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Acute hemopericardium is generally produced by complications of interventional procedures or traumatisms to the chest wall. In absence of those antecedents, clinicians face an arduous process of etiological diagnosis and treatment. We present the case of a male patient with history of Hodgkin's lymphoma and aortic endovascular treatment years ago, who develop an episode of fever, chest pain and dyspnea that was complicated with cardiac tamponade diagnosed with echocardiogram and angio- tomography. In the operating room hemopericardium was diagnosed and drained with resolution of symptoms. Diagnosis work out was carried out with suspicion of tuberculous or neoplastic pericarditis with negative results. Patient was discharged with the diagnoses of viral or idiopathic pericarditis. The case highlights the use of multimodality images and laboratories procedures to lead to a correct diagnoses and treatment.

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Incorporation of new technologies to assist the liposuction procedure is becoming increasingly common. These technologies allow for a softer technique, balanced shaping, elimination of excess adipose tissue, and skin tightening. Some of these technologies include ultrasound (US; US-assisted liposculpture, VASER-assisted liposuction), power suction (power-assisted liposuction), radiofrequency (RF; RF-assisted lipolysis), and laser (laser-assisted liposuction). In addition, some of these devices have been shown to reduce the incidence of hematomas/inflammation and shorten recovery time. We report our experience in high-definition liposculpture of the arms in addition to new technologies to improve skin retraction, comparing their results in terms of complications, satisfaction score, and aesthetic outcomes. We included patients with mild-to-moderate arm dermatochalasis (Duncan classification) fat deposits in the upper extremities who were considered candidates for third-generation US-assisted liposculpture, power-assisted liposuction, RF-assisted lipolysis/skin tightening, and laser-assisted liposuction. A total of 683 consecutive patients met the inclusion criteria for the study. Most of them were women (n = 605, 88%). Fat grafting was performed in 80 patients (11.7%). A significant portion of the patients were secondary cases (n = 223, 33%). Age ranged from 18 to 70 years (median = 38 years). BMI ranged from 17.8 to 34.8 kg/m2 (mean = 24.3 kg/m2). RF-assisted and laser-assisted high-definition liposculpture of the arms are both effective and reproducible techniques for patients who seek an athletic and slim arm contour. A low rate of complications and high satisfaction index support our findings.

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Protoceratium reticulatum is the main yessotoxin-producer along the Chilean coast. Thus far, the yessotoxin levels recorded in this region have not posed a serious threat to human health. However, a bloom of P. reticulatum during the austral summer of 2022 caused the first ban of shellfish collection, due to the high toxin levels. A bloom of P. reticulatum during the austral summer of 2020 allowed an evaluation of the fine-scale distribution of the dinoflagellate during a tidal cycle. High-resolution measurements of biophysical properties were carried out in mid-summer (February 18-19) at a fixed sampling station in Puyuhuapi Fjord, Chilean Patagonia, as part of an intensive 24-h biophysical experiment to monitor the circadian distributions of P. reticulatum vegetative cells and yessotoxins. High P. reticulatum cell densities (>20 × 103 cells L-1) were found in association with a warmer (14.5-15 °C) and estuarine (23.5-24.5 g kg-1) sub-surface water layer (6-8 m). P. reticulatum cell numbers and yessotoxins followed a synchronic distribution pattern consistent with the excursions of the pycnocline. Nevertheless, the surface aggregation of the cells was modulated by the light cycle, suggesting daily vertical migration. The yessotoxin content per P. reticulatum cell ranged from 9.4 to 52.2 pg. This study demonstrates both the value of fine-scale resolution measurements of biophysical properties in a highly stratified system and the potential ecosystem impact of P. reticulatum strains producing high levels of yessotoxins.

