[Psychological Impact of COVID-19 on Health Workers During the Second Year of the Pandemic in Latin America: Cross-Sectional Survey Study]. / Impacto psicológico del COVID-19 en los trabajadores sanitarios durante el segundo año de pandemia en Latinoamérica: estudio de encuesta transversal.

Introduction: The coronavirus pandemic continues to affect the mental health of healthcare personnel in Latin America (LA). Objective: To estimate the prevalence of psychological disturbances and associated risk factors for mental health in healthcare personnel in LA during the second year of the COVID-19 pandemic. Method: This multicenter cross-sectional study included a total sample of 5437 healthcare professionals from Argentina, Bolivia, Chile, Colombia, Ecuador, and Peru. The PHQ-9, GAD-7, and a brief demographic questionnaire were used. The prevalence of anxiety and depression was estimated based on the cut-off points of the instruments. Two multivariate logistic regressions were performed. Results: A population burden of anxiety (40.1%) and depression (62.2%) was found in healthcare personnel in LA. Among professionals in Argentina (OR = 1.374; P<.001), those working in state hospitals (OR = 1.536; P<.003), frontline healthcare workers for COVID patients (OR = 1.848; P<.001), general practitioners (OR = 1.335; P<.001), and specialists (OR = 1.298; P<.001), a higher risk of experiencing mental disorders was observed. Among women, younger personnel, and administrative staff, a higher probability of experiencing anxiety and depression was identified. Conclusions: The burden of mental disorders on healthcare personnel in Latin America is alarming. Psychological support services are necessary, aimed at providing measures for professionals to develop healthy coping mechanisms that mitigate the impact of the pandemic on their well-being and facilitate post-crisis adjustment.

New Hybrid Scaffolds Based on 5-FU/Curcumin: Synthesis, Cytotoxic, Antiproliferative and Pro-Apoptotic Effect.

A series of 5-FU-Curcumin hybrids were synthesized, and their structures were elucidated by spectroscopic analysis. The synthesized hybrid compounds were evaluated in different colorectal cancer cell lines (SW480 and SW620) and in non-malignant cells (HaCaT and CHO-K1), to determine their chemopreventive potential. Hybrids 6a and 6d presented the best IC50 value against the SW480 cell line with results of 17.37 ± 1.16 µM and 2.43 ± 0.33 µM, respectively. Similarly, compounds 6d and 6e presented IC50 results of 7.51 ± 1.47 µM and 14.52 ± 1.31 µM, respectively, against the SW620 cell line. These compounds were more cytotoxic and selective than curcumin alone, the reference drug 5-fluorouracil (5-FU), and the equimolar mixture of curcumin and 5-FU. In addition, hybrids 6a and 6d (in SW480) and compounds 6d and 6e (in SW620) induced cell cycle arrest in S-phase, and, compounds 6d and 6e caused a significant increase in the sub-G0/G1 phase population in both cell lines. Hybrid 6e was also observed to induce apoptosis of SW620 cells with a respective increase in executioner caspases 3 and 7. Taken together, these results suggest that the hybrids could actively act on a colorectal cancer model, making them a privileged scaffold that could be used in future research.

Resveratrol/Hydrazone Hybrids: Synthesis and Chemopreventive Activity against Colorectal Cancer Cells.

A series of resveratrol/hydrazone hybrids were obtained and elucidated by spectroscopic analysis. All compounds were evaluated against colorectal cancer cells (SW480 and Sw620) and nonmalignant cell lines (HaCaT and CHO-K1) to establish the selectivity index. Among the hybrids evaluated, compounds 6e and 7 displayed the highest cytotoxic activity with IC50 values of = 6.5 ± 1.9 µM and 19.0 ± 1.4 µM, respectively, on SW480 cells. In addition, hybrid 7 also exhibited activity on SW620 cells with an IC50 value of 38.41 ± 3.3 µM. Both compounds were even more toxic against these malignant cells in comparison to the nonmalignant ones, as evidenced by higher selectivity indices 48 h after treatment. These compounds displayed better activity and selectivity than parental compounds (PIH and Resveratrol) and the reference drug (5-FU). In addition, it was observed that both compounds caused antiproliferative activity probably exerted by cell cycle arrest at the G2/M or G0/G1 phases, with the formation of cells in the subG0/G1 phase. Furthermore, it was noticed that compound 7 induced mitochondrial depolarization in SW480 cells and positive staining for propidium iodide in both cancer cell lines, suggesting cell membrane damage involving either apoptosis or other processes of death.

