Resumen: Durante el invierno de 2023, Chile enfrentó una compleja situación relacionada con al virus respiratorio sincicial (VRS). Después de experimentar una disminución en la circulación del VRS durante los años de la pandemia de SARS-CoV-2, se observó un brote tardío en la primavera de 2022 y un inicio anticipado del brote en 2023, con un aumento significativo en el número de casos graves. La poca efectividad en la planificación estratégica y comunicación de riesgo contribuyeron a la complejidad de la situación. Para evitar lo anterior el próximo invierno, se sugieren medidas como vigilancia activa, unificación de definiciones para infecciones respiratorias agudas, identificación de variantes del VRS, educación pública sobre contagios y preparación anticipada respecto a camas hospitalarias y personal de salud. Se destaca la importancia de la inmunización y colaboración intersectorial para adquirir nuevas alternativas preventivas como también la necesidad de una comunicación temprana sobre la importancia de la inmunización e identificación de grupos de alto riesgo, mejora en capacitaciones del personal médico y planificación estratégica del Ministerio de Salud buscando un enfoque proactivo y colaborativo para abordar la compleja situación del VRS en futuros inviernos. El Comité Asesor en Vacunas y Estrategias de Inmunización de Chile ya realizó un análisis y recomendación sobre una nueva alternativa de prevención. Este grupo de trabajo apoyará cualquier decisión del Ministerio de Salud en políticas públicas que intenten un cambio en el paradigma del control de esta enfermedad por la salud de los niños/as de nuestro país.

Abstract: During the winter of 2023, Chile faced a complex situation related to the respiratory syncytial virus (RSV). After experiencing a decline in RSV circulation during the years of the SARS-CoV-2 pandemic, a late outbreak was observed in the spring of 2022 and an early onset of the outbreak in 2023, with a significant increase in the number of serious cases. The ineffectiveness of strategic planning and risk communication contributed to the complexity of the situation. To avoid the above next winter, measures such as active surveillance, unification of definitions for acute respiratory infections, identification of RSV variants, public education about infections and advance preparation regarding hospital beds and health personnel are suggested. The importance of immunization and intersectoral collaboration to acquire new preventive alternatives is highlighted, as well as the need for early communication about the importance of immunization and identification of high-risk groups, improvement in training of medical personnel and strategic planning of the Ministry of Health. seeking a proactive and collaborative approach to address the complex RSV situation in future winters. The Chilean Immunization Advisory Committee has already carried out an analysis and recommendation on a new prevention alternative. This working group will support any decision of the Ministry of Health in public policies that attempt a change in the paradigm of control of this disease for the health of the children of our country.

Background: Pesticides are widely used to increase crop yields and vector control. However, both acute and chronic exposure have health consequences. There is paucity of information about the global occurrence of pesticide poisonings. Aim: To characterize the reports of pesticide exposures received by a University Poison Information Center. Material and Methods: All pesticide exposures reported in Chile between 2006 and 2013 were analyzed. A data-collection sheet provided by the International Programme on Chemical Safety of the World Health Organization, was used to collect information. Results: In the study period, 13,181 reports were analyzed. The main age groups exposed were preschoolers and adults. Sixty one percent of exposures occurred accidentally and 24.8% were suicide attempts. Exposures to acetylcholinesterase inhibitors was reported in 29.3% of cases, to superwarfarin rodenticides in 28.5% and to pyrethroids in 24.0%. An increased risk of suicide attempts with pesticides was observed among women, when compared with men (odds ratio: 1.5; 95% confidence intervals: 1.4-1.6; p < 0.001). The risk was higher among teenage girls. Conclusions: The amount of cases under acetyl cholinesterase inhibitor exposure, the most toxic pesticides currently in use should be highlighted. Workers should be educated and all cases should be reported to take actions aiming at reducing these events.

Background: Exposure to Biological Agents during work is an emergent type of occupational risk. Aim: To characterize occupational biological risk exposure among Chilean workers which have been registered by the Toxicology Information Center, between January 2006 and December 2009. Material and Methods: All incoming calls reporting exposure to biological agents during the studied period were analyzed. The information obtained from the caller was registered using the Communication Record Instrument of the WHO International Programme on Chemical Safety (IPCS INTOX). Results: In the studied period, 77 calls were received. The mean age of exposed patients was 35 ± 15 years and 57% of them were females. The most common involved agents were vaccines for veterinary use (42%) followed by Loxosceles laeta bites in 16%. The main routes of exposure were injections, cuts and needle stick injuries in 39% and stings and bites in 38%. The highest exposure rates were observed in Southern Chile due to self-inoculation of veterinary vaccines used in the salmon industry (22.7/100.000 actual workers). Fifty-eight percent of calls were from health care workers, and 51% of them were from health care facilities. Sixty percent of exposures occurred during summer and spring. There was a fourfold higher risk of calls involving women exposed to bites or stings (odds ratio (OR) 4.5 (CI95 1.5-13.9, p < 0.01). Men had a fourfold higher risk of being exposed to vaccines or medications for veterinary use (OR 4.2, CI95 1.4-12.6 p < 0.01). Conclusions: Most calls involving an exposure to a biological agent were caused by self-inoculation of veterinary medications.

