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Ataxias are characterized by aberrant movement patterns closely related to cerebellar dysfunction. Purkinje cell axons are the sole outputs from the cerebellar cortex, and dysfunctional activity of Purkinje cells has been associated with ataxic movements. However, the synaptic characteristics of Purkinje cells in cases of ataxia are not yet well understood. The nicotinamide antagonist 3-acethylpyridine (3-AP) selectively destroys inferior olivary nucleus neurons so it is widely used to induce cerebellar ataxia. Five days after 3-AP treatment (65mg/kg) in adult male Sprague-Dawley rats, motor incoordination was revealed through BBB and Rotarod testing. In addition, in Purkinje cells from lobules V-VII of the cerebellar vermis studied by the Golgi method, the density of dendritic spines decreased, especially the thin and mushroom types. Western blot analysis showed a decrease in AMPA and PSD-95 content with an increase of the α-catenin protein, while GAD-67 and synaptophysin were unchanged. Findings suggest a limited capacity of Purkinje cells to acquire and consolidate afferent excitatory inputs and an aberrant, rigid profile in the movement-related output patterns of Purkinje neurons that likely contributes to the motor-related impairments characteristic of cerebellar ataxias.

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Objetivo: La litiasis biliar es una patología frecuente en Chile y el mundo, que suele presentarse como colecistocoledocolitiasis. Dentro de las alternativas para su manejo está el rendez-vous laparoendoscópico (RVLE), que consiste en una colecistectomía laparoscópica asociada a colangiopancreatografía endoscó-pica retrograda (ERCP). Este trabajo tiene como objetivo evaluar la implementación de esta técnica para el tratamiento de la colecistocoledocolitiasis en un hospital universitario. Materiales y Métodos: Cohorte retrospectiva de 4 años de pacientes con colecistocoledocolitiasis en quienes se realizó un RVLE. Resultados: Se incluyeron 296 pacientes, de edad promedio de 52 años, siendo un quinto mayor de 70 años, y presentando un 29,3% comorbilidades significativas. Un 65,2% fueron urgencias y un 12,2% presentó colangitis aguda. El éxito de la técnica fue de un 82,8%. Los cálculos mayores de 5 mm se asociaron al fracaso de ésta. La principal causa de fracaso fue el no paso de la guía hacia el duodeno (13,5%). La morbilidad, clínicamente significativa, fue de 9,5% y la mortalidad global a los 90 días fue de 0,68%. Discusión: El RVLE es un tratamiento eficaz para la colecistocoledocolitiasis en un tiempo quirúrgico, incluso en pacientes mayores de 70 años con comorbilidades, aunque con mayor morbilidad en colangitis aguda. La colangioresonancia magnética es útil en el diagnóstico y aporta información como el tamaño de los cálculos. El no paso de la guía es la principal causa de fracaso, pero se resuelve en la mayoría de los casos con una ERCP tradicional.

Objective: Gallstone disease is a common condition in Chile and worldwide, often manifesting as cholecystocholedocholithiasis. One of the treatment options is laparoendoscopic rendezvous (RVLE), involving laparoscopic cholecystectomy combined with endoscopic retrograde cholangiopancreatography (ERCP). This study aims to assess the effectiveness of this technique in managing cholecystocholedocholithiasis at a university hospital. Materials and Methods: A retrospective cohort study spanning four years was conducted on patients diagnosed with cholecystocholedocholithiasis who underwent RVLE. Results: The study included 296 patients, with an average age of 52 years. One-fifth of them were over 70 years old, and 29.3% had significant comorbidities. Of these cases, 65.2% were classified as emergencies, and 12.2% presented with acute cholangitis. The overall success rate of the RVLE procedure was 82.8%. Notably, the presence of gallstones larger than 5 mm was associated with a higher likelihood of procedure failure. The primary reason for failure was the inability of the guidewire to advance into the duodenum (13.5%). Clinically significant morbidity occurred in 9.5% of cases, and the overall mortality rate at 90 days was 0.68%. Discussion: RVLE is an effective treatment for cholecystocholedocholithiasis within a single surgical intervention, even in patients over 70-years-old with comorbidities. However, it is important to note that the procedure is associated with increased morbidity when performed in cases of acute cholangitis. Magnetic resonance cholangiopancreatography serves as a valuable diagnostic tool, providing insights into stone size. The most common cause of procedure failure is the inability of the guidewire to pass through, although this issue can often be resolved with a traditional ERCP.

