Resumo Objetivo Recomenda-se o encaminhamento imediato de pacientes com fatores de risco para espectro placentário acreta (PAS, na sigla em inglês) para centros especializados, favorecendo assim o diagnóstico precoce e o manejo interdisciplinar. No entanto, erros diagnósticos são frequentes, mesmo em centros de referência (CRs). Buscou-se avaliar o desempenho do diagnóstico pré-natal para PAS em um hospital latino-americano. Métodos Um estudo descritivo retrospectivo incluindo pacientes encaminhados por suspeita de SAP foi realizado. Os dados dos exames de imagem do pré-natal foram comparados com os diagnósticos finais (intraoperatórios e/ou histológicos). Resultados Foram incluídos 162 pacientes no presente estudo. A idade gestacional mediana no momento da primeira ultrassonografia suspeita de PAS foi de 29 semanas, mas as pacientes chegaram ao CR de PAS com 34 semanas. A frequência de resultados falso-positivos nos hospitais de referência foi de 68,5%. Sessenta e nove pacientes foram operadas com base na suspeita de PAS com 35 semanas e houve 28,9% de falso-positivos no CR. Em 93 pacientes, o diagnóstico de PAS foi descartado no CR, com frequência de falso-negativos de 2,1%. Conclusão O diagnóstico pré-natal de PAS é melhor no CR. Entretanto, mesmo nestes centros, resultados falso-positivos são comuns; portanto, a confirmação intraoperatória do diagnóstico de SAP é essencial.

Abstract Objective The immediate referral of patients with risk factors for placenta accreta spectrum (PAS) to specialized centers is recommended, thus favoring an early diagnosis and an interdisciplinary management. However, diagnostic errors are frequent, even in referral centers (RCs). We sought to evaluate the performance of the prenatal diagnosis for PAS in a Latin American hospital. Methods A retrospective descriptive study including patients referred due to the suspicion of PAS was conducted. Data from the prenatal imaging studies were compared with the final diagnoses (intraoperative and/or histological). Results A total of 162 patients were included in the present study. The median gestational age at the time of the first PAS suspicious ultrasound was 29 weeks, but patients arrived at the PAS RC at 34 weeks. The frequency of false-positive results at referring hospitals was 68.5%. Sixty-nine patients underwent surgery based on the suspicion of PAS at 35 weeks, and there was a 28.9% false-positive rate at the RC. In 93 patients, the diagnosis of PAS was ruled out at the RC, with a 2.1% false-negative frequency. Conclusion The prenatal diagnosis of PAS is better at the RC. However, even in these centers, false-positive results are common; therefore, the intraoperative confirmation of the diagnosis of PAS is essential.

Background: IgG4-related disease (IgG4 RD) is an immune-mediated fibro-inflammatory disorder, with tissue infiltration of IgG4+ plasma cells. It causes pseudotumors, tumors, and a wide spectrum of clinical manifestations. Aim: To report the clinical, laboratory, histopathological and treatment characteristics of a group of Chilean patients with IgG4 RD. Material and Methods: Review of medical records of 52 patients aged 18 to 76 years with IgG4 RD seen at six medical centers. Results: Elevated IgG4 serum levels (> 135 mg/dl) were found in 18 of 44 (41%) patients. There was histological confirmation of the disease in 46 patients. The most common sites of involvement were lungs, eyes and kidneys. Eighteen (35%) patients had only one organ involved, 34 (65%) patients had two organs and 13 (25%) patients had three or more organs. The involvement of two organs was significantly more common in men (p < 0.05). In patients with only one organ involvement, the most frequent location was orbital and meningeal. All patients with kidney or lung disease had multiorgan involvement. All patients received corticosteroid therapy, 67% synthetic immunosuppressants, and 16% rituximab. Conclusions: ER-IgG4 can affect any tissue. Multiorgan involvement was more common in this series, with preference for lungs, eyes and kidneys. An excellent response to steroids is characteristic of the disease, but with a high relapse rate that requires additional immunosuppression.

ABSTRACT The aim of this study was to determine by SDS PAGE the protein profile of the seminal plasma of Romosinuano (ROMO) and Costeño con Cuernos (CCC) bulls and their relationship with sperm quality parameters in fresh and thawed semen. Three ejaculates per bull were collected by electro-ejaculate from 10 ROMO and 10 CCC sires. Viability (VF), mass motility (MMF), individual rapid progressive motility (MIRPF) and sperm concentration (CE) were determined in fresh semen. Seminal plasma (PS) was obtained by double centrifugation. Individual motility of rapid progressives (MIRPPC), progressivity (PRPC), rapid progressives (RPPC) and medium progressive (MPPC) were determined in thawed semen, in both cases using the CASA computerized analysis system. Additionally, viability (VPC) and membrane integrity were determined by the hypoosmotic test. Proteins were separated by polyacrylamide gel electrophoresis (SDS PAGE). The data was analyzed by Student’s T test and the presence of proteins by Chi square. The relationship between proteins and seminal quality parameters using Pearson’s correlation test and principal components of forward regression. In fresh semen, differences (p<0.05) were found between the two breeds for CE and MIRPF, and in thawed semen for VPC. Ten protein bands were evidenced in ROMO bulls and 7 in CCC bulls. The 13, 83 and 121 kDa bands were positively related and the 15 kDa negatively with VF from ROMO bulls. Protein bands 21, 25, 102 and 174 were associated with both MF and CE in ROMO bulls. In conclusion, the electrophoretic profiles of seminal plasma proteins from Romosinuano and Costeño con Cuernos bulls were established. The relationships between the bands detected with the sperm quality could partly explain the fertilizing capacity of the sperm of these breeds.

