Phospholipid scramblase 1: an essential component of the nephrocyte slit diaphragm.

Blood ultrafiltration in nephrons critically depends on specialized intercellular junctions between podocytes, named slit diaphragms (SDs). Here, by studying a homologous structure found in Drosophila nephrocytes, we identify the phospholipid scramblase Scramb1 as an essential component of the SD, uncovering a novel link between membrane dynamics and SD formation. In scramb1 mutants, SDs fail to form. Instead, the SD components Sticks and stones/nephrin, Polychaetoid/ZO-1, and the Src-kinase Src64B/Fyn associate in cortical foci lacking the key SD protein Dumbfounded/NEPH1. Scramb1 interaction with Polychaetoid/ZO-1 and Flotillin2, the presence of essential putative palmitoylation sites and its capacity to oligomerize, suggest a function in promoting SD assembly within lipid raft microdomains. Furthermore, Scramb1 interactors as well as its functional sensitivity to temperature, suggest an active involvement in membrane remodeling processes during SD assembly. Remarkably, putative Ca2+-binding sites in Scramb1 are essential for its activity raising the possibility that Ca2+ signaling may control the assembly of SDs by impacting on Scramb1 activity.

Analysis of Heart Rate Variability in Individuals Affected by Amyotrophic Lateral Sclerosis.

INTRODUCTION: Amyotrophic lateral sclerosis (ALS) produces alterations in the autonomic nervous system (ANS), which explains the cardiac manifestations observed in patients. The assessment of heart rate variability (HRV) is what best reflects the activity of the ANS on heart rate. The Polar H7 Bluetooth® device proves to be a non-invasive and much faster technology than existing alternatives for this purpose. OBJECTIVE: The goal of this study is to determine HRV using Polar H7 Bluetooth technology in ALS patients, comparing the obtained measurements with values from healthy individuals. METHOD: The sample consisted of 124 participants: 68 diagnosed with ALS and 56 healthy individuals. Using Polar H7 Bluetooth technology and the ELITE HRV application, various HRV measurements were determined for all participants, specifically the HRV index, RMSSD, RMSSD LN, SDNN index, PNN50, LF, HF, LF/HF ratio, HR average, and HF peak frequency. RESULTS: Statistically significant differences were observed between ALS patients and healthy individuals in the HRV index, RMSSD, RMSSD LN, SDNN index, PNN50, HF, and LF, where healthy individuals exhibited higher scores. For the HR average, the ALS group showed a higher value. Values were similar when comparing men and women with ALS, with only a higher HF peak frequency observed in women. CONCLUSION: The Polar H7 Bluetooth® device is effective in determining heart rate variability alterations in ALS, being a promising prognostic tool for the disease.

A Novel Closed-Loop Electrical Brain Stimulation Device Featuring Wireless Low-Energy Ultrasound Power and Communication.

OBJECTIVES: This study aimed to indicate the feasibility of a prototype electrical neuromodulation system using a closed-loop energy-efficient ultrasound-based mechanism for communication, data transmission, and recharging. MATERIALS AND METHODS: Closed-loop deep brain stimulation (DBS) prototypes were designed and fabricated with ultrasonic wideband (UsWB) communication technology and miniaturized custom electronics. Two devices were implanted short term in anesthetized Göttingen minipigs (N = 2). Targeting was performed using preoperative magnetic resonance imaging, and locations were confirmed postoperatively by computerized tomography. DBS systems were tested over a wide range of stimulation settings to mimic minimal, typical, and/or aggressive clinical settings, and evaluated for their ability to transmit data through scalp tissue and to recharge the DBS system using UsWB. RESULTS: Stimulation, communication, reprogramming, and recharging protocols were successfully achieved in both subjects for amplitude (1V-6V), frequency (50-250 Hz), and pulse width (60-200 µs) settings and maintained for ≥six hours. The precision of pulse settings was verified with <5% error. Communication rates of 64 kbit/s with an error rate of 0.05% were shown, with no meaningful throughput degradation observed. Time to recharge to 80% capacity was <9 minutes. Two DBS systems also were implanted in the second test animal, and independent bilateral stimulation was successfully shown. CONCLUSIONS: The system performed at clinically relevant implant depths and settings. Independent bilateral stimulation for the duration of the study with a 4F energy storage and full rapid recharge were achieved. Continuous function extrapolates to six days of continuous stimulation in future design iterations implementing application specific integrated circuit level efficiency and 15F storage capacitance. UsWB increases energy efficiency, reducing storage requirements and thereby enabling device miniaturization. The device can enable intelligent closed-loop stimulation, remote system monitoring, and optimization and can serve as a power/data gateway to interconnect the intrabody network with the Internet of Medical Things.

[Osteosarcoma as a GES-Listed Pathology: 7-Year Experience at a National Reference Center]. / Osteosarcoma como patología GES. Experiencia de 7 años en Centro de Referencia Nacional.

