Abstract: Since the onset of the SARS-CoV-2 pandemic, the pediatric population has been less affected by the disease both in frequency and severity. However, since April cases of variable presentation and severity characterized by inflammatory phenomena that affect multiple organs have been reported, a condition called Multisystem Inflammatory Syndrome in Children (MIS-C). The literature has reported frequent cardiac involvement, up to 80%. This is characterized by myocardial injury with a significant increase of biomarkers such as serum troponins I and T, BNP, or NT-ProBNP coupled with varying degrees of ventricular dysfunction, pericarditis, valvulitis, and arrhythmias. Coronary compromise has also been described, which can occur in up to 23% of cases, and ranges from dila tations to aneurysms. Inpatient and outpatient cardiology follow-up has been systematized based on the clinical phenotypes such as myocardial injury (myocarditis, valvulitis, pericarditis), shock (usua lly vasoplegic), Kawasaki disease-type manifestations, and those MIS-C that do not comply with the clinic of the previous three. This last group represents the main challenge in the short-, medium- and long-term follow-up, therefore, it is necessary a multidisciplinary team for managing these patients. Considering the high frequency of cardiac compromise in MIS-C, and the importance of reaching a consensus regarding its management and follow-up, we present these recommendations according to the current state of knowledge regarding this recently described pathology.

Resumen: Desde la aparición de la pandemia por SARS-CoV-2, la población pediátrica ha sido menos afectada por la enfermedad tanto en frecuencia como en severidad. Sin embargo, desde abril de este año se han reportado casos de presentación y gravedad variables, caracterizados por fenómenos inflamato rios que afectan múltiples órganos, condición denominada Síndrome Inflamatorio Multisistémico Pediátrico (PIMS). La literatura describe frecuente compromiso cardíaco, hasta en un 80%. Este se caracteriza por injuria miocárdica con significativa elevación de biomarcadores: Troponinas séricas I/T, BNP o NT-ProBNP, unido a diversos grados de disfunción ventricular, pericarditis, valvulitis y arritmias. Además, se ha evidenciado la presencia de compromiso coronario el cual puede ocurrir hasta en un 23% de los casos, en un rango que va desde dilataciones hasta aneurismas. El seguimien to cardiológico hospitalizado y ambulatorio se ha sistematizado en base a los fenotipos clínicos de presentación: injuria miocárdica (miocarditis, valvulitis, pericarditis), shock (habitualmente de tipo “vasopléjico”), manifestaciones tipo Enfermedad de Kawasaki y aquellos casos PIMS que no cumplen con la clínica de los tres precedentes. Este último grupo es el que representa el mayor desafío en el cor to, mediano y seguimiento a largo plazo. Por esta razón se requiere un equipo multidisciplinario para su manejo. Considerando la alta frecuencia del compromiso cardíaco en el PIMS y la importancia de lograr un consenso en su manejo y seguimiento, se presentan estas recomendaciones según el estado actual del conocimiento de esta patología recientemente descrita.

Abstract: Introduction: Tetralogy of Fallot (TOF) is the most frequent cyanotic congenital heart disease. Pulmonary regurgitation (PR) and right ventricle (RV) enlargement and dysfunction are the most common long-term complications. Cardiac magnetic resonance (CMR) is the gold standard for RV evaluation. Objective: To analyze CMR results in the follow-up of TOF patients. Patients and Method: All CMR performed between 2007 and 2012 in TOF patients with transannular patch (TAP) repair or infundibular widening, and without pulmonary valve replacement (PVR) were included. Pulmonary regurgitant fraction (PRF), ventricular end-diastolic (EDV) and end-systolic volume (ESV), and ejection fraction (EF) were examined. Results: 122 CMR were performed in 114 patients. Average age at CMR was 15.4±7.4 years. 53.3% of them presented severe PR (> 40%). RVEDV was 157.3 ± 38.6 ml/m2, RVESV was 85.3 ± 27 ml/m2 and RVEF was 46.4 ± 7.1%. RVEDV was > 150 ml/ m2 in 48.4% and > 170 ml/m2 in 32.8% of patients. Patients with TAP showed larger RV volumes compared with those with infundibular widening. RVEDV > 170 ml/m2 showed worse RVEF that those with lower RVEDV (47.9 ± 7% vs 43.2 ± 6.4%, p < 0.01). Conclusion: Almost half of the pa tients showed significant RV enlargement, demonstrating that the indication of CMR is late in their follow-up. TAP was associated with higher RVEDV and RVESV, but no worse RVEF.