RESUMEN El objetivo del estudio fue determinar mediante SDS PAGE el perfil de proteínas del plasma seminal de toros criollos Romosinuano (ROMO) y Costeño con Cuernos (CCC) y su relación con los parámetros de calidad espermática en semen fresco y descongelado. Se colectaron tres eyaculados por toro mediante electro-eyaculación de 10 reproductores ROMO y 10 CCC. En semen fresco se determinó viabilidad (VF), motilidad masal (MMF), motilidad individual rápida progresiva (MIRPF) y concentración espermática (CE). El plasma seminal (PS) se obtuvo mediante doble centrifugación. En el semen descongela- do se determinó motilidad individual de rápidos progresivos (MIRPPC), progresividad (PRPC), rápidos progresivos (RPPC) y medios progresivos (MPPC), en ambos casos usando el sistema de análisis computarizado CASA. Adicionalmente se determinó la viabilidad (VPC), e integridad de la membrana mediante el test hipoosmótico. Las proteínas se separaron por electroforesis en geles de poliacrilamida (SDS PAGE). Los datos se analizaron mediante prueba de T de student y la presencia de proteínas por Chi cuadrado. La relación entre las proteínas y los parámetros de calidad seminal mediante la prueba de correlación de Pearson y componentes principales de regresión hacia adelante. En semen fresco se evidenciaron diferencias (p<0.05) entre las dos razas para CE y MIRPF, y en semen congelado-descongelado para VPC. Se evidenciaron 10 bandas de proteína en toros ROMO y 7 en toros CCC. Las bandas de 13, 83 y 121 kDa se relacionaron positiva- mente y la de 15 kDa negativamente con VF de toros ROMO. Las bandas de proteínas de 21, 25, 102 y 174 se relacionaron tanto con MF y CE en toros ROMO. En conclusión, se establecieron los perfiles electroforéticos de proteínas del plasma seminal de toros ROMO y CCC. Las relaciones entre las bandas detectadas con la calidad espermática podrían explicar en parte la capacidad fecundante del espermatozoide de estas razas.

The transition to and through college can affect the mental health of college students. The situation in medical students is particularly worrisome, considering that they have high rates of psychopathology. These mental health problems can be associated with worse academic and professional outcomes and worse patient care. In this scenario, it is relevant to look at how this problem can be addressed considering variables of both mental health and educational systems in medicine. Therefore, initiatives to promote well-being during the career are proposed. The importance of well-being at an institutional level should be defined. Also, the foundations of learning neurosciences from the point of view of well-being should be incorporated. Considering that well-being goes beyond the absence of discomfort, the role of educational environment both in learning and in mental health should be recognized. Proven effective interventions should be incorporated. It must be considered that not every initiative linked to well-being is necessarily positive and that discomfort to a certain extent can be exploited educatively as well. The well-being of medical students is a complex, dynamic and multidimensional issue. These principles are orientations for different actors of the educational process, to define how they will approach this problem in their contexts.

Abstract Background: Infectious diarrhea is still a major problem in public health, especially in children under 5 years of age. The identification of the etiologic agent is important for the clinical management of the diarrhea episode and, from the epidemiological point of view, to implement control measures. Aim: To determine the presence of gastrointestinal pathogens in children under five years of age with diarrhea in a Chilean rotavirus surveillance center. Methods: Observational study in children under five years of age who were hospitalized for diarrhea at the Dr. Luis Calvo Mackenna Hospital from December 2015 to December 2019. Molecular detection was performed using the FilmArray gastrointestinal (FilmArray GI®) panel. Results: We analyzed 493 diarrheal stool samples of children, 427 samples (87%) were positive and 66 samples (13%) were negative. Of positive samples, 174 samples (41%) and 253 samples (59%) were positive for one or more pathogen, respectively. In children under one year and the group between one and four years there was a predominance of infections caused by enteric virus. Rotavirus and norovirus were the most common virus in both age groups. The most frequent bacteria were EPEC (27%), C. difficile (17%), EAEC (14%) and Campylobacter (9%). In parasites, Giardia lamblia and Cryptosporidium were identified, in 3% and 1% of the total samples, respectively. Conclusions: The molecular detection system used allowed an increase in the detection of enteropathogens in children under five years of age. The information generated by this type of surveillance could help to characterize the episodes of diarrhea in the population and might be a tool to technically advise the authorities in the decision-making process for the implementation of control measures.