BACKGROUND: Osteosarcoma (OS) is the most frequent malignant primary bone tumor. The explicit health guarantee (GES) plan in Chile, a law that guarantees diagnosis, treatment, and rehabilitation, incorporated OS in 2014. OBJECTIVES: To describe the characteristics of the population over 15 years, with a histopathological diagnosis of OS, to define survival rate and complications, and to identify variables that affect these outcomes. METHODS: A retrospective study from 2014 to 2020, including all patients affiliated with the public health system diagnosed with OS, with histological confirmation. From clinical records, we extracted demographic data, anatomical OS location, histopathological findings, admission stage, presence of metastases, treatment, complications, and survival. We determined prognostic factors by multivariate analysis. RESULTS: 133 patients, 58.8% men, the average age was 31 years, and the most frequent location was the distal femur (34.9%). 56.4% of the patients were admitted in Enneking stage IIB, and 36.4% presented metastasis at admission. 14.3% presented complications, the most frequent periprosthetic infection (6 cases). 16% of patients evolved with local recurrence. The multivariate model showed that age and metastases at admission constitute independent prognostic variables, with a hazard ratio of 1.017 for age (p = 0.016) and 3.13 for metastases (p = 0.0000). In the subgroup analysis, patients without metastases at diagnosis had a 5-year survival of 54% versus 11% for the group with metastases. Adjusting for age, the 5-year survival for the non-metastatic and metastatic groups was 73% and 22%, respectively. CONCLUSION: This is our country's first demographic description study of patients with OS. In our series, the age of presentation and the presence of metastases at admission were factors that significantly affect prognosis. When adjusting for age, the survival percentages are comparable to those reported in other international centers specialized in sarcomas.

Medication reconciliation in hospitalized hematological patient. / Conciliación de la medicación en el paciente hematológico ingresado.

OBJECTIVE: The main objective was to analyze unjustified discrepancies during the medication reconciliation process in patients admitted to the Hematology Service of our hospital and the pharmaceutical interventions. As a secondary objective, to detect possible points of the procedure to be perfected with a view to protocolizing the medication reconciliation process in hematological patients that adapts to the conditions of our center. METHODS: Cross-sectional observational pilot study carried out in a reference hospital in hematology for a population of 800,000 inhabitants. Adult inpatients admitted to the Hematology Service between August and October 2022 whose medication had been reconciled were included. The main variables were: number and type of unjustified discrepancy, proposed pharmaceutical intervention, and acceptance rate. RESULTS: 36 conciliation processes were analyzed, 34 admissions and 2 intrahospital transfer. 58.3% of the patients presented at least one unjustified discrepancy. 38 unjustified discrepancies were detected, with an acceptance of pharmaceutical interventions of 97.4%. The most common types of discrepancy were medication omission (56.8%) and drug interaction (24.3%). The most frequent pharmaceutical interventions were reintroducing medication (48.6%) and treatment discontinuation (16.2%). Polypharmacy and chemotherapy multiplied by 4 the probability of presenting drug interactions. CONCLUSIONS: The most common unjustified discrepancies in the medication reconciliation process in hospitalized hematology patients are: Medication omission and drug interactions. The reintroduction of medication and suspension of the prescription are the most frequent accepted pharmaceutical interventions. Polypharmacy is related to an increase in unjustified discrepancies. The factors that promote the appearance of interactions are admissions to receive chemotherapy treatment and polypharmacy. The main point of improvement detected is the need to create a circuit that allows conciliation to be carried out on discharge. Medication reconciliation contribute to improving patient safety by reducing medication errors.

Clinical Progression and Load Management For Proximal Hamstring Tendinopathy In A Long-Distance Runner: A Case Report.

Background and Purpose: The characteristics of Proximal Hamstring Tendinopathy (PHT) include deep, localized pain in the region of the ischial tuberosity. Chronic lesions are often found in long-distance runners. Compression of the tendon and shear force at its insertion at the ischial tuberosity during hip flexion/adduction is a key etiologic factor. The aim of this case report is to analyze the effectiveness of an exercise protocol with progression of tendon loading in PHT in an amateur runner, by assessing pain and functional capacity. Case Description: The subject was a 30-year-old male runner. After participating in a 10km race, he experienced an insidious onset of deep buttock pain in the right ischial tuberosity. His pain was aggravated by running on sloped roads and prolonged sitting on hard surfaces, particularly while driving. The visual analog scale (VAS) for pain, the Puranen-Orave test (PO), the Bent-Knee stretch test (BK stretch), the supine plank test, the Victorian Institute of Sport Assessment-proximal hamstring tendons (VISA-H) questionnaire, and the sciatic nerve mobility (via the Slump test) were assessed. The intervention involved a 12-week progressive loading exercise program divided into four phases. Outcomes: The initial pain was reduced at 6 weeks of intervention and further decreased at 12 weeks (VAS from 7, to 5 and to 1). Function increased at 6 weeks and at 12 weeks (VISA-H from 23, to 53, to 80). Sciatic nerve mobility was normal. Conclusion: The progression of training in a subject with PHT tendon injury based on isometric exercise, concentric/eccentric, energy storage, progressively increasing hip flexion was beneficial, increasing function and decreasing pain. Studies with a larger sample size and a more precise methodological design would be necessary to support this type of intervention in clinical practice. Level of Evidence: 5.

Muscle Changes during Direct Attack under Different Conditions in Elite Wheelchair Fencing.

Wheelchair fencing is a medium-distance combat sport in which the wheelchair is fixed to the floor. This requires a maximum concentration and gestational speed. Refined techniques and fatigue tolerance are essential to achieve competitive results. AIM: The main objective of this study was to measure the speed and muscular participation of a direct attack gesture with and without fatigue in a sample of elite wheelchair fencers. METHODS: The maximal isometric force, gestural speed, and resistance to gestural velocity were estimated in 10 elite performed direct fencers. RESULTS: The results revealed that sitting height and wingspan were important factors in achieving the highest speed, especially in women (r = 0.9; p = 0.07). Other factors, such as the elbow angle where the closed position was better, affected muscle contraction in both categories of athletes (p = 0.01). The onset of fatigue was earlier in category B than in category A, with greater variation in direct attack movement. The results highlight the importance of analyzing direct attacks for the best application of quick force, speed, and muscle participation, as well as identifying the onset of technical deterioration to devise a competitive strategy. These parameters may allow for precise design of conditioning sessions for elite wheelchair shooters.