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We aimed to develop and validate caries prognosis models in primary and permanent teeth after 2 and 10 y of follow-up through a machine learning (ML) approach, using predictors collected in early childhood. Data from a 10-y prospective cohort study conducted in southern Brazil were analyzed. Children aged 1 to 5 y were first examined in 2010 and reassessed in 2012 and 2020 regarding caries development. Dental caries was assessed using the Caries Detection and Assessment System (ICDAS) criteria. Demographic, socioeconomic, psychosocial, behavioral, and clinical factors were collected. ML algorithms decision tree, random forest, and extreme gradient boosting (XGBoost) were employed, along with logistic regression. The discrimination and calibration of models were verified in independent sets. From 639 children included at the baseline, we reassessed 467 (73.3%) and 428 (66.9%) children in 2012 and 2020, respectively. For all models, the area under receiver operating characteristic curve (AUC) at training and testing was above 0.70 for predicting caries in primary teeth after 2-y follow-up, with caries severity at the baseline being the strongest predictor. After 10 y, the SHAP algorithm based on XGBoost achieved an AUC higher than 0.70 in the testing set and indicated caries experience, nonuse of fluoridated toothpaste, parent education, higher frequency of sugar consumption, low frequency of visits to the relatives, and poor parents' perception of their children's oral health as top predictors for caries in permanent teeth. In conclusion, the implementation of ML shows potential for determining caries development in both primary and permanent teeth using easy-to-collect predictors in early childhood.

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PURPOSE: A controlled study evaluated the effect of condensed tannins (CT) from Gymnopodium floribundum leaf meal (GF), infection with Haemonchus contortus (I) and their interaction, on feed intake, diet digestibility and retention of N (NR) and energy (ER) in hair sheep lambs. METHODS: Thirty-six, worm-free hair sheep lambs (14.9 ± 1.56 kg body weight) were housed in metabolic cages. Eighteen animals were infected with 6000 H. contortus L3, while other 18 lambs were kept non-infected. On day 28th post-infection (PI), infected lambs were assigned to three diet groups: a diet without GF (I-NONGF), a diet with GF (I + GF) and a diet with GF + polyethylene glycol (PEG) (I + GF + PEG). Non-infected (NI) lambs were assigned to similar diet groups: NI-NONGF, NI + GF and NI + GF + PEG. The packed cell volume (% PCV), ante-mortem faecal egg counts and post-mortem worm burdens were also evaluated. RESULTS: Infection did not affect digestibility, NR and ER. Meanwhile, CT intake from the GF diet reduced the digestibility of dry matter, organic matter and crude protein, as well as NR, compared to lambs consuming the NONGF and GF + PEG diets (P < 0.05). Although, the digestible energy was similar between lambs consuming NONGF and GF + PEG diets, the ER was higher for lambs consuming the control NONGF diet. Diets did not affect the PCV, or the ante-mortem and post-mortem parasitological variables. CONCLUSION: The costs on N and energy metabolism were mainly associated with the CT content of the GF diet, but other features of the diet such as the high lignin content, seemed to affect animals consuming GF meal. Meanwhile, the H. contortus infection had a non-significant impact.

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INTRODUCTION: The pregnancy period represents the most intense period of growth and development. Pre-pregnancy weight influences weight gain during pregnancy. Leptin is a hormone mainly derived from white adipose tissue, during pregnancy leptin is also produced by the placenta. It has been suggested that the effects of placental leptin on the mother may contribute to endocrine-mediated alterations in energy balance; a dysregulation in leptin levels or its receptors may lead to poor birth outcomes. Therefore, the main goal of the present study was to analyze the differences in birth outcomes by maternal weight with the expression level of leptin receptor in maternal peripheral blood mononuclear cell (PBMC) and placental tissue. METHODS: Women with full-term gestation and its offspring were enrolled. Total RNA from maternal PBMC and placenta was obtained to perform the analysis of expression of the leptin receptor (LEPR) gene trough real-time PCR technique. Data were analyzed using one-way ANOVA or Mann-Whitney u test when applicable. Pearson correlation coefficient was used to determine the relationship between continuous variables (Stata v.13); p ≤ 0.05 was considered statistically significant. RESULTS: No statistically significant differences were found between LEPR expression level and the BMI studied groups in maternal PBMC and placental tissue. Interaction between gestational weight gain (GWG) and LEPR in maternal PBMC explain in a 32% the variability of the newborn weight. CONCLUSIONS: LEPR expression level in maternal PBMC correlates with newborn measurements independent from sex. GWG can affect fetal development by increasing fetal birth weight.