Resumen Introducción: Las diarreas de causa infecciosa son un problema de salud pública, especialmente en niños bajo los cinco años. La identificación de los agentes etiológicos puede ser relevante para el manejo del cuadro clínico y, desde el punto de vista epidemiológico, para la implementación de medidas de control. Objetivo: Determinar la presencia de patógenos entéricos en niños bajo los cinco años que se hospitalizaron por diarrea aguda en uno de los centros centinelas de la red de vigilancia de rotavirus en Chile. Pacientes y Métodos: Estudio observacional en niños menores de cinco años que se internaron por cuadros de diarrea en el Hospital Dr. Luis Calvo Mackenna, durante diciembre del 2015 a diciembre del 2019, el que forma parte de la red de vigilancia de rotavirus del Ministerio de Salud de Chile. Las muestras fecales se analizaron mediante un test molecular, FilmArray GI® panel, que permite la detección de 22 patógenos entéricos virales, bacterianos y parasitarios. Resultados: Se analizaron 493 muestras fecales de niños con episodios de diarrea infecciosa, detectando al menos un patógeno en 427 muestras (87%). De estas muestras positivas, se detectó solo un patógeno en 174 muestras (41%) y dos o más patógenos en 253 muestras (59%). En el grupo de niños bajo un año y el grupo entre uno y cuatro años hubo un predominio de infecciones causadas por virus gastroentéricos, siendo rotavirus y norovirus los virus más detectados en ambos grupos de edad. Las bacterias más frecuentes fueron EPEC (27%), C. difficile (17%), EAEC (14%) y Campylobacter (9%). Respecto a los parásitos, se identificó Giardia lamblia y Cryptosporidium, en el 3 y 1% del total de las muestras, respectivamente. Conclusión: La detección molecular utilizada permitió detectar un alto número de enteropatógenos en niños bajo los cinco años. La información generada por este tipo de vigilancia, podría ayudar a caracterizar en la población los episodios de diarrea causados por los principales patógenos entéricos y podría ser una herramienta para asesorar técnicamente a las autoridades en la toma de decisión para la implementación de medidas de control contra estos patógenos.

RESUMEN INTRODUCCIÓN. El tiempo es un factor importante en el tratamiento del ACV agudo, con la pandemia de covid-19 se puede ver afectada la adherencia a las guías. Se han reportado tasas de ACV en presencia de covid-19 alrededor del 5%, además un aumento en el tiempo de consulta de los pacientes en otras regiones del mundo y una mayor ocupación de camas de UCI para patologías respiratorias que usualmente se destinan a pacientes con ACV. Este documento recoge las recomendaciones del comité de Enfermedad Cerebrovascular de la Asociación Colombiana de Neurología basados en la literatura y votadas por consenso. OBJETIVOS. Proporcionar una guía rápida adaptada a los diferentes escenarios de atención de ACV en Colombia, divididos en centro listo, primario y avanzado incluyendo una ruta de atención para paciente con sospecha de covid-19 denominada Código ACV protegido, que incluye el uso de elementos de protección personal para pacientes y personal de salud. PUNTOS PRINCIPALES. Dentro de las recomendaciones principales está el cuestionario de tamizaje al ingreso a urgencias, uso de tapabocas para el paciente, considerar todo Código ACV sospechoso de covid-19, toma de PCR para covid-19 en todos los ACV y llevar a zona buffer. En sospecha de oclusión proximal incluir tomo-grafía de tórax a la evaluación de imágenes. CONCLUSIONES. Establecer pautas de atención durante la pandemia covid-19 permite optimizar protección para pacientes y personal de salud, disminuir retrasos y tratar de evitar que pacientes no reciban el tratamiento adecuado en los diferentes niveles de atención del sistema de salud.

SUMMARY INTRODUCTION. Time is an important factor in the treatment of acute stroke, with the COVID-19 pandemic adherence to guidelines can be affected. Stroke rates in the presence of COVID-19 have been reported around 5%, in addition to an increase in the consultation time of patients in other regions of the world and a greater occupation of ICU beds for respiratory pathologies that are usually intended for patients with stroke. This document contains the recommendations of the Cerebrovascular Disease Committee of the Colombian Neurology Association based on the literature and voted by consensus. OBJECTIVES. Provide a quick guide adapted to the different stroke care scenarios in Colombia, divided into ready, primary and advanced centers, including a care route for a patient with suspected COVID-19 called the protected stroke code, which includes the use of protection elements for the patient and the healthcare team. MAIN FACTS. Among the main recommendations are the screening questionnaire on admission to the emergency department, the use of face masks for the patient, considering all suspected stroke code as COVID-19, taking the PCR for COVID-19 in all strokes and taking them to the buffer zone. In suspected large vessel occlusion, include chest tomography to image evaluation. CONCLUSIONS. Establishing guidelines of care during the COVID-19 pandemic allows optimizing protection for patients and health care personnel, reducing delays and trying to avoid patients not receiving adequate treatment at different levels of attention in the health system.