Widespread Pressure Pain Hyperalgesia Is Not Associated with Morphological Changes of the Wrist Extensor Tendon in Unilateral Lateral Epicondylalgia: A Case-Control Study.

OBJECTIVE: The aims of the current study were to investigate the presence of widespread pressure hyperalgesia, the presence of structural changes in the wrist extensor tendon and muscle, and their association in people with lateral epicondylalgia (LE). METHODS: Thirty-seven patients with LE (43% women; mean age = 45.5 [SD = 9.5] years) and 37 controls matched for age and sex and free of pain participated in this study. Pressure pain thresholds (PPTs) were assessed bilaterally over the symptomatic area (elbow), 2 segment-related areas (C5-C6 joint, second intermetacarpal space), and 1 remote area (tibialis anterior) in a blinded design. Ultrasound measurements (eg, cross-sectional area, thickness, width) of the common wrist extensor tendon and extensor carpi radials brevis muscle as well as thickness of supinator muscle were assessed. RESULTS: Patients with LE exhibited lower PPTs bilaterally at all points and lower PPTs at the lateral epicondyle and second intermetacarpal space at the symptomatic side as compared to the nonsymptomatic side (η2 from 0.123-0.369; large effects). Patients exhibited higher cross-sectional area and width of the common wrist extensor tendon (η2 from 0.268-0.311; large effects) than controls bilaterally, whereas tendon thickness was also higher (η2 = 0.039; small effects) on the painful side than on the nonpainful side. CONCLUSIONS: This study reported bilateral widespread pressure pain hyperalgesia and morphological changes in the tendon, but not the muscle, in LE. Pressure pain sensitivity and morphological changes were not associated in individuals with LE. IMPACT STATEMENT: Management of LE should consider altered nociceptive pain processing and structural tendon changes as 2 different phenomena in patients with LE.

Effects of Adding Four Sessions of Ultrasound-Guided Percutaneous Electrical Nerve Stimulation to an Exercise Program in Patients with Shoulder Pain: A Randomized Controlled Trial.

Objective: Percutaneous electrical nerve stimulation (PENS) appears to be effective for the treatment of musculoskeletal pain. The aim of this trial was to investigate the effects on disability and pain, as well as on the psychological aspects of adding PENS into an exercise program in patients with subacromial pain syndrome. Methods: A randomized, parallel-group clinical trial was conducted. Sixty patients with subacromial pain were allocated into exercise alone (n = 20), exercise plus PENS (n = 20), or exercise plus placebo PENS (n = 20) groups. Patients in all groups performed an exercise program twice daily for 3 weeks. Patients allocated to the PENS group also received four sessions of ultrasound-guided PENS targeting the axillar and suprascapular nerves. Patients allocated to the exercise plus placebo PENS received a sham PENS application. The primary outcome was related disability (Disabilities of the Arm, Shoulder, and Hand, DASH). Secondary outcomes included mean pain, anxiety levels, depressive symptoms, and sleep quality. They were assessed at baseline, one week after, and one and three months after. An analysis was performed using intention-to-treat with mixed-models ANCOVAs. Results: The results revealed no between-group differences for most outcomes (related disability: F = 0.292, p = 0.748, n2p = 0.011; anxiety: F = 0.780, p = 0.463, n2p = 0.027; depressive symptoms: F = 0.559, p = 0.575, n2p = 0.02; or sleep quality: F = 0.294, p = 0.747, n2p = 0.01); both groups experienced similar changes throughout the course of this study. Patients receiving exercise plus PENS exhibited greater improvement in shoulder pain at one month than those in the exercise (Δ -1.2, 95%CI -2.3 to -0.1) or the placebo (Δ -1.3, 95%CI -2.5 to -0.1) groups. Conclusions: The inclusion of four sessions of ultrasound-guided PENS targeting the axillar and suprascapular nerves into an exercise program did not result in better outcomes in our sample of patients with subacromial pain syndrome at one and three months after treatment.

Predictive Model of Anxiety and Depression Perception in Multiple Sclerosis Patients: Possible Implications for Clinical Treatment.

Multiple Sclerosis (MS) is a neurodegenerative disease characterized by motor and non-motor symptoms, including emotional distress, anxiety, and depression. These emotional symptoms currently have a pharmacological treatment with limited effectiveness; therefore, it is necessary to delve into their relationship with other psychological, functional, or prefrontal alterations. Additionally, exploring non-pharmacological therapeutic alternatives that have shown benefits in addressing emotional distress in MS patients is essential. AIM: To establish a predictive model for the presence of anxiety and depression in MS patients, based on variables such as psychological well-being, functional activity, and prefrontal symptoms. Additionally, this study aimed to propose non-pharmacological therapeutic alternatives based on this model. MATERIALS AND METHODS: A descriptive, observational, and cross-sectional study was conducted with a sample of 64 diagnosed MS patients who underwent functional and cognitive assessments using the following questionnaires and scales: Functional Activities Questionnaire (FAQ), Acceptance and Action Questionnaire (AAQ-II), Experiences Questionnaire (EQ), Self-Compassion Scale Short Form (SCS-SF), Beck Depression Inventory II (BDI-II), State-Trait Anxiety Inventory (STAI), and Prefrontal Symptoms Inventory (PSI). RESULTS: The model showed an excellent fit to the data and indicated that psychological well-being was the most significant predictor of the criteria (ß = -0.83), followed by functional activity (ß = -0.18) and prefrontal symptoms (ß = 0.15). The latter two are negatively related to psychological well-being (ß = -0.16 and ß = -0.75, respectively). CONCLUSIONS: Low psychological well-being is the variable that most significantly predicts the presence of anxiety and depression in MS patients, followed by functional activity and prefrontal alterations. Interventions based on mindfulness and acceptance are recommended, along with nutritional interventions such as antioxidant-enriched ketogenic diets and moderate group physical exercise.