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At the end of summer 2020, a moderate (~105 cells L-1) bloom of potential fish-killing Karenia spp. was detected in samples from a 24 h study focused on Dinophysis spp. in the outer reaches of the Pitipalena-Añihue Marine Protected Area. Previous Karenia events with devastating effects on caged salmon and the wild fauna of Chilean Patagonia had been restricted to offshore waters, eventually reaching the southern coasts of Chiloé Island through the channel connecting the Chiloé Inland Sea to the Pacific Ocean. This event occurred at the onset of the COVID-19 lockdown when monitoring activities were slackened. A few salmon mortalities were related to other fish-killing species (e.g., Margalefidinium polykrikoides). As in the major Karenia event in 1999, the austral summer of 2020 was characterised by negative anomalies in rainfall and river outflow and a severe drought in March. Karenia spp. appeared to have been advected in a warm (14-15 °C) surface layer of estuarine saline water (S > 21). A lack of daily vertical migration patterns and cells dispersed through the whole water column suggested a declining population. Satellite images confirmed the decline, but gave evidence of dynamic multifrontal patterns of temperature and chl a distribution. A conceptual circulation model is proposed to explain the hypothetical retention of the Karenia bloom by a coastally generated eddy coupled with the semidiurnal tides at the mouth of Pitipalena Fjord. Thermal fronts generated by (topographically induced) upwelling around the Tic Toc Seamount are proposed as hot spots for the accumulation of swimming dinoflagellates in summer in the southern Chiloé Inland Sea. The results here provide helpful information on the environmental conditions and water column structure favouring Karenia occurrence. Thermohaline properties in the surface layer in summer can be used to develop a risk index (positive if the EFW layer is thin or absent).

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Introducción: Los bioderivados propuestos como candidatos a ingredientes alimentarios suelen requerir ciertas evaluaciones para las aplicaciones inmunonutricionales Los hongos comestibles-medicinales son un surtidor de compuestos con estas potencialidades. Entre ellos, las setas Pleurotus ostreatus contienen metabolitos bioactivos, con importantes usos en la industria alimenticia y en la práctica terapéutica de la industria médico-farmacéutica. Los ensayos de citotoxicidad in vitro constituyen métodos valiosos para evaluarproductos de origen natural, como los extractos fúngicos. Objetivo: Evaluar la citotoxicidad de dos extractos obtenidos de la seta Pleurotus ostreatus en diferentes líneas celulares. Método: Se obtuvieron extractos hidrosolubles a partir del micelio y de los cuerpos fructíferos de Pleurotus ostreatus en laboratorios del Centro de Estudios de Biotecnología Industrial de la Universidad de Oriente. Se evaluó la citotoxicidad de los bioproductos por el ensayo de reducción del colorante resazurina sobre tres líneas celulares en el Laboratorio de Microbiología, Parasitología e Higiene (LMPH) de la Universidad de Amberes, Bélgica. Se utilizaron células no adherentes THP-1 (pre-monocitos de leucemia humana), células adherentes Caco-2 (epitelio de adenocarcinoma de colon humano) y células adherentes RAW 264.7 (macrófagos murinos). Resultados: Los extractos de Pleurotus ostreatus no resultaron citotóxicos para ninguna de las líneas celulares estudiadas humanas o murina, ya que no ocasionaron daños sobre la viabilidad de las célulasepiteliales del sistema gastrointestinal, nisobrelas células del sistema inmune empleadas. Conclusiones: Este resultado demuestra que ambos bioderivados fúngicos pueden ser aplicados con seguridad en estudios inmunonutricionales.(AU)

Introduction: Bioderivatives proposed as candidates for food ingredients usually require certain evaluations for immunonutritional applications. Edible-medicinal mushrooms are a source of compounds with these potentials. Among them, Pleurotus ostreatus mushrooms contain bioactive metabolites, with important uses in the food industry and in the therapeutic practice of the medical-pharmaceutical industry. In vitro cytotoxicity assays are valuable methods to evaluate products of natural origin, such as fungal extracts. Objective: To evaluate the cytotoxicity of two extracts obtained from the Pleurotus ostreatus mushroom in different cell lines. Method: Water-soluble extracts were obtained from the mycelium and fruiting bodies of Pleurotus ostreatus in laboratories of the Center for Industrial Biotechnology Studies of the Universidad de Oriente. The cytotoxicity of the bioproducts was evaluated by the resazurin dye reduction assay on three cell lines at the Laboratory of Microbiology, Parasitology and Hygiene (LMPH) of the University of Antwerp, Belgium. Non-adherent THP-1 cells (human leukemia pre-monocytes), Caco-2 adherent cells (human colon adenocarcinoma epithelium) and RAW 264.7 adherent cells (murine macrophages) were used. Results: Pleurotus ostreatus extracts were not cytotoxic for any of the human or murine cell lines studied, since they did not cause damage to the viability of the epithelial cells of the gastrointestinal system, nor to the immune system cells used. Conclusions: This result demonstrates that both fungal bioderivatives can be safely applied in immunonutritional studies.(AU)