Background: Paracetamol (acetaminophen) is an analgesic and antipyretic drug widely used across the world. Its ingestion is one of the most common causes of drug overdose. In the United States is the first cause of acute hepatitis in adults. Aim: To describe the epidemiological profile of paracetamol overdose in Chile. Material and Methods: Cross sectional retrospective study that included all the phone call inquiries received at the Poison Control Center of the Pontificia Universidad Catolica de Chile (CITUC) during 2009. Results: Nine hundred fifty nine inquiries involving acute paracetamol exposures were received. Women represented a 63.1% of the cases. Half of the cases were suicide attempts, of which 74.8% were women. Accidental exposures occurred mainly in children. In 29.3% of the patients, the exposure was considered to involve a hepatotoxic dose. Women had 2.7 times the risk of men to ingest a toxic dose of paracetamol with suicidal purpose (Odds ratio (OR) = 2.7; 95% confidence interval (Cl): 2.1-3.6; p < 0.001). Adolescents had 3.4 times the risk of the general consultants (OR: 3.4; 95% Cl: 2.4-4.7; p < 0.001). Conclusions: Paracetamol overdose is common in Chile. Authorities should carry out preventive measures. Antidotes and the capacity to measure plasma levels of paracetamol should be available in healthcare centers.

OBJETIVO: Revisar os artigos mais relevantes sobre a pediatria ambiental, seus efeitos potenciais para a saúde e, especialmente, seus avanços na prevenção. FONTES DOS DADOS: Foi realizada uma pesquisa utilizando as bases de dados MEDLINE/PubMed e SciELO. Foram revisados artigos de 1990 a 2010, além de capítulos de livros relacionados à pediatria ambiental. SÍNTESE DOS DADOS: Há uma variedade significativa de fatores que tornam as crianças altamente vulneráveis à exposição a riscos ambientais, associados principalmente ao consumo comparativamente maior de água, comida e ar por parte da criança, em relação ao seu peso corporal. De acordo com a Organização Mundial de Saúde, mais de 3 milhões de crianças menores de 5 anos morrem devido a doenças relacionadas ao meio ambiente. Aproximadamente 30-40% das doenças pediátricas estão relacionadas a fatores ambientais. As crianças estão constantemente expostas a vários riscos ambientais para a saúde, dentre os quais se destacam: água contaminada, falta de condições adequadas de saneamento, poluição do ar, vetores de doenças, perigos químicos, injúrias e acidentes. CONCLUSÕES: Atualmente, os pediatras são desafiados a tratar das necessidades de saúde ligadas à pediatria ambiental. A história pediátrica deve ser mais abrangente, acrescentando-se questões pontuais que ajudem a identificar potenciais riscos ambientais. A conscientização e o entendimento sobre os efeitos nocivos das várias condições ambientais e o conhecimento sobre as medidas de prevenção relacionadas resultarão em intervenções oportunas e adequadas que melhorarão a saúde e o desenvolvimento das nossas crianças.

OBJECTIVE: To review the most relevant articles regarding environmental pediatrics, its potential effects on health, and especially its advances in prevention. SOURCES: A literature search was conducted using MEDLINE/PubMed and SciELO databases. Articles from 1990 to 2010 were reviewed, in addition to book chapters related to environmental pediatrics. SUMMARY OF THE FINDINGS: There is a significant variety of factors that make children highly vulnerable to environmental hazard exposure, which are mainly associated with children’s comparatively greater consumption of water, food, and air in relation to body weight. According to the World Health Organization, every year more than 3 million children under the age of 5 die because of environment-related conditions. Approximately 30 to 40% of pediatric diseases are related to environmental factors. Children are constantly exposed to various environmental health hazards, among which the following stand out: contaminated water, lack of adequate sanitation facilities, air pollution, disease vectors, chemical hazards, injuries, and accidents. CONCLUSIONS: Nowadays, pediatricians are challenged to address environmental pediatrics health care needs. The pediatric health history needs to be more comprehensive by adding pointed questions to help identify potential environmental risks. Awareness and understanding of the noxious effects of various environmental conditions and knowledge of the related prevention measures will result in timely and adequate interventions that will improve our children’s health and development.

