Unveiling Melanoma: A Deep Dive into Disparities at a Latin-American Cancer Institute.

INTRODUCTION: The worldwide incidence of melanoma has increased in the last 40 years. Our aim was to describe the clinic-pathological characteristics and outcomes of three cohorts of patients diagnosed with melanoma in a Latin-American cancer institute during the last 20 years. METHODS: We evaluated three retrospective patient cohorts diagnosed with melanoma at Instituto Nacional de Enfermedades Neoplasicas (INEN), a public hospital in Lima, Peru, for the years 2005-2006, 2010-2011, and 2017-2018. Survival rate differences were assessed using the Log-rank test. RESULTS: Overall, 584 patients were included (only trunk and extremities); 51% were male, the mean age was 61 (3-97) years, and 48% of patients resided in rural areas. The mean time to diagnosis was 22.6 months, and the mean Breslow thickness was 7.4 mm (T4). Lower extremity was the most common location (72%). A majority of the patients (55%) had metastases at the time of presentation, with 36% in stage III and 19% in stage IV. Cohorts were distributed as 2005-2006 (n = 171), 2010-2011 (n = 223), and 2017-2018 (n = 190). No immunotherapy was used. Cohort C exhibited the most significant increase in stage IV diagnoses (12.3%, 15.7%, 28.4%, respectively; p < 0.01). The median overall survival rates at the three-year follow-up demonstrated a decline over the years for stages II (97%, 98%, 57%, respectively; p < 0.05) and III (66%, 77%, 37%; p < 0.01). CONCLUSIONS: There has been a worsening in the incidence of late-stage metastatic melanoma in Peru throughout the years, coupled with a significant decline in overall survival rates. This is underscored by the fact that half of the population lives in regions devoid of oncological access.

The effect of the attitude towards risk/ambiguity on examination grades: cross-sectional study in a Portuguese medical school.

Given the high prevalence of multiple-choice examinations with formula scoring in medical training, several studies have tried to identify other factors in addition to the degree of knowledge of students which influence their response patterns. This study aims to measure the effect of students' attitude towards risk and ambiguity on their number of correct, wrong, and blank answers. In October 2018, 233 3rd year medical students from the Faculty of Medicine of the University of Porto, in Porto, Portugal, completed a questionnaire which assessed the student's attitudes towards risk and ambiguity, and aversion to ambiguity in medicine. Simple and multiple regression models and the respective regression coefficients were used to measure the association between the students' attitudes, and their answers in two examinations that they had taken in June 2018. Having an intermediate level of ambiguity aversion in medicine (as opposed to a very high or low level) was associated with a significant increase in the number of correct answers and decrease in the number of blank answers in the first examination. In the second examination, high levels of ambiguity aversion in medicine were associated with a decrease in the number of wrong answers. Attitude towards risk, tolerance for ambiguity, and gender did not show significant association with the number of correct, wrong, and blank answers for either examination. Students' ambiguity aversion in medicine is correlated with their performance in multiple-choice examinations with negative marking. Therefore, it is suggested the planning and implementation of counselling sessions with medical students regarding the possible impact of ambiguity aversion on their performance in multiple-choice questions with negative marking.

Development of clobetasol-loaded biodegradable nanoparticles as an endodontic intracanal medicament.