Resumen: Introducción: La tetralogía de Fallot (TF) es la cardiopatía congénita cianótica más frecuente. La insuficiencia pulmonar (IP) y dilatación del ventrículo derecho (VD) son las complicaciones más fre cuentes a largo plazo. La resonancia magnética cardiaca (RMC) es el “gold standard” para la evalua ción del VD. Objetivo: Analizar la información obtenida de las RMC en el seguimiento de pacientes con TF. Pacientes y Método: Se incluyeron RMC realizadas entre 2007 y 2012 a pacientes con TF, reparados con parche transanular (PTA) o ampliación infundibular (AInf) y sin recambio valvular pulmonar (RVP). La fracción de regurgitación pulmonar (FRP), el volumen y función ventricular fueron evaluados. Resultados: Se realizaron 122 RMC a 114 pacientes. Edad promedio al examen 15,4 ± 7,4 años. 53,3% presentó IP severa (> 40%). La media del volumen de fin de diástole del VD (VFDVD) fue 157,3 ± 38,6 ml/m2, fin de sístole (VFSVD) de 85,3 ± 27 ml/m2 y fracción de eyección (FEVD) 46,4 ± 7,1%. 48,4% presentaba un VFDVD mayor de 150 ml/m2 y el 32,8% mayor a 170 ml/ m2. El PTA se relacionó con mayores volúmenes de VD que la AInf. VFDVD mayor a 170 ml/m2 mos traron peor FEVD (FEVD 47,9 ± 7% vs 43,2 ± 6,4%, p < 0,01). Discusión: Casi la mitad mostró una significativa dilatación del VD demostrando que la indicación de RMC es tardía en el seguimiento. El PTA se asoció con mayores VFDVD y VFSVD pero no a peor FEVD.

A retrospective study of 15 canine patients from the neighborhoods of Camagüey, Cuba in the period 2016-2017, with clinical signs compatible with hemoparasitosis and laboratory diagnosis by blood smear and Giemsa coloration of canine ehrlichiosis. An alternative therapy with antianemic reconstitutes, hydration with Lactate Ringer and oxytetracycline was proposed for the treatment of canine ehrlichiosis.

Se hizo un estudio retrospectivo de 15 pacientes caninos de los barrios del municipio Camagüey, Cuba, en el periodo 2016-2017, con signos clínicos compatibles con hemoparasitosis y con diagnóstico de laboratorio mediante frotis sanguíneo y coloración Giemsa de ehrlichiosis canina. Se propuso una terapia alternativa con reconstituyentes antianémicos, hidratación con Lactato Ringer y oxitetraciclina para el tratamiento de la ehrlichiosis canina.

The aim of this retrospective study was to show the use of vincristine sulfate via subcutaneous in the control of genital and extragenital Canine Transmissible Venereal Tumour (TVT), by reviewing seven cases treated between 2000 and 2016 with clinical signs compatible with TVT. The clinical diagnosis of TVT was based on the macroscopic morphology and location of tumours and the signs of this pathology. Chemotherapy with vincristine sulfate at doses of 0.025 mg/kg for 3 to 6 weeks was effective in all cases, with remission of clinical signs.

Este estudio retrospectivo tuvo como objetivo demostrar el uso del sulfato de vincristina, vía subcutánea, para el control del tumor venéreo transmisible canino (TVT) de ubicación genital y extragenital, mediante la revisión de siete casos atendidos entre 2000 a 2016 con signos clínicos compatibles con TVT. El diagnóstico clínico del TVT se orientó por la morfología macroscópica y la localización, así como por los signos de esta patología. La quimioterapia con sulfato de vincristina en dosis de 0.025 mg/kg por 3 a 6 semanas, fue efectiva en todos los casos, observándose remisión de los signos clínicos.