Statistical analysis plan for the multicenter, open, randomized controlled clinical trial to assess the efficacy and safety of intravenous tirofiban vs aspirin in acute ischemic stroke due to tandem lesion, undergoing recanalization therapy by endovascular treatment (ATILA trial).

RATIONALE: In-stent reocclusion after endovascular therapy has a negative impact on outcomes in acute ischemic stroke (AIS) due to tandem lesions (TL). Optimal antiplatelet therapy approach in these patients to avoid in-stent reocclusion is yet to be elucidated. AIMS: To assess efficacy and safety of intravenous tirofiban versus intravenous aspirin in patients undergoing MT plus carotid stenting in the setting of AIS due to TL. SAMPLE SIZE ESTIMATES: Two hundred forty patients will be enrolled, 120 in every treatment arm. METHODS AND DESIGN: A multicenter, prospective, randomized, controlled (aspirin group), assessor-blinded clinical trial will be conducted. Patients fulfilling the inclusion criteria will be randomized at MT onset to the experimental or control group (1:1). Intravenous aspirin will be administered at a 500-mg single dose and tirofiban at a 500-mcg bolus followed by a 200-mcg/h infusion during the first 24 h. All patients will be followed for up to 3 months. STUDY OUTCOMES: Primary efficacy outcome will be the proportion of patients with carotid in-stent thrombosis within the first 24 h after MT. Primary safety outcome will be the rate of symptomatic intracranial hemorrhage. DISCUSSION: This will be the first clinical trial to assess the best antiplatelet therapy to avoid in-stent thrombosis after MT in patients with TL. TRIAL REGISTRATION: The trial is registered as NCT05225961. February, 7th, 2022.

Sebaceous Adenoma: A Dermoscopic Case Perspective.

This report focuses on sebaceous skin tumors, specifically sebaceous adenoma, sebaceoma, and sebaceous carcinoma, along with their association with Muir-Torre syndrome (MTS). A clinical case of a 25-year-old male with a suspected sebaceous neoplasm based on dermoscopy appearance is presented. The histopathological examination confirmed the diagnosis and surgical management resulted in successful treatment. The report highlights the importance of considering differential diagnoses and utilizing dermoscopy for accurate evaluation of these rare skin tumors.

Osteosarcoma como patología GES. Experiencia de 7 años en Centro de Referencia Nacional

Introducción: El osteosarcoma (OS) es el tumor óseo primario maligno más frecuente. En 2014 se incorporó en Chile dentro del plan de garantías explícitas en salud (GES), ley que garantiza el tratamiento desde la sospecha hasta su tratamiento y rehabilitación. Objetivos: Describir las características de la población mayor de 15 años, con diagnóstico histopatológico de OS, definir su sobrevida, complicaciones e identificar variables que afectan estos resultados. Materiales y Métodos: Estudio retrospectivo, se incluyó a todos los pacientes con diagnóstico de OS, con confirmación histológica, desde 2014 a 2020. Datos demográficos, sitio anatómico, hallazgos histopatológicos, estadio de ingreso, presencia de metástasis, tratamiento, complicaciones y sobrevida fueron registrados. Se realizó un estudio multivariante para determinar factores pronósticos. Resultados: 133 pacientes fueron incluidos. 58,8% hombres, la edad promedio fue 31 años y la localización más frecuente fue fémur distal (34,9%). El 56,4% de los pacientes ingresó en estadio Enneking IIB, 36,4% presentó metástasis al ingreso. Un 14,3% presentó complicaciones, siendo la más frecuente la infección periprotésica (6 casos). El 16% evolucionó con recidiva local. El modelo multivariante mostró que la edad y presencia de metástasis al ingreso constituyen variables pronósticas independientes, con un cociente de riesgo de 1,017 para edad (p = 0,016) y de 3,13 para presencia de metástasis (p = 0,0000). En el análisis de subgrupos, los pacientes sin metástasis al diagnóstico presentaron sobrevida a 5 años de 54% versus 11% para el grupo con metástasis; al ajustar por edad, la sobrevida a 5 años para el grupo sin metástasis y con metástasis fue de 73% y 22% respectivamente. Conclusión: Este es el primer estudio de descripción demográfica de pacientes con OS que se realiza en nuestro país. Los resultados son similares a lo reportado por la literatura internacional, destacando en nuestra serie la edad de presentación y presencia de metástasis al ingreso como factores que afectan el pronóstico de una manera significativa. Al ajustar por edad, los porcentajes de sobrevida son equiparables con lo reportado en otros centros internacionales especializados en sarcomas.

