ABSTRACT Introduction: The study of comorbidity requires a multilateral approach with a view to improving the quality of care for these patients by the care system. Objectives: To explore the magnitude of the comorbidity of chronic diseases in adults admitted to hospitals. Methods: Prospective-observational-longitudinal-analytical study. Patients hospitalized in a medical clinic room or clinical patients in indiscriminate hospitalization rooms are included, Multicenter study in 42 centers, with 2 years of recruitment. Consecutive sampling. Descriptive, inferential and regression statistics. Results: 5925 recruited, male gender 50,3%, age 60,66 ± 0,25 years, main origin from the guard 73%, stay 12,61 ± 0,24 days, longer in surgical (15,45 ± 0,67 vs 11,76 ± 0,23, p < 0,00001), 23% received surgical treatment. Main educational level: complete secondary school 21,6%. Economic difficulties: 20%, mortality 9,26%, prevalence of dyslipidemia, diabetes and hypertension: 22,53%, 28,82% and 51,86% with 473 new diagnoses in said pathologies, BMI: 27,88 ± 0,65, Global Charlson 2,09 ± 0,02 and in deaths 3,84 ± 0,11. The average number of pathologies per patient was 2,14 ± 0,01 and increased with age (p value for linear regression < 0,00001). Conclusions: Hypertension, diabetes and dyslipidemia represented the most prevalent entities in the clinical hospitalization room, cardiovascular, respiratory, infectious, oncological, neurological, metabolic and nephrological diseases were independent predictors of mortality.

RESUMEN Introducción: El estudio de la comorbilidad requiere de un enfoque multilateral con vistas a mejorar la calidad de la atención de los enfermos por el sistema de atención. Objetivos: Explorar la magnitud de la comorbilidad de enfermedades crónicas en adultos internados en los hospitales. Métodos: Se realizó un estudio prospectivo-observacional-longitudinal-analítico. Se incluyeron pacientes internados en las Salas de Clínica Médica o pacientes clínicos en Salas de Internación Indiscriminada. Se realizó un estudio multicéntrico en 42 centros en un período de 2 años, con un muestreo consecutivo. Para el estudio se tuvo en cuenta la estadística descriptiva, inferencial y de regresión. Resultados: El total de pacientes en el estudio fue de 5925, masculinos con el 50,3 % de edad 60,66 ± 0,25 años. Principal procedencia desde la guardia el 73 %. La estadía hospitalaria de 12,61 ± 0,24 días, mayormente en pacientes quirúrgicos (15,45 ± 0,67 vs 11,76 ± 0,23; p < 0,00001). El 23 % recibió tratamiento quirúrgico. El principal nivel educativo: secundario completo 21,6 %. Dificultades económicas: 20 %, mortalidad 9,26 %; prevalencia de dislipemia, diabetes e hipertensión: 22,53 %; 28,82 % y 51,86 % con 473 nuevos diagnósticos, IMC: 27,88 ± 0,65, Charlson global 2,09 ± 0,02 y en óbitos 3,84 ± 0,11. La media de patologías por paciente fue de 2,14 ± 0,01 y aumentó con la edad (p valor regresión lineal < 0,00001). Conclusiones: La hipertensión, la diabetes y la dislipemia representaron las entidades más prevalentes en Salas de Internación Clínica, Las enfermedades cardiovasculares, respiratorias, infectológicas, oncológicas, neurológicas, metabólicas y nefrológicas fueron predictores independientes de mortalidad.

Resumen Se registra por primera vez para el Cenozoico del Caribe y la América Neotropical el género Parascyllium. En la actualidad las 5 especies existentes del género se restringen a las aguas meridionales de Australia y a nivel mundial los registros fósiles de Parascyllium son sumamente escasos, de allí que el registro fósil costarricense sea un hecho tan significativo.

Abstract The genus Parascyllium is recorded for the first time for the Cenozoic of the Caribbean and Neotropical America Region. Currently the 5 extant species of the genus are restricted to southern Australian waters, and the worldwide fossil records of Parascyllium are extremely scarce, which is why the Costa Rican fossil record is such a significant finding.