Los incendios forestales son multicausales afectan frecuentemente zonas tropicales y subtropicales. Son dinámicos en tiempo y espacio, y generan fuertes impactos sobre el medio ambiente. Para identificar el patrón espacial de estos en diferentes coberturas vegetales, se generaron mapas de susceptibilidad bruta a incendios (SB), basada en características intrínsecas de vegetación, y susceptibilidad neta (SN), SB mas variables climáticas y topográficas, a escala regional. La mayor área afectada está dominada por pastos con muy altas SB (27.19%) y SN (18.38%). Los bosques naturales (zona noroccidental) y plantados (alrededor del embalse Riogrande II) presentaron baja SB. Se confirma que los patrones espaciales de la susceptibilidad a incendios están relacionados con factores climáticos y topográficos. En zonas con alta y muy alta SB, el área de cada categoría disminuyó incluyendo estos factores. La relación entre la estructura de paisaje y SN no mostró una clara tendencia, ya que la estructura a nivel de paisaje de los bosques y rastrojos fue muy variable por grado de susceptibilidad. Las categorías más críticas de SN se registraron en paisajes muy homogéneos con parches pequeños de bosque y rastrojos (entre 0.3 y 2.1 ha), y poca variabilidad en el tamaño y formas de parches.

Wildfires have many causes, they often affect tropical and subtropical areas. They are dynamic in time and space, and generate strong impacts on the environment. To identify the spatial pattern of these in different vegetation covers, maps of the gross susceptibility to fires were generated (GS) (based on the intrinsic characteristics of the vegetation) and the net susceptibility (SN) (more climatic and topographic variable GS), at a regional level. The most affected area is dominated by grasses with very high GS (27.19%) and a SN of (18.38%). The natural forests (north - west zone) and planted (around the Riogrande II reservoir) showed low GS. It is confirmed that the spatial patterns of susceptibility to fires are related to climatic and topographic factors. In areas with high and very high GS, the area of each category decreased including these factors. The relationship between landscape structure and NS showed no clear trend, since the structure at the landscape level of forests and stubble was very variable by degree of susceptibility. The most critical categories of NS were recorded in very homogenous landscapes with small patches of forest and brush (between 0.3 and 2.1 ha), and little variability in the size and shapes of the patches.

Vascular complications secondary to surgical treatment of localized kidney cancer are more frequent when a nephron-sparing surgery is performed. However, radical nephrectomy is not exempt from them. We report the case of a pseudoaneurysm of the main renal artery with fistulous communication to ascending colon after radical nephrectomy. The patient presented with an episode of hypovolemic shock due to lower gastrointestinal bleeding.

Las complicaciones vasculares secundarias al tratamiento quirúrgico del cáncer de riñón localizado son más frecuentes cuando se realiza una cirugía conservadora de nefronas. Sin embargo, la nefrectomía radical no está exenta de ellas. Presentamos el caso de un pseudoaneurisma de la arteria renal principal con comunicación fistulosa a colon ascendente tras nefrectomía radical. El paciente debutó con un episodio de shock hipovolémico debido a hemorragia digestiva baja.

This study was designed to assess the influence of resistance training on salivary immunoglobulin A (IgA) levels and hormone profile in sedentary adults with Down syndrome (DS). A total of 40 male adults with DS were recruited for the trial through different community support groups for people with intellectual disabilities. All participants had medical approval for participation in physical activity. Twenty-four adults were randomly assigned to perform resistance training in a circuit with six stations, 3 days per week for 12 weeks. Training intensity was based on functioning in the eight-repetition maximum (8RM) test for each exercise. The control group included 16 age-, gender-, and BMI-matched adults with DS. Salivary IgA, testosterone, and cortisol levels were measured by ELISA. Work task performance was assessed using the repetitive weighted-box-stacking test. Resistance training significantly increased salivary IgA concentration (P=0.0120; d=0.94) and testosterone levels (P=0.0088; d=1.57) in the exercising group. Furthermore, it also improved work task performance. No changes were seen in the controls who had not exercised. In conclusion, a short-term resistance training protocol improved mucosal immunity response as well as salivary testosterone levels in sedentary adults with DS.

