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During the COVID-19 crisis, the Chilean Ministry of Health and the Ministry of Sciences, Technology, Knowledge and Innovation partnered with the Instituto Sistemas Complejos de Ingeniería (ISCI) and the telecommunications company ENTEL, to develop innovative methodologies and tools that placed operations research (OR) and analytics at the forefront of the battle against the pandemic. These innovations have been used in key decision aspects that helped shape a comprehensive strategy against the virus, including tools that (1) provided data on the actual effects of lockdowns in different municipalities and over time; (2) helped allocate limited intensive care unit (ICU) capacity; (3) significantly increased the testing capacity and provided on-the-ground strategies for active screening of asymptomatic cases; and (4) implemented a nationwide serology surveillance program that significantly influenced Chile’s decisions regarding vaccine booster doses and that also provided information of global relevance. Significant challenges during the execution of the project included the coordination of large teams of engineers, data scientists, and healthcare professionals in the field; the effective communication of information to the population; and the handling and use of sensitive data. The initiatives generated significant press coverage and, by providing scientific evidence supporting the decision making behind the Chilean strategy to address the pandemic, they helped provide transparency and objectivity to decision makers and the general population. According to highly conservative estimates, the number of lives saved by all the initiatives combined is close to 3,000, equivalent to more than 5% of the total death toll in Chile associated with the pandemic until January 2022. The saved resources associated with testing, ICU beds, and working days amount to more than 300 million USD. Funding: This work was supported by the ANID PIA/APOYO [Grant AFB180003 and AFB220003], used to hire research assistants for developing solutions, information systems, data management, and training of field staff. Fieldwork was funded by the Ministry of Health of the Government of Chile. M. Goic acknowledges the financial support of Fondecyt [Project 1221711] and the Institute for Research in Market Imperfections and Public Policy [Grant IS130002 ANID]. D. Sauré acknowledges the financial support of Fondecyt [Project 1211407]. Finally, G. Weintraub and A. Carranza thank the Stanford RISE COVID-19 Crisis Response Faculty Seed Grant Program for helpful financial support.

Voluntary shelter-in-place directives and lockdowns are the main nonpharmaceutical interventions that governments around the globe have used to contain the Covid-19 pandemic. In this paper, we study the impact of such interventions in the capital of a developing country, Santiago, Chile, that exhibits large socioeconomic inequality. A distinctive feature of our study is that we use granular geolocated mobile phone data to construct mobility measures that capture (1) shelter-in-place behavior and (2) trips within the city to destinations with potentially different risk profiles. Using panel data linear regression models, we first show that the impact of social distancing measures and lockdowns on mobility is highly heterogeneous and dependent on socioeconomic levels. More specifically, our estimates indicate that, although zones of high socioeconomic levels can exhibit reductions in mobility of around 50%–90% depending on the specific mobility metric used, these reductions are only 20%–50% for lower income communities. The large reductions in higher income communities are significantly driven by voluntary shelter-in-place behavior. Second, also using panel data methods, we show that our mobility measures are important predictors of infections: roughly, a 10% increase in mobility correlates with a 5% increase in the rate of infection. Our results suggest that mobility is an important factor explaining differences in infection rates between high- and low-incomes areas within the city. Further, they confirm the challenges of reducing mobility in lower income communities, where people generate their income from their daily work. To be effective, shelter-in-place restrictions in municipalities of low socioeconomic levels may need to be complemented by other supporting measures that enable their inhabitants to increase compliance. This paper was accepted by David Simchi Levi, healthcare management.

Resumen: Objetivo: Establecer el valor diagnóstico del tiempo de duplicación (TD) en la evaluación de nódulos pulmonares sólidos. Método: Se revisó las tomografías computadas (TC) de pacientes derivados por nódulo pulmonar (NP) sólido, que contaran con TC comparativo previo o posterior, incluyendo sólo aquellas lesiones con confirmación histológica. Las metástasis fueron excluidas. Los TD fueron calculados con metodología 2D y 3D. Resultados: La muestra correspondió a 71 NP en 60 pacientes (mediana 68 años, 45-92 años, 59% hombres), 63 de ellos malignos (neoplasias primarias pulmonares) y 8 benignos. No hubo diferencias en las curvas ROC entre TD calculado mediante método 2D vs 3D. Para TD de entre 40 y 400 días, la sensibilidad, especificidad y valor predictivo negativo (VPN) fueron de 63,5%, 62,5% y 17,9%; y para TD de entre 20 y 600 días, de 80,9%, 37,5% y 20,0%. Conclusión: La medición del TD de un NP es de limitada utilidad al querer descartar su naturaleza maligna.

