Background: The appropriate use of analgesia, sedation, neuromuscular blockade and the diagnosis and prevention of delirium (ASBD) are associated with better outcomes in critically ill patients at Intensive Care Unit (ICUs). Aim: To know the practices about analgesia, sedation, delirium, and neuromuscular blockade use among healthcare professionals working in adult ICUs in Chile. Material and Methods: An electronic survey was sent to 812 professionals working in ICUs using a previously published instrument, which was adapted and authorized by the author. Results: We received 278 surveys. Fifty two percent of respondents were physicians, 34% nurses and 11% physical therapists. Their age ranged between 30 and 39 years in 43% and was over 50 years in 9%. Eighty four percent evaluated pain routinely, but only 26% use a validated scale. Sedation was routinely evaluated with a validated scale and 73% referred to have a protocol. Neuromuscular block is seldom used, and little monitoring occurs (43%). Delirium is routinely evaluated by 48% of respondents, usually using the CAM-ICU scale. Conclusions: There is a heterogeneous adherence to the ASBD recommended practices. The main gaps are in the assessment of pain, monitoring of neuromuscular blockade and diagnosis of delirium through validated instruments.

Abstract Identifying the risk factors for dental caries is vital in epidemiology and clinical practices for developing effective preventive strategies, both, at the individual and collective levels. Different causality/determination models have been proposed to understand the development process of dental caries. In the present review, we designed a model inspired by the world-known social determinants models proposed in the 90s and more recently in the 10s, wherein the contextual factors are placed more externally and encompass the individual factors. The contextual factors included those related to the cultural and societal values, as well as the social and health government policies. The individual factors were classified into the following categories: socioeconomic (social class, occupation, income, and education level), demographic characteristics (age, sex, and ethnicity), behavioral factors (non-use of fluoride dentifrice, sugar consumption, poor oral hygiene, and lack of preventive dental care), and biological factors (recent caries experience/active caries lesions, biofilm retentive factors, developmental defects of the enamel, disabilities, saliva amount and quality, cariogenic biofilm). Each of these variables was addressed, while focusing on the current evidence from studies conducted in Latin American and Caribbean countries (LACC). Based on the proposed model, educational aspects were addressed, and individual caries risk assessment and management decisions were proposed; further, implications for public health policies and clinical practice were described. The identification of modifiable risk factors for dental caries should be the basis for multi-strategy actions that consider the diversity of Latin American communities.

RESUMO O delirium é uma condição importante em pacientes críticos, com impactos em longo prazo em termos de mortalidade, condição cognitiva e funcional, e qualidade de vida. Apesar do progresso ocorrido nos anos recentes em seu diagnóstico, prevenção e tratamento, seu impacto continua relevante, de forma que é necessário explorar novas estratégias de prevenção e tratamento. Dentre as estratégias preventivas não farmacológicas, relatos recentes sugerem o papel da terapia ocupacional por meio de uma série de intervenções que podem ter impacto no desenvolvimento do delirium. O objetivo desta revisão é avaliar os estudos que discutem o papel da terapia ocupacional na prevenção do delirium em populações de pacientes críticos, além de sugerir perspectivas para pesquisas nesta área.

ABSTRACT Delirium is a relevant condition in critically ill patients with long-term impacts on mortality, cognitive and functional status and quality of life. Despite the progress in its diagnosis, prevention and management during the last years, its impact persists being relevant, so new preventive and therapeutic strategies need to be explored. Among non-pharmacologic preventive strategies, recent reports suggest a role for occupational therapy through a series of interventions that may impact the development of delirium. The aim of this review is to evaluate the studies evaluating the role of occupational therapy in the prevention of delirium in critically ill patient populations, and suggests perspectives to future research in this area.

The immunomodulatory activity was studied in function of the production of γ-IFN induced by the methanolic extracts (ME) of the white, black, red and purple ecotypes of Lepidium peruvianum, Chacón (at present Lepidium meyenii Walp.) maca, on cultures of human T lymphocytes obtained of periferic blood. After cultivating the lymphocytes with the respective ME of maca during 14 hours, only the ME of the purple ecotype induced the significant production of IFN-γ by Elispot quantified. The methanolic extract of the purple ecotype of maca possesses important immunostimulatory properties triggering the activation of the human T lymphocytes.

