Summary The subjective experience that underlies the ways in which families underprivileged participate in school life tends to be invisiblized within the broad range of studies on parents' school involvement practices and educational equity. This article presents the results of a semantic structural analysis of 19 semistructured interviews with mothers of students living in socially underprivileged environments. The interviews were aimed at answering the following research question: "how do teacher communicative styles, as perceived by underprivileged parents, influence their way of participating at school?" Results suggest the preeminence of a critical and undervaluing teacher communicative style that prevents mothers' parental competences from being recognized. This perception inhibits parental participation while also encouraging parents to be more vigilant of teacher work in the classroom (e.g. volunteering to work in the classroom or engaging in actions aimed at defending their right to be acknowledged by appealing to actors with more power within the school). The results obtained should encourage policymakers and school professionals, along with parents, to generate a school culture that is free from discriminatory treatment and more appreciative of parents' abilities, needs, and potential for taking part in the school-based development and learning of children.

Resumen La experiencia subjetiva que subyace a los modos cómo las familias de grupos vulnerables participan en la escuela, tiende a invisibilizarse dentro del amplio conjunto de estudios sobre prácticas de participación de los padres en la escuela y equidad educativa. Se presentan los resultados del análisis estructural semántico de 19 entrevistas semi-estructuradas realizadas a madres de estudiantes que se desarrollan en medios socialmente desfavorecidos, orientadas a responder la pregunta de investigación siguiente: ¿cómo incide el estilo comunicativo docente, percibido por padres desfavorecidos, en su modo de participar en la escuela? Los resultados sugieren la preeminencia de un estilo comunicativo docente de carácter crítico y desvalorizador por sobre el reconocimiento hacia las competencias parentales de estas madres. Esta percepción, inhibe la participación de los padres, pero también estimula mayor vigilancia de los padres hacia el trabajo docente en el aula (v.g. voluntariado en el aula o acciones reinvidicativas del derecho a ser considerado acudiendo a otros actores con más poder dentro de la escuela). Los resultados de este estudio instan, a las políticas educativas y a los profesionales de la escuela a generar, en conjunto con sus apoderados, una cultura escolar libre de trato discriminatorio y con mayor reconocimiento a su capacidad, necesidades y posibilidades de participar en los procesos de desarrollo y aprender escolar de los hijos/as en distintas esferas de acción.

INTRODUCTION: Chronic kidney disease is a serious health problem in El Salvador. Since the 1990s, there has been an increase in cases unassociated with traditional risk factors. It is the second leading cause of death in men aged >18 years. In 2009, it was the first cause of in-hospital death for men and the fifth for women. The disease has not been thoroughly studied. OBJECTIVE: Characterize clinical manifestations (including extrarenal) and pathophysiology of chronic kidney disease of nontraditional causes in Salvadoran farming communities. METHODS: A descriptive clinical study was carried out in 46 participants (36 men, 10 women), identified through chronic kidney disease population screening of 5018 persons. Inclusion criteria were age 18 - 59 years; chronic kidney disease at stages 2, 3a and 3b, or at 3a and 3b with diabetes or hypertension and without proteinuria; normal fundoscopic exam; no structural abnormalities on renal ultrasound; and HIV-negative. Examinations included social determinants; psychological assessment; clinical exam of organs and systems; hematological and biochemical parameters in blood and urine; urine sediment analysis; markers of renal damage; glomerular and tubular function; and liver, pancreas and lung functions. Renal, prostate and gynecological ultrasound; and Doppler echocardiography and peripheral vascular and renal Doppler ultrasound were performed. RESULTS: Patient distribution by chronic kidney disease stages: 2 (32.6%), 3a (23.9%), 3b (43.5%). Poverty was the leading social determinant observed. Risk factor prevalence: agrochemical exposure (95.7%), agricultural work (78.3%), male sex (78.3%), profuse sweating during work (76.3%), malaria (43.5%), NSAID use (41.3%), hypertension (36.9%), diabetes (4.3%). General symptoms: arthralgia (54.3%), asthenia (52.2%), cramps (45.7%), fainting (30.4). Renal symptoms: nycturia (65.2%), dysuria (39.1%), foamy urine (63%). Markers of renal damage: macroalbuminuria (80.4%), β2 microglobulin (78.2%), NGAL (26.1%). Renal function: hypermagnesuria (100%), hyperphosphaturia (50%), hypernatriuria (45.7%), hyperkaluria (23.9%), hypercalciuria (17.4%), electrolyte polyuria (43.5%), metabolic alkalosis (45.7%), hyponatremia (47.8%), hypocalcemia (39.1%), hypokalemia (30.4%), hypomagnesemia (19.6%). Imaging: Ultrasound showed fatty liver (93.5%) and vascular Doppler showed tibial artery damage (66.7%). Neurological symptoms: abnormal tendon reflexes (45.6%), Babinski sign and myoclonus (6.5%), sensorineural hearing loss (56.5%). CONCLUSIONS: This chronic kidney disease studied behaves clinically like chronic tubulointerstitial nephropathy, but with systemic manifestations not attributable to kidney disease. While male agricultural workers predominated, women and adolescents were also affected. Findings support a hypothesis of multifactorial etiology with a key role played by nephrotoxic environmental agents.