Purpose The aim of this study was to assess the efficacy and safety of Dentoxol mouthrinse in reducing the severity of oral mucositis (OM) secondary to radiation therapy (RT) for head and neck cancer. Methods A randomized, double-blind, placebo-controlled, multicenter phase II clinical trial was conducted. Subjects were asked to use Dentoxol (n = 55) or control (n = 53) mouthrinse 5 times/day during RT. Twice a week, OM was assessed clinically using the WHO scale and the Oral Mucositis Daily Questionnaire (OMDQ) was completed. Results The incidence of severe OM was 40.7% in the Dentoxol group and 51% in the control group (p = 0.265). Comparing all recorded clinical assessments, severe OM was seen in 13.3% of all assessments in the Dentoxol group vs. 21.8% in the control group (p = 0.000). There was a statistically significant lower proportion of assessments showing severe OM in the Dentoxol group at weeks 4, 5, and 6 of RT. The mean duration of severe OM was 11.95 days in the Dentoxol group vs. 14.59 days in the control group (p = 0.502). There was no difference between groups in mouth pain and its impact on function. The use of Dentoxol was safe and was not linked to any serious adverse events. Conclusion The use of Dentoxol 5 times/day is safe and resulted in significantly fewer time-points with severe OM and a delay in the onset of severe OM, compared with a control rinse. A phase III clinical trial is warranted to confirm efficacy and address the limitations of this study.

Atypical Fibroxanthoma is an unusual dermal mesenchymal tumor. It especially affects older adults and occurs in areas of sun exposure. We report a 75 years old male with a history of sun exposure without using a hat presenting with a scalp nodule. An incisional biopsy showed an atypical fibroxantoma. In a new surgical procedure, the tumor was completely excised. The tumor relapsed in two occasions after subsequent excisions and the patient was treated with adjuvant radiotherapy avoiding new relapses.

Background: Treatment of spine bone metastases with stereotactic radio-therapy (SBRT) may produce greater pain relief than palliative radiotherapy. Aim: To evaluate the analgesic response to SBRT. Material and Methods: A search was made in an electronic database of all patients treated by SBRT in our center. We found 20 patients that were treated with SBRT in the spine on 24 sites (lesions). Analgesic response was evaluated at 3 and 6 months after SBRT. Other factors such as age, sex, functional status, diagnosis, metastasis location, dosimetry and toxicity of the treatment were also described. Results: The median follow-up was 8.1 months. Complete pain relief occurred at three months in 74% of the treated sites. At three months, 78% of the patients presented a functional status 0 (ECOG). The median dose used was 24 Gy in 2 fractions. No cases of G3 or greater toxicity were recorded. Conclusions: The analgesic response to SBRT seems to be better than that reported for palliative radiotherapy.

Atypical Fibroxanthoma is an unusual dermal mesenchymal tumor. It especially affects older adults and occurs in areas of sun exposure. We report a 75 years old male with a history of sun exposure without using a hat presenting with a scalp nodule. An incisional biopsy showed an atypical fibroxantoma. In a new surgical procedure, the tumor was completely excised. The tumor relapsed in two occasions after subsequent excisions and the patient was treated with adjuvant radiotherapy avoiding new relapses.

Treatment of spine bone metastases with stereotactic radio-therapy (SBRT) may produce greater pain relief than palliative radiotherapy.To evaluate the analgesic response to SBRT.A search was made in an electronic database of all patients treated by SBRT in our center. We found 20 patients that were treated with SBRT in the spine on 24 sites (lesions). Analgesic response was evaluated at 3 and 6 months after SBRT. Other factors such as age, sex, functional status, diagnosis, metastasis location, dosimetry and toxicity of the treatment were also described.The median follow-up was 8.1 months. Complete pain relief occurred at three months in 74% of the treated sites. At three months, 78% of the patients presented a functional status 0 (ECOG). The median dose used was 24 Gy in 2 fractions. No cases of G3 or greater toxicity were recorded.The analgesic response to SBRT seems to be better than that reported for palliative radiotherapy.