Abstract Background Recessive Dystrophic Epidermolysis Bullosa (RDEB) is a rare inherited skin disease caused by variants in the COL7A1 gene, coding for type VII collagen (C7), an important component of anchoring fibrils in the basement membrane of the epidermis. RDEB patients suffer from skin fragility starting with blister formation and evolving into chronic wounds, inflammation and skin fibrosis, with a high risk of developing aggressive skin carcinomas. Restricted therapeutic options are limited by the lack of in vitro models of defective wound healing in RDEB patients. Results In order to explore a more efficient, non-invasive in vitro model for RDEB studies, we obtained patient fibroblasts derived from discarded dressings) and examined their phenotypic features compared with fibroblasts derived from non-injured skin of RDEB and healthy-donor skin biopsies. Our results demonstrate that fibroblasts derived from RDEB chronic wounds (RDEB-CW) displayed characteristics of senescent cells, increased myofibroblast differentiation, and augmented levels of TGF-β1 signaling components compared to fibroblasts derived from RDEB acute wounds and unaffected RDEB skin as well as skin from healthy-donors. Furthermore, RDEB-CW fibroblasts exhibited an increased pattern of inflammatory cytokine secretion (IL-1β and IL-6) when compared with RDEB and control fibroblasts. Interestingly, these aberrant patterns were found specifically in RDEB-CW fibroblasts independent of the culturing method, since fibroblasts obtained from dressing of acute wounds displayed a phenotype more similar to fibroblasts obtained from RDEB normal skin biopsies. Conclusions Our results show that in vitro cultured RDEB-CW fibroblasts maintain distinctive cellular and molecular characteristics resembling the inflammatory and fibrotic microenvironment observed in RDEB patients’ chronic wounds. This work describes a novel, non-invasive and painless strategy to obtain human fibroblasts chronically subjected to an inflammatory and fibrotic environment, supporting their use as an accessible model for in vitro studies of RDEB wound healing pathogenesis. As such, this approach is well suited to testing new therapeutic strategies under controlled laboratory conditions.

Resumen El género Otodus y sus especies han sido registradas en el sur de América Central desde el Eoceno, sus restos están asociadas a sedimentos calcáreos o clásticos propios de ambientes sublitorales y neríticos internos. Una de esas formaciones geológicas es la Fm. Santa Teresa con un rango de edad Mioceno Medio - Plioceno Inferior, aflorante en la margen pacífica y las partes altas del extremo sur de la Península de Nicoya, donde se habían reportado y descrito con anterioridad una serie de hallazgos de Otodus (Megaselachus) chubutensis y Otodus (Megaselachus) megalodon. A lo largo de varias décadas, restos dentales asociados al género Otodus se han venido registrando en el Sur de la península de Nicoya, algunos constituyen hallazgos fortuitos y algunos incluso fuera de contexto geológico. Sin embargo, las ubicaciones dadas por las personas que hicieron los hallazgos, permiten establecer con algún grado de certeza las unidades sedimentarias de donde las muestras procedían, permitiéndonos incrementar el conocimiento, abundancia y diversidad del registro fósil de estos tiburones gigantes.

Abstract The Otodus genus and its species have been recorded in Southern Central America since the Eocene epoch, its remains are associated with calcareous or clastic sediments typical of sublitoral or inner neritic environments. One of these geological formations is Santa Teresa Fm. with a Middle Miocene to Lower Pliocene age range, outcropping in the Pacific margin and the elevated parts at the southern end of the Nicoya Peninsula, where a series of finds of Otodus (Megaselachus) chubutensis and Otodus (Megaselachus) megalodon had been previously reported. Over several decades, dental remains associated with Otodus genus have been recorded at Southern Nicoya Peninsula, fortuitous finds, some of them without direct geological context. However, the locations given by the people who made the findings, allow us to establish with some degree of certainty the sedimentary units from which the samples came, allowing us to increase the knowledge of the abundance and diversity of the fossil record of these giant sharks.

Resumo Introdução Uma série de medidas restritivas de atenção à saúde emergiram limitando as ações que incluem o trabalho do terapeuta ocupacional, requerendo adaptações para atender as pessoas que dele necessitam. Objetivo Identificar o impacto e as adaptações no atendimento de profissionais clínicos de terapia ocupacional devido à pandemia de COVID-19 na Colômbia. Métodos: Estudo transversal que aplicou um questionário online em janeiro-fevereiro de 2021 a terapeutas ocupacionais colombianos em ambientes clínicos/hospitalares. Foram analisadas variáveis sociodemográficas, prática profissional clínica e o impacto da COVID-19 em termos de perda de emprego, modificações e adaptações para a intervenção. As análises descritivas são realizadas por variável e um teste de independência Qui-quadrado para associações entre as variáveis. Resultados Participaram 382 terapeutas ocupacionais colombianos. O tempo médio de exercício profissional foi de 10,8 anos. Do total, 89% trabalhavam antes da pandemia e continuaram seu trabalho, pelo menos 64% afirmaram que perderam o emprego devido ao COVID-19. Dos que continuaram a trabalhar, 20.5% o fizeram virtualmente e 79.5% em clínica presencial. Em nível virtual, 89% o fizeram por exigência de trabalho e pelo menos 53% o fizeram sem treinamento em telessaúde. Presencialmente, 68% relataram restrições nas ações praticadas e diminuição dos encaminhamentos para terapia. Conclusão A pandemia redimensionou as ações do terapeuta ocupacional, modificando os meios e formas de intervenção e permitindo a reinvenção do seu trabalho.

