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The skin of fish is a physicochemical barrier that is characterized by being formed by cells that secrete molecules responsible for the first defense against pathogenic organisms. In this study, the biological activity of peptides from mucus of Seriola lalandi and Seriolella violacea were identified and characterized. To this purpose, peptide extraction was carried out from epidermal mucus samples of juveniles of both species, using chromatographic strategies for purification. Then, the peptide extracts were characterized to obtain the amino acid sequence by mass spectrometry. Using bioinformatics tools for predicting antimicrobial and antioxidant activity, 12 peptides were selected that were chemically produced by simultaneous synthesis using the Fmoc-Tbu strategy. The results revealed that the synthetic peptides presented a random coil or extended secondary structure. The analysis of antimicrobial activity allowed it to be discriminated that four peptides, named by their synthesis code 5065, 5069, 5070, and 5076, had the ability to inhibit the growth of Vibrio anguillarum and affected the copepodite stage of C. rogercresseyi. On the other hand, peptides 5066, 5067, 5070, and 5077 had the highest antioxidant capacity. Finally, peptides 5067, 5069, 5070, and 5076 were the most effective for inducing respiratory burst in fish leukocytes. The analysis of association between composition and biological function revealed that the antimicrobial activity depended on the presence of basic and aromatic amino acids, while the presence of cysteine residues increased the antioxidant activity of the peptides. Additionally, it was observed that those peptides that presented the highest antimicrobial capacity were those that also stimulated respiratory burst in leukocytes. This is the first work that demonstrates the presence of functional peptides in the epidermal mucus of Chilean marine fish, which provide different biological properties when the fish face opportunistic pathogens.

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Background: Juvenile nasoangiofibroma (JNA) is a rare, highly vascular, locally aggressive benign tumor which affects male adolescents. It accounts for 0.05-0.5% of head and neck tumors with recurrence rates of 6-50%. The internal maxillary artery is the main source of JNA. Objective: To evaluate the relationship between vascular supply as a factor associated with JNA recurrence. Material and methods: An cohort study was performed in patients diagnosed with NAJ. We collected demographic data, vascular contribution by angiography and tomography results to classify them according to their stage (Radkowski classification), and if they received adjuvant radiotherapy. Post-surgical CT scans were requested to evaluate recurrence and if any of the variables were related to this. Results: A sample of 14 male patients who met the inclusion criteria was collected. The mean age was 14.71 ± 4.08 years. According to Radkowski classification, stage IA, IIA and IIC were reported in 14.3%, IIB and IIB in 7.1% and IIIA in 42.9%. 42.9% had recurrence and out of these, 66.7% had irrigation of the right carotid system and the same percentage of patients received radiotherapy as adjuvant treatment. Conclusions: There is a tendency in tumor recurrence associated with vascular contribution from the right carotid system, as well as with patients who received radiotherapy.

Introducción: el nasoangiofibroma juvenil (NAJ) es un tumor benigno, raro, altamente vascular y localmente agresivo que afecta a adolescentes del sexo masculino. Representa de 0.05 a 0.5% de los tumores de cabeza y cuello con tasas de recurencia del 6-50%. La arteria maxilar interna se considera el principal aporte de los NAJ. Objetivo: evaluar la relación entre el aporte vascular como factor asociado con la recurrencia de NAJ. Material y métodos: se realizó un estudio de cohorte en pacientes con diagnóstico de NAJ. Se recabaron datos demográficos, el aporte vascular por resultados de angiografía y de tomografía para clasificarlos según su estadio (clasificación de Radkowski), y si recibieron radioterapia adyuvante. Se solicitaron tomografías postquirúrgicas para evaluar la recurrencia y si alguna de las variables tiene relación con esta. Resultados: se recolectó una muestra de 14 pacientes del sexo masculino que cumplieron con los criterios de inclusión. La edad promedio fue de 14.71 ± 4.08 años. Según la clasificación de Radkowski, se reportó un estadio IA, IIA y IIC en 14.3%, IIB y IIB en un 7.1% y IIIA en 42.9%. El 42.9% tuvo recurrencia y de estos, el 66.7% tenía irrigación del sistema carotídeo derecho y recibieron radioterapia como tratamiento adyuvante el mismo porcentaje de pacientes. Conclusiones: existe una tendencia en la recurrencia del tumor asociada al aporte vascular proveniente del sistema carotídeo derecho y también a los pacientes que recibieron radioterapia.