Introdução: Bioderivados propostos como candidatos a ingredientes alimentícios geralmente requerem determinadas avaliações para aplicações imunonutricionais. Pleurotus ostreatus contêm metabólitos bioativos, com importantes utilizações na indústria alimentícia e na prática terapêutica da indústria médico-farmacêutica. Ensaios de citotoxicidade in vitro são métodos valiosos para avaliar produtos de origem natural, como extratos de fungos. Objetivo: Avaliar a citotoxicidade de dois extratos obtidos do cogumelo Pleurotus ostreatus em diferentes linhagens celulares. Método: Extratos hidrossolúveis foram obtidos do micélio e dos corpos frutíferos de Pleurotus ostreatus nos laboratórios do Centro de Estudos de Biotecnologia Industrial da Universidade de Oriente. A citotoxicidade dos bioprodutos foi avaliada pelo ensaio de redução do corante resazurina em três linhagens celulares no Laboratório de Microbiologia, Parasitologia e Higiene (LMPH) da Universidade de Antuérpia, Bélgica. Foram utilizadas células THP-1 não aderentes (pré-monócitos de leucemia humana), células aderentes Caco-2 (epitélio de adenocarcinoma do cólon humano) e células aderentes RAW 264.7 (macrófagos murinos). Resultados: Os extratos de Pleurotus ostreatus não foram citotóxicos para nenhuma das linhagens celulares humanas ou murinas estudadas, pois não causaram danos à viabilidade das células epiteliais do sistema gastrointestinal, nem às células do sistema imunológico utilizadas. Conclusões: Este resultado demonstra que ambos os bioderivados fúngicos podem ser aplicados com segurança em estudos imunonutricionais.(AU)

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OBJETIVO: Analizar la distribución espacial y tendencia temporal de egresos hospitalarios asociados con enfermedad isquémica del corazón (IHD, por sus siglas en inglés) en Chile, para el periodo 2002-2020. Material y métodos. Estudio ecológico mixto. Se incluyeron casos de IHD >=18 años registrados en Chile entre 2002-2020. Representación cartográfica a nivel comunal según sexo y residencia. Se utilizó autocorrelación espacial aplicando I de Moran local univariado por sexo. Tendencia temporal se evaluó mediante el modelo segmentado de Poisson (JP). RESULTADOS: 434 061 casos totales. Se presentan tasas de hospitalización mínimas de 53 por cada 100 000 habitantes para sexo masculino y 32 por cada 100 000 habitantes para sexo femenino. Las tasas máximas determinadas corresponden a 638 por cada 100 000 habs. para sexo masculino y 364 por cada 100 000 habs. para sexo femenino. Las Comunas registran valores de I de Moran para hombres que tienden a dispersarse a medida que avanza el periodo analizado (0.247 a 0.334) y en el caso de las mujeres tienden a agruparse (0.244 a 0.223). Esta tendencia refleja comportamiento de aumento en los rangos etarios de 18 a 24 años y de 25 a 34 años para sexo femenino. Conclusión. Existe una transición de tasas bajas a altas durante periodo estudiado. Es posible agrupar comunas con valores altos en la zona Centro y Sur de Chile, y valores bajos en la zona Norte del país. La existencia de hospital, en promedio, afecta las tasas de utilización para ambos sexos.