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Resumen La infección por SARS-CoV-2 (y la enfermedad causada por este virus: COVID-19), es de menor frecuencia y gravedad en pediatría. La naturaleza de esto sigue siendo motivo de análisis. No obstante, los niños tienen la potencialidad de infectarse, enfermarse y de transmitir la infección a otras personas. Este artículo revisa lo conocido hasta el momento acerca de epidemiología, etiopatogenia, cuadro clínico, diagnóstico y tratamiento de COVID-19 en niños.

SARS-CoV-2 infection (and the disease it causes: COVID-19), is less frequent and milder in the pediatric population. The reasons behind this milder clinical expression are under investigation. Nevertheless, children are still susceptible to be infected, to develop symptoms and disease, and to transmit the virus. In this article, we review the information about COVID-19 in children, including epidemiology, etiopathogenesis, diagnostic approach, clinical outcomes and treatment.

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The aim of this study was to analyzing the impact of germination time on the morphology, crystallinity, gelatinization and viscosity properties on the starch of Esmeralda and Perla barley variety. The two barley were germinated for 1 to 8 days, at 26 °C and 65% relative humidity. Micrographs showed the presence of pinholes and eroded surfaces. Starch in Esmeralda was hydrolyzed completely at 8 days of germination. Birefringence was reduced from day 4, losing molecular structuring of the crystalline area. Morphometric data: fractal dimension, area, perimeter, circularity, and roundness decreased significantly along germination time in both varieties. The entropy increased significantly, from 0.79 to 10.09 in Esmeralda and from 0.46 to 7.57 in Perla. Relative crystallinity decreased significantly in the Perla from 24.7% to 23.6%. Viscosity peaks were also significantly reduced, pasting temperature was constant in Esmeralda but in Perla was significantly reduced from 95.43 to 95.19 °C with germination, the gelatinization temperature increased significantly in the Esmeralda while in Perla it remained constant. Enthalpy decreased significantly to 75.8% and 37% in Esmeralda and Perla respectively. The study of germination impact on structural and physicochemical properties is important to identify the use of hydrolyzed starches in the food industry or others.

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Respiratory viral infections in the pediatric age are a frequent cause of morbidity. Advances in diagnostic techniques have allowed the identification of new agents, but Respiratory Syncytial Virus (RSV) continues to be the predominant agent in infants. The low physiological reserve that infants have can lead to claudication and the need for ventilatory support. Some patients develop severe acute respiratory distress syndrome (ARDS) that does not respond to oxygen therapy, noninvasive ventilation (NIV), invasive ventilation (IV) and high frequency ventilation (HFV) and require the support of extracorporeal membrane oxygenation (ECMO). . Currently associated mortality is less than 1% and 5% for patients with associated comorbidities. In the present work, the epidemiology, etiology, pathophysiology and management of infants who develop severe pneumonia of viral origin will be described.

Las Infecciones virales respiratorias en la edad pediátrica son una causa frecuente de morbilidad. Los avances en las técnicas diagnósticas han permitido identificar nuevos agentes, pero Virus Respiratorio Sincicial (VRS) sigue siendo el agente preponderante en lactantes. La baja reserva fisiológica que poseen los lactantes, puede llevar a claudicación y necesidad de soporte ventilatorio. Algunos pacientes desarrollan síndrome de dificultad respiratoria aguda (SDRA) grave que no responde a oxigenoterapia, ventilación no invasiva (VNI), invasiva (VI) y ventilación de alta frecuencia (VAF) y requieren del soporte de la Oxigenación de membrana extracorpórea (ECMO). La mortalidad asociada en la actualidad es menor al 1% y de 5% para los pacientes que presentan comorbilidades asociadas. En el presente trabajo se describirá la epidemiología, etiología, fisiopatología y manejo de los lactantes que desarrollan neumonía grave de origen viral.