Synthesis and Chemopreventive Potential of 5-FU/Genistein Hybrids on Colorectal Cancer Cells.

A series of 5-FU-Genistein hybrids were synthesized and their structures were elucidated by spectroscopic analysis. The chemopreventive potential of these compounds was evaluated in human colon adenocarcinoma cells (SW480 and SW620) and non-malignant cell lines (HaCaT and CHO-K1). Hybrid 4a displayed cytotoxicity against SW480 and SW620 cells with IC50 values of 62.73 ± 7.26 µM and 50.58 ± 1.33 µM, respectively; compound 4g induced cytotoxicity in SW620 cells with an IC50 value of 36.84 ± 0.71 µM. These compounds were even more selective than genistein alone, the reference drug (5-FU) and the equimolar mixture of genistein plus 5-FU. In addition, hybrids 4a and 4g induced time- and concentration-dependent antiproliferative activity and cell cycle arrest at the S-phase and G2/M. It was also observed that hybrid 4a induced apoptosis in SW620 cells probably triggered by the extrinsic pathway in response to the activation of p53, as evidenced by the increase in the levels of caspases 3/8 and the tumor suppressor protein (Tp53). Molecular docking studies suggest that the most active compound 4a would bind efficiently to proapoptotic human caspases 3/8 and human Tp53, which in turn could provide valuable information on the biochemical mechanism for the in vitro cytotoxic response of this compound in SW620 colon carcinoma cell lines. On the other hand, molecular dynamics (MD) studies provided strong evidence of the conformational stability of the complex between caspase-3 and hybrid 4a obtained throughout 100 ns all-atom MD simulation. Molecular mechanics Poisson-Boltzmann surface area (MM-PBSA) analyses of the complex with caspase-3 showed that the interaction between the ligand and the target protein is stable. Altogether, the results suggest that the active hybrids, mainly compound 4a, might act by modulating caspase-3 activity in a colorectal cancer model, making it a privileged scaffold that could be used in future investigations.

IL-4, IL-10, CCL2 and TGF-ß as potential biomarkers for severity in Plasmodium vivax malaria.

Cytokines and chemokines are immune response molecules that display diverse functions, such as inflammation and immune regulation. In Plasmodium vivax infections, the uncontrolled production of these molecules is thought to contribute to pathogenesis and has been proposed as a possible predictor for disease complications. The objective of this study was to evaluate the cytokine profile of P. vivax malaria patients with different clinical outcomes to identify possible immune biomarkers for severe P. vivax malaria. The study included patients with non-severe (n = 56), or severe (n = 50) P. vivax malaria and healthy controls (n = 50). Patient plasma concentrations of IL-4, IL-2, CXCL10, IL-1ß, TNF-α, CCL2, IL-17A, IL-6, IL-10, IFN-γ, IL-12p70, CXCL8 and active TGF-ß1 were determined through flow cytometry. The levels of several cytokines and chemokines, CXCL10, IL-10, IL-6, IL-4, CCL2 and IFN-γ were found to be significantly higher in severe, compared to non-severe P. vivax malaria patients. Severe thrombocytopenia was positively correlated with IL-4, CXCL10, IL-6, IL-10 and IFN-γ levels, renal dysfunction was related to an increase in IL-2, IL-1ß, IL-17A and IL-8, and hepatic impairment with CXCL10, MCP-1, IL-6 and IFN-γ. A Lasso regression model suggests that IL-4, IL-10, CCL2 and TGF-ß might be developed as biomarkers for severity in P. vivax malaria. Severe P. vivax malaria patients present specific cytokine and chemokine profiles that are different from non-severe patients and that could potentially be developed as biomarkers for disease severity.

[Prevalence and factors associated with subjective cognitive complaints in Latin American health workers during the COVID-19 pandemic]. / Prevalencia y factores asociados con las quejas cognitivas subjetivas del personal sanitario latinoamericano durante la pandemia de COVID-19.