Resumen El plátano y el café, son productos alimenticios básicos de la canasta familiar en Colombia, constituyéndose como fuentes importantes en el dinamismo de la economía del país. Dada la relevancia de estos productos, en esta investigación se evaluaron mediante el método RECIPE 2008, cinco impactos ambientales, a saber, calentamiento global, eutrofización acuática, acidificación terrestre, ecotoxicidad acuática y uso del suelo en tres agroecosistemas plataneros asociados con café del Suroeste antioqueño (Colombia), con un enfoque de “cuna a la puerta”. Encuestas y entrevistas aplicadas a los propietarios y empleados de las fincas y a los agentes relacionados con las cadenas productivas, se llevaron a cabo para obtener los datos primarios, mientras que los datos secundarios fueron tomados de la base de datos Ecoinvent 3,1. El consumo de recursos y emisiones fueron asignados a una unidad funcional de 1 kg de plátano y 1 kg de café pergamino seco. Los sistemas productivos constaron de cuatro etapas: establecimiento/propagación, producción, postcosecha y distribución. El sistema de plátano generó menor impacto que el de café, y las etapas que más contribuyeron a la carga ambiental en las categorías de impacto en ambos cultivos, fueron el establecimiento /propagación y la producción. Esto debido principalmente por la fabricación y uso de fertilizantes.

Abstract Plantain and coffee are basic foodstuff of Colombian family standard basket, constituting important sources in the dynamism of the economy of the country. Given the importance of these products, five environmental impacts: global warming, aquatic eutrophication, terrestrial acidification, aquatic ecotoxicity and use of soil were evaluated in three plantain crops associated with coffee in Antioquia Southwest (Colombia), for this purpose RECIPE 2008 method with a cradle to gate approach was used. Surveys and interviews applied to owners and employees of the farms, and to agents related to the production chains were carried out to obtain primary data, secondary data were taken from Ecoinvent 3.1 database. Consumption of resources and emissions were assigned to a functional unit of 1 kg of plantain and 1 kg of dry parchment coffee. Production systems consisted of four stages: establishment/propagation, production, postharvest and distribution. Plantain system generated less impact than coffee, and the stages that contributed the most to the environmental burden on impact categories in both crops were establishment/propagation and production. This is mainly due to the manufacture and the use of fertilizers.

RESUMEN Introducción: La valoración de morbilidad psicológica resulta de interés porque la salud mental hace parte de la salud integral de un individuo, y la detección precoz de casos propende al bienestar emocional. Objetivo: Estimar la asociación entre trastornos mentales comunes y factores relacionados en estudiantes de Odontología de Cartagena, Colombia. Métodos: Estudio de corte transversal en 858 estudiantes de Odontología de Cartagena, Colombia, que respondieron a un cuestionario estructurado anónimo autoaplicado para evaluar la presencia de TMC (Cuestionario General de Salud-12), consumo problemático de alcohol (CAGE), variables sociodemográficas y otras relacionadas. Se realizó estadística descriptiva y análisis bivariable con pruebas de la x2. La fuerza de asociación se computó con razones de prevalencia (RP) e intervalos de confianza del 95% (IC95%). Con regresión log-binomial, se obtuvieron RP e IC95% ajustados. El análisis se realizó empleando Stata v.13.2 para Windows (Stata Corp.; College Station, Texas, Estados Unidos). Resultados: El promedio de edad fue 20,8 ± 3,01 arios y más de la mitad eran mujeres. La prevalencia de TMC fue del 30,3% (IC95%, 27,3-33,5). El modelo de regresión indicó como factores asociados: sexo (RP, 1,54; IC95%, 1,21-1,96), cambios económicos recientes (RP, 1,70; IC95%, 1,37-2,12), conflictos familiares (RP, 2,29; IC95%, 1,89-2,77)], abandono (RP, 1,58; IC95%, 1,23-2,03), historia de abuso (RP, 2,05; IC95%, 1,27-3,31) y consumo problemático de alcohol (RP, 1,35; IC95%, 1,02-1,78). Conclusiones: La prevalencia de TMC fue alta. Ser mujer y tener conflictos familiares, historia de abuso y consumo problemático de alcohol son factores de riesgo de TMC y deben ser cuidadosamente evaluados para la predicción del bienestar emocional.