Abstract Introduction A series of restrictive health care measures emerged limiting actions that include the work of occupational therapists and proposing adaptations to provide care to people who require it. Objective To identify the impact and adaptations in the care of Occupational Therapy clinical professionals due to the COVID-19 pandemic in Colombia. Methods Cross-sectional study that applies an online questionnaire in January-February 2021 to Colombian occupational therapists in clinical/hospital settings. Sociodemographic variables, clinical professional practice, and the impact of COVID-19 in terms of job loss, modifications, and adaptations for the intervention were analyzed. Descriptive analyzes are performed by variable and a Chi-square test of independence is applied for associations between variables. Results 382 Colombian occupational therapists participated. The average time of professional practice was 10.8 years. Of the total, 89% worked before the pandemic and continued their work, and at least 64% claimed that they lost their job due to COVID-19. Of those who continued to work, 20.5% did so virtually and 79.5% in a face-to-face clinic. On a virtual level, 89% did it due to a job requirement and at least 53% did it without training in telehealth. In face-to-face, 68% reported restrictions in the actions practiced and decreased referrals to therapy. Conclusions The pandemic has resized the actions of the occupational therapist, has modified the means and forms of intervention, allowing the reinvention of their work.

Resumen Introducción Una serie de medidas restrictivas para el cuidado de la salud emergieron limitando acciones que incluyen el quehacer de terapeutas ocupacionales y proponiendo adaptaciones para brindar atención a las personas que así lo requieran. Objetivo Identificar el impacto y las adaptaciones en la atención de los profesionales clínicos de terapia ocupacional a causa de la pandemia por COVID-19 en Colombia. Método Estudio de corte transversal que aplica cuestionario online en enero-febrero de 2021 a terapeutas ocupacionales colombianos en ambientes clínicos/hospitalarios. Se analizaron variables sociodemográficas, ejercicio profesional clínico y el impacto del COVID-19 en cuanto a la pérdida del empleo, modificaciones y adaptaciones para la intervención. Se realizan análisis descriptivos por variable y se aplica prueba Chi-cuadrado de independencia para asociaciones entre variables. Resultados 382 terapeutas ocupacionales colombianos participaron. El tiempo promedio de ejercicio profesional fue de 10.8 años. Del total, el 89% trabajaba antes de la pandemia y continuó sus labores, al menos el 64% adujo que perdió su trabajo por el COVID-19. De los que continuaron trabajando el 20.5% lo hizo de manera virtual y el 79.5% en clínica presencial. A nivel virtual, el 89% lo hizo debido a exigencia laboral y al menos el 53% lo realizó sin formación en telesalud. Presencialmente, el 68% reportó restricciones en las acciones practicadas y disminución de remisiones a terapia. Conclusiones La pandemia ha redimensionado el actuar del terapeuta ocupacional, modificando los medios y formas de intervención y permitiendo la reinvención de su quehacer.

Resumen El altiplano de Grano de Oro posee una altitud media de 1100 m s.n.m. y un área de ⁓5.5 km2, es una anomalía morfológica en la cordillera de Talamanca, con características morfoestructurales y de sedimentología fluvial particulares. Consiste en una cuenca exorreica en la cual predomina una llanura de inundación con geoformas y litofacies típicas. Sus depósitos están distribuidos principalmente a lo largo del eje fluvial del río Moravia y dentro de las geoformas del sistema fluvial meándrico se reconocen: terrazas, barras de arena, canales, lagos, entre otros. Se propone un modelo de génesis para la cuenca en donde la geometría y cinemática de la falla Alcantarilla, al NW del altiplano, provocan un régimen transpresivo y una estructura en flor positiva, basculando el bloque estructural al E del altiplano, represando el río Moravia. La falla Alcantarilla es probablemente neotectónica, debido a la presencia de sismicidad y la edad de los depósitos en la cuenca. Las geoformas y los sedimentos observados son jóvenes y presentan una evolución elevada y variable debido al modelado permanente del paisaje posglaciar (desde el Groenlandiense) relacionado directamente con una tectónica activa leve y con alteraciones procedentes de la intervención humana, que influyen en la dinámica fluvial en el territorio.

