Sistema Regional de Información
en línea para Revistas Científicas de América Latina,
el Caribe, España y Portugal

O Antropoceno abre caminho para um novo paradigma na história do planeta Terra, colocando em destaque a crise ecológica global, resultado das ações antrópicas, e a necessidade de uma nova ética ecológica. Com efeito, faz-se necessário buscar respostas jurídicas aos desafios que emergem nessa conjuntura. Desse modo, o presente artigo analisa, sob o enfoque do desenvolvimento mais sustentável, uma proposta de base principiológica para fundamentar a proteção ambiental na nova época geológica do Antropoceno. Nesse intuito, primeiramente, o trabalho aborda as implicações jurídicas decorrentes do reconhecimento do Antropoceno, compreendendo-o como um conceito que ultrapassa a Geologia e adentra ao mundo jurídico como um paradigma inédito. Na sequência, estuda os princípios do Direito Ambiental ou Ecológico que se manifestam como resposta às rupturas causadas pelo Antropoceno. Para tanto, adota-se o enfoque teórico dogmático e o método dedutivo. A pesquisa é exploratória, descritiva, bibliográfica e documental.

This Paper seeks, based on the undeniable relationship between health protection and the fight against climate change, the analysis of the public health model established in our climate legal system based on the actions of the Autonomous Communities. For this, the Law 7/2021, of May 20, on Climate Change and Energy Transition, as a legal framework, must be considered, as well as the different legal situation of the Autonomous Communities, depending on whether they have legislated or not in this matter. Thus, the Paper concludes with some reflections about the effectiveness of a model based on heterogeneous actions of the mentioned Autonomous Communities regarding public health and climate change.

El Acuerdo de París de 2015 hace reiteradamente referencia a la “progresión”. Esta reiteración al concepto de progresión, vinculado a una idea que va más allá de la “no regresión”, tiene grandes consecuencias respecto a la efectividad del propio tratado y, por consiguiente, respecto de la consecución de los objetivos climáticos que el propio instrumento jurídico internacional establece. A pesar de su gran importancia, su naturaleza jurídica, su obligatoriedad y su alcance parecen no estar claros, de tal forma que, uno de los principales elementos clave del Acuerdo de París, queda en una indefinición jurídica y operativa. Es por ello que, el presente estudio, trata de arrojar claridad a este aspecto concreto, abordando cuestiones tan específicas como: la progresión como un principio rector y como obligación jurídica internacional o como estándar de diligencia debida en el ámbito del Acuerdo de París sobre cambio climático.

HIV infection is a global epidemic, with a prevalence of 0.8%. In Latin America, Chile, Brazil and Uruguay are the countries with the highest rates. The transgender population is the most affected (OR of 48.8 compared to the general population). Multiple bio-psycho-social factors explain these issues. The low use of condoms for pressure from the partner, the idea of reaffirmation of gender, the fear to be replaced by a cisgender person, the presence of commercial sex, among others, influence the highest rates of infection. HIV prevention measures have been implemented, but few specifically targeted at transgender people. Pre-exposure prophylaxis (PreP) seems to be a new prevention alternative in this group, and the integration of support units in gender reaffirmation with units that deliver PreP could increase their adherence and coverage. In HIV (+) transgender people there is low adherence to antiretroviral therapy (ART), in part due to the prioritization of hormonal treatment and the fear that ART will alter their hormonalization process. The few data that exist show that hormonalization is not affected by ART, but that some hormonal treatments could lower the levels of certain antiretriovirals. More studies must be done to  evaluate the interaction between antiretrovirals and gender affirming hormone therapy.

Introducción: Debido a sus propiedades antiinflamatorias, se ha planteado que el uso de las estatinas podría influir en la evolución de la infección por el virus de influenza. Objetivo: Evaluar el efecto de la terapia con estatinas sobre la mortalidad por influenza. Material y Métodos: Se realizó un meta-análisis que incluyó estudios que evaluaron el uso de estatinas en pacientes con influenza e informaron los datos sobre mortalidad, después de buscar en las bases de datos PubMed/MEDLINE, Embase y Cochrane Controlled Trials. Se aplicó un modelo de efectos aleatorios. Se analizó el riesgo de sesgos y se desarrolló un análisis de sensibilidad. Resultados: Se identificaron y se consideraron elegibles para el análisis ocho estudios (diez cohortes independientes), que incluyeron un total de 2.390.730 de pacientes. Un total de 1.146.995 de sujetos analizados recibieron estatinas mientras que 1.243.735 de sujetos formaron parte del grupo control. La terapia con estatinas se asoció con una menor mortalidad (OR: 0,66; IC 95%: 0,51-0,85). El análisis de sensibilidad mostró que los resultados fueron robustos. Conclusiones: Nuestros datos sugieren que, en una población con influenza, el uso de estatinas se asoció con una reducción significativa de la mortalidad. Estos resultados deben confirmarse en futuros ensayos clínicos.