Background and objectives: An increase in emotional disturbances and complaints about cognitive performance has been observed in Latin American healthcare workers during the SARS-CoV-2 pandemic, which can affect attention capacity and increase the levels of stress and burnout of these professionals. The objective was to analyse subjective cognitive complaints (SCC) and associated factors in health personnel during the COVID-19 pandemic in five Latin American countries.Methods: Multicentre cross-sectional study, which included 3,738 professionals from Colombia, Chile, Argentina, Ecuador, Bolivia, and Peru. The Generalized Anxiety Disorder Scale (GAD-7) and the Patient Health Questionnaire (PHQ-9) was used to assess depression, and the Mini-Z to assess Burnout. For the SCC, an item on cognitive concerns in attention and memory was used.Results: The prevalence of cognitive complaints was 69.2%. The factors associated with a higher risk of SCC were the scores in the GAD-7, PHQ and Mini-Z, in addition to being part of the Ecuadorian health personnel.Conclusions: There is a high prevalence of SCC in health personnel, which is modulated by emotional states and stress.

Presentation of Bilateral Facial Paralysis in Melkersson-Rosenthal Syndrome.

Introduction. Melkersson-Rosenthal syndrome (MRS) is a neuromucocutaneous disorder characterized by the following classic symptom triad: peripheral facial paralysis, orofacial edema, and scrotal or fissured tongue. It is rare, and since most of the patients are oligo- or monosymptomatic, it makes it difficult to diagnose. Clinical Case. We present a 26-year-old male patient with a history of sickle cell trait, untreated snoring, and left peripheral facial paralysis when he was 11 years old. This was an overall 20-day clinical profile that started with left peripheral facial paralysis, which was accompanied by moderate-intensity occipital pulsatile headaches. Additionally, the patient experienced paresthesias in the tongue and feelings of labial edema. After one week, he manifested peripheral facial paralysis on the right side. Physical examination revealed bilateral peripheral facial paralysis, mild labial edema, and a scrotal or fissured tongue. The patient received corticosteroids, which resulted in improvement of the edema and facial paralysis. Discussion. MRS is a rare disorder that predominantly affects women, typically starting in their 20s or 30s. The etiology is unknown. However, a multifactorial origin that involves environmental factors and a genetic predisposition has been proposed, which causes a dysfunction of the local immune system and autonomic nervous system (ANS) and an appearance of granulomatous inflammation in the lips and tongue. Facial paralysis usually appears later on; however, it can occur from its clinical debut. There are no curative treatments. Therapy is focused on modulating the patient's immune response, and relapses are frequent.

Harris's hawks (Parabuteo unicinctus) hematological parameters in different tropical locations.

This work described and compared the hematological findings of 25 clinically healthy Harris's hawks (Parabuteo unicinctus) in captivity at two different tropical locations: 16 samples from Aguascalientes, which altitude is 1878 mean sea level, and nine samples from Amecameca which altitude is 2650 mean sea level. Blood samples were collected from the brachial vein of each raptor under physical restraint. Significant differences between the two locations were found in some parameters including total, erythrocytes, heterophils, basophils, lymphocytes, and heterophil/lymphocyte ratio. When the results were compared to the reference values, the population of Amecameca showed decreased values of hematocrit (32.21 ± 13.72%), hemoglobin (107.40 ± 45.60 g L-1) and erythrocytes (1.98 ± 0.63 ×1012 per µL). This work contributed to the knowledge of variations in blood parameters of clinically healthy captive Harris`s hawks at different tropical locations and sex. The information will enable clinicians to provide appropriate veterinary diagnostics and care to ensure the health and welfare of raptors kept in captivity.

Educational Strategies to Develop and Implement a Comprehensive Health Care Model Focused on Primary Care in Colombia.

The traditional, subject-based medical curriculum in Colombia has been mainly focused on the biomedical model proposed by Flexner in 1910. This means learning outcomes or competences are framed on curative care and the specialization of physicians. Students are mainly trained to work in highly complex hospitals in urban centers and encouraged to enroll (as soon as possible) in residencies. This curriculum lacks pertinence to implement the new Colombian Primary Health Care Model as the focus is a shift toward the promotion of health and prevention of illness. Recommendations to provide light on how to implement a change for ensuring pertinence of medical education in this context are discussed.

Targeting Neuroplasticity, Cardiovascular, and Cognitive-Associated Genomic Variants in Familial Alzheimer's Disease.