Mining is one of the most important industrial activities in Chile and there is growing concern on pollution by some mining and metallurgical processes. We have studied the contents of heavy metals in sediments from three river basins in Chile. Samples were collected based on hydrologic criteria in six sites along the rivers in their path from the Andes to the Pacific Ocean. Particle induced X-ray emission (PIXE), was used to determine elemental concentrations, and enrichment factors were used to evaluate the significance of anthropogenic sources. The results indicate the presence of Si, Al and Fe as major components. Cu, Cr, Mn, Pb and Zn are the main trace elements. In the Aconcagua river basin, which has less mining activity, the elemental concentrations are within the range of normal crust. Instead, samples from Choapa and Cachapoal river basins present high enrichment factors, mainly in copper. This is consistent with the fact that copper mines operate in the area. A correlation of the values obtained to copper using ICP and PIXE technique was statistically acceptable. Therefore, determination of Cu in river sediment by PIXE allows identification of areas affected by mining activities in river basins of northern Chile.

The purpose of this article is to show in a general way the mathematical basis of the fractal geometry and how this geometrical point of view is applied to problems which appear in the finite element analysis of complex civil engineering structures, where the definition of the size of the elements that compose the mesh is important, such that the discretization of the continuum medium be representative and consequently the obtained results be more reliable. To show the applicability of this technology, a fractal algorithm (developed by the authors) is presented, by means of which it is possible to do automatic efficient local remeshing of finite element meshes for two-dimensional stress analyses. The results are compared with analytical solutions which are reproduced with excellent approximation.

La finalidad de este artículo es presentar de manera general las bases matemáticas de la geometría fractal y cómo este punto de vista geométrico se aplica a problemas que se presentan en el análisis de obras civiles complejas mediante el método del elemento finito, en el cual es importante la definición del tamaño de los elementos que componen la malla, de manera tal que la discretización del medio continuo sea representativa y consecuentemente los resultados obtenidos sean confiables. Para mostrar la aplicabilidad de esta técnica, se presenta un algoritmo fractal (desarrollado por los autores), mediante el cual se puede hacer remalleo automático de mallas bidimensionales de elemento finito, con lo cual se logran refinamientos locales eficientes de los problemas bajo análisis. Los resultados se comparan con soluciones analíticas mostrando que éstas se reproducen con excelente aproximación.

Background: Surgical correction of congenital heart diseases (CHD) intends to improve quality of life (QL) in affected patients. In Chile this aspect has not been objectively evaluated, especially through comparison with normal children. Aim: to compare the quality oflife in three groups of CHD patients with that of normal controls. Three aspects of QL were evaluated. Methods: three groups of patients with CHD (Ventricular septal defect, Tetralogy of Fallot, Single Ventricle) were compared to a group ofhealthy children from the south east área of Santiago. A standard QL questionnaire was used to evaluate school performance, physical and general daily activities and family life . A treadmill test with a modified Bruce protocol was used to evaluate physical capacity Results: There were 12 patients in the VSD, 12 in the Fallot, 15 in the Single Ventricle and 20 in the normal groups. 52% were males. Age at each school level, school performance (grades and failure rates) were similar across groups except for a lower performance in patients with Single Ventricle. Physical capacity (duration of stress test) was lower in patients with Single Ventricle (7.3 min average) compared to normal (11.75min), VSD (12.2min) and Tetralogy of Fallot (10.0 min). The results ofthese test correlated with subjective performance of physical capacity. Similarly patients with Single Ventricle perceived a greater limitation for daily activities (60%) compared to VSD (100%), Fallot's (89%) and healthy controls (89%). In general, parents of CHD patients perceived a greater limitation compared to their children. Family life was not different among groups. Conclusions: The perception of QL in these patients with corrected CHD did not differ compared to healthy controls. Objective evaluation showed a lower physical capacity in patients with a more severe type of CHD.