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Interventions that address adolescent conduct problems are essential for decreasing negative risk behaviors and promoting positive protective factors among youth. Although interventions have been developed and tested in the United States, preventive evidence-based interventions (EBIs) are less available in Latin American countries such as Ecuador. Therefore, the purpose of this study was to evaluate the efficacy of an evidence-based, parent-centered intervention, Familias Unidas, in preventing/reducing conduct problems, across time, among youth in Guayaquil, Ecuador. Ecuadorian youth (ages 12 through 14) and their respective primary caregiver were recruited from two public schools and randomized to either Familias Unidas or Community Practice. A series of latent growth models were run to test for differences between Familias Unidas and Community Practice on conduct disorder symptoms across three timepoints covering 6 months. Ecuadorian mental health professionals were trained to deliver the evidence-based intervention. Findings indicate no direct relationship between condition and average change in conduct problems at 6 months post baseline. However, indirect effects favoring Familias Unidas over Community Practice were found through improvements in family functioning. Findings highlight that Familias Unidas was efficacious in an international setting and indicate the viability of successfully delivering preventive EBIs in Ecuador.

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Several methods have been described to shorten orthodontic treatments, but the main disadvantage is their invasiveness. Animal studies have shown that piezopuncture can accelerate the rate of tooth movement without causing collateral damage. Objective: To evaluate the clinical outcome, in terms of safety and efficacy, of a flapless piezopuncture on maxillary canine distalization. Methods: A split-mouth randomized clinical trial was carried out on five patients. Piezopuncture was performed on a random side of the maxillary arch to assess the rate of canine movement on the stimulated side, compared to the non-stimulated control side after 15 (T1), 30 (T2), and 60 (T3) days. Also, immediate side effects and changes in buccal bone thickness after one year were assessed. Results: Distalization on the intervention versus control side at T1 was 1.24±0.21mm versus 0.64±0.33mm (p=0.005); at T2 it was 2.00±0.28mm versus 1.36±0.49mm (p=0.046); and at T3 it was 4.28±0.66mm versus 3.65±0.88mm (p=0.102). No adverse effects related to the surgical procedure were observed or reported by patients. The thickness of the buccal bone plate showed no significant changes. Conclusions: Flapless piezopuncture accelerates the rate of tooth movement in orthodontic patients over the first 15 days and its effect declines over the next 45 days.

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Electronic cigarettes had become a public health concern, generating the need of having standardized instruments to evaluate the consequences of their use. Objective: The goal of this study was to adapt and evaluate the validity and reliability of the Electronic Cigarette Dependence Index (ECDI) to a Colombian sample. Method: In this instrumental quantitative research, the instrument was adapted to the Spanish language, evaluated by expert judges and contested by 128 adult regular electronic cigarettes users. Results: The results suggest a single factor structure with reliable goodness of fit measures and values of internal consistency between acceptable and adequate. Conclusion: These results suggest the ECDI as a valid and reliable index to be used in Colombian samples.

El consumo de cigarrillo electrónico se ha convertido en un problema de salud publica, lo que ha generado la necesidad de contar con instrumentos estandarizados que evalúen las consecuencias de su uso. Objetivo: El objetivo del presente estudio fue adaptar y evaluar las condiciones de validez y confiabilidad del Índice de Dependencia del Cigarrillo Electrónico (IDCE) en una muestra de adultos colombianos. Método: Se realizó una investigación de tipo cuantitativa instrumental, en la cual el instrumento fue adaptado al español, evaluado por jueces y aplicado a 128 consumidores de cigarrillo electrónico. Resultados: El análisis factorial confirmatorio muestra una estructura unifactorial, con adecuados índices de bondad de ajuste, que concuerda con la propuesta teórica, y se hallan valores de consistencia interna entre aceptables y adecuados. Conclusión: Los resultados permiten indicar que el índice de dependencia del cigarrillo electrónico es una escala válida y confiable para ser utilizada en adultos colombianos.

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Objetivo: Determinar la asociación entre los valores de glicemia y mortalidad en la Unidad de Cuidados Intensivos Pediátricos (UCIP) del Hospital de Emergencias Pediátricas. El estudio: Estudio de cohorte retrospectivo, en pacientes pediátricos entre 1 mes y 18 años; hospitalizados en la UCIP del Hospital de Emergencias Pediátricas por más de 48 horas, durante el año 2016. Hallazgos: Se incluyeron 184 pacientes. La mediana de edad fue de 33.5 meses, la mortalidad fue de 11.54%. El análisis ajustado demostró que glucosa máxima en 24 horas y valor en la escala de Pediatric Index of Mortality 2 (PIM2) podrían presentarse como factores de riesgo para mortalidad, a diferencia de sexo, edad y valor de escala de Glasgow que se presentaron como factores protectores. Conclusión: En la serie evaluada se encontró asociación entre el valor de glucosa máxima en las primeras 24 horas y mortalidad en la UCIP. Es preciso realizar estudios prospectivos para evaluar dicha asociación