The identification of novel genetic variants contributing to the widespread in the age of onset (AOO) of Alzheimer's disease (AD) could aid in the prognosis and/or development of new therapeutic strategies focused on early interventions. We recruited 78 individuals with AD from the Paisa genetic isolate in Antioquia, Colombia. These individuals belong to the world largest multigenerational and extended pedigree segregating AD as a consequence of a dominant fully penetrant mutation in the PSEN1 gene and exhibit an AOO ranging from the early 1930s to the late 1970s. To shed light on the genetic underpinning that could explain the large spread of the age of onset (AOO) of AD, 64 single nucleotide polymorphisms (SNP) associated with neuroanatomical, cardiovascular, and cognitive measures in AD were genotyped. Standard quality control and filtering procedures were applied, and single- and multi-locus linear mixed-effects models were used to identify AOO-associated SNPs. A full two-locus interaction model was fitted to define how identified SNPs interact to modulate AOO. We identified two key epistatic interactions between the APOE*E2 allele and SNPs ASTN2-rs7852878 and SNTG1-rs16914781 that delay AOO by up to ~ 8 years (95% CI 3.2-12.7, P = 1.83 × 10-3) and ~ 7.6 years (95% CI 3.3-11.8, P = 8.69 × 10-4), respectively, and validated our previous finding indicating that APOE*E2 delays AOO of AD in PSEN1 E280 mutation carriers. This new evidence involving APOE*E2 as an AOO delayer could be used for developing precision medicine approaches and predictive genomics models to potentially determine AOO in individuals genetically predisposed to AD.

The influence of different curriculum designs on students' dropout rate: a case study.

The relationship between students' withdrawal and educational variables has generated a considerable number of publications. As the explosion of information in sciences and integration theories led to creating different curriculum designs, it has been assumed that differences among designs explain academic success and, therefore, students' retention. However, little attention has been given to examine explicitly how diverse designs influence dropout rates in practice, which questions if decisions to reform curricula are sufficiently informed. This article describes our curriculum reform, which exposes our former and current curriculum designs as having had dissimilar dropout percentages. Furthermore, we aimed to explore the influence of different curriculum designs on students' dropout rates. The conclusion is that dropout variations may be explained not only because of the curriculum design itself, but also because of the power relationship changes between teachers and students that brought out the design change. Consequently, more research is needed to fully understand the political implications of different curriculum designs and their influence on dropout rates.

El nuevo trívium en la formación médica más allá de la comunicación médico-paciente / The new trivium in medical training beyond the doctor-patient communication

Uno de los elementos innovadores de los currículos de medicina en las últimas décadas es el énfasis en la comunicación médico-paciente. Sin embargo, las competencias comunicativas van más allá; implican habilidades cognitivo-lingüísticas que soporten la escucha activa, la lectura, la escritura y la oralidad en el contexto del aprendizaje y práctica de la medicina. Creemos que limitar la enseñanza de la comunicación al encuentro médico-paciente deja de lado los procesos cognitivos y las manifestaciones lingüísticas fundamentales para asegurar el éxito comunicativo del médico dentro de la sociedad. En otras palabras, además de las técnicas para una mejor comunicación, las habilidades cognitivo-lingüísticas resultan esenciales en el momento de elegir, organizar, clasificar y categorizar la información que se ha de brindar tanto al paciente y su familia como a la comunidad médica para el mejoramiento de la salud de individuos y poblaciones. En este artículo pretendemos argumentar por qué es importante el aprendizaje integral de las habilidades comunicativas, ejemplificando el caso del nuevo trívium del currículo de medicina de la Universidad del Rosario, la cual constituye un espacio propicio para que el estudiante desarrolle habilidades cognitivo-lingüísticas para la comunicación clínica en su comunidad científica.

One of the innovative elements of medical curricula in recent decades is the emphasis on the doctor-patient communication. However, communicative competences go further; they involve cognitive-linguistic skills that support active listening, reading, writing and orality in the context of learning and practicing medicine. We believe that limiting the teaching of communication to the doctor-patient encounter leaves the cognitive processes and the fundamental linguistic manifestations aside to ensure the communicative success of the doctor within the society. In other words, in addition to the techniques for better communication, cognitive-linguistic skills are essential at the time of choosing, organizing, classifying and categorizing the information that must be provided both to the patient and his family and to the medical community for the improvement of the health of individuals and populations. In this article, we intend to argue why it is important to comprehensively learn the communication skills, exemplifying the case of the new trivium of the medicine curriculum of Universidad del Rosario, which constitutes a favorable space for the students to develop cognitive-linguistic skills for the clinical communication in their scientific community.