Background: Osteosarcoma (OS) is the most frequent malignant primary bone tumor. The explicit health guarantee (GES) plan in Chile, a law that guarantees diagnosis, treatment, and rehabilitation, incorporated OS in 2014. Objectives: To describe the characteristics of the population over 15 years, with a histopathological diagnosis of OS, to define survival rate and complications, and to identify variables that affect these outcomes. Methods: A retrospective study from 2014 to 2020, including all patients affiliated with the public health system diagnosed with OS, with histological confirmation. From clinical records, we extracted demographic data, anatomical OS location, histopathological findings, admission stage, presence of metastases, treatment, complications, and survival. We determined prognostic factors by multivariate analysis. Results: 133 patients, 58.8% men, the average age was 31 years, and the most frequent location was the distal femur (34.9%). 56.4% of the patients were admitted in Enneking stage IIB, and 36.4% presented metastasis at admission. 14.3% presented complications, the most frequent periprosthetic infection (6 cases). 16% of patients evolved with local recurrence. The multivariate model showed that age and metastases at admission constitute independent prognostic variables, with a hazard ratio of 1.017 for age (p = 0.016) and 3.13 for metastases (p = 0.0000). In the subgroup analysis, patients without metastases at diagnosis had a 5-year survival of 54% versus 11% for the group with metastases. Adjusting for age, the 5-year survival for the non-metastatic and metastatic groups was 73% and 22%, respectively. Conclusion: This is our country's first demographic description study of patients with OS. In our series, the age of presentation and the presence of metastases at admission were factors that significantly affect prognosis. When adjusting for age, the survival percentages are comparable to those reported in other international centers specialized in sarcomas.

El costo esperado de cáncer en Chile / The expected cost of cancer in Chile

BACKGROUND: Cancer is a public health priority in Chile. AIM: To estimate the expected annual cost of cancer in Chile, due to direct costs of health services, working allowances and indirect costs for productivity losses. MATERIAL AND METHODS: We undertook an ascendent costing methodology to calculate direct costs. We built diagnostic, treatment and follow-up cost baskets for each cancer type. Further, we estimated the expenditure due to sick leave subsidies. Both estimates were performed either for the public or private sector. Costs related to productivity loss were estimated using the human capital approach, incorporating disease related absenteeism premature deaths. The time frame for all estimates was one year. RESULTS: The annual expected costs attributed to cancer was $1,557 billion of Chilean pesos. The health services expected annual costs were $1,436 billion, 67% of which are spent on five cancer groups (digestive, hematologic, respiratory, breast and urinary tract). The expected costs of sick leave subsidies and productivity loss were $48 and $71 billion, respectively. CONCLUSIONS: Cancer generates costs to the health system, which obliges health planners to allocate a significant proportion of the health budget to this disease. The expected costs estimated in this study are equivalent to 8.9% of all health expenditures and 0.69% of the Gross Domestic Product. This study provides an updated reference for future research, such as those aimed at evaluating the current health policies in cancer.

Riesgo de recurrencia y factores de riesgo de invasión del cáncer diferenciado de tiroides / Risk of recurrence and risk factors for invasion of differentiated thyroid cancer

Introducción: El cáncer diferenciado de tiroides (CDT) se encuentra representado por el carcinoma papilar y el carcinoma folicular. Comprende la gran mayoría (>90%) de todos los cánceres de tiroides. Objetivos: Estratificar el riesgo de recurrencia inicial de los pacientes con CDT. Relacionar la edad, sexo y tamaño tumoral con el riesgo de recurrencia, invasión capsular, ganglionar, vascular y de tejido peritiroideo. Materiales y métodos: Estratificar el riesgo de recurrencia inicial de los pacientes con CDT. Relacionar la edad, sexo y tamaño tumoral con el riesgo de recurrencia, invasión capsular, ganglionar, vascular y de tejido peritiroideo. Resultados: El 87% fueron del sexo femenino. La edad media fue de 43±14 años. Predominó el riesgo de recurrencia bajo en el 49% de los pacientes, seguido del riesgo intermedio (33%) y riesgo alto (18%). El tamaño tumoral ˃1cm confiere mayor riesgo de ser estratificado como riesgo de recurrencia intermedio/alto (OR 5,7 IC 95% 3,6-9). El sexo masculino representó mayor riesgo de invasión ganglionar (OR 2,8 IC 95% 1,2-6,6); la edad ≥55 años lo fue en la invasión vascular (OR 2,1 IC 95% 1,1-4,1); el tamaño >1cm constituyó un mayor riesgo de manera significativa de invasión capsular (OR 10,5 IC 95% 6,5-17), invasión ganglionar (OR 10,2 IC 95% 3,8-26,9), invasión vascular (OR 30,7 IC 95% 4,2-224) e invasión de tejido peritiroideo (OR 5,2 IC 95% 3,3-8,2). Conclusión: El riesgo de recurrencia inicial más frecuente fue el riesgo bajo. El sexo masculino, la edad ≥55años y el tamaño >1cm constituyen factores de riesgo de invasión a estructuras vecinas.