ABSTRAC Objective: To determine the association between glycemia values and mortality in the Pediatric Intensive Care Unit. The study: Retrospective cohort study in pediatric patients between 1 month and 18 years; hospitalized in the PICU for more than 48 hours. Findings: 184 patients were included. The median age was 33.5 months; mortality was 11.54%. The adjusted analysis showed that maximum glucose in 24 hours and PIM2 scale value could be presented as risk factors for mortality, unlike sex, age, and Glasgow scale value, which were presented as protective factors. Conclusion: In the series evaluated, an association was found between the value of maximum glucose in the first 24 hours and mortality in the PICU. Prospective studies are needed to assess this association.

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Introducción: un caso de rabdomiólisis severa asociado a síndrome inflamatorio multisistémico asociado a COVID -19 (MIS-C). Reporte de caso: en un niño de 1 año 10 meses que presentó síntomas digestivos, mialgias, debilidad, fiebre y orina oscura. Prueba serológica COVID-19 IgM (-) IgG (+), PCR COVID-19 negativo. Creatin-quinasa (CK) inicial fue no dosable, siendo el nivel reportado más alto de 517 600 U/L. El valor de creatinina se mantuvo normal durante toda la hospitalización. Recibió Inmunoglobulina humana 2 g/Kg, Metilprednisolona 10 mg/Kg/d y ácido acetil salicílico para manejo de MIS-C. Se brindó hidratación enérgica y alcalinización de orina para manejo de rabdomiólisis. Conclusión: Evolución favorable con alta luego de diez días. Existen pocos casos reportados de rabdomiólisis asociados a MIS-C, y ninguno con valores tan altos de CK. En base a las posibles complicaciones se sugiere realizar dosaje de CK de forma rutinaria en todos los pacientes con MIS-C.

Introduction: A case of severe rhabdomyolysis associated with multisystem inflammatory syndrome related to COVID-19 (MIS-C). Case of report: is presented in a one-year 10-month-old boy who presented digestive symptoms, myalgia, weakness, fever, and dark urine. COVID-19 IgM (-) IgG (+) serological test, COVID-19 PCR negative. Initial creatine kinase (CK) presented non-dosable values, with the highest reported level being 517,600 U/L. The creatinine value remained normal throughout the hospitalization. He received human immunoglobulin 2 g/Kg, Methylprednisolone 10 mg/Kg/d, and acetylsalicylic acid to manage MIS-C. Aggressive hydration and urine alkalinization were provided to manage rhabdomyolysis. Conclusion: Positive evolution with discharge after ten days. Few reported cases of rhabdomyolysis are associated with MIS-C and none with such high CK values. Based on the possible complications, performing CK dosing in all patients with MIS-C is suggested routinely.

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RESUMEN Introducción: El síndrome de burnout es conceptualizado como la forma inadecuada de afrontar el estrés crónico dado por exposición crónica a condiciones laborales inadecuadas. Afecta la salud mental, general y el rendimiento laboral de las personas. Objetivo: Determinar la presencia de síndrome de burnout en el personal de medicina interna y la Unidad de Cuidados Intensivos del Hospital Provincial General Docente de Riobamba, Chimborazo, Ecuador. Métodos: Se realizó una investigación básica, no experimental, transversal, descriptiva y correlacional en un universo de 77 trabajadores, de los cuales 65 conformaron la población de estudio. Se aplicaron cuestionarios para identificar presencia de síndrome de burnout, depresión y rendimiento laboral. Se utilizó la prueba de correlación de Pearson para identificar relación entre variables. Resultados: Predominio de pacientes con síndrome de burnout (52,31 %), depresión posible (47,69 %) y autopercepción de rendimiento laboral como adecuado (44,62 %). Dentro de las subescalas de la enfermedad la de mayor afectación fue la de realización personal con un 47,69 % de trabajadores en nivel medio y 39,23 % en nivel alto. Conclusiones: Existió predominio de trabajadores con síndrome de burnout y se identificó una correlación positiva fuerte entre las variables depresión y síndrome de burnout, así como entre esta variable y rendimiento laboral. Entre las variables depresión y rendimiento laboral la correlación obtenida fue positiva media.