OBJETIVO: Descrever e analisar três ferramentas usadas no sistema de avaliação aplicado ao internato em pediatria por um período de 7 anos na Faculdade de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. MÉTODOS: Pesquisa observacional retrospectiva projetada para as modalidades de avaliação usadas de 2001 a 2007 que foram implementadas no internato em pediatria. As ferramentas foram as seguintes: exame clínico objetivo estruturado (objective structured clinical examination, OSCE), exame escrito e diretrizes de observação de prática clínica diária (DOPCD). Os métodos de avaliação foram aplicados ao internato em pediatria do sexto ano, com um total de 697 alunos. A análise estatística incluiu uma avaliação descritiva, com correlação e regressões linear simples e múltipla (ANOVA), teste de Bonferroni e coeficiente alfa de Cronbach. O nível de significância foi de 5%. RESULTADOS: Escores de sucesso com a OSCE foram atingidos em 75,7±8%, com melhor média entre o sexo feminino (p < 0,001). Os escores de OSCE melhoraram após o terceiro ano de implementação. O coeficiente alfa de Cronbach foi de 0,11-0,78. O exame escrito teve escore médio de 79,8±10%, e não houve diferenças quanto a gênero. O escore médio de DOPCD 97,1±3%, com melhores resultados entre as mulheres (p < 0,005). A correlação entre os três métodos de avaliação mostrou uma relação positiva moderada, exceto no ano de 2007, quando a correlação foi maior (p < 0,001). CONCLUSÕES: Análise do sistema de avaliação da aprendizagem foi realizada usando OSCE, exame escrito e DOPCD, que são complementares entre si, gerando bons resultados.

OBJECTIVE: To describe and analyze three tools used in the assessment system applied to the pediatric internship over a 7-year period at the School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. METHODS: Retrospective observational research design for the assessment modalities implemented in the pediatric internship from 2001 through 2007. The tools were as follows: objective structured clinical examination (OSCE), written examination and daily clinical practice observation guidelines (DCPOG). The assessment methods were applied to the sixth-year pediatric internship with a total of 697 students. Statistical analysis included a descriptive assessment, with correlation and simple linear and multiple regressions (ANOVA), Bonferroni test and Cronbach's alpha coefficient. Significance level was set at p < 0.05. RESULTS: OSCE success scores were reached in 75.7±8%, with a better mean among females (p < 0.001). OSCE scores improved after the third year of implementation. Cronbach's alpha coefficient was 0.11-0.78. Written examination had a mean score of 79.8±10% and there were no sex differences. Mean DCPOG score was 97.1±3% and the results were better among females (p < 0.005). Correlation between the three assessment methods showed a moderate positive relationship except in the year of 2007, where the correlation was higher (p < 0.001). CONCLUSIONS: Analysis of the learning assessment system was performed using OSCE, written examination and DCPOG, which are complementary to each other, and yielded good results.

Background: Loxoscelism is caused by the bite of spider Loxosceles laeta. It can cause a cutaneous or systemic syndrome. Aim: To determine the epidemiológica! and clinical features of patients bitten by the Chilean recluse spider (Loxosceles laeta). Material and Methods: All communications received at a telephonic orientation center for intoxications during 2005 were analyzed, selecting those who involved patients with symptoms that suggested loxoscelism (i.e., pain, burning sensation, blue area, hematuria, fever or myalgia). These were derived to the emergency room for confirmation of the diagnosis. Forty-eight hours after the initial communication, patients were contacted by phone to find out about the definitive diagnosis. The variables analyzed were: gender, age, geographical location, time since exposure, part of the body involved, clinical signs and definitive diagnosis. Results: Of 2,831 telephonic consultations with suspected loxoscelism, the diagnosis was confirmed in 287. All of these patients had cutaneous loxoscelism and only 7.3% of them developed visceral loxoscelism. Fifty six percent of patients with loxoscelism presented two or more clinical signs. The most common were a blue area, pain and a burning sensation, in 69%, 58% and 38% of patients, respectively. Fifty-one percent of patients developed signs within the first 12 hours. All patients with visceral syndrome presented with hemoglobinuria. No cases of loxoscelism were registered in areas located southern than the Xth region of Chile. There were no fatalities attributed to loxoscelism. Conclusions: Most cases of loxoscelism of this series were cutaneous. The population must be educated about the clinical signs of spider bite to seek early and adequate medical treatment