Thrombotic microangiopathy (TMA) is a clinical-pathological syndrome defined by microangiopathic hemolytic anemia, thrombocytopenia, and organ dysfunction, commonly affecting the kidneys. The etiologies are diverse and include genetic disorders (affecting complement proteins or other pathways, such as cobalamin metabolism), infections, autoimmune diseases, malignancies, transplantation, pregnancy, and drugs. Differentiating these causes is essential, as treatment strategies and prognoses vary widely. This consensus document, developed by a multidisciplinary group of clinicians and geneticists, provides a structured approach for evaluating TMA, with particular focus on complement-mediated TMA (C-TMA). C-TMA should be considered when TMA features persist after resolution or exclusion of secondary causes. Diagnostic confirmation relies on clinical judgment, histopathology, and a favorable response to C5 complement inhibitors, such as eculizumab or ravulizumab. This therapeutic response is considered both diagnostic and prognostic. Complement gene variants (e.g., CFH, CFI, MCP/CD46, and others) and copy number variations (e.g., CFHR1-5 deletions) are found in up to 50–60
Respiratory infections represent one of the leading causes of pediatric consultations and hospitalizations in Chile, where rapid etiological identification is essential for clinical decision-making. We evaluated the impact of implementing the BIOFIRE® SPOTFIRE® Respiratory (R) Panel in the pediatric Emergency Department of a public referral hospital in Santiago, using a pre–post cross-sectional design comparing two winter periods (July 2023 vs. July 2024). Clinical records, laboratory data, and operational indicators were analyzed to assess changes in diagnostic yield, turnaround time, hospitalizations, discharges, supplementary test requests, and antimicrobial use. A total of 470 patients were included (224 in 2023; 246 in 2024). The etiological detection rate increased from 58.0% to 87.8% after the implementation of Spotfire® (p < 0.0001), with marked increases in the identification of adenovirus, RSV, rhinovirus/enterovirus, and seasonal coronaviruses. Rapid molecular testing was associated with a significant rise in emergency department discharges (23.7% vs. 57.3%; p < 0.0001) and a reduction in hospitalizations (76.3% vs. 42.7%; p < 0.0001) and readmissions (9.2% vs. 0.5%; p < 0.0001). Requests for complete blood counts, chest X-rays, and antimicrobial prescriptions at discharge also decreased significantly. These effects persisted in key subgroups, including infants and children with comorbidities. In this high-demand winter setting, the BIOFIRE® SPOTFIRE® R Panel improved diagnostic performance and supported more efficient and targeted clinical management.
The aim of this study was to compare the two methodological approaches recommended in ICRP Publication 135 for establishing regional diagnostic reference levels (DRLs), by applying them to a common multicountry dataset from the Optimisation of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean (OPRIPALC) programme. A retrospective methodological analysis was conducted using radiation dose data collected between December 2020 and December 2023 from centres participating in OPRIPALC. After applying predefined inclusion criteria, data cleaning and trimming in accordance with ICRP-135 recommendations, 1684 paediatric interventional cardiology procedures from 11 centres in eight countries were included. Kerma area product (PKA) was selected as the primary dosimetric quantity. Regional DRLs were derived using two approaches: Method A, based on the 75th percentile of pooled patient levelPKAdata, and Method B, based on the 75th percentile of centre specific medianPKAvalues assumed to represent typical country values. DRLs were established using predefined age and weight groups. Both methodologies preserved the expected increase in DRL values with patient age, weight and procedural type. However, Method A consistently produced higher regional DRL values than Method B, particularly for therapeutic procedures and higher age or weight categories. These differences reflect the effects of data aggregation rather than differences in the underlying dataset. This study aims at illustrating the practical implications of one method over the other, rather than to recommend one methodology over the other. The findings highlight the importance of methodological transparency in regional DRL initiatives and support the applicability of the OPRIPALC framework for paediatric interventional cardiology in other regions.
Antimicrobial Stewardship Programs (ASPs) are a cornerstone strategy to mitigate the global threat of antimicrobial resistance (AMR), primarily driven by inappropriate antimicrobial use. ASPs aim to optimize antimicrobial therapy by ensuring appropriate indication, agent selection, dosing, route of administration, and duration of treatment. Through these interventions, ASPs improve clinical outcomes, reduce adverse drug events, decrease selective pressure for resistant organisms, and contribute to healthcare cost containment. Effective implementation requires a multidisciplinary approach involving physicians, pharmacists, microbiologists, nurses, and information technology specialists, and must be tailored to local epidemiology and healthcare system capacity in accordance with World Health Organization (WHO) recommendations. This narrative review describes the development and evolution of the national antimicrobial stewardship policy in Chile, based on a review of publications indexed in SciELO, official documents from the Ministry of Health (MINSAL), and relevant national legislation. In Chile, antimicrobial stewardship initiatives began in the late 1990s with regulatory measures mandating prescription-only dispensing of antimicrobials and the introduction of national technical standards for rational antimicrobial use. After that, Chile adopted a comprehensive One Health approach and implemented national AMR action plans aligned with WHO strategies. Substantial progress has been achieved across hospital, primary care, veterinary, and aquaculture settings, including expanded ASP coverage, strengthened regulatory frameworks, national surveillance systems for antimicrobial consumption and resistance, and incorporation of stewardship indicators into institutional performance metrics. Despite these advances, challenges related to workforce capacity, technological infrastructure, and long-term monitoring persist and must be addressed to further consolidate national ASP implementation.
INTRODUCTION:Hemorrhage causes 40 % of deaths from trauma. Low- and middle- income countries (LMICs) claim the majority of these deaths, in part due to lack of resources and organization in the prehospital and hospital arenas. Guatemala experiences a high burden of trauma-related injuries but does not have the resources nor the emergency response system to deal with it. In Guatemala, firefighters (bomberos) lead trauma responses, yet do not receive medical training. Recognizing these gaps in LMICs, we developed "CrashSavers", a low cost, openly accessible, self-training mobile phone-based platform to teach hemorrhage control techniques to first responders in Guatemala City. In this manuscript, we present the evaluation and outcomes of the bomberos who were trained with CrashSavers. METHODS:Our self-administered educational program teaches first responders to train themselves in the decision making and psychomotor skills of tourniquet placement. This free platform, accessible via mobile phone, provides didactic material, virtual reality cases and instructions to construct a bleeding extremity simulator. Sixty-four bomberos were trained from July-August 2022. Eighteen months later they were retested to assess knowledge retention. Interviews were conducted with all bomberos to elicit feedback, which were then analyzed with narrative synthesis. We assessed medical knowledge, confidence, and surgical skills pre and post training. RESULTS:After training, bomberos were able to apply the tourniquet more efficiently and more confidently. The time taken to stop a bleed on the simulator dropped from 58.5 s to 39.2 s, p < 0.003. Assessment of their skills 18 months after initial training showed that they were able to retain both confidence and psychomotor skill of tourniquet placement. Qualitative analysis showed overall positive experience with the course. CONCLUSIONS:A low cost, easily accessible, self-taught course of didactics, VR cases and simulation successfully trained bomberos to control a bleeding extremity. This may be a solution for the large gaps in LMIC trauma response, as traditional programs designed for high income countries (HICs) are inaccessible, expensive and time intensive. With CrashSavers, learners became faster and more confident in stopping a bleed, and in a situation where time is blood and blood is life, efficiency is key.
