hours. Hyperlactatemia was defined as lactate >2.1 mEq.L-1. Results We studied 28 patients, 61% of whom developed hyperlactatemia. The variables associated with PO-HL in the univariate analysis were anesthetic time, the total dose of intraoperative ephedrine, and lower intraoperative central venous oxygen saturation (ScvO2). Multivariate analysis confirmed the association between the use of ephedrine (p = 0.004), intraoperative hypotension (p = 0.026), and use of phenylephrine (p = 0.001) with PO-HL. Conclusions The use of intraoperative ephedrine, phenylephrine and intraoperative hypotension were independently associated with the development of PO-HL. This finding should lead to new studies in this field, as well as a judicious interpretation of the finding of a postoperative increase in lactate levels.

Abstract Background: Low-dose alteplase (LrtPA) has been shown not to be inferior to the standard-dose (SrtPA) with respect to death/disability. Objective: We aim to evaluate the percentage of patients treated with LrtPA at our center after the ENCHANTED trial and the factors associated with the use of this dosage. Methods: Prospective study in consecutive patients with an acute stroke admitted between June 2016 and November 2018. Results: 160 patients were treated with intravenous thrombolysis, 50% female; mean age 65.4±18.5 years. Of these, 48 patients (30%) received LrtPA. In univariate analysis, LrtPA was associated with patient's age (p=0.000), previous modified Rankin scale scores (mRS) (p<0.000), hypertension (p=0.076), diabetes mellitus (p=0.021), hypercholesterolemia (p=0.19), smoking (p=0.06), atrial fibrillation (p=0.10), history of coronary artery disease (p=0.06), previous treatment with antiplatelet agents (p<0.000), admission International Normalized Ratio-INR (p=0.18), platelet count (p=0.045), leukoaraiosis on neuroimaging (p<0.003), contraindications for thrombolytic treatment (p=0.000) and endovascular treatment (p=0.027). Previous relevant bleedings were determinants for treatment with LrtPA. Final diagnosis on discharge of stroke mimic was significant (p=0.02) for treatment with SrtPA. In multivariate analysis, mRS (OR: 2.21; 95%CI 1.37‒14.19), previous antiplatelet therapy (OR: 11.41; 95%CI 3.98‒32.70), contraindications for thrombolysis (OR: 56.10; 95%CI 8.81‒357.80), leukoaraiosis (OR: 4.41; 95%CI 1.37‒14.10) and diagnosis of SM (OR: 0.22; 95%CI 0.10‒0.40) remained independently associated. Conclusions: Following the ENCHANTED trial, LrtPA was restricted to 30% of our patients. The criteria that clinicians apply are based mostly on clinical variables that may increase the risk of brain or systemic hemorrhage or exclude the patient from treatment with lytic drugs. Background Lowdose Low dose (LrtPA standarddose standard SrtPA (SrtPA deathdisability death disability death/disability Objective dosage Methods 201 2018 Results 16 50 female 654185 65 4 18 5 65.4±18. years these 30 (30% analysis s p=0.000, p0000 p p=0.000 , 0 000 (mRS p<0.000, p<0.000 (p<0.000) p=0.076, p0076 p=0.076 076 (p=0.076) p=0.021, p0021 p=0.021 021 (p=0.021) p=0.19, p019 p=0.19 19 (p=0.19) p=0.06, p006 p=0.06 06 (p=0.06) p=0.10, p010 p=0.10 10 (p=0.10) RatioINR Ratio INR p=0.18, p018 p=0.18 (p=0.18) p=0.045, p0045 p=0.045 045 (p=0.045) p<0.003, p0003 p<0.003 003 (p<0.003) (p=0.000 p=0.027. p0027 p=0.027 . 027 (p=0.027) p=0.02 p002 02 (p=0.02 OR (OR 2.21 221 2 21 95CI CI 95 1.37‒14.19, 1371419 1.37‒14.19 1 37 14 1.37‒14.19) 11.41 1141 11 41 3.98‒32.70, 3983270 3.98‒32.70 3 98 32 70 3.98‒32.70) 56.10 5610 56 8.81‒357.80, 88135780 8.81‒357.80 8 81 357 80 8.81‒357.80) 4.41 441 1.37‒14.10 1371410 0.22 022 22 0.10‒0.40 010040 40 Conclusions drugs 20 65418 6 65.4±18 (30 p000 p=0.00 00 p<0.00 (p<0.000 p007 p=0.07 07 (p=0.076 (p=0.021 p01 p=0.1 (p=0.19 p00 p=0.0 (p=0.06 (p=0.10 (p=0.18 p004 p=0.04 04 (p=0.045 (p<0.003 (p=0.00 (p=0.027 (p=0.0 2.2 9 137141 1.37‒14.1 11.4 114 398327 3.98‒32.7 7 56.1 561 8813578 8.81‒357.8 35 4.4 44 0.2 0.10‒0.4 01004 6541 65.4±1 (3 p<0.0 (p<0.00 (p=0.07 p0 p=0. (p=0.1 (p=0.04 (p=0. 2. 13714 1.37‒14. 11. 39832 3.98‒32. 56. 881357 8.81‒357. 4. 0. 0.10‒0. 0100 654 65.4± ( p<0. (p<0.0 p=0 (p=0 1371 1.37‒14 3983 3.98‒32 88135 8.81‒357 0.10‒0 010 65.4 p<0 (p<0. p= (p= 137 1.37‒1 398 3.98‒3 8813 8.81‒35 0.10‒ 01 65. p< (p<0 (p 13 1.37‒ 39 3.98‒ 881 8.81‒3 0.10 (p< 1.37 3.98 88 8.81‒ 0.1 1.3 3.9 8.81 1. 3. 8.8 8.