INTRODUÇÃO: A sedação profunda em pacientes gravemente enfermos se associa a uma maior duração da ventilação mecânica e à permanência mais longa na unidade de terapia intensiva. Diversos protocolos foram utilizados para melhorar esses desfechos. Implantamos e avaliamos um protocolo de sedação baseado em analgesia, direcionado por objetivos e cuidado por enfermeiros, em pacientes gravemente enfermos submetidos à ventilação mecânica. MÉTODOS: Realizamos um estudo multicêntrico prospectivo em duas fases (antes e depois), que envolveu 13 unidades de terapia intensiva localizadas no Chile. Após uma fase observacional (grupo observacional, N=155), delineamos, implantamos e avaliamos um protocolo de sedação cuidado por enfermeiros, direcionado por objetivos (grupo de intervenção, N=132) para tratar pacientes que necessitaram de ventilação mecânica por mais do que 48 horas. O parâmetro primário de avaliação foi a obtenção de dias livres de ventilador até o dia 28. RESULTADOS: No grupo de intervenção, a proporção de pacientes com sedação profunda ou coma diminuiu de 55,2 para 44,0%. A incidência de agitação não se alterou entre os períodos, permanecendo em cerca de 7%. Dias livres de ventilador até o dia 28, permanência na unidade de terapia intensiva e mortalidade foram similares em ambos os grupos. Após 1 ano, a presença de sintomas de desordem de estresse pós-traumático nos sobreviventes foi similar entre os grupos. CONCLUSÕES: Delineamos e implantamos no Chile um protocolo de sedação baseado em analgesia, direcionado por objetivos e cuidado por enfermeiros. Embora não se tenha observado melhora nos principais desfechos, observamos que o presente protocolo foi seguro e factível, e que resultou em períodos mais curtos de sedação profunda, sem aumento da agitação.

INTRODUCTION: Deep sedation in critically ill patients is associated with a longer duration of mechanical ventilation and a prolonged length of stay in the intensive care unit. Several protocols have been used to improve these outcomes. We implement and evaluate an analgesia-based, goal-directed, nurse-driven sedation protocol used to treat critically ill patients who receive mechanical ventilation. METHODS: We performed a prospective, two-phase (before-after), non-randomized multicenter study that involved 13 intensive care units in Chile. After an observational phase (observational group, n=155), we designed, implemented and evaluated an analgesia-based, goal-directed, nurse-driven sedation protocol (intervention group, n=132) to treat patients who required mechanical ventilation for more than 48 hours. The primary outcome was to achieve ventilator-free days by day 28. RESULTS: The proportion of patients in deep sedation or in a coma decreased from 55.2% to 44.0% in the interventional group. Agitation did not change between the periods and remained approximately 7%. Ventilator-free days to day 28, length of stay in the intensive care unit and mortality were similar in both groups. At one year, post-traumatic stress disorder symptoms in survivors were similar in both groups. CONCLUSIONS: We designed and implemented an analgesia-based, goal-directed, nurse-driven sedation protocol in Chile. Although there was no improvement in major outcomes, we observed that the present protocol was safe and feasible and that it resulted in decreased periods of deep sedation without increasing agitation.