Abstract The Grano de Oro plateau has an average altitude of 1,100 m a.s.l. and an area of ⁓5.5 km2, it is a morphological anomaly in the Talamanca mountain range, with particular morphostructural and fluvial sedimentology characteristics. It consists of an exorheic basin in which a floodplain predominates with typical geoforms and lithofacies. Its deposits are mainly distributed along the fluvial axis of the Moravia River and within the geoforms of the meandering fluvial system are recognized: terraces, sand bars, channels, lakes, among others. A genesis model is proposed for the basin where the geometry and kinematics of the Alcantarilla fault, to the NW of the plateau, cause a transpressive regime and a positive flower structure, tilting the structural block to the E of the altiplano, damming the Moravia River. The Alcantarilla fault is probably neotectonic, due to the presence of seismicity and the age of the deposits in the basin. The geoforms and sediments observed are young and present a high and variable evolution due to the permanent modeling of the postglacial landscape (since the Greenlandian) directly related to mild active tectonics and alterations from human intervention, which influence the fluvial dynamics in the territory.

Resumo Uma grande porcentagem da atividade econômica na Colômbia corresponde ao setor agrícola. Neste, a banana verde ocupa o segundo lugar em produção e área plantada. No entanto, a plantação é afetada por diversas doenças, dentre as quais se destaca a Sigatoka negra, causada pelo fungo Mycosphaerella fijiensis. A doença reduz muito o nível de produção agrícola e embora existam medidas de prevenção que permitam reduzir sua incidência, falta apoio aos pequenos produtores, que não possuem ferramentas tecnológicas para apoiar os processos de detecção da doença. Este artigo apresenta o desenvolvimento de um sistema de suporte à detecção de Sigatoka negra por meio de imagens digitais. Para isso, é realizado um processo de caracterização do usuário agrícola e, em seguida, implementa-se uma metodologia de aprendizado de máquina para classificar a doença em um dispositivo móvel. O sistema de apoio é validado a partir de testes laboratoriais e de campo e socialização com o usuário agrícola.

Abstract A large percentage of Colombia’s economic activity corresponds to the agricultural sector. In this sector, plantains rank second in production and planted area. However this crop is affected by different diseases, among which The Black Sigatoka stands out, caused by the fungus Mycosphaerella fijiensis. The disease highly reduces the production level of the crop and although there are prevention measures that allow reducing the incidence of the disease, there’s a lack of support for small producers in Colombia, who do not have technological tools to support the disease detection processes. This article outlines the development of a support system for the detection of black sigatoka using digital images. For this, a characterization process of the agricultural user is carried out, then, a machine learning methodology is implemented to classify the disease on a mobile device. The support system is validated through laboratory tests, field tests and the feedback from the agricultural user.

Resumen El volcán Turrialba posee en su cima un graben complejo con rumbo aproximado N50°E, de 3,5 km de longitud y un ancho máximo de 2,8 km, limitado por un sistema complejo de fallas sinestrales con componente normal, varios cráteres orientados N45°E y una caldera de avalancha desportillada hacia el NE, de 6 km de longitud y 2,5 km (en promedio) de ancho. En el flanco SW se presentan dos conos secundarios con orientación N30°E; todos estos el- ementos evidencian una zona de debilidad volcanotectónica con sentido NE a lo largo de por lo menos 9 km. El análisis de las fallas secundarias asociadas presentes en sus flancos, de la morfoneotectónica y de la sismicidad, junto con los rasgos morfovolcánicos, sugieren un modelo volcanotectónico más complejo para este volcán que el planteado hasta el momento en la literatura. Se propone la existencia de una falla regional de rumbo sinestral, orientada SW-NE, la cual en superficie forma una estructura en flor negativa y genera un graben complejo limitado principalmente por las fallas Elia y Ariete. Los esfuerzos transtensivos favorecieron la formación de los cráteres y escarpes, mientras que los esfuerzos transpresivos debieron de producir una domificación tectónica y la formación de zonas altamente fracturadas. Las zonas de debilidad y el posible plegamiento favorecieron la formación de un colapso sectorial hacia el NE, con el concomi- tante desarrollo de una o varias avalanchas de escombros volcánicos. Un mecanismo similar pudo ser el disparador de la avalancha de escombros volcánica de Angostura hace 17 ka, teniendo por fuente de origen la caldera de avalancha de Coliblanco, en el flanco SW del Turrialba. Las fallas Ariete y Elia poseen un potencial sísmico de Mw 6,2 y 6,0; respectivamente y, a través de ellas, se puede producir la generación de nuevos focos eruptivos y colapsos sectoriales.