RESUMEN Introducción: Dosis reducidas de trombolitico (LrtPA) podrían no ser inferiores en muerte/discapacidad. Objetivo: Evaluar el porcentaje de pacientes tratados con LrtPA en nuestro centro después del ensayo ENCHANTED, y los factores asociados con el uso de esta dosis. Métodos: Estudio prospectivo de pacientes consecutivos con infarto cerebral ingresados entre junio de 2016 y noviembre de 2018. Resultados: 160 pacientes fueron tratados con trombólisis intravenosa, 50% mujeres; edad media 65,4±18,5 años. 48 casos (30%) recibieron LrtPA. En el análisis univariado, LrtPA se asoció con la edad del paciente (p=0,000), escala de Rankin modificadas (mRS) (p<0,000), hipertensión arterial (p=0,076), diabetes mellitus (p=0,021), hipercolesterolemia (p=0,19), tabaquismo (p=0,06), fibrilación auricular (p=0,10), antecedentes de enfermedad coronaria (p=0,06), tratamiento previo con antiplaquetarios (p<0,000), International Normalized Ratio-INR (p=0,18), recuento de plaquetario (p=0,045), leucoaraiosis en neuroimagen (p<0,003), contraindicaciones para el tratamiento trombolítico (p=0,000) y tratamiento endovascular (p=0,027). Las hemorragias previas relevantes fueron determinantes para el tratamiento con LrtPA. El diagnóstico al alta de imitador de accidente cerebrovascular fue significativo (p=0,02) para el tratamiento con dosis estándar. El análisis multivariado demostró que mRS (OR: 2,21; IC95% 1,37‒14,19), tratamiento antiplaquetario previo (OR: 11,41; IC95% 3,98‒32,7), contraindicaciones para trombólisis (OR: 56,1; IC95% 8,81‒357,8), leucoaraiosis (OR: 4,41; IC95% 1,37‒14,1) y un diagnóstico de imitador de accidente cerebrovascular (OR: 0,22; IC95% 0,1‒0,40) fueron asociados con la dosis recibida. Conclusiones: LrtPA está restringido al 30% de nuestros pacientes. Los criterios para tomar esta decisión se basan en variables que podrían aumentar el riesgo de hemorragia cerebral/sistémica o excluir al paciente del tratamiento con fármacos líticos. Introducción (LrtPA muertediscapacidad muerte discapacidad muerte/discapacidad Objetivo ENCHANTED Métodos 201 2018 Resultados 16 intravenosa 50 mujeres 654185 65 4 18 5 65,4±18, años 30 (30% univariado p=0,000, p0000 p p=0,000 , 0 000 (mRS p<0,000, p<0,000 (p<0,000) p=0,076, p0076 p=0,076 076 (p=0,076) p=0,021, p0021 p=0,021 021 (p=0,021) p=0,19, p019 p=0,19 19 (p=0,19) p=0,06, p006 p=0,06 06 (p=0,06) p=0,10, p010 p=0,10 10 (p=0,10) RatioINR Ratio INR p=0,18, p018 p=0,18 (p=0,18) p=0,045, p0045 p=0,045 045 (p=0,045) p<0,003, p0003 p<0,003 003 (p<0,003) (p=0,000 p=0,027. p0027 p=0,027 . 027 (p=0,027) p=0,02 p002 02 (p=0,02 estándar OR (OR 2,21 221 2 21 IC95 IC 1,37‒14,19, 1371419 1,37‒14,19 1 37 14 1,37‒14,19) 11,41 1141 11 41 3,98‒32,7, 398327 3,98‒32,7 3 98 32 7 3,98‒32,7) 56,1 561 56 8,81‒357,8, 8813578 8,81‒357,8 8 81 357 8,81‒357,8) 4,41 441 1,37‒14,1 137141 0,22 022 22 0,1‒0,40 01040 40 recibida Conclusiones cerebralsistémica sistémica líticos 20 65418 6 65,4±18 (30 p000 p=0,00 00 p<0,00 (p<0,000 p007 p=0,07 07 (p=0,076 (p=0,021 p01 p=0,1 (p=0,19 p00 p=0,0 (p=0,06 (p=0,10 (p=0,18 p004 p=0,04 04 (p=0,045 (p<0,003 (p=0,00 (p=0,027 (p=0,0 2,2 IC9 11,4 114 39832 3,98‒32, 9 56, 881357 8,81‒357, 35 4,4 44 1,37‒14, 13714 0,2 0,1‒0,4 0104 6541 65,4±1 (3 p<0,0 (p<0,00 (p=0,07 p0 p=0, (p=0,1 (p=0,04 (p=0, 2, 11, 3983 3,98‒32 88135 8,81‒357 4, 1,37‒14 1371 0, 0,1‒0, 010 654 65,4± ( p<0, (p<0,0 p=0 (p=0 398 3,98‒3 8813 8,81‒35 1,37‒1 137 0,1‒0 01 65,4 p<0 (p<0, p= (p= 39 3,98‒ 881 8,81‒3 1,37‒ 13 0,1‒ 65, p< (p<0 (p 3,98 88 8,81‒ 1,37 0,1 (p< 3,9 8,81 1,3 3, 8,8 1, 8,