ABSTRACT Introduction: Psychological morbidity assessments are of interest since mental health is part of a person's overall health and early detection promotes emotional well-being. Aim: To determine the association between common mental disorders and related factors in dental students from Cartagena, Colombia. Methods: We conducted a cross-sectional study in 858 dental students from Cartagena, Colombia; who answered a structured anonymous self-report questionnaire to assess the presence of common mental disorders (CMD) (General Health Questionnaire-12), problematic alcohol consumption (CAGE), sociodemographic and other related variables. Data were analyzed using descriptive statistics and bivariate analysis was conducted later using x2 tests. The strength of association was obtained with prevalence ratios (PR) and 95% confidence intervals (95%CI). Finally adjusted PRs, and 95%CIs were obtained using a log-binomial regression model. Statistical analysis was performed using Stata v.13.2 for Windows (Stata Corp.; TX, USA). Results: The average age was 20.8 ± 3.01 years of age, and more than half were females. CMD overall prevalence was 30.3% (95%CI, 27.3-33.5). The regression model suggested as associated factors: sex (PR, 1.54; 95%CI, 1.21-1.96), recent economic changes (PR, 1.70; 95%CI, 1.37-2.12), family conflicts [PR, 2.29; 95%CI, 1.89-2.77), abandonment (PR, 1.58; 95%CI, 1.232.03), history of abuse (PR, 2.05; 95%CI, 1.27-3.31), and problematic alcohol consumption (PR, 1.35; 95%CI, 1.02-1.78). Conclusions: CMD prevalence was high. Being female, family conflicts, history of abuse and problematic alcohol consumption are considered as risk factors for CMD development and should be carefully assessed to predict emotional well-being.

ABSTRACT: Objective: The aim of this study was to establish the prevalence of signs and symptoms of temporomandibular disorders (TMD) in patients with malocclusion. Materials and methods: Cross-sectional descriptive study. A total of 951 clinical records were reviewed, of patients admitted in the Postgraduate Program of Orthodontia from the Faculty of Dentistry of the University of Chile, between the years 2013 and 2015. The programs Excel 2013 and Stata v. 12 were used, and for the comparison between the age groups the statistical test of Kruskall Wallis was used. Results: Of the total number of patients with malocclusion, 43.85% had at least one sign or symptom of TMD, being the mandibular deviation the most prevalent sign with 43.22%, followed by joint noise with 12.62%. Pain was the least prevalent symptom with 2%. The adults group had the most prevalence of signs and symptoms of TMD. There was no statistical difference between genders. Conclusion: Since TMD signs and symptoms are such a common condition in patients with malocclusion, the assessment of TMJ is necessary to consider when planning an orthodontic treatment, to establish an adequate treatment plan.

RESUMEN: Objetivo: El objetivo de este estudio fue establecer la prevalencia de signos y síntomas de trastornos temporomandibulares (TTM) en pacientes con maloclusión. Materiales y métodos: Estudio transversal descriptivo. Se revisaron de forma manual 951 fichas clínicas de pacientes ingresados en el Postítulo de Ortodoncia de la Facultad de Odontología de Universidad de Chile (FOUCH) entre los años 2013 y 2015. Se utilizaron los programas Excel 2013, Stata v. 12 y para la comparación entre grupos etarios se utilizó la prueba estadística de Kruskall Wallis. Resultados: Del total de pacientes con maloclusión, el 43,9% presentaron al menos un signo o síntoma de TTM, siendo la desviación mandibular el signo más prevalente con un 43,2%, seguido por el ruido articular con un 12,6%. El dolor fue el síntoma menos prevalente con un 2%. Los adultos fueron los que presentaron mayor prevalencia de signos y síntomas de TTM. No hubo diferencia estadística entre géneros. Conclusión: Debido a que los signos y síntomas de TTM son una condición tan común en pacientes con maloclusión, es necesaria la evaluación de la ATM siempre que se piense en iniciar un tratamiento ortodóncico, para así establecer un adecuado plan de tratamiento.

Abstract: The current horizons of social transformation on a planetary scale and the crisis of centric-state political participation have impacted on the key notions of public space and the common. In this qualitative research we analyze the meanings in relation to public space and political action in the oral report of four autonomous social organizations of Valparaíso whose focus is the amplification and care of common spaces. The analysis of the contents and a subsequent interpretation from the ch'ixi -as an epistemological and methodological resource- reveals a notion of a contentious public space, characterized as a field of tactical openness in relation to the dominant politics for the deployment of autonomous policies of management, decision and common usufruct of the wealth available in the spaces, in a dynamic that overflow the capitalist and centric-state logic imposed about them. Finally, it is suggested to deepen studies to track the collective and autonomous capacities of the management of the spaces, assuming the critics to the eurocentrism and patriarchy, in order to understand the horizons of the desire and the practical potential of the community base organizations beyond of centric-state approaches.