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The frequency of harmful algal blooms (HABs) has increased over the last two decades, a phenomenon enhanced by global climate change. However, the effects of climate change will not be distributed equally, and Chile has emerged as one important, vulnerable area. The Chilean Patagonian region (41‒56°S) hosts two marine ecoregions that support robust blue economies via wild fisheries, aquaculture, and tourism. However, the harmful algal bloom-forming dinoflagellate Alexandrium catenella, a causative agent of paralytic shellfish poisoning outbreaks, threatens the viability of blue industries in this region and others worldwide. Despite the proliferation of A. catenella blooms over the last few decades, the role of sedimentary resting cysts in the recurrence of harmful algal blooms and the species' northward expansion across Chilean Patagonia is not well understood. As a resting cyst-producing species, the sediment-cyst dynamics of A. catenella likely contribute to the geographical expansion and bloom recurrence of this species. For this purpose, we analyzed a decade of A. catenella surface sediment cyst records across the two ecoregions of the Chilean Patagonian System that were further stratified into five subregions based on water temperature, salinity, dissolved oxygen, and nutrient characteristics. We also analyzed spatio-temporal cyst dynamics in a pre-, during-, and post-bloom scenario of the Chiloense ecoregion (more northern) of the Magellanic province. Our results indicated highly variable A. catenella resting cyst abundances, with a maximum of 221 cysts cm-3 recorded in 2002 after an intense bloom. Generalized linear mixed models and linear mixed models found that sampling season, subregion, and Total Organic Matter (%) explained resting cyst presence and density. The results also demonstrated the presence of A. catenella cysts in northern subregions, evidencing the northward geographical expansion observed during the last few decades. The risks of A. catenella bloom recurrence from small, patchy resting cyst distributions across broad geographical areas and under changing environmental conditions are discussed.

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Background: The use of heuristics in clinical decision-making processes increases in contexts of high uncertainty, such as those in Intensive Care Units (ICU. Given the impossibility of empirically studying their impact on real-world conditions, clinical vignettes were developed with the goal of identifying the use of heuristics in the care of critically ill patients during the COVID-19 pandemic in different clinical contexts. Methodology: Vignettes were designed by critical care physicians in Spain to assess the use of representativeness, availability, and status quo heuristics in the care of critically ill patients during the COVID-19 pandemic. The construct, internal and external validity of the vignettes designed in Spain, the United States and Chile were evaluated. A questionnaire was piloted with the vignettes being validated in the three aforementioned countries through a computer application built for this purpose. Results: 16 study vignettes grouped into 5 models were created: each model included between 2 and 4 vignettes. The vignettes designed were closed-response vignettes with 2-3 possible alternatives. The vignettes, initially developed in Spain in Spanish, were translated to English and adapted to the Spanish used in Chile. The clinical content of the vignettes was not modified during the translation process. Conclusions: The vignettes allow for the study of the use of heuristics in critical care clinical decision making in the context of the COVID-19 pandemic. The piloting and validation process used can serve as a model for similar multinational studies exploring clinical decision making.

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Dinophysis acuminata and D. acuta, which follows it seasonally, are the main producers of lipophilic toxins in temperate coastal waters, including Southern Chile. Strains of the two species differ in their toxin profiles and impacts on shellfish resources. D. acuta is considered the major cause of diarrhetic shellfish poisoning (DSP) outbreaks in Southern Chile, but there is uncertainty about the toxicity of D. acuminata, and little information on microscale oceanographic conditions promoting their blooms. During the austral summer of 2020, intensive sampling was carried out in two northern Patagonian fjords, Puyuhuapi (PUY) and Pitipalena (PIT), sharing D. acuminata dominance and D. acuta near detection levels. Dinophysistoxin 1 (DTX 1) and pectenotoxin 2 (PTX 2) were present in all net tow samples but OA was not detected. Although differing in hydrodynamics and sampling dates, D. acuminata shared behavioural traits in the two fjords: cell maxima (>103 cells L-1) in the interface (S ~ 21) between the estuarine freshwater (EFW)) and saline water (ESW) layers; and phased-cell division (µ = 0.3-0.4 d-1) peaking after dawn, and abundance of ciliate prey. Niche analysis (Outlying Mean Index, OMI) of D. acuta with a high marginality and much lower tolerance than D. acuminata indicated an unfavourable physical environment for D. acuta (bloom failure). Comparison of toxin profiles and Dinophysis niches in three contrasting years in PUY-2020 (D. acuminata bloom), 2018 (exceptional bloom of D. acuta), and 2019 (bloom co-occurrence of the two species)-shed light on the vertical gradients which promote each species. The presence of FW (S < 11) and thermal inversion may be used to provide short-term forecasts of no risk of D. acuta blooms and OA occurrence, but D. acuminata associated with DTX 1 pose a risk of DSP events in North Patagonian fjords.