Background: Intravenous thrombolysis (IT) in acute ischemic stroke (AIS) is time dependent. The time elapsed from hospital admission to the thrombolytic bolus is named door to needle time (DNT) and is recommend to be of less than 60 min. Aim: To describe the DNT in our center and determine those factors associated with a DNT longer than 60 min. Material and Methods: Prospective analysis of patients treated with IT at a private hospital between June 2016 and June 2019. The percentage of patients with DNT exceeding 60 min, and the causes for this delay were evaluated. Results: IT was used in 205 patients. DNT was 43.6 ± 23.8 min. Forty patients (19.5% (95% CI, 14.4-25.7), had a DNT longer than 60 min. Uni-varied analysis demonstrated that AIS with infratentorial symptomatology (ITS), was significantly associated with DNTs exceeding 60 min. A history of hypertension, a higher NIH Stroke Scale score, the presence of an hyperdense sign in brain tomography (p = 0.001) and the need for endovascular therapy (p = 0.019), were associated with DNT shorter than 60 min. Multivariate analysis ratified the relationship between ITS and DNT longer than 60 min (Odds ratio: 3.19, 95% confidence intervals 1.26-8). Conclusions: The individual elements that correlated with a DNT longer than 60 min were the failure to detect the AIS during triage and doubts about its diagnosis.