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INTRODUCTION AND AIM: Mantle cell lymphoma is an aggressive subtype of B-cell non-Hodgkin lymphoma and its incidence is 0.5/100,000 inhabitants. Gastrointestinal involvement at diagnosis is 15-30%. The aim of our study was to analyze the clinical and endoscopic characteristics of mantle cell lymphoma affecting the digestive tract. MATERIAL AND METHODS: A retrospective study was conducted, based on a case series of patients with mantle cell lymphoma affecting the gastrointestinal tract that were diagnosed over a 10-year period. RESULTS: Ten patients (11.7%) had gastrointestinal tract involvement. The upper endoscopic findings were polypoid lesions (66%), thickened folds (44%), and nonspecific changes in the mucosa (33%). At colonoscopy, polypoid lesions were viewed in 100% of the patients and ulcerated lesions in 40%. CONCLUSION: Polypoid lesions are the most common endoscopic characteristics in patients with mantle cell lymphoma of the gastrointestinal tract. Upper endoscopy and colonoscopy should be carried out on patients with mantle cell lymphoma, even those with nonspecific symptoms, to check their gastrointestinal status. Gastrointestinal involvement has an impact on disease staging.

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Objetive: To assess the effect of the hydrodissection on operative morbidity and operative time in patients undergoing vaginal surgery for pelvic organ prolapse. Material and methods: Experimental, prospective, longitudinal, comparative, randomized study: randomized controlled clinical. Randomly, 44 patients were assigned to receive management hydrodissection with epinephrine (Group 1= 22) or not hydrodissection (Group 2= 22) prior to the start of the surgical procedure. The variables analyzed were operative morbidity (defined as infection, hematoma and surgical postoperative bleeding requiring transfusion) and surgical time required to complete the procedure. Results: The average age was 58.1 years (± 9.3) in the group of hydrodissection and 63.0 years (± 10.6) in the group without hydrodissection (p = .111). The frequency of postoperative complications was similar enters both groups (p> .05) presenting only one case of postoperative hematoma in Group 1 and none in Group 2. The operative bleeding was significantly lower in the hydrodissection group (240.9 ± 111.9 mL) compared with the group of non hydrodissection (324.1 ± 104.9 mL). No significant difference in operative time was found (p = 0.67) compared with 135.5 (± 22.6) minutes in Group 1 and 139.3 (± 32.5) minutes. Conclusion: Hydrodissection with epinephrine compared with non Hydrodissection significantly reduces operative bleeding but no differences in operative morbidity and operative time in patients undergoing vaginal surgery in the management of pelvic organ prolapse.

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Suicide attempts in children are an important worldwide cause of morbidity and mortality and an emerging reason for admission in Pediatric Critical Care. Objective: Identify the epidemiologic and clinical characteristics of patients with drug poisoning with a suicide purpose as an admission cause in a Chilean Pediatric Intensive Care Unit (PICU). Design: Retrospective observational study. Setting: 14 beds PICU of a tertiary care public teaching hospital in Santiago de Chile. Material and Method: All patients admitted to the PICU between January 2005 and December 2008 for self-inflicted drug poisoning with an expressed intention of suicide were included. Analysis of the PICU clinical chart was performed with sampling on an excel data base. For seasonal distribution we used statistical analysis Xil. Results: 178 of 3045 PICU admissions were diagnosed as drug poisoning (5,8 percent), 108 of them for suicide attempts (60,6 percent).The number of annual patients increased, with highest incidence in spring and autumn and lowest in winter. Mean and median age was 13 years, 8,4 percent less than 12 years. 88,9 percent were females. They used polipharmacy in 57 percent. Drugs were taken from home. Antidepressants and sedatives were the most often used. An underlying psychiatric condition was present in 100 cases (92,6 percent). Associated factors were family disfunction, school problems, abuse and violation and bullying. Mean PICU stay was 1,46 days with 16,7 percent requiring transient mechanical ventilation No death was reported in this serie. Conclusions: The number of cases of suicide attempt via drug ingestion as a motive for admission in PICU is increasing, causing a raising number of short and transient admissions, more in spring less in winter. Risk factors were mostly an underlying psychiatric disorder and family disfunction.