Introduction: Differentiated thyroid cancer (DTC) is represented by papillary carcinoma and follicular carcinoma. It comprises the vast majority (> 90%) of all thyroid cancers. Objectives: Stratify the risk of initial recurrence of patients with DTC. Relate age, sex, and tumor size to the risk of recurrence, capsular, nodal, vascular, and perithyroid tissue invasion. Materials and methods: Observational, descriptive, retrospective, cross-sectional study with an analytical component. A total of 432 patients with a diagnosis of DTC from Hospital de Clínicas, Instituto de Previsión Social and Instituto Nacional del Cáncer between 2011 and 2015 were included. Results: 87% were female. The mean age was 43 ± 14 years. Low recurrence risk predominated in 49% of patients, followed by intermediate risk (33%) and high risk (18%). Male sex, age ≥55 years and tumor size ˃1cm confer a higher risk of being stratified as intermediate / high recurrence risk, but only size> 1cm was significantly (OR 5.7 95% CI 3.6-9). Male sex represented a higher risk of lymph node invasion (OR 3.1 95% CI 1.4-2.8) and vascular invasion (OR 2.3 95% CI 1.1-4.8); age ≥55 years was in the vascular invasion (OR 2.6 95% CI 1.4-4.9); size> 1cm constituted a significantly higher risk of capsular invasion (OR 10.7 95% CI 6.7-17.3), nodal invasion (OR 10.5 95% CI 4-27.7), vascular invasion (OR 33 95% CI 4.5-244) and invasion of perithyroid tissue (OR 5.1 95% CI 3.2-8.1). Conclusion: The most frequent initial recurrence risk was low risk. Male sex, age ≥55 years, and size> 1cm are risk factors for invasion of neighboring structures.

Comparación de antibióticoterapia en la apendicitis complicada en pediatría / Comparison of antibiotic therapy in complicated appendicitis in pediatrics

INTRODUCCIÓN. La apendicitis aguda es una patología pediátrica quirúrgica que en su fase complicada requiere uso de antibióticos en el postoperatorio; encontrar la mejor opción como experiencia local, fue necesario. OBJETIVO. Comparar un esquema de antibioticoterapia triple vs un doble respecto a variables: demográficas, clínicas y de costos en pacientes pediátricos con apendicitis complicada. MATERIALES y MÉTODOS. Estudio analítico transversal. Población de 133 pacientes y una muestra de 93, operados por apendicitis complicada; 58 recibieron ampicilina + metronidazol + gentamicina y 35 ceftriaxona + metronidazol. Se comparó las variables: estadía hospitalaria, complicaciones y costo monetario de cada esquema. Se realizó en la Unidad de Cirugía Pediátrica del Hospital de Especialidades Carlos Andrade Marín, en el periodo enero de 2017 a octubre de 2018. Los datos fueron analizados con R-Studio 1.8.366 para Windows. RESULTADOS. No hubo diferencia estadística con respecto a: estadía hospitalaria (p=0,261); complicaciones como infección del sitio quirúrgico (p=0,196), re-intervención quirúrgica (p=0,653) y costo (p=0,059). CONCLUSIÓN. Se comparó el esquema de antibioticoterapia triple vs un doble, utilizados en apendicitis complicada en pediatría. No se encontró diferencias estadísticamente significativas en este reporte preliminar, con la diferencia de que con el esquema doble la frecuencia de administración fue menor y se evitó la exposición a los efectos colaterales de los aminoglicósidos.

INTRODUCTION. Acute appendicitis is a pediatric surgical pathology that in its complicated phase requires the use of antibiotics during the postoperative period; finding the best option as local experience was a must. OBJECTIVE. Compare a triple vs a double antibiotic therapy scheme respect demographic, clinical and cost variables in pediatric patients whit complicated apendicitis. MATERIALS AND METHODS. Cross-sectional analytical study. Population of 133 patients and sample of 93, with complicated appendicitis; 58 received ampicillin + metronidazole + gentamicin and 35 ceftriaxone + metronidazole. The following variables were compared; hospital stay, complications and monetary cost of each scheme. It was performed in the Pediatric Surgery Unit of the Hospital of Specialties Carlos Andrade Marin, during january 2017, through october 2018. The data were analyzed with R-Studio 1.8.366 for Windows. RESULTS. There was no statistical difference regarding hospital stay (p=0.261); complications such as surgical site infection (p=0.196), re-surgical intervention (p=0.653); nor cost (p=0.059). CONCLUSION. Triple vs. Double antibiotic therapy scheme used in complicated appendicitis in pediatrics was compared. No statistically significant differences were found in this preliminary report, how ever with the double scheme the frequency of administration was lower and exposure to side effects of aminoglycosides was avoided.

Cirugía de cabeza y cuello durante la pandemia de COVID-19 en Colombia: Experiencia de un centro de excelencia / Head and neck surgery during the COVID-19 pandemic in Colombia: Experience from a center of excellence

Introducción. La pandemia por SARS-CoV-2 modificó la prestación de servicios de salud para priorizar el manejo de los casos emergentes. La Asociación Colombiana de Cirugía fue una de las primeras en liderar dichas iniciativas. Este estudio describe el comportamiento de los servicios de salud de un centro especializado en patología de cabeza y cuello en Medellín, Colombia. Métodos. Este es un análisis retrospectivo de una cohorte prospectiva, en el que se usó la base de datos administrativa. Las variables analizadas fueron el número y tipo de consultas y procedimientos, realizados en el periodo de enero-julio de 2109 y su comparación con el mismo periodo de 2020. Se realizó un análisis descriptivo usando porcentajes, promedio y desviación estándar. Resultados. Se analizaron 3521 consultas y 866 procedimientos quirúrgicos. Se observó una caída del número de consultas, que alcanzó su punto más bajo en el mes de abril, con un 33,9 % de disminución El porcentaje de consultas de telemedicina aumentó desde marzo de 2020, hasta alcanzar un 98 % en el mes de abril. Se observó una caída del número de procedimientos, con un aumento compensatorio en junio del 62,5 %. A la fecha, ningún paciente ni integrante del equipo de atención en salud ha presentado infección por COVID-19. Discusión. La pandemia de COVID-19 tuvo un efecto importante en el número de consultas y de procedimientos quirúrgicos de cabeza y cuello. La estrategia de telemedicina ayudó a compensar la disminución del acceso a la atención especializada

