Renal involvement is a frequent complication in antineutrophil cytoplasmic antibodies (ANCA)associated vasculitides, adding morbidity and mortality, such as chronic kidney disease and the need for renal replacement therapy. With the aim of reaching a consensus on relevant issues regarding the diagnosis, treatment and follow-up of patients with these diseases, the Chilean Societies of Nephrology and Rheumatology formed a working group that, based on a critical review of the available literature and their experience, raised and answered consensually a set of questions relevant to the subject. This document includes aspects related to the clinical diagnosis, the histological characteristics, the therapeutic alternatives to induce and maintain the remission of the disease, relapse surveillance strategies and complementary therapies.

Renal involvement affects over one half of patients with Systemic Lupus Erythematosus increasing their mortality and morbidity, including chronic renal disease and the need of renal replacement therapies. Aiming to achieve a consensus in the most relevant topics on diagnosis, therapy and follow-up of patients with lupus renal disease, the Chilean Societies of Nephrology and Rheumatology constituted a workgroup that, based on a critical review of the available literature and their experience, raised and answered by consensus a set of relevant questions. This document includes aspects related to the clinical diagnosis, the importance of a suitable histological classification, therapeutic alternatives to induce and maintain disease remission, strategies for follow-up, additional therapies and ginecological-obstetric issues.

Human infection by Streptococcus suis is a zoonosis with a known occupational risk. Meningitis is its most frequent clinical manifestation. We present the first two cases in Chile. First case: 54-year-old female patient, pig-farmer. She presented headache, vomiting, confusion and meningismus. She presented septic shock. Second case: 48-year-old male patient, also pig farmer, presented headache, vomiting and meningismus. A Gram's staining of cerebrospinal fluid (CSF) showed gram-positive cocci in both cases. Ceftriaxone and dexamethasone treatment was administered. The CSF cultures were positive for Streptococcus suis serotype 2. The patients experienced a good outcome, without neurological sequelae at the time of discharge. It is considerable to evaluate epidemiologic factors in order to suspect this etiological agent in cases of meningitis. These cases enhance the need of heighten awareness of potential for occupational exposure and infection by this emerging human pathogen. Educating population at risk about simple preventive measures must be considered.

La infección humana por Streptococcus suis es una zoonosis con riesgo ocupacional conocido, siendo la meningitis aguda su manifestación clínica más frecuente. Se presentan los dos primeros casos en Chile. Primer caso: Mujer de 54 años con un cuadro de cefalea y vómitos, confusión y signos meníngeos. Evolucionó con un shock séptico. Segundo caso: Varón de 48 años, refirió cefalea y vómitos. Presentó signos meníngeos al examen físico. En ambos casos en la tinción de Gram de líquido cefalorraquídeo (LCR) se observaron cocáceas grampositivas. Fueron tratados con ceftriaxona y dexametasona. El cultivo de LCR fue positivo en ambos casos para S. suis serotipo 2. En los dos pacientes la evolución clínica fue favorable, sin alteraciones neurológicas al alta. En ambos casos se obtuvo en forma retrospectiva el antecedente de realizar labores de crianza de ganado porcino. Se destaca la importancia de investigar los antecedentes epidemiológicos para sospechar este agente etiológico en meningitis aguda. Se debe considerar el riesgo ocupacional en una posible infección por este patógeno humano emergente y educar a la población en riesgo sobre medidas preventivas simples.

O objetivo deste estudo foi analisar as estratégias utilizadas pelos agricultores do sul do Chile para enfrentar a escassez de mão de obra e identificar as variáveis que determinam cada uma dessas estratégias. Foram aplicados um modelo de logística multinomial e razões de chance com probabilidades previstas a uma amostra de 384 agricultores, além de entrevistas e grupos focais para determinados produtores, profissionais e funcionários públicos. Os principais resultados mostram que 32,3% dos produtores afirmaram que a escassez de mão de obra é um problema. Desse percentual, 52% optaram pela estratégia de melhorar a remuneração, 13,8% escolheram melhorar as condições de trabalho dos trabalhadores, 9,5% escolheram usinar e 24,1% não seguem nenhuma estratégia. A produção de culturas que requer mão de obra intensiva (por exemplo, a fruta exportável) escolhe a estratégia de melhorar o salário; o nível de escolaridade dos agricultores influencia a estratégia para melhorar as condições de trabalho; e a idade dos agricultores determina a estratégia de usinagem. No entanto, a produção de culturas com mão de obra intensiva apresenta o maior efeito. A principal desvantagem da estratégia de "melhores salários" é que os trabalhadores não querem se comprometer com o seu trabalho.

This study analyzes the strategies that farmers in the south of Chile use to face current labor shortages and identify the variables that determine each of these strategies. A multinomial logit model and odds ratios plots with predicted probabilities were applied to a sample of 384 farmers. Interviews and focus groups were applied to specific producers, professionals and public officials. The main results show that only 32.3% of farmers declared that labor shortage is a problem. Of this percentage 52% chose the strategy of paying better, 13.8% chose improve the workers' working conditions, 9.5% chose to mechanize, and 24.1% did not follow a strategy. The production of labor-intensive products (e.g., exportable fruit) determines the strategy of paying better; the farmer's educational level influences the strategy of improving the working conditions, and the farmer's age affects the strategy of mechanizing. However, the production of labor-intensive products exhibits the greater effect. The main disadvantage of the "pay better" strategy is that workers do not want to commit to their job.