Introducción: El intento de suicidio en pediatría, via ingestión de fármacos, es una importante causa de mor-bimortalidad en el mundo y un creciente motivo de ingreso a cuidados intensivos. Objetivo: Identificar las características clínicas y epidemiológicas de los pacientes con intoxicación por fármacos con un intento de suicidio, como causa de ingreso a una Unidad de Cuidados Intensivos Pediátricos en Chile (UC1P). Diseño: Estudio retrospectivo observacional. Pacientes y Método: UClP de 14 camas críticas en un hospital pediátrico de Santiago. Se incluyeron todos los pacientes ingresados a la UClP debido a intento de suicidio por ingestión de fármacos, entre enero 2005 a diciembre 2008. Resultados: 178 de 3 045 egresos se debieron a intoxicación por fármacos (5,8 por ciento) ,108 de ellos por intento de suicidio (60,6 por ciento). La tendencia observada es a un incremento anual, con mayor incidencia en primavera y otoño, y menor en invierno. La media y mediana de edad fue de 13 años, 8,4 por ciento menor de 12 años. 88,9 por ciento fueron mujeres, Se utilizó polifarmacia en un 57 por ciento con fármacos disponibles en el hogar. Antidepresivos y sedantes fueron los más usados. Patología psiquiátrica de base se diagnosticó en un 92,6 por ciento de los casos. Factores asociados fueron disfunción familiar, problemas en el colegio, abuso y violación, bullying. La estadía promedio en UClP fue de 1,5 días, requiriendo un 16,7 por ciento ventilación mecánica transitoria. No hubo fallecidos en esta serie. Conclusiones: El intento de suicidio por ingestión de fármacos como motivo de ingreso a UClP ha aumentado, requiriendo estadías cortas y transitorias, mayormente en primavera y menos en invierno. Factores asociados fueron patología psiquiátrica de base y disfunción familiar.

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Carotid body type-I cells respond to acute hypoxia with membrane depolarization and calcium-dependent neurotransmitter release. The inhibition of a TASK-like background potassium channels plays a key role in initiating this response. Chronic hypoxia enhances the carotid body chemosensory responses evoked by acute hypoxia, however the accurate mechanism by which chronic hypoxia increases carotid body reactivity is not clear. Therefore, we investigated the effects of chronic hypoxia upon TASK-like currents in isolated type-I cells. Carotid bodies were excised from anaesthetized newborn Sprague-Dawley rats and dissociated by collagenase-trypsin digestion. Isolated cells were maintained under 5% CO(2) in normoxic (21% O(2)) or hypoxic (1-2% O(2)) environment for 24 and 48 hours. Channel activity (NPo) was recorded using the cell-attached configuration of the patch-clamp technique. In normoxic and 24 hours hypoxic cultured cells, acute hypoxic stimuli decreases NPo approximately 70% with no effects on current amplitude. On the other hand, in cultured cells subjected to 48 hours of hypoxia, NPo decreases near to 90% in response to acute hypoxia. We concluded that continuous hypoxic exposure enhances the TASK-like channel activity inhibition in response to acute hypoxia. Our results provide a potential mechanism by which chronic hypoxia increases carotid body reactivity.

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We conducted a cross-sectional study in northwest Mexico in order to investigate the association between giardiasis and serum vitamin A in 40 Giardia-infected and 70 Giardia-free schoolchildren who were covered by a regional school breakfast program. There were no significant differences in age, Z-scores for nutritional indices of height for age, weight for age, or weight for height, socioeconomic conditions (employment and education of the parents, household conditions, sanitation facilities, type of drinking water, and family income), and mean daily intakes of vitamin A in the Giardia-free (899 +/- 887 microg) and the Giardia-infected (711 +/- 433 microg) groups. A higher concentration of serum retinol was found in the Giardia-free group than in the Giardia-infected group (0.75 micromol/L versus 0.61 micromol/L, respectively; p < 0.0001). Giardia-infected children were more likely to be vitamin A-deficient than the Giardia-free children (OR = 3.2; 95% CI = 1.2-8.5). Although 95% of the children met the daily-recommended intakes of vitamin A, half of them showed subclinical vitamin A deficiency. It is recognized that vitamin A deficiency is multifactorial and giardiasis was a factor significantly associated with this deficiency in this study. Mexican program developers and policymakers should be aware about the distinction between dietary deficiencies and deficiency diseases when current national program strategies for parasitic control and vitamin A supplementation are redesigned.