Abstract The Turrialba volcano has a complex graben on its summit with an approximate strike of N50°E, a length of 3.5 km and a maximum width of 2.8 km. The boundaries of the graben are a complex system of left-lateral, strike-slip faults with normal component, several craters oriented N45°E and a collapse caldera oriented to the NE of 6 km long and 2.5 km wide. Two secondary cones are on its SW flank with N30°E orientation; all these elements show a NE volcanotectonic trend along 9 km. The analysis of secondary faults presents on its flanks, the morphoneotectonics and seismicity, together with morphovolcanic features, suggests a volcanotectonic model more complex than those proposed in the literature for this volcano. We propose the existence of a regional left-lateral strike-slip fault, oriented SW-NE, which forms a flower structure at the surface, generating a complex graben bounded by the Elia and Ariete faults. The transtensive stress favored the formation of the craters and escarpments, whereas the transpresive stress produced a dome fold structure and highly fractured areas. The zones of weakness and possible folding favored the formation of a sectoral collapse toward the NE, with the associated development of one or several volcanic debris avalanche deposits. A similar mechanism could be the trigger of the Angostura volcanic debris avalanche 17 ka ago, from the Coliblanco avalanche caldera on the SW flank of Turrialba. The Ariete and Elia faults have a seismic potential of Mw 6.2 and 6.0, respectively. The generation of new eruptive volcanic vents and sector collapses along these faults can also occur in the future.

RESUMO Racional: A gastrectomia laparoscópica tem numerosas vantagens perioperatórias, mas a sobrevivência em longo prazo após este procedimento tem sido menos estudada. Objetivo: Comparar resultados de sobrevivência, oncológica e perioperatória entre a gastrectomia completamente laparoscópica vs. aberta para câncer gástrico precoce. Método: Este estudo foi retrospectivo e os principais resultados foram a sobrevivência global e específica de cinco anos, contagem de linfonodos e taxa de ressecção R0. Resultado secundário foi a morbidade pós-operatória. Resultados: Foram incluídos 116 pacientes (59% homens, idade 68 anos, comorbidades 73%, IMC 25) que foram submetidos a 50 gastrectomias laparoscópicas e 66 gastrectomias abertas. As características demográficas, a localização do tumor, o tipo de operação, a extensão da dissecção dos linfonodos e do estágio não diferiram significativamente entre os grupos. A taxa geral de complicações foi semelhante em ambos os grupos (40% vs. 28%, p=ns) e complicações classificadas Clavien 2 (36% vs. 18%, p=0,03), respiratórias (9% vs. 0%, p=0,03) e as da parede abdominal (12% vs. 0%, p=0,009) foram significativamente menores após a gastrectomia laparoscópica. A contagem de linfonodos (21 contra 23, p=ns) e a taxa de ressecção R0 (100% vs. 96%; p=ns) não diferiram significativamente entre os grupos. A sobrevida global de cinco anos (84% vs. 87%, p=0,31) e a sobrevida específica (93% vs. 98%, p=0,20) não diferiram significativamente entre os grupos de gastrectomia laparoscópica e aberta. Conclusão: Estes resultados suportam resultados oncológicos similares e sobrevida em longo prazo para pacientes com câncer gástrico precoce após gastrectomia laparoscópica e gastrectomia aberta. Além disso, a abordagem laparoscópica está associada com morbidade menos grave e menor ocorrência de complicações respiratórias e da parede abdominal.