El presente trabajo analiza la responsabilidad civil del Estado derivada de los daños causados a las personas por la ocurrencia de incidentes de ciberseguridad y que constituyan un incumplimiento al deber de seguridad en el tratamiento de datos personales, conforme el derecho chileno. Bajo el concepto de falta de servicio, se analizan los estándares de ciberseguridad que debe observar el Estado como responsable del tratamiento de datos personales, además del estándar de diligencia exigible al Estado en caso de incidentes que afecten a los sistemas informáticos utilizados para la provisión de dichos servicios públicos y que, como resultado, producen perjuicios para los titulares de datos personales.

Introduction. A high prevalence of hypogonadism (H) has been demonstrated in patients with metabolic syndrome (MetS). There are no studies in Latin America showing the prevalence of H in MetS in men below 60 years of age. The objective of this study was to determine the association between the MetS and levels of testosterone (T) and calculated free testosterone (cfT) in men under 60 years of age. Methodology. 101 men were included between 18 and 60 years who met the IDF MetS criteria. The diagnosis of H was considered Results. H with T was 17.8% and 20.7% with cfT. The H according to T had higher BMI, waist circumference, visceral fat, markers of insulin resistance, SHBG, LH, and E2. We find an inverse but weak significant correlation between T, visceral fat, and HOMA index. The linear regression analysis showed that E2 and visceral fat are determinants in H. Conclusion. We found a high prevalence of H using T and cfT in Chilean patients with MetS below 60 years of age, who turned out to be more insulin-resistant and have more visceral fat, waist, and E2 than non-H.

El síndrome de nariz vacía es una enfermedad de reciente descripción, que no tiene una definición clínica clara. Se puede originar como complicación de la cirugía de resección de cornetes, en especial del inferior. La fisiopatología no está del todo definida, pero es probable que posterior a la resección de cornetes se altere la permeabilidad nasal, interfiriendo con los mecanismos neurosensitivos y con las funciones de los cornetes. Su síntoma principal, es la obstrucción nasal paradójica. El diagnóstico es clínico, basado en los síntomas con los hallazgos de una cavidad nasal amplia posterior a la cirugía nasal. El tratamiento es difícil por lo subjetivo de los síntomas, prefiriendo en un comienzo el tratamiento médico y reservando la cirugía para casos más severos. Lo más importante es la prevención, realizando cirugías lo más conservadora posibles de la anatomía de la cavidad nasal.

In mammals, efferent projections to the cochlear receptor are constituted by olivocochlear (OC) fibers that originate in the superior olivary complex. Medial and lateral OC neurons make synapses with outer hair cells and with auditory nerve fibers, respectively. In addition to the OC system, there are also descending projections from the auditory cortex that are directed towards the thalamus, inferior colliculus, cochlear nucleus, and superior olivary complex. Olivocochlear function can be assessed by measuring a brainstem reflex mediated by auditory nerve fibers, cochlear nucleus neurons, and OC fibers. Although it is known that the OC reflex is activated by contralateral acoustic stimulation and produces a suppression of cochlear responses, the influence of cortical descending pathways in the OC reflex is largely unknown. Here, we used auditory cortex electrical microstimulation in chinchillas to study a possible cortical modulation of cochlear and auditory nerve responses to tones in the absence and presence of contralateral noise. We found that cortical microstimulation produces two different peripheral modulations: (i) changes in cochlear sensitivity evidenced by amplitude modulation of cochlear microphonics and auditory nerve compound action potentials and (ii) enhancement or suppression of the OC reflex strength as measured by auditory nerve responses, which depended on the intersubject variability of the OC reflex. Moreover, both corticofugal effects were not correlated, suggesting the presence of two functionally different efferent pathways. These results demonstrate that auditory cortex electrical microstimulation independently modulates the OC reflex strength and cochlear sensitivity.