Integración curricular mecanicista versus sistémica / Curricular integration in medical education

Introducción: la integración curricular ha sido un factor fundamental para el desarrollo de los currículos médicos modernos; sin embargo, en sus modelos más conocidos, que incluyen la integración horizontal y vertical, se continúan entendiéndose el aprendizaje de la medicina en torno a temas, tal como se hace en los currículos tradicionales. Esta manera de concebir el aprendizaje no permite analizar de manera metodológica el diseño de currículos integrados/integradores que involucran otras formas de aprender. Objetivo: suscitar una reflexión teórica y metodológica sobre la integración curricular en la educación médica con la finalidad de orientar el diseño y la evaluación de los currículos integrados/integradores y polemizar sobre qué tan innovadoras son las integraciones verticales y horizontales. Desarrollo: los currículos integrados horizontal y verticalmente son similares a los currículos tradicionales fragmentados en su concepción lineal del diseño, mientras que en la integración curricular sistémica, cuyos ejemplos pueden visualizarse en los currículos diseñados mediante el aprendizaje basado en problemas, se aborda el diseño curricular de manera circular mediante la conexión de cuestiones que se retroalimentan las unas a las otras, por tanto, las actividades de aprendizaje podrían diseñarse y evaluarse de forma simultánea. Conclusiones: al pensar en la integración curricular como una estrategia de innovación educativa implica debatir qué se entiende por currículos integrados/integradores, cómo se analizando la práctica de nuestros currículos médicos, con qué marcos teóricos estamos realizando ese análisis y qué implicaciones tiene esto en el diseño y la evaluación de los currículos(AU)

Introduction: Curricular integration has been a fundamental factor in the development of modern medical curricula; however, in its more well-known models, including horizontal and vertical integrations, the learning of medicine around subjects, as it is done in traditional curricula, continues to be understood. This way of conceiving learning does not allow methodological analysis of the design of integrated/integrative curricula that involve other ways of learning. Objective: To stimulate a theoretical and methodological reflection on curriculum integration in medical education, with the aim of orienting the design and assessment of integrated/integrative curricula and to discuss how innovative vertical and horizontal integrations are. Development: Horizontally and vertically integrated curricula are similar to traditional curricula fragmented in their design linear conception, while in systemic curricular integration, examples of which can be visualized in curricula designed through problem-based learning, curricular design is addressed in a circular way by connecting issues that feed back to one another; therefore, learning activities could be designed and assessed simultaneously. Conclusions: Thinking about curricular integration as a strategy of educational innovation implies discussing what we are understanding as integrated/ integrative curricula, how we are analyzing the practice of our medical curricula, with which theoretical frameworks we are doing that analysis, and what implications this has in curricula design and assessment(AU)

Integrated Medical Curriculum: Advantages and Disadvantages.

Most curricula for medical education have been integrated horizontally and vertically--vertically between basic and clinical sciences. The Flexnerian curriculum has disappeared to permit integration between basic sciences and clinical sciences, which are taught throughout the curriculum. We have proposed a different form of integration where the horizontal axis represents the defined learning outcomes and the vertical axis represents the teaching of the sciences throughout the courses. We believe that a mere integration of basic and clinical sciences is not enough because it is necessary to emphasize the importance of humanism as well as health population sciences in medicine. It is necessary to integrate basic and clinical sciences, humanism, and health population in the vertical axis, not only in the early years but also throughout the curriculum, presupposing the use of active teaching methods based on problems or cases in small groups.

Medical education and the healthcare system--why does the curriculum need to be reformed?

Medical education has been the subject of ongoing debate since the early 1900s. The core of the discussion is about the importance of scientific knowledge on biological understanding at the expense of its social and humanistic characteristics. Unfortunately, reforms to the medical curriculum are still based on a biological vision of the health-illness process. In order to respond to the current needs of society, which is education's main objective, the learning processes of physicians and their instruction must change once again. The priority is the concept of the health-illness process that is primarily social and cultural, into which the biological and psychological aspects are inserted. A new curriculum has been developed that addresses a comprehensive instruction of the biological, psychological, social, and cultural (historical) aspects of medicine, with opportunities for students to acquire leadership, teamwork, and communication skills in order to introduce improvements into the healthcare systems where they work.