Se estudió la actividad inmunoduladora sobre cultivos de linfocitos T humanos de sangre periférica. Se evaluó la producción de IFN-γ inducida por los extractos metanólicos (EM) de los ecotipos blanco, negro, rojo y morado de Lepidium peruvianum (conocida también como Lepidium meyenii Walp.) maca. Luego de cultivar los linfocitos con los respectivos EM de maca durante 14 horas sólo el EM del ecotipo morado indujo la producción significativa de IFN-γ cuantificada mediante Elispot. El extracto metanólico del ecotipo morado de maca posee propiedades inmunoestimuladoras importantes, desencadenando la activación de linfocitos T humanos.

The classic treatment of the cutaneous leishmaniosis consists on the injection of 15-20 ampoule of Glucantine what causes serious secondary effects. This fact justifies the search of new medications what motivated the present investigation. The objective was to evaluate the leishmanicidal activity of the methanolic extracts (ME) of the white, red, purple and black ecotypes of Lepidium peruvianum Chacón (at present Lepidium meyenii Walp.) about the growth of Leishmania braziliensis peruviana in vitro. The promastigotes reached the logarithmic phase to the fifth day of cultivation at 27 ºC in the two-phase Columbia medium with 15% of defibrinated sheep blood and they faced, for separate, with the ME to concentrations of 50, 100, 200 and 400 μg/ml. The recounts were made daily with camera Neubauer. The maximum decrease of promastigotes (17.41% of viability) took place to the second day for the purple ecotype with the concentration of 400 mg/ml. The leishmanicidal effect would be related with the imidazolic alkaloids, glucosinolates, flavonoids, tannins and saponines present in the ME. The conclusion is that only ME of the white and purple ecotypes presents leishmanicidal activity, at second day of culture.

El tratamiento clásico de la leishmaniosis cutánea consiste en la inyección de 15-20 ampollas de Glucantine lo que ocasiona efectos secundarios, este hecho justifica la búsqueda de nuevos medicamentos motivando la presente investigación. El objetivo fue evaluar in vitro la actividad leishmanicida de los extractos metanólicos (EM) de los ecotipos blanco, rojo, morado y negro de Lepidium peruvianum, Chacón (también conocida como Lepidium meyenii Walp.), sobre el crecimiento de Leishmania braziliensis peruviana. Los promastigotes alcanzaron la fase de crecimiento exponencial al quinto día de cultivo a 27 ºC en el medio bifásico Columbia, suplementado con 15% de sangre desfibrinada de carnero, en ese momento se enfrentaron, por separado, con los EM a concentraciones de 50, 100, 200 y 400 μg/ml. Los recuentos se hicieron diariamente con cámara Neubauer. La máxima disminución de promastigotes se produjo al segundo día de enfrentamiento para el ecotipo morado (17,41% de viabilidad) empleando 400 mg/ml. El efecto leishmanicida estaría relacionado con los alcaloides imidazólicos presentes en el EM. Se concluye que al segundo día de enfrentamiento con el EM, el ecotipo morado presenta la mayor actividad leishmanicida seguido del ecotipo blanco.

The macrophages play an important role in the innate and adaptative response. Upon appropriate activation, macrophages released a variety of cytotoxic mediators like the Nitric Oxide (NO). The objective was to evaluate the production of NO for murine peritoneal macrophages cultivated with methanol extracts (ME) of different ecotypes of Lepidium peruvianum Chacón (at present Lepidium meyenii Walp.) red, black, purple and white. The ME was prepared using maca powdered macerated in methanol (1:2) during 10 days. Peritoneal macrophages were obtained of mice 3 days after having injected them 1 ml of thioglycolate broth; they were cultivated for triplicate during 18 hrs at 37 °C in RPMI 1640 medium supplemented with 10% fetal calf serum. The dose of ME was of 800 μg/ml for ecotype, were considered controls without ME. The production of NO was assayed by nitrite accumulation in the supernatant culture and it was evidenced with Peter Griess's reagent, the nitrite concentrations were calculated based on the standard curve elaborated with NaNO2. The produced concentrations of nitrite were of 7,45; 6,79; 5,76; 5,61 and 6,81 mM for the ME purple, black, white, red ecotypes and control respectively, although with the purple ecotype it was superior (p> 0,05).