Background: In the perioperative context, a frailty evaluation scale must consider certain characteristics such as validation, execution speed, simplicity, the capacity to measure multiple dimensions and not being dependent on a cognitive or physical test that could not be performed prior to surgery. The test should select patients that could benefit from interventions aimed to improve their postoperative outcomes. Aim: To validate two frailty evaluation scales for the perioperative period. Material and Methods: The Risk Analysis Index with local modifications (RAI-M) were applied to 201 patients aged 73 ± 7 years (49% women) and the Edmonton frailty scale were applied in 151 patients aged 73 ± 7 years (49% women) in the preoperative period. Their results were compared with the Rockwood frailty index. Results: The Edmonton frail scale showed adequate psychometric properties and assessed multiple dimensions through 8 of the 11 original questions, achieving a discrimination power over 80% compared to the Rockwood Index. The RAI- M, demonstrated solid psychometric properties with a tool that examines 4 dimensions of frailty through 15 questions and reviewing the presence of 11 medical comorbidities. This scale had a discrimination power greater than 85% and it was significantly associated with prolongation of the planned hospital stay and mortality. Conclusions: RAI-M is a short and easily administered scale, useful to detect frailty in the preoperative period.

Introduction: Operative wound infections of patients undergoing total hip arthroplasty have an incidence from 2% to 5%, generating impact on hospital stay, resource use, prolonged antibiotic therapy, including temporary or definitive sequelae. Objective: To generate a predictive model for surgical wound infection in patients undergoing total hip arthroplasty between 2012 and 2014 at the High Complexity Hospital. Material and Method: Cohort of patients with total hip arthroplasty. A description of the epidemiological variables was made and a predictive model was generated by means of logistic regression. Results: 441 patients were analyzed. The predictive model obtained included the variables: days of post-operative stay (OR 1.11 IC95% [1.03 - 1.20]), transfusion of at least one unit of red blood cells (OR 3.13 IC95% [1.17 - 10.86]), diagnosis of previous depression to surgery (OR 5.75 IC95% [1.32 - 25.32], non-compliance with antibioprophylaxis administration time (OR 5.46 IC95% [1.68 - 17.78], P < 0.001) and pseudo R2 = 0.2293. Score point of 13 points with sensitivity 44.4%, specificity of 91.6%, LR (+) 5.29, LR (-) 0.61, 1 to 6 points “low risk”, 7 to 12 points “medium risk”, 13 to 18 points “high risk”, from 19 points as “maximum risk”. Conclusion: the model presents a good predictive capacity of operative wound infection and adequately represents the cohort under study.

Resumen Introducción: Las infecciones de herida operatoria de pacientes intervenidos de artroplastía total de cadera, presentan una incidencia desde 2 a 5%, generando impacto en la estadía hospitalaria, uso de recursos, antibioterapia prolongada y secuelas temporales o definitivas. Objetivo: Generar un modelo predictivo para la infección de herida operatoria en pacientes intervenidos de artroplastía total de cadera, entre los años 2012 y 2014, en un hospital de alta complejidad. Material y Método: Cohorte de pacientes con artroplastía total de cadera. Se efectuó la descripción de las variables epidemiológicas y se generó un modelo predictivo por regresión logística. Resultados: Se analizaron 441 pacientes. El modelo predictivo obtenido incluyó las variables: días de estadía post operatoria (OR 1,11 IC95% [1,03-1,20]), transfusión de al menos una unidad de glóbulos rojos (OR 3,13 IC95% [1,17-10,86]), diagnóstico de depresión previo a la cirugía (OR 5,75 IC95% [1,32-25,32], incumplimiento del tiempo de administración de la antibioprofilaxis (OR 5,46 IC95% [1,68-17,78]; p < 0,001) y pseudo R2 = 0,2293. Punto de corte de “score” de 13 puntos con sensibilidad 44,4%, especificidad de 91,6%, LR (+) 5,29, LR (-) 0,61, considerando además la siguiente clasificación: 1 a 6 puntos “bajo riesgo”, 7 a 12 puntos “mediano riesgo”, 13 a 18 puntos “alto riesgo”, desde 19 puntos como “máximo riesgo”. Conclusión: El modelo presenta una buena capacidad de predicción de infección de herida operatoria y representa adecuadamente a la cohorte en estudio.