Costo-efectividad de la colecistectomía laparoscópica y de la abierta en una muestra de población colombiana / Cost-effectiveness of laparoscopic versus open cholecystectomy

Introducción. La colecistectomía ha sido objeto de varios estudios clínicos y de costos a nivelmundial. Objetivo. Evaluar el costo-efectividad de la colecistectomía abierta y de la laparoscópica desde laperspectiva del tercer pagador. Materiales y métodos. Se llevó a cabo un estudio de costo-efectividad en dos hospitales de Bogotá. Se obtuvieron los datos de efectividad de las cirugías a partir de un estudio de cohortes, y se obtuvo enforma retrospectiva el tipo de colecistectomía y en forma prospectiva, el resultado. Se incluyeron 376 pacientes intervenidos por colecistitis o litiasis de mayo de 2005 a junio de 2006; 156 pacientes fueron intervenidos por colecistectomía abierta y 220 por laparoscopia. Los resultados que se analizaron fueron los siguientes: frecuencia de complicaciones, estancia hospitalaria, reincorporación a las labores cotidianas y duración de la cirugía. Los costos se recolectaron según el tipo de estudio económico y sólo se incluyeron los costos directos. Posteriormente, se planteó un estudio de costo-efectividad a un año desde la perspectiva del tercer pagador; se propuso un modelo de árbol de decisiones y se calcularon las razones de incremento de costo-efectividad para cada uno de los desenlaces propuestos. Resultados. Los resultados de la colecistectomía abierta frente a la laparoscópica fueron: OR ajustado de complicaciones: 2,02 (IC95% 0,94-4,37); conversión quirúrgica (tasa): 3,2%; estancia: 2,2 Vs. 1,6,p=0,003; reincorporación a cotidianidad: 32,5 Vs. 9,6, p<0,001; duración quirúrgica: 22 minutos (p<0,001) menor en la colecistectomía abierta; desde la perspectiva del tercer pagador, costo promedio: US$995 Vs. US$ 1.048; incremento del costo-efectividad: US$ 7,4 favoreciendo la laparoscópica; desde la perspectiva paciente, costo promedio: US$ 53.2 Vs. US$ 104,8; incremento del costo-efectividad: US$-7.3 favoreciendo la laparoscópica; cero mortalidad. La variable que más impactó tiene en la toma de decisiones en términos de costos es el costo del procedimiento quirúrgico. Conclusiones. Hubo mayor estancia hospitalaria en la colecistectomía abierta frente a la mayor duración quirúrgica en la laparoscópica; en el costo directo de la laparoscópica: menor para IPS y pacientes; y en costo-efectividad equiparable para ambos procedimientos.

Introduction. Cholecystectomy has been the subject of several clinical and cost comparison studies. Objective. The results of open or laparoscopy cholecystectomy were compared in terms of cost and effectiveness from the perspective of health care institutions and from that of the patients. Materials and methods. The cost-effectiveness study was undertaken at two university hospitals in Bogotá, Colombia. The approach was to select the type of cholecystectomy retrospectively and then assess the result prospectively. The cost analysis used the combined approach of micro-costs and daily average cost. Patient resource consumption was gathered from the time of surgery room entry to time of discharge. A sample of 376 patients with cholelithiasis/cystitis (May 2005-June 2006) was selected--156 underwent open cholecystectomy and 220 underwent laparoscopic cholecystectomy. The following data were tabulated: (1) frequency of complications and mortality, post-surgical hospital stay, (2) reincorporation to daily activities, (3) surgery duration, (4) direct medical costs, (5) costs to the patient, and (6) mean and incremental cost-effectiveness ratios. Results. Frequency of complications was 13.5% for open cholecystectomy and 6.4% for laparoscopic cholecystectomy (p=0.02); hospital stay was longer in open cholecystectomy than in laparoscopic cholecystectomy (p=0.003) as well as the reincorporation to daily activities reported by the patients (p<0.001). The duration of open cholecystectomy was 22 min longer than laparoscopic cholecystectomy (p<0.001). The average cost of laparoscopic cholecystectomy was lower than open cholecystectomyand laparoscopic cholecystectomy was more cost-effective than open cholecystectomy (US$ 995 vs. US$ 1,048, respectively). The patient out-of-pocket expenses were greater in open cholecystectomy compared to laparoscopic cholecystectomy (p=0.015). Mortality was zero. Conclusions: The open laparoscopy procedure was associated with longer hospital stays, where asthe cholecystectomy procedure required a longer surgical duration. The direct cost of the latter was lower for both for the health care institution and patients. The cost-effectiveness for both procedures was comparable.