Resumen: Los actuales horizontes de transformación social a escala planetaria y la crisis de participación política estado-céntrica han repercutido en las nociones de espacio público y lo común. En esta investigación cualitativa analizamos los significados en relación al espacio público y la acción política en el relato oral de cuatro organizaciones sociales autónomas de Valparaíso enfocadas en la amplificación y cuidado de espacios comunes. El análisis de contenidos y una posterior interpretación desde lo ch’ixi -como recurso epistemológico y metodológico- revelaron una noción de espacio público contenciosa, caracterizada como campo de apertura táctica en la relación con la política masculino dominante para el despliegue de políticas autónomas de gestión, decisión y usufructo común de la riqueza disponible en los espacios, en una dinámica que desborda las lógicas capitalistas y estado-céntricas impuestas sobre los mismos. Finalmente, se sugiere profundizar estudios para rastrear las capacidades colectivas y autónomas de gestión de los espacios, asumiendo la crítica al eurocentrismo y al patriarcado, en aras de comprender los horizontes de deseo y potencial práctico de las organizaciones de base comunitaria más allá de perspectivas estado-céntricas.

ABSTRACT Introduction: Traffic accidents are a serious public health problem, however, their socio-economic impact has not been described in Paraguay. Objectives: to determine the socioeconomic impact of motorcycle accidents in victims <19 years of age in 2016. Materials and Methods: this was a descriptive, observational, retrospective study. All patients aged ≤19 years who were admitted to the Trauma Hospital (TH) with a history of a motorcycle accident in 2016 were included. The data and costs were obtained from the Statistics Department and the Admissions Department of the TH. Results: 700 patients were included, all of whom were admitted to the TH due to a motorcycle accident. The average age of the patients was 15.6 ± 4.33 years. 78% (546/700) were male. Of those injured, 450 (64.2%) were drivers and 250 (35.7%) were passengers. The average age of the drivers was 17 ± 4.3 years (range 11-19 years) and that of the passengers was 12.3 ± 4.4 years (range <1-19 years). Among the drivers, only 50.4% (227/450) were of the legal age to obtain a driver's license. Only 7.7% (54/695) of the victims wore a helmet at the time of the accident. 89.2% (625/700) of patients required hospitalization stays of 2 or more days of length, of which 7.6% required PICU admission. The mean number of regular ward hospitalization days and PICU days were 11.04 days (SD 14.85 days) and 16.57 days (SD 23 days), respectively. 25.1% (176/700) had some degree of disability or long-term effects and 5.4% (38/700) died. The direct costs per hospitalization per day in the ward and in the PICU were US$ 275.4 and 737.2, respectively. The direct costs for motorcycle accidents in 2016 was US$ 2,587,179.2. The years of potential life lost (YPLL) in 2016 were 2159 years. Conclusions: The socioeconomic impact of motorcycle accidents represents an extremely high social cost, stemming from a preventable cause of death.

RESUMEN Introducción: Los accidentes de tránsito constituyen un grave problema de salud pública, sin embargo, su impacto socioeconómico no se conoce en el Paraguay. Objetivos: determinar el impacto socioeconómico de los accidentes de moto en <19 años en el año 2016. Materiales y Métodos: estudio descriptivo, observacional, retrospectivo. Se incluyeron todos los pacientes ≤19 años que acudieron al Hospital de Trauma (HT) con antecedente de accidente de moto en el año 2016. Los datos y los costos fueron obtenidos de la base de datos del Dpto. de Estadísticas y del Dpto. de Ingresos del HT, respectivamente. Resultados: se incluyeron 700 pacientes que acudieron al HT por accidente de moto. La edad media de los pacientes fue de 15,6 ± 4.33 años. El 78% (546/700) era de sexo masculino. De los accidentados 450 (64,2%) era conductor y 250 (35,7%) acompañante. La media de edad de los conductores fue de 17 ± 4,3 años (rango 11 - 19 años) y de los acompañantes 12,3 ± 4,4 (rango <1 - 19 años). Entre los conductores solo el 50.4% (227/450) tenía la edad reglamentaria para obtener licencia de conducir. Solo el 7,7% (54/695) de los accidentados usaba casco al momento del accidente. Requirió hospitalización por 2 o más días el 89,2% (625/700) de los pacientes, de los cuales el 7.6% requirió ser hospitalizado en UCIP. La media de días de hospitalización en sala y UCIP fue de 11.04 días (DS 14,85 días) y 16.57 (DS 23 días). El 25,1% (176/700) tuvo algún grado de discapacidad o secuela y el 5,4% (38/700) falleció. Los costos directos por hospitalización por día en sala y en UCIP fueron de 275,4 y 737,2 $, respectivamente. Los costos directos por accidentes de moto en el año 2016 fue de 2.587.179,2$. Los años de vida potencialmente perdidos (AVPP) en el año 2016, fueron de 2159 años. Conclusiones: El impacto socioeconómico de los accidentes de motos, representa un costo social extremo derivado de una causa de muerte que podría prevenirse.