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Harmful algal blooms of toxin-producing microalgae are recurrent in southern Chile. Paralytic shellfish poisoning (PSP) outbreaks pose the main threat to public health and the fishing industry in the Patagonian fjords. This study aims to increase understanding of the individual and spatial variability of PSP toxicity in the foot of Concholepas concholepas, Chile's most valuable commercial benthic invertebrate species, extracted from the Guaitecas Archipelago in Chilean Patagonia. The objective is to determine the effect of pigment removal and freezing during the detoxification process. A total of 150 specimens (≥90 mm length) were collected from this area. The live specimens were transferred to a processing plant, where they were measured and gutted, the foot was divided into two equal parts, and pigment was manually removed from one of these parts. The PSP toxicity of each foot (edible tissue) was determined by mouse bioassay (MBA) and high-performance liquid chromatography with fluorescence detection and postcolumn oxidation (HPLC-FLD PCOX). The individual toxicity per loco, as the species is known locally, varied from <30 to 146 µg STX diHCL eq 100 g−1 (CV = 43.83%) and from 5.96 to 216.3 µg STX diHCL eq 100 g−1 (CV = 34.63%), using MBA and HPLC, respectively. A generalized linear model showed a negative relation between individual weight and toxicity. The toxicological profile showed a dominance of STX (>95%), neoSTX and GTX2. The removal of pigment produced a reduction in PSP toxicity of up to 90% and could represent a good detoxification tool moving forward. The freezing process in the muscle with pigment did not produce a clear pattern. There is a significant reduction (p < 0.05) of PSP toxicity via PCOX but not MBA. Furthermore, the study discusses possible management and commercialization implications of the findings regarding small-scale fisheries.

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Harmful algal blooms (HABs) in southern Chile are a serious threat to public health, tourism, artisanal fisheries, and aquaculture in this region. Ichthyotoxic HAB species have recently become a major annual threat to the Chilean salmon farming industry, due to their severe economic impacts. In early austral autumn 2021, an intense bloom of the raphidophyte Heterosigma akashiwo was detected in Comau Fjord, Chilean Patagonia, resulting in a high mortality of farmed salmon (nearly 6000 tons of biomass) within 15 days. H. akashiwo cells were first detected at the head of the fjord on March 16, 2021 (up to 478 cells mL-1). On March 31, the cell density at the surface had reached a maximum of 2 × 105 cells mL-1, with intense brown spots visible on the water surface. Strong and persistent high-pressure anomalies over the southern tip of South America, consistent with the positive phase of the Southern Annular Mode (SAM), resulted in extremely dry conditions, high solar radiation, and strong southerly winds. A coupling of these features with the high water retention times inside the fjord can explain the spatial-temporal dynamics of this bloom event. Other factors, such as the internal local physical uplift process (favored by the north-to-south orientation of the fjord), salt-fingering events, and the uplift of subantarctic deep-water renewal, likely resulted in the injection of nutrients into the euphotic layer, which in turn could have promoted cell growth and thus high microalgal cell densities, such as reached by the bloom.