Intensive care medicine in Chile is still in its dawn. It has experienced a progressive growth in the last decade, but continues to be weak. Although investments in the discipline have increased fivefold, there is still a severe deficiency of intensive care specialists. This issue will represent a serious problem in the near future. The Ministry of Health gathered an expert committee to study the problem and propose solutions for the future development of the discipline.

In order to answer this question, we compare intragonadal contents of testosterone (T) in males of two neighboring populations of Peromyscus melanotis J. A. Allen and Chapman, 1897, that differ in their population density and in its seasonal fluctuations, even though they inhabit in quite similar habitat conditions. Although an affirmative answer to this question would corroborate the idea that this androgen has a density-dependent effect, since it has been proposed that T increases at low densities and vice versa, our results did not confirm this thesis: T showed no differences between the two populations, since both had the same seasonal pattern for the androgen, throughout four years of study, with a maximum in the summer, as would be expected in this temperate species whose reproductive optimum occurs at that time of the year. Therefore, density differences between both populations must be rather due to subtle microhabitat differences.

Para abordar esta pregunta, se compara el contenido intragonadal de testosterona (T) en machos de dos poblaciones aledañas de Peromyscus melanotis J. A. Allen y Chapman, 1897, que difieren en su densidad poblacional y en sus fluctuaciones estacionales, no obstante que habitan en condiciones de hábitat muy similares. Si bien una respuesta afirmativa a la pregunta confirmaría que este andrógeno influye sobre la densidad poblacional, ya que se ha propuesto que aumenta cuando la densidad disminuye y viceversa, nuestros resultados no apoyan esta tesis: la T no mostró diferencias entre las dos poblaciones, pues ambas tuvieron el mismo patrón de contenido estacional del andrógeno con un máximo en el verano, a lo largo de cuatro años; tal como se esperaría en una especie de zonas templadas cuyo óptimo reproductivo ocurre en esa época del año. En consecuencia, las diferencias de densidad entre las poblaciones estudiadas deben estar más bien relacionadas con sutiles diferencias de microhábitat.

Objective: to identify lethality and mortality rates and, mortality risk factors in ventilator associated pneumonia (VAP) on 114 patients treated between 2000 and 2007. Method: Twenty five risk factors were analyzed, emphasizing age, gender, APACHE score, associated diseases, hypotension at intake, coma, hospitalization time, length of time of ventilation, emergeney intubation, reintubation, previous antibiotics, and resistant microrganisms. Results: Lethality was 25.4 %, and mortality was 2.4 %. Association between lethality, and APACHE score was found (p: 0.04). Critical APACHE valué was 22. Also, in early pneumonia, association between lethality and nasogastric tube (p: 0.01, I.C. 95 % 1.39 - 6.35) was found. No association with late pneumonia was found among mortality and clinical practices. Death's RR (relative risk) increase in following valúes with: previous neurological disease 2.7 (p: 0.15, IC 95 % 1.15 - 6.5), neurological comaRR2 (p: 0.2, IC 95 % 0.54 - 7.53). Nevertheless, at multivariate analysis no mortality risk factors were identified. Fair association with time in ICU (p: 0.051 IC 95 % 0.99 - 1.17) and, male sex (p: 0.051, IC 95 % 0.99 - 6.72) was found. Conclusions: We observed múltiple factors associated to mortality in VAP: use of nasogastric catheter, longer stay in ICU and male sex.