Background: A low hand grip strength is a prognostic factor both in healthy people and hospitalized subjects. Local normal hand grip strength values are needed to define cutoff points of abnormality. Aim: To measure handgrip strength in Chilean people aged 20 to 70 years and propose normal values for healthy people in this age range. Material and Methods: Handgrip strength was measured using a JAMAR hydraulic dynamometer in 436 males and 465 females aged 20 to 70 years and who were free of disease. They were recruited from waiting rooms in several public and private hospitals and outpatient clinics, under self-evaluation of inclusion criteria. Results: The variability of the handgrip strength in women was smaller in than men. Tables containing handgrip strength values by age and sex and the ranges between three standard deviations were prepared. Conclusions: This study contributes with normal handgrip strength values in Chile to be used for the diagnosis and management of various conditions, such sarcopenia, obesity, oncological patients, Intensive Care Unit acquired weakness (ICU-aw) and weaning of mechanical ventilation.

Background: There is a paucity of validated instruments for screening depression in adolescent populations in Chile. Aim: To determine the diagnostic accuracy of the adolescent version of Patient Health Questionnaire-9 (PHQ-9). Material and Methods: The PHQ-9 was transculturally adapted and administered to adolescents aged 15 to 19 years residing in Santiago de Chile, who were then evaluated with a semi structured interview (Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version or K-SADS-PL) and the Beck Depression Inventory. Internal validity, concurrent validity, and discriminatory power of the PHQ-9 were analyzed. Results: We evaluated 245 adolescents aged 16.2 ± 1 years (71% females). Two hundred and ten presented with a depressive episode and 35 were healthy. The sensitivity and specificity of the scale were 86.2 and 82.9% for 11 points, with a positive likelihood ratio of 5.02. Conclusions: The PHQ-9 is sensitive and specific enough to be used as a screening tool in adolescents with suspected depression. At a 11-point cut-off score as proposed, the likelihood to find a positive result in a subject with depression is five times higher.

Background: The Woman Abuse Screening Tool (WAST) is a screening tool for domestic violence used in Unites States. Aim: To carry out the cultural adaptation of the WAST instrument for early detection of domestic violence in primary health care. Material and Methods: Qualitative techniques for cultural adaptation were used in stages 1 and 2 and quantitative techniques were used in stage 3. The validity of content was assessed using judge tests carried out with experts in the field. Linguistic adaptation was carried out using a focal group technique to ensure semantic and language comprehension. Finally, the culturally adapted instrument was applied to 16 women who were victims of violence and to 28 women without a history of violence. Results: For cultural adaptation, the judges’ test added the item of economic violence to the instrument. According to the focus groups, some words were changed to facilitate understanding by the subjects. According to the scores obtained in women with and without a history of violence, a cut-off point of 15 points was defined to determine a history of domestic violence with a sensitivity of 100% and a specificity of 96%. The Cronbach Alpha of the questionnaire was 91%. Conclusions: WAST is an effective and easily applied instrument for the early detection of domestic violence.