ABSTRACTS Introduction: Burnout syndrome is conceptualized as the inadequate way of coping with chronic stress caused by chronic exposure to inadequate working conditions. It affects the mental and general health and the work performance of the people. Objective: to determine the presence of Burnout syndrome in the internal medicine staff and the intensive care unit of the Provincial General Teaching Hospital of Riobamba, Chimborazo, Ecuador. Methods: A basic, non-experimental, cross-sectional, descriptive and correlational research was carried out in a universe of 77 workers, of which 65 made up the study population. Questionnaires were applied to identify the presence of burnout syndrome, depression and work performance. Pearson's correlation test was used to identify a relationship between variables. Results: prevalence of patients with burnout syndrome (52.31%), possible depression (47.69%) and self-perception of work performance as adequate (44.62%). Within the subscales of the disease, the one with the greatest affectation was that of personal fulfillment with 47.69% of workers in the medium level and 39.23% in the high level. Conclusions: there was a predominance of workers with burnout syndrome and a strong positive correlation was identified between the variables depression and burnout syndrome, as well as between this variable and job performance. Among the variables depression and work performance, the correlation obtained was positive medium.

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OBJECTIVE: To assess the association between fluid overload (FO) and other risk fac tors in the mortality of patients admitted to the Pediatric Intensive Care Unit (PICU). PATIENTS AND METHOD: A historical cohort study was conducted. Pediatric patients older than one month and younger than 18 years who were hospitalized in the PICU for more than 48 hours during 2016 were included. Demographic and clinical data were recorded. FO was calculated as [Sum of daily (fluid in - fluid out)/weight at ICU admission] x 100. Poisson regression analysis was perfor med to determine factors associated with mortality. RESULTS: 171 patients were included. The median age was 31 months (RIQ 8; 84). Mortality was 8.18%. FO in the surviving population was 7% and 11.5% in the deceased patients (p < 0.05). The adjusted analysis identified FO as a major risk factor for mortality with a Relative Risk 1.32 (1.24 - 1.40); age and Glasgow Coma Scale were protective factors. CONCLUSION: Fluid overload is an independent risk factor for mortality in the analyzed PICU cohort.

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BACKGROUND: Pemphigus (Pm) is a chronic and recalcitrant autoimmune disease that affects the skin and mucous membranes. The first line of treatment are systemic corticosteroids; however, there are patients who are refractory to them, as well as to other immunosuppressants. Rituximab has been used as a successful alternative since 2000 with good results but without information on its behavior in the Mexican population. OBJECTIVE: To assess the clinical response to treatment with rituximab in Mexican patients with pemphigus. METHODS: This was a cross-sectional, retrospective study in a tertiary hospital, which included patients with moderate-severe pemphigus who had been treated with rituximab from 2007 to 2020. RESULTS: Six medical records of patients diagnosed with pemphigus were obtained; four of them with Pm vulgaris, and two of them with pemphigus foliaceus; all patients had received systemic immunosuppressive therapy prior to rituximab. All six patients went into remission of the disease in an average of 12.5 weeks. CONCLUSION: The use of rituximab for the treatment of patients with moderate-severe Pm who were refractory to immunosuppressive therapy proved to be very useful, and control of the disease was achieved in the medium term, without severe or idiosyncratic adverse effects in the analyzed Mexican population.

Antecedentes: El pénfigo es una enfermedad autoinmune crónica y recalcitrante que afecta piel y mucosas. El tratamiento de primera línea son los corticosteroides sistémicos, aunque hay pacientes refractarios a estos y a otros inmunosupresores. Como alternativa, desde el año 2000 se ha utilizado el rituximab con buenos resultados, pero sin información de su comportamiento en población mexicana. Objetivo: Evaluar la respuesta clínica al tratamiento con rituximab en pacientes mexicanos con pénfigo. Métodos: Se trató de un estudio transversal, retrospectivo en un hospital de tercer nivel, en el que se incluyeron pacientes con pénfigo moderado-severo tratados con rituximab entre 2007 y 2020. Resultados: Se obtuvieron seis expedientes de pacientes con diagnóstico de pénfigo, cuatro presentaron la variedad vulgar y dos, la variedad foliácea; todos recibieron tratamiento sistémico inmunosupresor previo al rituximab. Los seis pacientes tuvieron remisión de la enfermedad en un promedio de 12.5 semanas. Conclusión: El rituximab para el tratamiento de pacientes con pénfigo moderado-severo refractario a tratamiento inmunosupresor demostró ser de gran utilidad y logró un control de la enfermedad a mediano plazo, sin efectos adversos severos ni idiosincráticos en la población mexicana estudiada.

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