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Objective: To evaluate the association between chronic exposure to high altitude and the presence of coronary ectasia (CE) in patients with ST-segment elevation myocardial infarction (STEMI) treated in a highly specialized cardiovascular reference hospital in Peru. Materials and methods: Retrospective matched case-control study. The cases were patients with CE and controls without CE. The relationship between CE and chronic exposure to high altitude was evaluated considering intervening variables such as arterial hypertension, diabetes mellitus, dyslipidemia, smoking, and hematocrit values. Patients with chronic inflammatory pathologies, chronic obstructive pulmonary disease, and previous revascularization were excluded. Multivariate logistic regression was applied to obtain the OR value and their respective confidence intervals. Results: Eighteen cases and 18 controls were studied, most of them were men with an average age of 65 years. Thirty-six percent of the population came from high altitude; in this group 76.9% had coronary ectasia of the infarct-related artery. The mean hematocrit value was slightly higher in the high-altitude native (46 ± 7% versus 42 ± 5%, p=0.094). Multivariate conditional logistic regression did not find a significant relationship between exposure to high altitude and the risk of presenting CE (OR:6.03, IC95%: 0.30-118, p=0.236). Conclusions: In patients with STEMI, we found no association between chronic exposure to high altitude and coronary ectasia.

Objetivo: Evaluar la asociación entre la exposición crónica a gran altura y la presencia de ectasia coronaria (EC) en pacientes con infarto de miocardio con elevación del segmento ST (IAMCEST) tratados en un hospital de referencia de alta especialidad cardiovascular en Perú. Materiales y métodos: Estudio retrospectivo de casos y controles emparejados. Los casos fueron pacientes con EC y los controles sin EC. Se evaluó la relación entre EC y exposición crónica a la altura, teniendo en cuenta variables intervinientes como hipertensión arterial, diabetes mellitus, dislipidemia, tabaquismo y valores de hematocrito. Se excluyeron los pacientes con patologías inflamatorias crónicas, enfermedad pulmonar obstructiva crónica y revascularización previa. Se aplicó una regresión logística multivariable para obtener el valor OR y sus respectivos intervalos de confianza. Resultados: Se estudiaron 18 casos y 18 controles, la mayoría hombres con una edad media de 65 años. El 36% de la población procedía de zonas de gran altitud, de ellos, el 76,9% presentaba ectasia coronaria en la arteria responsable del infarto. El valor medio de hematocrito era ligeramente superior en los nativos de altitud (46 ± 7% frente a 42 ± 5%, p=0,094). La regresión logística condicional multivariable no encontró una relación significativa entre la exposición a gran altitud y el riesgo de presentar EC (OR:6,03, IC95%: 0,30-118, p=0,236). Conclusiones: En pacientes con IAMCEST no encontramos asociación entre la exposición crónica a gran altitud y la presencia de ectasia coronaria.

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ST-segment elevation myocardial infarction (STEMI) is a clinical entity whose adequate treatment will depend on its prompt recognition, accurate diagnosis, and management in reperfusion networks. The first contact with these patients is generally done in centers without reperfusion capacity, attended by non-cardiologist doctors, and in centers far from hospitals with greater resolution capacity, something that is well known in our country. This manuscript proposes a strategy for the diagnosis and treatment of STEMI in centers without percutaneous coronary intervention capacity of the public health system in Peru, emphasizing not losing sight of electrocardiographic patterns compatible with coronary artery occlusion, adequate fibrinolysis and management of its complications, the treatment of infarction in special populations and highlighting the importance of the pharmacoinvasive strategy as the main form of reperfusion treatment in our country.

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The impact of COVID-19 on agricultural markets, especially the beef market, represents one of the greatest food security challenges the world is facing in the post-pandemic era and, for this reason, has been widely documented. This study contributes to the literature through a comprehensive impact analysis of the effects of COVID-19 on both the demand and supply of beef in Latin America and thus provides valuable information for two of the most important links of the beef value chain. Robust econometric methods and a graphic analysis were used that give solidity to the investigation. The analysis used a data panel of supply and demand variables between 2018 and 2022 derived from the US Department of Agriculture. The results suggest that the beef market was strongly affected by the pandemic related health emergency, presenting decreases in both consumption and production. These effects are transitory, however, since the analysis of the post-pandemic data revealed that consumption and production return to normal and seem to grow until smoothing out over time.