ABSTRACT Background: Laparoscopic gastrectomy has numerous perioperative advantages, but the long-term survival of patients after this procedure has been less studied. Aim: To compare survival, oncologic and perioperative outcomes between completely laparoscopic vs. open gastrectomy for early gastric cancer. Methods: This study was retrospective, and our main outcomes were the overall and disease-specific 5-year survival, lymph node count and R0 resection rate. Our secondary outcome was postoperative morbidity. Results: Were included 116 patients (59% men, age 68 years, comorbidities 73%, BMI 25) who underwent 50 laparoscopic gastrectomies and 66 open gastrectomies. The demographic characteristics, tumour location, type of surgery, extent of lymph node dissection and stage did not significantly differ between groups. The overall complication rate was similar in both groups (40% vs. 28%, p=ns), and complications graded at least Clavien 2 (36% vs. 18%, p=0.03), respiratory (9% vs. 0%, p=0.03) and wound-abdominal wall complications (12% vs. 0%, p=0.009) were significantly lower after laparoscopic gastrectomy. The lymph node count (21 vs. 23 nodes; p=ns) and R0 resection rate (100% vs. 96%; p=ns) did not significantly differ between groups. The 5-year overall survival (84% vs. 87%, p=0.31) and disease-specific survival (93% vs. 98%, p=0.20) did not significantly differ between the laparoscopic and open gastrectomy groups. Conclusion: The results of this study support similar oncologic outcome and long-term survival for patients with early gastric cancer after laparoscopic gastrectomy and open gastrectomy. In addition, the laparoscopic approach is associated with less severe morbidity and a lower occurrence of respiratory and wound-abdominal wall complications.

Abstract Dental fluorosis is a pathology for which little information about its prevalence in the state of Coahuila, Mexico is available. The aim of this descriptive study with transverse temporality is to identify the dental fluorosis prevalence and severity on adolescents aged 12 and 15 years. A questionnaire, a modified Dean’s fluorosis index, and a community’s fluorosis index were used to examine the upper anterior sextant of 1205 adolescents. The total prevalence of fluorosis for Coahuila was calculated in 53%. According to the severity index, the most prevalent code was very mild. The community’s fluorosis index was 0.602, this value indicates closeness to a public health problem. It is suggested to investigate water wells of the involved communities, in order to avoid a public health issue.

Resumen La fluorosis dental es una patología de la que se tiene poca información en cuanto a su prevalencia en el estado de Coahuila, México. La finalidad de este estudio descriptivo con temporalidad transversal es identificar la prevalencia y severidad de fluorosis dental en adolescentes de 12 y 15 años. Se aplicó un cuestionario e inspección del sextante anterior superior en 1205 adolescentes mediante el índice de Dean modificado y el índice comunitario de fluorosis. La prevalencia de fluorosis calculada fue de 53%. Según el grado de severidad, el código más prevalente fue muy leve. El índice comunitario de fluorosis fue de 0.602, valor que indica cercanía a un problema de salud pública. Se sugiere realizar una investigación en los pozos de agua en las comunidades involucradas para evitar un problema de salud pública.

Resumen La fonoaudiología y la terapia ocupacional son profesiones que, dentro de la extensión de sus campos de acción, deben velar por el adecuado desarrollo de los niños en el contexto cotidiano, promoviendo así habilidades y capacidades vitales para el crecimiento integral. En ese sentido, el objetivo del presente texto es reflexionar acerca del rol profesional y los respectivos servicios que pueden ofrecer estas disciplinas en el marco de la estrategia "De Cero a Siempre" y la promulgación de la Ley 1804 de 2016 para la primera infancia. Esta reflexión se nutre de las políticas, lineamientos y programas nacionales e internacionales del período 2005-2016 y plantea un análisis crítico sobre las acciones, las funciones y el rol de estas profesiones, con énfasis particular en la atención primaria en salud.

Abstract Speech-Language Pathology and Occupational Therapy are professions that, within the scope of their fields of action, must ensure the adequate development of children in their daily context, thus promoting essential skills and abilities for a comprehensive growth. In this sense, the objective of this article is to reflect on the professional role and the services offered by these disciplines within the framework of the "De Cero a Siempre" (From Zero to Forever) strategy and the enactment of Law 1804 of 2016 for early childhood. This reflection draws on national and international policies, guidelines and programs for the period 2005-2016 and proposes a critical analysis of the actions, functions and role of these professions, with a particular emphasis on primary health care.