Los macrófagos desempeñan un rol importante en la respuesta innata y adaptativa, durante su activación producen mediadores citotóxicos como Óxido Nítrico (NO). El objetivo fue evaluar la producción de NO por macrófagos peritoneales de ratón cultivados con extractos metanólicos (EM) de los ecotipos rojo, negro, morado y blanco de Lepidium peruvianum Chacón (también conocida como Lepidium meyenii Walp). Los EM se prepararon empleando maca pulverizada macerada en metanol (1:2) durante 10 días. Los macrófagos peritoneales se obtuvieron de ratones 3 días después de haberles inyectado 1 ml de Caldo Tioglicolato por vía intraperitoneal; se cultivaron por triplicado durante 18 h a 37 °C en medio RPMI 1640 suplementado con 10% de suero de bovino fetal. La dosis de EM fue de 800 μg/ml por ecotipo, se consideraron controles sin EM. La producción de NO se determinó por acumulación de nitrito en el medio y se evidenció con el reactivo de Peter Griess, las concentraciones de nitrito se calcularon en base a la curva estándar elaborada con NaNO2. Las concentraciones producidas de nitrito fueron de 7,45; 6,79; 5,76; 5,61 y 6,81 mM para los EM de los ecotipos morado, negro, blanco, rojo y control respectivamente. Los cuatro ecotipos indujeron la producción de NO, aunque con el ecotipo morado fue superior (p>0,05).

The search of natural compound with cytotoxic and antitumoural activities is one of the current priorities of the fight against the cancer; being necessary to analyze new extracts of plants. The objective in this paper was to evaluate the cytotoxic activity of the methanolic extract (ME) of the black, purple and yellow ecotypes of Lepidium peruvianum, Chacón (at present Lepidium meyenii Walp.), Maca, on the cellular lines HeLa (Human Epithelial Carcinoma) and HT-29 (Human Colon Adenocarcinoma). For the cellular line HT-29, the inhibitory concentration of 50% of the cellular growth (IC50) with the black, purple and yellow ecotypes was of 8,32 mg/ml, 9,28 mg/ml and 0,487 mg/ml, respectively; while for the cellular line HeLa was of 2,4 mg/ml, 1,93 mg/ml and 0,66 mg/ml respectively. Additionally, ME of the yellow ecotype was evaluated with two years of storage (10ºC) determining an IC50 4,29 mg/ml for HT-29 and 4,17 mg/ml for HeLa. We concludes that the cytotoxic effect of the yellow ecotype on HT-29 and HeLa went high to the showed by the black and purple ecotypes; that the most sensitive cellular line to the yellow, black and purple ecotypes is HeLa, and that the ME of the yellow ecotype conserved its cytotoxic properties in spite of the time of storage.

La búsqueda de compuestos naturales con actividad citotóxica y antitumoral es una de las prioridades actuales de la lucha contra el cáncer; motivo por el cual el objetivo del presente trabajo fue evaluar la actividad citotóxica de los extractos metanólicos (EM) de los ecotipos negro, morado y amarillo de Lepidium peruvianum, Chacón (conocida también como Lepidium meyenii Walp.) (maca) sobre las líneas celulares HeLa (Human Epithelial Carcinoma) y HT-29 (Human Colon Adenocarcinoma). Se determinó que la concentración inhibitoria del 50% del crecimiento celular (IC50) para la línea celular HT-29, con los ecotipos negro, morado y amarillo fue de 8,32 mg/ml, 9,28 mg/ml y 0,487 mg/ml respectivamente, mientras que para la línea celular HeLa fue de 2,4 mg/ml, 1,93 mg/ml y 0,66 mg/ml respectivamente. Adicionalmente, se evaluó un EM del ecotipo amarillo con dos años de almacenamiento (10 ºC) determinándose como IC50 4,29 mg/ml para HT-29 y 4,17 mg/ml para HeLa. Se concluye que el efecto citotóxico del ecotipo amarillo sobre HT-29 y HeLa fue superior al mostrado por los ecotipos negro y morado; que la línea celular más sensible a los ecotipos amarillo, negro y morado es HeLa, y que el EM del ecotipo amarillo conservó sus propiedades citotóxicas pese al tiempo de almacenamiento, aunque éstas disminuyeron.