The main goal of this work was to identify the mechanisms responsible for carbapenem resistance in 61 Chilean clinical isolates of Enterobacteriaceae (Enterobacter spp., Serratia marcescens, Morganella morganii, Escherichia coli and Klebsiella pneumoniae) with reduced susceptibility to at least one carbapenem (ertapenem, imipenem or meropenem). All of the isolates were analysed for the presence of carbapenemases, extended spectrum b-lactamases (ESBLs), AmpC enzymes and outer-membrane proteins. None of the isolates exhibited carbapenemase activity nor did they have any of the carbapenemase genes that were screened for. Most of the 61 strains produced at least one ESBL and/or one AmpC enzyme and either lost their porins or had altered porins according to sequence analysis. The distribution of ESBLs and AmpC enzymes was different among the species studied. Resistance in K. pneumoniae and E. coli isolates was associated with ESBLs; in M. morganii isolates, resistance was attributed to overexpression of an AmpC enzyme; and in Enterobacter spp. isolates, resistance was associated with both types of enzymes. In K. pneumoniae isolates, porin integrity was more a determinant of carbapenem resistance than the presence of ESBLs, whereas in isolates of Enterobacter spp., M. morganii and S. marcescens, the presence of an overexpressed AmpC enzyme was associated with higher imipenem and meropenem MIC values. Therefore, carbapenem resistance in Chilean isolates is not due to true carbapenemases but rather to a combination of porin loss/alteration and b-lactamase activity. The fact that carbapenemases were not detected in this study is unique, given that many countries in the region have already reported the presence of these enzymes.

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Chilean consensus for the integral care of children and adults with cystic fibrosisCystic Fibrosis (CF) is the most frequent hereditary disease in whites, with a reserved prognosis. Since 2003, Chile began a comprehensive National Cystic Fibrosis Program, directed by the Respiratory Health Unit of the Ministry of Health. To date, the main results of the Program record a significantly longer survival (average 27 years) and a significant reduction in the age of diagnosis of patients admitted from 2006 onwards. Access to Chilean Explicit Health Guarantees, the implementation of neonatal screening in some regions of the country, the organization and setting up of CF-trained teams of various specialties, has contributed to improving results. Although the main manifestations are of the respiratory and digestive system, the multisystemic nature of CF makes it necessary to know the different aspects involved in its management, in order to optimize the results of the treatment and the resources invested, both in the public and private sectors. This document is a review and an update on the main aspects of the diagnosis, monitoring and treatment of the respiratory and non-respiratory manifestations of CF.

Introduction: Meditation has been a practice studied from different perspectives, especially from health, but little from qualitative methodologies that account for the subjective processes of change in everyday life. Objective: The following study pretends to get to know the meaning that a group of students attributes to the use of meditation in their daily life. Method: From a qualitative methodology, there is an investigation in the experience of university students who participated in a general training course in which ten meditation meetings were held. The recollection of data was done from semi-structured interviews to the participants, with the review of personal binnacles in which they reported their experience in every meditation. Results: The meditation practice had implications in the personal, relational and societal areas, emphasizing the well-being that the meditation generates in the short and medium-term, contributing to self-care, to self-knowledge and the change of the perspective on themselves, on others and the social reality, favoring the transforming actions in these areas. Conclusion: The meditation generates a rupture in the subject's daily life, experience that would have favored their critical thinking regarding their reality, which is complemented with other strategies from occupational therapy could contribute to the intervention processes, assuming a facilitating role for the transformation of individual life and social reality. Meditação: análise crítica da experiência de jovens universitários em seu cotidiano e saúdeResumo: Introdução: A meditação tem sido uma prática estudada sob diferentes perspectivas, principalmente em saúde, mas pouco em metodologias qualitativas que explicam os processos subjetivos de mudança na vida cotidiana. Objetivo: O presente estudo apresenta os significados que um grupo de estudantes atribui a uma prática de meditação na relação com a sua vida cotidiana. Método: A partir de uma metodologia qualitativa, avaliou-se a experiência de estudantes universitários que participaram de um Curso de Formação Geral onde foram conduzidas 10 sessões de meditação. A coleta de dados foi feita a partir de entrevistas semiestruturadas, juntamente com a revisão de registros pessoais nos quais os alunos apontavam suas experiências após a realização de cada sessão de meditação. Resultados: A prática da meditação pelos alunos apresentou implicações no seu nível pessoal, nas relações interpessoais e na participação social, desta forma permitindo correlacionar a meditação ao bem-estar gerado a curto e médio prazos. Contribuiu também para a melhora no que diz respeito a: autocuidado, autoconhecimento, mudança na autopercepção, na percepção com relação aos outros e na realidade social, favorecendo assim ações transformadoras nestas áreas. Conclusão: A meditação permite uma pausa na vida cotidiana, favorecendo pensamento um crítico sobre sua realidade e, ao ser complementado com outras estratégias utilizadas pela Terapia Ocupacional, poderia contribuir aos diversos processos de int...

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