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The prepubic congenital sinus is a rare type of urethral duplication of unknown origin. Different embryological theories and classifications has been proposed. Most cases are diagnosed during childhood. The Retrograde Urethrocystography is very important as it determines the diagnosis and helps choosing the best treatment option. We present a case of a prepubic congenital sinus in a 39 years old male who presented with purulent discharge from an accessory meatus in the base of the penis.

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Objetivos: Describir patologías obstétricas asociadas, manejo perinatal y pronóstico neonatal del recién nacido de muy bajo peso al nacer (RNMBPN). Método: Estudio transversal efectuado en el Hospital de Puerto Montt, Chile, en 347 RNMBPN, en el periodo 2000 - 2005. Resultados: La incidencia de RNMBPN fue de 1,59 por ciento. El 70 por ciento de las pacientes recibió corticoides prenatales. La principal causa de interrupción fue el síndrome hipertensivo del embarazo. El 68,5 por ciento de los partos fueron por cesárea. El 23,7 por ciento y 9,3 por ciento presentó depresión neonatal severa al minuto y cinco minutos de vida, respectivamente. La cesárea se asoció a una reducción significativa del riesgo de depresión neonatal severa y muerte neonatal. Las principales complicaciones neonatales fueron el síndrome de dificultad respiratoria (61,5 por ciento) y sepsis neonatal (24,7 por ciento). El 29,7 por ciento de los recién nacidos fallece. Las causas de muerte son la prematurez (44,7 por ciento), las infecciones (30,1 por ciento) y las malformaciones congénitas (14,6 por ciento). Conclusiones: En nuestro centro el manejo los RNMBPN presentó un aumento significativo del uso de corticoides antenatales, de surfactante y asistencia ventilatoria con CPAP nasal. Hubo una reducción significativa de la depresión neonatal severa a los 5 minutos de vida. La sobrevida neonatal presentó un aumento significativo en el cuartil de 500 a 749 gramos. La cesárea se asocia a una disminución significativa de la depresión neonatal severa y muerte neonatal.

Objective: To describe obstetric morbidity, perinatal management and neonatal outcome in very low birth weight new born (VLBWNB). Method: Cross-sectional study in the Puerto Montt Hospital in 347 VLBWNB, from 2000 to 2005. Results: The VLBWNB incidence was 1.59 percent. 70 percent of the patients received prenatal corticoids. The main cause of interruption was hypertensive disorders; 68.5 percent of births were by caesarean delivery; severe neonatal depression occurred in 23.7 percent and 9.3 percent by Apgar score at one and five minutes respectively. The caesarean delivery Odds ratio for severe neonatal depression and neonatal death was 0.41 (IC 95 percent=0.25-0.70) and 0.43 (IC 95 percent=0.26-0.70), respectively. The main neonatal complications were respiratory distress syndrome (61.5 percent) and neonatal sepsis (24.7 percent), 29.7 percent of the new born died. The main mortality causes were prematurity (44.7 percent), infections (30.1 percent) and malformations (14.6 percent). Conclusions: At the evaluated period, the management of VLBWNB at our hospital presents a significant increment in antenatal corticoids administration, surfactant and nasal CPAP use. Also presents a significant reduction of severe neonatal depression at five minutes in Apgar score. The neonatal survival shows a significant increment in 500 to 749 g of birth weight cuartil. Caesarean section was associated with significant diminution of severe neonatal depression and neonatal death in VLBWNB.

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INTRODUCTION: Upper gastrointestinal bleeding is a common cause of medical attention, with a mortality in Mexico of 8.5%. Our main objective was to determine the association of this pathology with cardiac conduction disturbances and other clinical variables. MATERIAL AND METHODS: We reviewed the electrocardiograms and files of patients attended for acute upper gastrointestinal bleeding at the Internal Medicine Service of the National Medical Center "20 de Noviembre", they must have had a previous normal electrocardiogram; excluding those with severe hemorrhage, this means, presented with hypotension managed with intravenous fluids and/or vasoactive drugs. Statistical analysis was performed using the SPSS10 program. RESULTS AND CONCLUSIONS: 56 patients were included, 34 women and 22 men; 60.7% were older than 70 years. We report an association between acute upper gastrointestinal bleeding and electrocardiographic changes, principally right bundle branch block in 30.35% of cases.

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