AIM: The aim of current study is the development and optimization of biodegradable polymeric nanoparticles (NPs) to be used in the field of Endodontics as intracanal medication in cases of avulsed teeth with extended extra-oral time, utilizing PLGA polymers loaded with the anti-inflammatory drug clobetasol propionate (CP). METHODOLOGY: CP-loaded nanoparticles (CP-NPs) were prepared using the solvent displacement method. CP release profile from CP-NPs was assessed for 48 h against free CP. Using extracted human teeth, the degree of infiltration inside the dentinal tubules was studied for both CP-NPs and CP. The anti-inflammatory capacity of CP-NPs was evaluated in vitro measuring their response and reaction against inflammatory cells, in particular against macrophages. The enzyme-linked immunosorbent assay (ELISA) was used to examine the cytokine release of IL-1ß and TNF-α. RESULTS: Optimized CP-NPs displayed an average size below 200 nm and a monomodal population. Additionally, spherical morphology and non-aggregation of CP-NPs were confirmed by transmission electron microscopy. Interaction studies showed that CP was encapsulated inside the NPs and no covalent bonds were formed. Moreover, CP-NPs exhibited a prolonged and steady release with only 21% of the encapsulated CP released after 48 h. Using confocal laser scanning microscopy, it was observed that CP-NPs were able to display enhanced penetration into the dentinal tubules. Neither the release of TNF-α nor IL-1ß increased in CP-NPs compared to the LPS control, displaying results similar and even less than the TCP after 48 h. Moreover, IL-1ß release in LPS-stimulated cells, decreased when macrophages were treated with CP-NPs. CONCLUSIONS: In the present work, CP-NPs were prepared, optimized and characterized displaying significant increase in the degree of infiltration inside the dentinal tubules against CP and were able to significantly reduce TNF-α release. Therefore, CP-NPs constitute a promising therapy for the treatment of avulsed teeth with extended extra-oral time.

Calcium hydroxide-loaded nanoparticles dispersed in thermosensitive gel as a novel intracanal medicament.

AIM: Design, produce and assess the viability of a novel nanotechnological antibacterial thermo-sensible intracanal medicament This involves encapsulating calcium hydroxide (Ca(OH)2) within polylactic-co-glycolic acid (PLGA) nanoparticles (NPs) and dispersing them in a thermosensitive gel (Ca(OH)2-NPs-gel). In addition, perform in vitro and ex vivo assessments to evaluate tissue irritation and penetration capacity into dentinal tubules in comparison to free Ca(OH)2. METHODOLOGY: Reproducibility of Ca(OH)2-NPs was confirmed by obtaining the average size of the NPs, their polydispersity index, zeta potential and entrapment efficiency. Moreover, rheological studies of Ca(OH)2-NPs-gel were carried out with a rheometer, studying the oscillatory stress sweep, the mean viscosity value, frequency and temperature sweeps. Tolerance was assessed using the membrane of an embryonated chicken egg. In vitro Ca(OH)2 release was studied by direct dialysis in an aqueous media monitoring the amount of Ca(OH)2 released. Six extracted human teeth were used to study the depth of penetration of fluorescently labelled Ca(OH)2-NPs-gel into the dentinal tubules and significant differences against free Ca(OH)2 were calculated using one-way anova. RESULTS: Ca(OH)2-NPs-gel demonstrated to be highly reproducible with an average size below 200 nm, a homogeneous NPs population, negative surface charge and high entrapment efficiency. The analysis of the thermosensitive gel allowed us to determine its rheological characteristics, showing that at 10°C gels owned a fluid-like behaviour meanwhile at 37°C they owned an elastic-like behaviour. Ca(OH)2-NPs-gel showed a prolonged drug release and the depth of penetration inside the dentinal tubules increased in the most apical areas. In addition, it was found that this drug did not produce irritation when applied to tissues such as eggs' chorialantoidonic membrane. CONCLUSION: Calcium hydroxide-loaded PLGA NPs dispersed in a thermosensitive gel may constitute a suitable alternative as an intracanal antibacterial medicament.

Definition of sensory and instrumental thresholds of acceptability for selection of cassava genotypes with improved boiling properties.