Background: Ventilator-associated pneumonia (VAP) is frequent in critical COVID-19 patients. Its early diagnosis is essential for its prognosis. Aim: To demonstrate the usefulness of the FilmArray Pneumo panel (FAP-P) in confirming or ruling out VAP in these patients. Methods: Retrospective study of 71 critical COVID-19 patients with suspected VAP in whom cultures and FAP-P were performed for diagnostic confirmation. Clinical characteristics, microbiology and mortality are described. The validity and safety of FAP-P is defined. Results: The use of FAP-P and cultures ruled out VAP in 29 patients (40.8%). In 41 patients, VAP was confirmed and the 30-day mortality was 48.8%. Forty-eight samples were studied, the cultures were positive in 30 (62.5%) and 33 bacteria were detected, FAP-P detected 32 of these 33 bacteria; 37 bacteria were exclusively detected by PFA-P. The most prevalent bacteria were Klebsiella pneumoniae (31.4%), Pseudomonas aeruginosa (21.4%) and Acinetobacter calcoaceticus-baumannii (14.2%). The sensitivity, specificity, positive predictive value and negative predictive value of FAP-P with respect to cultures were 96.9%, 92.5%, 46.4% and 99.8%, respectively. One patient had VAP due to Burkholderia cepacia bacteria not detected by FAP-P. Conclusions: FAP-P is an effective molecular technique to rule out and diagnose VAP, allowing rapid suspension of antibiotics or early targeted treatment.

Background: Coronavirus disease 2019 (COVID-19) has spread fast globally comprising a great variety of clinical presentations. It was reported that 15% of patients required admission to intensive care units (ICU). Previous epidemiological studies have reported higher risk of healthcare-associated infections (HCAI) in those patients requiring invasive mechanical ventilation (iMV) due to COVID-19. Aim: To analyze the incidence of HCAI in adults under iMV admitted to ICU of Anchorena San Martín Clinic during COVID-19 pandemic. Methods: Retrospective cohort study, the analysis of normality was carried out using the Shapiro-Wilk test. The multiple regression analysis was performed automatically, based on backward elimination of the variables (backward selection). For the comparison between the COVID-19 and non-COVID-19 groups, the T test or Wilcoxon test was used, as appropriate; and the c2 or Fisher's exact test. All cumulative incidence function estimates were made with the cmprsk package. Results: 252 patients were included, 40 patients developed HCAI (accumulated incidence was 15.9%), counting for 60 total HCAI events. Age (OR 0.96), number of central venous access devices (CVAD) (OR 2.01), COVID-19 (OR 2.96) and prone positioning (OR 2.78) were associated with HCAI. HCAI was associated with more days of iMV and ICU stay. The accumulated incidence of HCAI in non-COVID-19 patients was lower than in COVID-19 patients. iMV days and mortality were higher in COVID-19.  29.6% of COVID-19 patients developed HCAIs vs 7.1% of non-COVID-19 ones. Conclusion: We describe the incidence of HCAI. Age, COVID-19, CVAD, prone positioning and ICU stay were associated with higher probability of HCAIs.

Background: Antimicrobials use is associated with diverse secondary effects, as allergies, specific adverse drug reactions and emergence of antimicrobial resistance. Effective risk communication to the general public about their uses and potential issues is critical. International experience reveals deficient knowledge in countries without educational policies regarding this issue, but their implementation can reverse such deficit. There are scarce publications at regional and national level about these topics. Aim: To describe the knowledge and behaviors regarding antimicrobial use in adults in Santiago de Chile. Methods: We conducted a cross-sectional study through a survey in 300 people in Santiago de Chile, evaluating 4 areas about antimicrobials: knowledge, use, behaviors, and antimicrobial resistance knowledge. Results: 297 people were surveyed with ages between 18 and 81 years old. Seventy-five percent of them were younger than 45 years old. 65% of the surveyed thinks antimicrobials works against viruses, 51% believes they work against the common cold and, 32% of the population has used them without a prescription,. Fifty-one percent of the sample has heard about antimicrobial resistance and 33% knows its correct definition. Conclusions: The Chilean population has an important deficit in antimicrobial knowledge and use.

The birth, rise and decline, of vaccine production at the Bacteriological Institute of Chile is recounted by mouth of who was for seventeen years first in charge of manufacturing and then director of the institution. The vicissitudes of the BCG vaccine, the introduction of tetanus toxoid, the end of smallpox vaccine, and the triumph of the rabies vaccine are often related with comments from those who participated in the events.