Introduction Children with Down's syndrome (DS) have a higher risk of congenital malformations and acute diseases, with increased risk of hospital admissions compared with the general population. This study describes patterns of hospital admissions for children and adolescents with DS. Patients and methods A retrospective study of hospital admissions of children with DS, younger than 15 years old, and cared for by the Paediatric Department of the Hospital Clínico Pontificia Universidad Católica de Chile, between 2008 and 2011. Results There were 222 admissions of 161 patients with DS during the study period, of which 110 were girls. The median age was 8 months, and the median hospital stay was 6 days. Just over half (56.7%) of the hospital stays were in the Paediatric Critic Care Unit. Heart surgery was performed on 59.4%, and the principal congenital heart defect attended was atrioventricular canal. The principal diagnosis, other than heart surgery, was lower respiratory tract infection. In this series, 3 children died. Conclusions Children with DS are a relevant group for inpatient care, because their high incidence in Chile, their respiratory and cardiovascular risk, prolonged hospitalizations, high frequency of critical care days and mortality risk. This group has special and complex needs during their hospitalizations and it is necessary to create a multidisciplinary team with competences to take care the particular characteristics of this vulnerable group.

Introducción Los niños con síndrome de Down (SD) tienen mayor frecuencia de malformaciones congénitas y de enfermedades con riesgo de hospitalización en comparación con la población general. El objetivo de este trabajo fue caracterizar las estancias hospitalarias de niños con SD. Pacientes y método Estudio retrospectivo en niños con SD menores de 15 años atendidos en el Servicio de Pediatría del Hospital Clínico de la Pontificia Universidad Católica de Chile, durante los años 2008-2011. Resultados De los 222 egresos hospitalarios de 161 niños con SD, 110 correspondieron a mujeres, con una mediana de edad de 8 meses y una mediana de estancia hospitalaria de 6 días. El 56,7% ingresó en la unidad de pacientes críticos. El 59,4% de los egresos fue por corrección quirúrgica de su cardiopatía congénita. La infección respiratoria aguda baja fue el principal diagnóstico de egreso por causa no cardioquirúrgica. Hubo 3 fallecidos en la serie. Conclusiones Los niños con SD son un grupo relevante para los cuidados hospitalarios, no solo por su alta incidencia en Chile, sino por ser un grupo de riesgo respiratorio y cardiovascular, con hospitalizaciones prolongadas, alta frecuencia de estancia en cuidados críticos y riesgo de mortalidad. Este grupo de niños necesita cuidados complejos y su atención requiere de un equipo multidisciplinario que conozca sus características particulares.

Introduction: Endoscopic submucosal dissection (ESD) is nowadays the standard treatment for a subgroup of early gastric cancer with low risk of lymph node metastasis. This procedure has the advantage of achieving a higher percentage of negative margins and of allowing resections of larger tumors compared with the endoscopic mucosal resection (EMR) method, being less invasive compared with surgery. Aim: To analyze the postoperative outcomes, histology and overall survival of patients undergoing ESD in our center. Methods: Descriptive study. Data were collected from clinical records of patients undergoing ESD from January 2008 to June 2012. Results: 15 patients (8 males and 7 females, median age 70 years (45-88)) were included. The tumor was located at upper, middle and lower third in 2, 5 and 8 patients, respectively. Median tumor size was 13.5 mm (6-21). Most tumors were classified as type IIc. Among postoperative complications, there was 1 gastric bleeding and 3 gastric perforations. Hospital stay was 3 days (1-23). There was no mortality. There was one case of submucosal invasion. Negative margins were achieved in 86.7%. There was one deep and one lateral positive margin, managed by surgery and re-ESD, respectively. At 16 months (7-61) of median follow-up, overall survival was 100%. Tumor recurrence was observed in one patient at 51 months, was treated by surgery. Conclusion: ESD is a feasible technique in the minimally invasive management of early gastric cancer, allowing a high percentage of negative margins.

Introducción: La disección endoscópica de la submucosa (DES) es actualmente el tratamiento estándar en pacientes con cáncer gástrico incipiente y bajo riesgo de metástasis ganglionares, con la ventaja de obtener un mayor porcentaje de márgenes negativos que en la mucosectomía y ser menos invasivo que la cirugía. Objetivo: Analizar los resultados inmediatos, anatomía patológica y sobrevida alejada de los pacientes sometidos a DES en nuestro centro. Métodos: Estudio descriptivo. Revisión de los registros clínicos de pacientes con lesiones gástricas incipientes sometidos a DES entre enero de 2008 y junio de 2012. Resultados: Serie compuesta por 15 pacientes, 8 de sexo masculino. Mediana de edad 70 años (45-88). Ubicación tumoral: tercio superior en 2, tercio medio en 5 y tercio inferior en 8. La mediana de tamaño tumoral fue 13,5 mm (6-21). La mayoría fueron lesiones IIc. Dentro de las complicaciones postoperatorias, hubo 1 hemorragia digestiva tratada por endoscopia y 3 perforaciones gástricas tratadas quirúrgicamente (gastrorrafia). Mediana de hospitalización, 3 días (1-23). No se registró mortalidad post-procedimiento. Se obtuvieron bordes negativos en un 86,7% de los casos. Un paciente presentó margen profundo positivo, tratado mediante gastrectomía subtotal y otro presentó positividad en un margen lateral, manejado con una nueva DES. Mediana de seguimiento 16 meses (7-61), sin fallecidos por patología tumoral. Hubo 1 recurrencia tumoral (51 meses), tratada quirúrgicamente. Conclusión: La DES representa una alternativa en el manejo de las lesiones gástricas incipientes, permitiendo un alto porcentaje de márgenes negativos.