Objetivo: Identificar la tasa de letalidad, mortalidad y factores de riesgo de mortalidad en neumonía asociada a ventilación mecánica (NAVM) en 114 pacientes de la cohorte 2000-2007. Se estudiaron 25 factores de riesgo del paciente y de las prácticas clínicas. Resultados: La tasa de letalidad fue 25,4%) y la tasa de mortalidad de 2,4%>. Se encontró asociación entre el puntaje APACHE al momento del diagnóstico de neumonía y mortalidad (p: 0,04). El valor crítico de APACHE de alto riesgo fue igual o mayor a 22. En neumonía precoz se identificó como factor de letalidad la presencia de sonda naso-gástrica (p: 0,01, IC 95%> 1,39-6,35). Para las variables categóricas no se encontró asociación significativa entre la exposición y mortalidad. El RR en presencia de enfermedad neurológica previa (accidente vascular encefálico) fue 2,7 (p: 0,15, IC 95% 1,15-6,5), coma al ingreso 2 (p: 0,2, IC 95% 0,54-7,53). En neumonía tardía, no se identificaron factores de riesgo asociados a la atención. El análisis multivariado de todas esas exposiciones no identificó factores significativos asociados a mortalidad. Identificamos una asociación débil con días de estada en UCI (p: 0,051 IC 95% 0,99-1,17) y sexo masculino (p: 0,051, IC 95% 0,99-6,72). Conclusiones: Los resultados muestran una relación multifactorial de prácticas clínicas y del paciente para fallecer por NAVM. Como factor de prácticas clínicas encontramos asociado a mortalidad el uso de sonda nasogástrica y mayor permanencia en UCI. Dependiente del paciente encontramos una débil asociación entre mortalidad y sexo masculino.

Background: The outcome oí' mechanically ventilated patients can be inñuenced byfactors such as the indication of mechanical ventilation (MV) and ventilator parameters. Aim: To describe the characterístics of patients receiving MV in Chilean critical care uníts. Material and methods: Prospective cohort of consecutive adult patients admitted to 19 intensive care uníts ([CU) from 9 Chilean cities who received MV for more than 12 hours between September lst, 2003, and September 28th, 2003. Demographic data, severity of illness, reason for the initiation of MV, ventilation modes and settings as well as weaning strategies were registered at the initiation and then, daily throughout the course of MV for up to 28 days. ¡CU and hospital mortality were recorded. Resulte: Of 588 patients admitted, 156 (26.5%) received MV (57% males). Mean age and Simplified Acute Physiology Score-II (SAPSII) were 54.6±18years and 40.6±16.4 points respectively The most common indications for MV were acute respiratory failure (71.1%) and coma (22.4%). Assist-control mode (71.6%) and synchronized intermittent mandatory ventilation (SIMV) (14,2%) were the most frequently used. T-tube was the main weaning strategy. Mean duration of MV and length of stay in ICU were 7.8±8.7 and 11.1± 14 days respectively. OverallICUmortality was 33.9% (53patients). The main factors independently associated with increased mortality were (1) SAPS II ≥ 60 points (Odds Patio (OR), 10.5; 95% CI, 1.04-106.85) and (2) plateaupressure ≥ 30 cm Hfi atsecond day (OR, 3.9; 95% CI, 1.17-12.97). Conclusions: Conditionspresent at the onsetofMVand ventilator management were similar to those reported in the literature. Magnitude ofmultiorgan dysfunction and high plateau pressures are the most important factors associated with mortality).

The reaction in acidconditions of Leptocarpin 1, a compound with antitumor activity, formed two new isomeric products, 8b-angeloyl-1b,3b-dihydroxy-4,10-dimethyl,-D11(13) methylen-4Z,9Z-dieneheliangol-6,12-olide 2 and 8b-angeloyl-1b,3b-dihydroxy-4-methyl-D11(13),D11(14)-dimethylen-4Z-eneheliangol-6,12-olide 3, whose structures reported in this study were established by spectroscopy (¹H-NMR, 13C-NMR, MS and IR) and confirmedthrough ROESY experiments and theoretical studies by molecular mechanics. The in vitro cytotoxicity of these isomeric compounds was less active than leptocarpin, showing the importance of the oxirane ring in the biological activity. Cytotoxic activity was measured in six cancer cell lines