Abstract: Aim: To describe the frequency of exclusive breastfeeding at 6 months in binomial of mother and in fants with Down Syndrome (DS) attending at the Health net UC CHRISTUS (PSSPSD-UC), and iden tify the main factors associated with exclusive breastfeeding cessation. Patients and Methods: Prevalence study of exclusively breastfeeding at 6 months of age that includes mother-child binomial of Chilean infants with (DS) aged 6-24 months, who attend the PSSPSD-UC. An on-line questionnaire was conducted, which included demographic data, child’s background and experience in breastfee ding. Results: The total sample consisted of 73 binomials. Forty-six percent (34/73) of the mothers exclusively breastfed until 6 months or longer, 67.1% (49/73) of the infants had a disease or malfor mation that interfere with breast feeding. Among the 39 mothers who did not exclusively breastfeed until 6 months, 25 (64.1%) referred child factors. Hospitalization during the first 6 months was the most significant factor affecting the cessation of breastfeeding (OR = 6,13). Conclusions: First study in Chile that describes the frequency of exclusive breastfeeding at 6 months of age in children with DS, which shows a large rate of exclusively breastfeeding in the studied sample. The adequate support and education in breastfeeding could allow to achieve a better rate of exclusive breastfeeding in this vulnerable group.

Resumen: Objetivos: Describir la frecuencia de lactancia materna exclusiva (LME) hasta los 6 meses en bino mio madre-hijo/a de niños con síndrome de Down (SD) en control en Programa de Seguimiento de Salud de Personas con SD de la Red de Salud UC CHRISTUS (PSSPSD-UC), e identificar los factores que influyen en el abandono de la LME. Pacientes y Método: Estudio de prevalencia de LME hasta los 6 meses, en el cual se estudió al binomio madre-hijo/a de niños chilenos con SD, entre 6 meses y 2 años, que se controlan en el PSSPSD-UC. Se utilizó un cuestionario on-line que incluyó datos de mográficos, antecedentes del hijo/a y experiencia en LM. Resultados: El total de la muestra obtenida fue de 73 binomios. El 46,6% (34/73) de las madres dieron LME hasta los 6 meses o más. El 67,1% (49/73) de los hijos presentó alguna patología o malformación asociada que influía en la lactancia. De las 39 madres que no dieron LME hasta los 6 meses, 25 (64,1%) fue por motivos del hijo/a. La hospitalización durante los primeros 6 meses de vida fue el factor más significativo en el cese de LME antes de los 6 meses (OR = 6,13). Conclusión Primer estudio en Chile que describe la frecuencia de LME a los 6 meses en niños con SD, en el que se obtuvo una alta frecuencia de LME en la población estudiada. El apoyo y educación adecuada sobre lactancia permitiría lograr una mayor tasa de LME en este grupo más vulnerable.

In this article, we reflect upon the question of what does it entail to conduct engaged ethnography in contexts of armed conflict. We describe our ethnographic experiences in Bellavista - Bojayá Chocó and Bahía Málaga - Valle del Cauca in Colombia. Our main conclusion is that engaged ethnography, in contexts of armed conflict, ought to be collaborative developing long-term relationships with the communities in which we work.

El propósito de este artículo es responder a la pregunta acerca de qué implica realizar una etnografía comprometida en contextos de conflicto armado. Las autoras describen sus experiencias etnográficas de casi una década en las comunidades de Bellavista, cabecera y Bahía Málaga - Valle del Cauca, en Colombia. En el artículo se concluye que una etnografía comprometida, en contextos de conflicto armado, debería ser colaborativa, desarrollando relaciones de largo plazo con las comunidades en las que se trabaja.

Resumo A farinha de banana verde (FBV) é uma alternativa viável para o aproveitamento dos frutos e possui alto teor de amido resistente (AR), que apresenta papel fisiológico similar ao das fibras alimentares. O objetivo deste trabalho foi produzir FBV de dois genótipos de bananeira (Prata e Caturra), além de selecionar aquele com maior teor de AR, para posterior substituição de parte da farinha de trigo integral por FBV, em uma formulação de pão de fôrma integral. Para a produção das farinhas, os frutos foram descascados, cortados em rodelas e estas foram submersas em uma solução de ácido ascórbico e ácido cítrico, sendo então distribuídas em bandejas e secas a 50 °C, por 7 horas, e moídas. As farinhas foram submetidas às análises de composição proximal e determinação do teor de AR. Posteriormente, foram processados pães integrais com a substituição de 10%, 15% e 20% de farinha de trigo integral pela FBV que obteve o maior teor de AR. Os pães controle e aquele que apresentou maior teor de AR e boas características tecnológicas, como volume específico, dureza e cor, foram submetidos aos testes sensoriais de aceitação e intenção de compra. O teor de AR encontrado para as FBV Prata e Caturra foram 24,1% e 13,7%, respectivamente. O pão com substituição de 15% de farinha de trigo integral por FBV foi escolhido para a análise sensorial. As formulações controle e com 15% de FBV atingiram Índices de Aceitação Sensorial de 88,7% e 82,1%, respectivamente. A atitude dos avaliadores foi positiva, segundo a qual 56% dos avaliadores “comprariam frequentemente” ou “comprariam sempre” o pão com 15% de FBV, não tendo sido observada rejeição para nenhuma das formulações.