Background: The Chilean Ministry of Health developed a healthy lifestyles intervention directed to adults with overweight and cardiovascular risk factors, called "Program on Healthy Eating and Physical Activity" (PASAF). Aim: To evaluate the impact of PASAF on nutritional status and metabolic parameters. Patients and Methods: We analyzed databases from three primary care centers belonging to a municipality of Metropolitan Santiago. We selected adults enrolled in the PASAF during three years (2007-2009). The program lasted four months and included an assessment of anthropometric and metabolic parameters at baseline and at the end, eight workshops with a nutritionist, seven with a psychologist and 32 sessions of physical activity. Result: We evaluated 526 subjects aged ≥ 18 years (93% females), of whom 85.6% attended the last appointment for assessment. Analyzing available data, attendance to workshops was < 50% of the scheduled sessions. Weight, body mass index and waist circumference decreased significantly (median: -1.4 kg, -0.6 kg/m² and -3 cm, respectively). The median weight loss was 1.8% of initial weight and 17.1% of participants experienced a decrease ≥ 5% of their initial weight. There were significant improvements in lipid levels and blood pressure among participants with lower initial excess weight. A reduction in fasting blood glucose was observed only among subjects who lost ≥ 5% of their initial weight. Conclusions: The PASAF modestly reduced nutritional parameters. Correction of metabolic parameters was especially effective in less obese subjects. The attendance to workshops was low.

72 1024x768 Background: A significant number of students in health careers do not have the knowledge to approve basic courses. Therefore, educational programs to level off knowledge have been developed. Aim : To associate the results of a leveling program with the academic performance in cell biology (CB) and biochemistry (BC) of first year medical students. Material and methods : We applied a test to first year medical students at the beginning and end of the leveling program (control test). The results obtained at the end of the leveling program were correlated with the results obtained in CB and BC. Results : Fifty seven of 89 (64%) first year medical students met the study entry criteria (54% female). Students who completed the leveling program had a significantly higher approval rate in CB (93% versus 75%, P = 0.024), and in BC (95% versus 69%, P = 0.001). After completing the leveling program, the risk of failing CB and BC, decreased by 72 and 84% respectively, Conclusions : This study shows that medical students who participate in the leveling program decrease the chances of failing in CB and BC. Normal 0 21 false false false ES X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tabla normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

El presente trabajo tiene como objetivo realizar una descripción de la vulnerabilidad de la Región Occidental del Paraguay, así como un análisis del rol que cumplen las mujeres y el potencial de adaptación que tienen para enfrentar los desafíos del cambio climático entorno al recurso agua. La revisión de literatura realizada permitió identificar que la principal causa de vulnerabilidad de la Región Occidental es el acceso al agua y como esta afecta a las condiciones de vida de los pobladores, se ha evidenciado el rol protagónico de la mujer como gestoras del recurso agua y el potencial de las mismas para construir capacidades que les permita adaptar sus medios de vida.

The Chilean Ministry of Health developed a healthy lifestyles intervention directed to adults with overweight and cardiovascular risk factors, called "Program on Healthy Eating and Physical Activity" (PASAF).To evaluate the impact of PASAF on nutritional status and metabolic parameters.We analyzed databases from three primary care centers belonging to a municipality of Metropolitan Santiago. We selected adults enrolled in the PASAF during three years (2007-2009). The program lasted four months and included an assessment of anthropometric and metabolic parameters at baseline and at the end, eight workshops with a nutritionist, seven with a psychologist and 32 sessions of physical activity.We evaluated 526 subjects aged ≥18 years (93% females), of whom 85.6% attended the last appointment for assessment. Analyzing available data, attendance to workshops was50% of the scheduled sessions. Weight, body mass index and waist circumference decreased significantly (median: -1.4 kg, -0.6 kg/m² and -3 cm, respectively). The median weight loss was 1.8% of initial weight and 17.1% of participants experienced a decrease ≥5% of their initial weight. There were significant improvements in lipid levels and blood pressure among participants with lower initial excess weight. A reduction in fasting blood glucose was observed only among subjects who lost ≥5% of their initial weight.The PASAF modestly reduced nutritional parameters. Correction of metabolic parameters was especially effective in less obese subjects. The attendance to workshops was low.

A significant number of students in health careers do not have the knowledge to approve basic courses. Therefore, educational programs to level off knowledge have been developed.To associate the results of a leveling program with the academic performance in cell biology (CB) and biochemistry (BC) of first year medical students.We applied a test to first year medical students at the beginning and end of the leveling program (control test). The results obtained at the end of the leveling program were correlated with the results obtained in CB and BC.Fifty seven of 89 (64%) first year medical students met the study entry criteria (54% female). Students who completed the leveling program had a significantly higher approval rate in CB (93% versus 75%, P = 0.024), and in BC (95% versus 69%, P = 0.001). After completing the leveling program, the risk of failing CB and BC, decreased by 72 and 84% respectively.This study shows that medical students who participate in the leveling program decrease the chances of failing in CB and BC.