ABSTRACT Objective The objective of this study was to evaluate the impact of the introduction of the 10-valent pneumococcal conjugate vaccine (PCV10) on the incidence of invasive pneumococcal disease (IPD) and on community-acquired pneumonia (CAP) in hospitalized children under 5 years of age in the southern area of Santiago, Chile. Methods An ecological study was conducted on the incidence of IPD and CAP in children under age 5 in the southern area of Santiago (Chile) from 2009 to 2015. The information used was from bacteriology laboratories in four hospitals, the Chilean Institute of Health Public (ISP), and hospital discharge records. Results A total of 6,461 cases of CAP and 173 cases of IPD were confirmed by the ISP; 169 of these cases were diagnosed in the bacteriology laboratories of the hospitals included in the study. When the incidence of cases in 2010 was compared to 2011-2015, the incidence ratio (IR) of IPD declined 10% annually (p=0.026) and CAP declined by 8% in the same period (p<0.001). Days of hospitalization due to IPD were reduced by 39% (p<0.001). Between 2009 and 2012, seven children died, but since then there have been no deaths due to these diseases. Conclusions The introduction of the PCV-10 vaccine into the National Immunization Program has had a positive effect, with a significant reduction in IPD and CAP and in days of hospitalization due to IPD, while preventing cases and deaths.

RESUMEN Objetivo El objetivo de este estudio fue evaluar el efecto de la incorporación de la vacuna antineumococica 10-valente (PCV 10) en la incidencia de la enfermedad neumocócica invasora (ENI) y en la neumonía adquirida en la comunidad (NAC) en niños hospitalizados menores de 5 años en el área sur de Santiago de Chile. Métodos Se realizó un estudio ecológico de la incidencia de ENI y NAC en menores de 5 años del área sur de Santiago de Chile de 2009 a 2015. Las fuentes de información utilizadas fueron las de los laboratorios de bacteriología de cuatro hospitales, del Instituto de Salud Pública de Chile (ISP) y los registros de egresos hospitalarios. Resultados Un total de 6 461 casos de NAC y 173 casos de ENI fueron confirmados por el ISP, de los cuales 169 casos fueron diagnosticados en los laboratorios de bacteriología de los hospitales incluidos en el estudio. Al comparar la incidencia de casos de 2010 frente a 2011-2015, la razón de incidencias (RI) de ENI se redujo 10% anualmente (p = 0,026) y la de NAC, 8% en el mismo período (p <0,001). El total de días cama ocupados en el período 2009-2015 fue de 39 565 con una mediana de días cama ocupados entre 4 y 5. Hasta 2012 fallecieron 7 niños y desde entonces no ha habido fallecimientos por estas enfermedades. Conclusiones La incorporación de la vacuna PCV-10 en el Programa Nacional de Inmunizaciones tuvo un efecto positivo, con una reducción significativa de las ENI y NAC y de la ocupación de camas por ENI y evitó casos y muertes.

RESUMO Objetivo Avaliar o efeito da incorporação da vacina pneumocócica 10-valente (PCV 10) na incidência de doença pneumocócica invasiva (DPI) e pneumonia adquirida na comunidade (PAC) em crianças menores de cinco anos internadas em hospital. Métodos Foi realizado um estudo ecológico da incidência de DPI e PAC em crianças menores de cinco anos na região sul de Santiago, no Chile, de 2009 a 2015. As fontes de informação usadas foram os registros dos laboratórios de bacteriologia de quatro hospitais, dados do Instituto de Saúde Pública do Chile (ISP) e registros de altas hospitalares. Resultados Ao todo, 6.461 casos de PAC e 173 casos de DPI foram confirmados pelo ISP, dos quais 169 casos foram diagnosticados nos laboratórios de bacteriologia dos hospitais participantes do estudo. Ao comparar a incidência de casos entre 2010 e o período de 2011–2015, observou-se um declínio de 10% na taxa de incidência anual de DPI (p = 0,026) e de 8% na de PAC no mesmo período (p<0,001). Os dias de leito ocupado por DPI tiveram uma redução de 39% ao ano (p <0,001). Sete crianças morreram até 2012 e a partir daí não ocorreram mais mortes por estas doenças. Conclusões A incorporação da vacina PCV-10 no programa nacional de vacinação surtiu um efeito positivo: houve uma redução significativa do número de casos de DPI e PAC e da ocupação de leitos por DPI e casos e mortes foram evitados.