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Abstract The deadly triad concept represented a dogma in the definition of poor outcomes and death associated with major bleeding in trauma. This model of end-stage disease was then rapidly transferred to other major bleeding scenarios. However, and notwithstanding the fact that it represented a severe scenario, the original triad fails to establish a sequence, which would be relevant when defining the objectives during the initial treatment of severe bleeding. Likewise, this model admits only one scenario where all the conditions shall co-exist, knowing that each one of them contributes with a different risk burden. Based on a structured review, we propose a pentad model that includes a natural pattern of events occurring with hypoxemia as the main trigger for the development of hypocalcemia, hyperglycemia, acidosis and hypothermia, as surrogates of multi-organ impairment. This severity model of major bleeding considers coagulopathy as a result of the failure to restore the initial components of damage.

Resumen El concepto de la tríada mortal significó un dogma en la definición de malos desenlaces y muerte asociados al sangrado mayor en trauma. Este modelo de afectación terminal fue luego rápidamente trasladado a otros escenarios de sangrado mayor. Sin embargo y a pesar de significar un escenario de gravedad, la tríada original falla en adjudicar una secuencialidad, lo cual sería importante a la hora de definir los objetivos durante el tratamiento inicial de la hemorragia grave. De igual forma, solo admite un único escenario en donde deben coexistir todas las condiciones, cuando se sabe que cada una atribuye una carga diferencial de riesgo. A partir de una revisión estructurada proponemos un modelo de pentada que incluye un patrón natural de eventos que se implantan sobre la hipoxemia como principal detonante para el desarrollo de hipocalcemia, hiperglucemia, acidosis e hipotermia como representantes del deterioro en múltiples sistemas. Este modelo de gravedad del sangrado mayor culmina con la coagulopatía como resultante de la falla en la resolución de los demás componentes previos.

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Harmful algal blooms, in particular recurrent blooms of the dinoflagellate Alexandrium catenella, associated with paralytic shellfish poisoning (PSP), frequently limit commercial shellfish harvests, resulting in serious socio-economic consequences. Although the PSP-inducing species that threaten the most vulnerable commercial species of shellfish are very patchy and spatially heterogeneous in their distribution, the spatial and temporal scales of their effects have largely been ignored in monitoring programs and by researchers. In this study, we examined the spatial and temporal dynamics of PSP toxicity in the clam (Ameghinomya antiqua) in two fishing grounds in southern Chile (Ovalada Island and Low Bay). During the summer of 2009, both were affected by an intense toxic bloom of A. catenella (up to 1.1 × 106 cells L-1). Generalized linear models were used to assess the potential influence of different environmental variables on the field detoxification rates of PSP toxins over a period of 12 months. This was achieved using a four parameter exponential decay model to fit and compare field detoxification rates per sampling site. The results show differences in the spatial variability and temporal dynamics of PSP toxicity, given that greater toxicities (+10-fold) and faster detoxification (20% faster) are observed at the Ovalada Island site, the less oceanic zone, and where higher amounts of clam are annually produced. Our observations support the relevance of considering different spatial and temporal scales to obtain more accurate assessments of PSP accumulation and detoxification dynamics and to improve the efficacy of fisheries management after toxic events.

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INTRODUCTION: ST-segment elevation myocardial infarction (STEMI) is the most severe clinical form of acute myocardial infarction, for which the current treatment consists of effective and timely myocardial reperfusion (within 12 hours of symptom onset). However, between 10% and 15% of patients with STEMI arrive at hospital facilities 12 hours after the onset of symptoms (late presentation). Therefore, the objective of the present study will be to determine if late revascularisation (12-72 hours after the onset of symptoms) affects the indicators of cardiovascular mortality, reinfarction, recurrent infarction, hospitalisation for heart failure and post infarction angina compared with no late revascularisation in patients with STEMI. METHODS AND ANALYSIS: A systematic literature search of PubMed, The Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Scopus and Global Health will be conducted. Publications in English, Portuguese or Spanish that report the clinical results of primary percutaneous revascularisation (primary PCI) in adult patients with STEMI 12-72 hours after the onset of symptoms will be included. Studies with participants with a diagnosis other than STEMI or patients with STEMI of >12 hours complicated by heart failure, cardiogenic shock or ventricular arrhythmias, and studies of combined interventions (pharmacoinvasive strategy) were excluded. Two independent authors will identify the relevant publications, and discrepancies will be adjudicated by a third author. Data extraction will be performed by two independent authors and verified by a third author. Risk of bias of studies will be assessed using the Cochrane 'risk of bias' tool (RoB 2) or Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool. If appropriate, a meta-analysis will be performed in order to examine the effect of late revascularisation in clinical outcomes of interest. ETHICS AND DISCUSSION: This study will use published data only, thus, ethical approval will not be required. The results will be disseminated through peer-reviewed publication and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42021283429.