Antecedentes: La corrección de las Cardiopatías Congénitas (CC) tiene como fin mejorar la calidad de vida de los pacientes portadores de ellas, pero no existen en nuestro medio estudios sobre ésta, ni su comparación con niños sanos. Objetivos: Estudiarla calidad de vida de los CC, objetivando tres áreas, en tres grupos de pacientes de complejidad diferente, y compararlos con un grupo sano. Método: Se escogieron 4 grupos de niños del área sur oriente de Santiago; 3 grupos de CC: comunicación interventricular (CIV), Tetralogía de Fallot(T4F), Ventrículo único (VU), y un grupo de niños sanos (S). Se sometieron a encuesta de calidad de vida ellos y sus padres, se evaluaron tres áreas especificas; actividad escolar, actividades cotidianas (actividad física y generales) y vida familiar. Se objetivó capacidad física con Test de Esfuerzo (TE), con protocolo de Bruce modificado, en todos. El análisis estadístico incluyó análisis de varianza y chi cuadrado. Resultados: Se seleccionaron 65 niños, 12 con CIV, 18 con T4F, 15 con VU,y20 sanos. Treinta y cuatro de ellos son hombres (52%). En escolaridad no existen diferencias significativas en edad/curso, promedio de notas (5.7), repetición (24.8%), en percepción de notas y rendimiento escolar los pacientes con VU tanto ellos como sus padres perciben peor rendimiento que sus pares. Con relación a actividades físicas generales el TE reveló concordancia con percepción cualitativa y diferencias de rendimientos de acuerdo a la gravedad de la patología, estadísticamente significativa sólo VU en esfuerzos mayores (S: 11:75min CIV: 12:2min, T4F:10min y VU: 7:3min). Con relación a actividades cotidianas, no perciben limitación de la vida diaria en forma significativa, excepto en algunas actividades, los pacientes con VU. Los padres de niños con CC tienen percepción de mayor limitación. Con relación a la vida familiar no hay diferencias significativas entre los 4 grupos. Conclusiones: En general la percepción de calidad de vida de los pacientes CC no difiere en forma importante del grupo sano, existiendo algunas limitaciones en la actividad física y en algunas actividades cotidianas propias de la mayor complejidad de la cardiopatía, que implica necesidad de medicamentos, mayor número de controles, exámenes, etc. Llama la atención que el grupo sano, que debiera ser nuestro parámetro basal se calificó como limitado en actividad física y medianamente contento con la vida, lo que demuestra que nuestro concepto médico de "salud" no se correlaciona con la percepción de salud de la población general.

Background: Cardiac tumors are very uncommon at all ages. There are important clinical differences between children and adults in the behavior of these tumors. Aim: To compare the behavior of primary and secondary cardiac tumors, from fetal age to adults. Patients and Method: Multicentric retrospective analysis of 38 children and adults with cardiac tumors, evaluated with echocardiography between January 1995 and August 2001. Medical records, echocardiographic and radiological examinations, surgical protocols and pathologic examinations were reviewed. Follow-up was obtained through data on medical records or calling patients by telephone. Results: Tumors were diagnosed in 38 patients (13 children and 25 adults), from a total of 31.800 echocardiograms. In children the diagnosis was made by fetal, transthoracic or transesophageal echocardiography in 23.6% and 8% of cases, respectively. Eighty five percent were primary (10 benign and 1 malignant) and 15%, secondary tumors. Fifty four percent were rhabdomyomas and 75% regressed spontaneously. Seventy seven percent were symptomatic and 31% were treated with surgery. During a follow up of 44±35 months, 31% of patients died. In adults, 76% of tumors were diagnosed by transthoracic and 20% by transesophageal echocardiography. Seventy six percent were primary (18 benign and 1 malignant) and 24% secondary tumors. Fifty six percent were myxomas. Ninety two percent were symptomatic and 84% were treated surgically. Twenty percent of patients died in the early postoperative period. No adult patients had a follow-up. Conclusions: Rhabdomyomas were solely found in children. In adults, myxomas are the predominat cardiac tumors. Primary and metastasic malignant tumors are observed both in children and in adults