Background: The laparoscopic approach for the treatment of gastric tumors has many advantages. Aim: To evaluate the results of a laparoscopic gastrectomy program developed in a public hospital. Patients and Methods: Retrospective review of epidemiological, perioperative and follow-up data of patients who were treated with a laparoscopic gastrectomy due to gastric tumors between 2006 and 2013. A totally laparoscopic technique was used for all cases. Complications were evaluated according to the Clavien-Dindo classification. Results: Fifty one patients, aged 65 (36-85) years, underwent a laparoscopic gastrectomy. In 22 patients a total gastrectomy was performed. Conversion rate to open surgery was 8%. Operative time was 330 (90-500) min and bleeding was 200 (20-500) ml. Median hospital stay was 7 (3-37) days. Postoperative morbidity was present in 17 (33%) patients, 3 (6%) patients had complications grade 3 or higher and one patient died (1.9%). Tumor pathology was adenocarcinoma in 39 patients. A complete resection was achieved in 97%. Twenty nine patients (74%) with gastric adenocarcinoma had early gastric cancer and 84% of patients were in stage one. Median lymph node count was 24. Median follow-up was 26 (1-91) months. There was no cancer related mortality among patients subjected to a curative resection. Overall survival for patients with adenocarcinoma was 92% at 3 years. Conclusions: This study supports the feasibility and safety of a laparoscopic gastrectomy program in a public hospital; with low morbidity, adequate lymph node dissection and long-term survival. This approach must be considered an option for selected patients with gastric cancer.

Introducción: Aún existen dudas sobre la conectividad cerebral en el trastorno bipolar tipo I (TBI) y son necesarios estudios con resonancia magnética funcional en estado de reposo (RMf-ER) durante la eutimia para identificar alteraciones funcionales del trastorno. Objetivo: Evaluar con RMf-ER la diferencias de activación cerebral entre los pacientes eutí-micos con TBI y los sujetos de control y explorar el efecto del litio en esta activación. Métodos: Estudio transversal de 21 pacientes eutímicos con TBI y 12 controles, usando RMf-ER y un análisis de componentes independientes. En el grupo con TBI, también se realizó una comparación entre 10 pacientes con TBI en monoterapia con litio y 11 sin medicación. Resultados: Se encontró mayor activación en el hipocampo derecho (p = 0,049) y el cíngulo posterior (p = 0,040) en la Default Mode Network (DMN) del grupo TBI frente a los controles. No hubo diferencias estadísticamente significativas entre el grupo de TBI con litio y los pacientes con TBI sin medicación. Conclusiones: Los resultados indican alteraciones en la activación y la conectividad cerebral en el TBI durante la eutimia y principalmente en el cíngulo posteriory el hipocampo dentro de la DMN, la cual podría tener relevancia en la regulación afectiva.

Introduction: As there are still doubts about brain connectivity in type I bipolar disorder (BID), resting-state functional magnetic resonance imaging (RS-fMRI) studies are necessary during euthymia for a better control of confounding factors. Objective: To evaluate the differences in brain activation between euthymic BID patients and control subjects using resting state- functional-magnetic resonance imaging (RS-fMRI), and to identify the lithium effect in these activations. Methods: A cross-sectional study was conducted on 21 BID patients (10 receiving lithium only, and 11 non-medicated) and 12 healthy control subjects, using RS fMRI and independent component analysis (ICA). Results: Increased activation was found in the right hippocampus (P = .049) and posterior cingulate (P = .040) within the Default Mode Network (DMN) when BID and control group were compared. No statistically significant differences were identified between BID on lithium only therapy and non-medicated BID patients. Conclusions: The results suggest that there are changes in brain activation and connectivity in BID even during euthymic phase and mainly within the DMN network, which could be relevant in affect regulation.