Introduction. The SARS-CoV-2 pandemic modified the provision of health services to prioritize the management of emerging cases. The Colombian Association of Surgery was one of the first to lead these initiatives. This study describes the behavior of the health services of a center specialized in head and neck pathology in Medellín, Colombia. Methods. This is a retrospective analysis of a prospective cohort, in which the administrative database was used. The variables analyzed were the number and type of consultations and procedures, carried out in the period from January to July 2019 and their comparison with the same period in 2020. A descriptive analysis was carried out using percentages, average and standard deviation. Results. On the database, 3,521 consultations and 866 surgical procedures were analyzed. A drop in the number of consultations was observed, reaching its lowest point in the month of April, with a 33.9% decrease. The percentage of telemedicine consultations increased since March 2020, reaching 98% in the month of April. A drop in the number of procedures was observed, with a compensatory increase in June of 62.5%. To date, no patient or member of the health care team has developed a COVID-19 infection. Discussion. The COVID-19 pandemic had a significant effect on the number of consultations and head and neck surgical procedures. The telemedicine strategy helped to compensate the decrease in access to specialized care

Factores que influyen en la elección de una carrera en atención primaria entre los estudiantes de medicina en América Central

[RESUMEN]. Objetivos. Identificar las especialidades preferidas, la percepción salarial y los factores que influencian la elección de una carrera en atención primaria en los estudiantes de último año de medicina o en servicio social de América Central. Métodos. Estudio multicéntrico de corte transversal con aplicación de una encuesta que investigó la información demográfica, la especialidad preferida, la percepción salarial y otros factores que influyen en la elección de la especialidad. Resultados. Participaron 1 722 estudiantes de 31 universidades que identificaron como futuras especialidades: cirugía (11,7%), ginecología/obstetricia (10,3%), pediatría (9,9%) y medicina interna (6,6%). Medicina general alcanzó 3,8% y medicina familiar 1,1%. Al agruparlas el mayor interés fue para las especialidades médicas (49,7%), seguido de las quirúrgicas (31,7%). Atención primaria registró un interés del 17,1%. Las especialidades quirúrgicas fueron percibidas como de mayor ingreso (USD 36 000); atención primaria fue percibida como la de menor ingreso (USD 24 000). El ingreso (23,6%), el trabajo a futuro (19,7%) y “hacer una diferencia en las personas” (8,9%) fueron los principales factores involucrados en la elección. “Trabajar con personas con escaso acceso” se asoció de manera significativa con la preferencia por la atención primaria. La preferencia por otras especialidades fue influenciada por el “prestigio percibido” y “disfrutar la vida” (P < 0,05). La mayoría de los participantes que eligieron la atención primaria provenían de una universidad pública (P < 0,05), lo que pone de relieve el papel de las instituciones estatales de educación superior. Conclusiones. Existe una combinación de factores facilitadores y de barreras que inciden en el desinterés hacia las carreras de atención primaria. Se requiere de estrategias desde la academia y el sector gubernamental, así como la definición de políticas públicas, que favorezcan la elección de la atención primaria.

[ABSTRACT]. Objectives. To identify the preferred specialties, salary perception and other factors that influence the choice of a career in primary care among last-year medical students or social service students in Central America. Methods. A cross-sectional, multicenter study using a survey that investigated demographic information, preferred specialty, salary perception, and other factors that influence the choice of a specialty. Results. A total of 1 722 students from 31 universities participated and identified as future specialties: surgery (11.7%), gynecology/obstetrics (10.3%), pediatrics (9.9%) and internal medicine (6.6%). General medicine was preferred by 3.8% and family medicine by 1.1%. On grouping them, the greatest interest was observed for medical specialties (49.7%), followed by surgical specialties (31.7%). Primary care registered an interest of 17.1%. Surgical specialties were perceived as having the highest income (USD 36 000); primary care was perceived as having the lowest income (USD 24 000). Income (23.6%), future work (19.7%) and “making a difference in people” (8.9%) were the main factors involved in the choice. “Working with people with low access” was significantly associated with preference for primary care. Preference for other specialties was influenced by “perceived prestige” and “enjoying life” (P < 0.05). Most participants who chose primary care were studying at a public university (P < 0.05), highlighting the role of public institutions of higher education. Conclusions. There is a combination of facilitating factors and barriers that affect the low interest in primary care careers. There is a need for strategies from academia and the government sector, as well as the definition of public policies, that support the choice of primary care.

Prevalencia de Cáncer de Tiroides en Centros de Referencia del Paraguay / Prevalence of Thyroid Cancer in Reference Centers of Paraguay