Abstract Unripe banana flour (UBF) is a viable alternative for using the fruit, since it has a high resistant starch (RS) content which presents a physiological role similar to that of dietary fibre. The objective of this study was to produce UBF from two banana genotypes (Lady Finger and Cavendish), and select the one with the highest level of RS for subsequent replacement of part of the whole wheat flour by UBF in a formulation for whole wheat loaves. For the production of UBF, the fruits were peeled, cut into slices, submerged in a solution of ascorbic acid and citric acid, spread on trays, dried at 50 °C for 7 hours and then ground. The flours were submitted to proximate composition and RS content analyses. Whole wheat loaves were then processed, replacing 10%, 15% and 20% of the whole wheat flour by the UBF containing the highest resistant starch content. The control loaves and the one with the highest RS content and good technological characteristics, such as specific volume, hardness and colour, were submitted to a sensory test for acceptance and purchase intent. The resistant starch contents found in the Finger and Cavendish UBF samples were 24.1% and 13.7% respectively. Loaves with 15% substitution of the whole wheat flour by UBF were chosen for the sensory analysis. The Control loaf formulation and that with 15% UBF reached acceptance levels of 88.7% and 82.1%, respectively. The attitude of the judges was positive since 56% of them answered they would buy the bread with 15% UBF frequently or always, and none of the formulations were rejected.

Resumen Objetivo: describir los perfiles clínicos y hemodinámicos de pacientes hospitalizados por falla cardíaca aguda. Métodos: estudio transversal de pacientes de 18 años o más, con diagnóstico de falla cardíaca aguda admitidos a un centro hospitalario de alta complejidad en Cali, Colombia, en un período de 7 meses. Se recolectó información sociodemográfica, clínica, perfiles clínicos y hemodinámicos de la falla cardiaca al ingreso, estancia hospitalaria y mortalidad. Se describieron las variables cuantitativas como promedios o medianas, y las categóricas como valor absoluto y porcentajes. Se realizaron tablas de frecuencia, y se graficaron los porcentajes de pacientes que ingresaron según el perfil clínico y hemodinámico de falla cardiaca aguda. Resultados: se incluyeron 99 pacientes con 143 episodios de falla cardíaca aguda. La mitad eran hombres y la mediana de edad 66 años (rango 21 a 97 años). 60% fueron afrodescendientes y 14,14% mestizos. Los perfiles clínicos más frecuentes fueron falla cardíaca aguda descompensada (72,46%), edema pulmonar agudo (10,14%) y falla cardiaca asociada a síndrome coronario agudo en 6,52%. Los perfiles hemodinámicos fueron ‘‘caliente y seco’’ 10,87%, ‘‘caliente y húmedo’’ 55,07%, ‘‘frío y húmedo’’ 28,26% y ‘‘frío y seco’’ en 5,8%. Conclusiones: la falla cardíaca aguda descompensada es el perfil de presentación clínica más común en nuestra población con dos tercios del total de casos. El perfil hemodinámico más frecuente fue el ‘‘caliente y húmedo’’ (Stevenson B), resultados que concuerdan con lo observado en estudios locales y registros internacionales.

Abstract Objective: To describe the clinical and haemodynamic profiles of patients admitted to hospital due to acute heart failure. Methods: A cross-sectional study was conducted on patients aged 18 years or older with a diagnosis of acute heart failure admitted to a high complexity hospital in Cali, Colombia, during a 7-month period. Sociodemographic, clinical and haemodynamic information of the cardiac failure was recorded on admission, as well as hospital stay and mortality. The quantitative variables are described as means or medians, and the categorical variables as absolute value and percentages. Frequency tables were made, and a graph made of the percentages of patients admitted, according to the clinical and haemodynamic profile of the acute heart failure. Results: The study included as total of 99 patients with 143 episodes of acute heart failure. Half of the patients were male, and the median age was 66 years (range 21 to 97 years). The majority (60%) were of African descent and 14.14% were Mestizos. The most common clinical profiles were decompensated heart failure (72.46%), acute pulmonary edema (10.14%), and heart failure associated with acute coronary syndrome in 6.52%. The haemodynamic profiles were ‘‘warm and dry’’ in 10.87%, ‘‘warm and wet’’ in 55.07%, ‘‘cold and wet’’ in 28.26%, and ‘‘cold and dry’’ in 5.8%. Conclusions: Decompensated acute heart failure is the most common clinical presentation profile in the population studied, with two-thirds of all cases. The most frequent haemodynamic profile was ‘‘warm and wet’’, results that agree with those observed in local studies and in international registers.