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Harmful algal blooms (HABs) are recurrent in the NW Patagonia fjords system and their frequency has increased over the last few decades. Outbreaks of HAB species such as Alexandrium catenella, a causal agent of paralytic shellfish poisoning, and Protoceratium reticulatum, a yessotoxins producer, have raised considerable concern due to their adverse socioeconomic consequences. Monitoring programs have mainly focused on their planktonic stages, but since these species produce benthic resting cysts, the factors influencing cyst distributions are increasingly gaining recognition as potentially important to HAB recurrence in some regions. Still, a holistic understanding of the physico-chemical conditions influencing cyst distribution in this region is lacking, especially as it relates to seasonal changes in drivers of cyst distributions, as the characteristics that favor cyst preservation in the sediment may change through the seasons. In this study, we analyzed the physico-chemical properties of the sediment (temperature, pH, redox potential) and measured the bottom dissolved oxygen levels in a "hotspot" area of southern Chile, sampling during the spring and summer as well as the fall and winter, to determine the role these factors may play as modulators of dinoflagellate cyst distribution, and specifically for the cysts of A. catenella and P. reticulatum. A permutational analysis of variance (PERMANOVA) showed the significant effect of sediment redox conditions in explaining the differences in the cyst assemblages between spring-summer and fall-winter periods (seasonality). In a generalized linear model (GLM), sediment redox potential and pH were associated with the highest abundances of A. catenella resting cysts in the spring-summer, however it was sediment temperature that most explained the distribution of A. catenella in the fall-winter. For P. reticulatum, only spring-summer sediment redox potential and temperature explained the variation in cyst abundances. The implications of environmental (physico-chemical) seasonality for the resting cysts dynamics of both species are discussed.

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OBJECTIVE: The primary percutaneous coronary intervention (PPCI) is the preferred reperfusion strategy for ST-segment elevation myocardial infarction (STEMI). The pharmacoinvasive strategy (PIs) is a reasonable alternative when prompt PPCI is not possible, especially in resource-limited regions. We aimed to compare PPCI versus PIs outcomes in Peru. METHODS: This was a retrospective cohort study based on the second Peruvian Registry of STEMI (PERSTEMI II). We compared the characteristics, in-hospital outcomes and 30-day mortality of patients undergoing PPCI during the first 12 h and those receiving a PIs. A propensity score-matched analysis was conducted to compare the effects of each treatment strategy on clinical outcomes. RESULTS: PIs patients were younger than PPCI patients, had a shorter first medical contact time, first medical contact to reperfusion time, and total ischemic time until reperfusion. Successful PCI was more frequent in the PIs group (84.4% vs. 71.1%, p = 0.035). There were no differences between PIs and PPCI in terms of total in-hospital mortality (5.2% vs. 6.6%, p = 0.703), cardiovascular mortality (4.2% vs. 5.3%, p = 0.735), cardiogenic shock (8.3% vs. 13.2%, p = 0.326), heart failure (19.8% vs. 30.3%, p = 0.112), or major bleeding (0% vs. 2.6%, p = 0.194). In the propensity score-matched analysis, the rates of cardiovascular mortality, postinfarction heart failure and successful reperfusion were similar. CONCLUSIONS: In this real-world study, no differences were found in the in-hospital outcomes between patients with STEMI who received PIs or PPCI.

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