Introducción: El Cáncer de tiroides es la neoplasia maligna más frecuente del sistema endócrino. Durante las últimas décadas se ha observado un aumento de su incidencia de forma progresiva en numerosos países y regiones del mundo. Objetivos: Determinar la prevalencia de Cáncer de tiroides y, los tipos histológicos, en 3 hospitales de referencia en Paraguay. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo, de corte transversal. Se incluyó a todos los pacientes sometidos a tiroidectomía parcial o total en el Hospital de Clínicas, Instituto de Previsión Social e Instituto Nacional del Cáncer, entre los años 2011 y 2015. Resultados: La prevalencia de cáncer de tiroides fue de 23,7% de 1913 pacientes sometidos a tiroidectomía. El 85,7% fueron del sexo femenino. La edad media fue de 43±14 años. El 85,4 % de los pacientes presentó Carcinoma Papilar; el 9,5% Carcinoma Folicular; el 3,1% Carcinoma Medular; el 1,6% Carcinoma Anaplásico y el 0,4% Carcinoma Papilar + Carcinoma Folicular en el mismo paciente. El sexo femenino fue más frecuente en todos los tipos histológicos y, el Carcinoma Medular resultó igual en ambos sexos. La edad media de los pacientes con Carcinoma Papilar fue de 42±13 años, Carcinoma Medular 49±15 años, del Carcinoma Folicular 50±18 años y Carcinoma Anaplásico 69±11 años. El tamaño promedio del Carcinoma Papilar fue de 19±17 mm, del Carcinoma Folicular 53±24 mm, del Carcinoma Medular 40±22 mm, y el Carcinoma Anaplásico 50±35 mm. Conclusión: Aproximadamente 1 de cada 4 pacientes sometidos a tiroidectomía presentó cáncer de tiroides, siendo más frecuente en el sexo femenino y, el Carcinoma Papilar es el tipo histológico más frecuente.

Introduction: Thyroid cancer is the most frequent malignant neoplasm of the endocrine system. During the last decades, an increase in its incidence has been observed progressively in many countries and regions of the world. Objectives: To determine the prevalence of thyroid cancer and its histological types in thyroidectomies carried out in reference hospitals in Paraguay. Materials and methods: Observational, descriptive, retrospective, cross-sectional study. All patients undergoing partial or total thyroidectomy at the Hospital de Clínicas, Instituto de Previsión Social and Instituto Nacional del Cáncer between 2011 and 2015 were included. Results: The prevalence of thyroid cancer was 23.7% of 1913 patients undergoing thyroidectomy. 85.7% were female. The mean age was 43 ± 14 years. 85.4% of the patients presented Papillary Carcinoma; 9.5% Follicular Carcinoma; 3.1% Medullary Carcinoma; 1.6% Anaplastic Carcinoma and 0.4% Papillary Carcinoma + Follicular Carcinoma in the same patient. The mean age of the patients with Papillary Carcinoma was 42 ± 13 years, Medullary Carcinoma 49 ± 15 years, Follicular Carcinoma 50 ± 18 years, and Anaplastic Carcinoma 69 ± 11 years. The average size of Papillary Carcinoma was 19 ± 17 mm, Medullary Carcinoma 40 ± 22 mm, Anaplastic Carcinoma 50 ± 35 mm, and Follicular Carcinoma 53 ± 24 mm. Conclusion: About 1 in 4 patients undergoing thyroidectomy has thyroid cancer, it is more frequent in women, and the most frequent histological type is Papillary Carcinoma.

Kinanthropometric assessment of individual, collective and fight sport players from the Spanish national sport technification program / Evaluación cineantropométrica en deportistas individuales, colectivos y de lucha, del programa nacional español de tecnificación deportiva

Nowadays, the study of kinanthropometric parameters is an important tool for both early talent selection and for evaluating the efficacy of a training program. This study aimed to determine the anthropometric characteristics, body composition indicators and somatotype components of individual (athletics, swimming and triathlon), collective (handball and volleyball) and fight (karate and taekwondo) sportsmen and sportswomen from the Valencian Sports Technification Centre. This study involved a total of 62 men and 56 women, they were divided in three subgroups, including individual (athletics, swimming and triathlon), collective (handball and volleyball) and fight (karate and taekwondo) sports. The assessment was carried out according to the one established by the International Society for Advancement of Kinanthropometry (ISAK). For men, the highest value of femur breath, ectomorphy and medial calf and front thigh skinfolds are obtained for triathletes, athletics, volleyball and karate, respectively. The highest values of triceps, biceps and abdominal skinfolds, relaxed arm girth, endomorphy and body fat percentage are shown for taekwondo, while the other highest values are obtained with handball. For women, the highest value of ectomorphy is obtained for athletics. The identified kinanthropometric parameters are useful when comparing between sports and sports subgroups for the selection of subjects and to help in their performance assessment.

En la actualidad, el estudio de los parámetros cineantropométricos es una herramienta importante tanto para la selección temprana del talento como para evaluar la eficacia de un programa de capacitación. Este estudio tuvo como objetivo determinar las características antropométricas, los indicadores de composición corporal y los componentes somatotípicos de deportistas y deportistas individuales (atletismo, natación y triatlón), colectivos (balonmano y voleibol) y de lucha (karate y taekwondo) del Centro Valenciano de Tecnificación Deportiva. Este estudio involucró a un total de 62 hombres y 56 mujeres, se dividieron en tres subgrupos, que incluyen deportes individuales (atletismo, natación y triatlón), colectivos (balonmano y voleibol) y peleas (karate y taekwondo). La evaluación se realizó de acuerdo con la establecida por la Sociedad Internacional para el Avance de la Cineantropometría (ISAK). Para los hombres, el valor más alto de la respiración del fémur, la ectomorfia y los pliegues de la pantorrilla y el muslo frontal se obtienen para triatletas, atletismo, voleibol y karate, respectivamente. Los valores más altos de tríceps, bíceps y pliegues abdominales, circunferencia relajada del brazo, endomorfia y porcentaje de grasa corporal se muestran para el taekwondo, mientras que los otros valores más altos se obtienen con balonmano. Para las mujeres, el mayor valor de la ectomorfía se obtiene para el atletismo. Los parámetros cineantropométricos identificados son útiles cuando se comparan entre deportes y subgrupos deportivos para la selección de sujetos y para ayudar en su evaluación del rendimiento.