BACKGROUND: Consumers of boiled cassava in Africa, Latin America and Asia use specific preference criteria to evaluate its cooking quality, in terms of texture, colour and taste. To improve adoption rates of improved cassava varieties intended for consumption after boiling, these preference criteria need to be determined, quantified and integrated as post-harvest quality traits in the target product profile of boiled cassava, so that breeding programs may screen candidate varieties based on both agronomic traits and consumer preference traits. RESULTS: Surveys of various end-user groups identified seven priority quality attributes of boiled cassava covering root preparation, visual aspect, taste and texture. Three populations of contrasted cassava genotypes, from good-cooking to bad-cooking, in three countries (Uganda, Benin, Colombia) were then characterized according to these quality attributes by sensory quantitative descriptive analysis (QDA) and by standard instrumental methods. Consumers' preferences of the texture attributes mealiness and hardness were also determined. By analysis of correlations, the consumers' preferences scores were translated into thresholds of acceptability in terms of QDA scores, then in terms of instrumental measurements (water absorption during boiling and texture analysis). The thresholds of acceptability were used to identify among the Colombian and Benin populations promising genotypes for boiled cassava quality. CONCLUSION: This work demonstrates the steps of determining priority quality attributes for boiled cassava and establishing their corresponding quantitative thresholds of acceptability. The information can then be included in boiled cassava target product profiles used by cassava breeders, for better selection and adoption rates of new varieties. © 2024 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Ocular surface disorders: office procedures for the allergist/clinical immunologist.

PURPOSE OF REVIEW: Ocular surface disorders (OSDs) are a prevalent and often debilitating condition encountered in clinical practice, particularly by allergists and clinical immunologists. RECENT FINDINGS: A comprehensive guide to office procedures for evaluating and managing OSDs, with a specific focus on ocular allergies, would assist in the evaluation process that begins with an initial patient assessment utilizing standardized forms to systematically gather detailed medical history, symptomatology, and environmental exposure data. This structured approach ensures a thorough understanding of the patient's condition and facilitates targeted interventions. In addition to allergy testing, the assessment of the tear film is essential for a comprehensive evaluation of OSDs. The Schirmer test is employed to quantify tear production, providing objective data on tear film adequacy and guiding interventions for tear film deficiencies. SUMMARY: This multifaceted diagnostic approach ensures that all contributing factors to OSDs are identified and appropriately managed. By integrating these office procedures, allergists and clinical immunologists can enhance their diagnostic accuracy and therapeutic efficacy, ultimately improving patient outcomes. This manuscript provides a practical resource, outlining some of the methodologies and clinical applications of each procedure, and highlighting their role in the holistic management of OSDs in allergic patients.

Revision of ex vivo endodontic biofilm model using computer aided design.

OBJECTIVE: Most endodontic diseases are bacterium-mediated inflammatory or necrotic process induced by contaminated dental pulp. Although great advances are being performed to obtain more efficient antibacterial strategies for persistent infections, most studies lack of representative models to test their antibacterial effects and their outcomes cannot be promptly translated to clinical practice. Therefore, this study aimed to refine an ex vivo endodontic biofilm model combining human tooth, computer guided design and 3D printing to obtain a more reproducible and predictable model. METHODS: Monoradicular teeth were cut using three different methods: hand-held (HCC), mechanical precision (MPC) and computer aid guided cutting (CGC). Then, blocks were reassembled. The different model preparations were assessed in terms of dimensional tolerance, surface analysis, liquid tightness and Enterococcus faecalis biofilm development for 21 days, which was studied by metabolic assays and confocal microscopy. Then, the proposed model was validated using different commercial disinfecting treatments. RESULTS: CGC exhibited significantly lower deviation and surface without defects compared to HHC and MPC, leading to superior liquid tightness. Similarly, mature biofilms with high metabolic activity and vitality were observed in all conditions, CGC showing the lowest variation. Regarding the model validation, all antibacterial treatments resulted in the complete eradication of bacteria in the standard 2D model, whereas commercial treatments exhibited varying levels of efficacy in the proposed ex vivo model, from moderately reduction of metabolic activity to complete elimination of biofilm. CONCLUSIONS: The novel guided approach represents a more reliable, standardized, and reproducible model for the evaluation of endodontic disinfecting therapies. CLINICAL SIGNIFICANCE: During antibacterial treatment development, challenging 3D models using teeth substrates to test antibacterial treatments novel guided approach represents a more reliable, standardized, and reproducible model for the evaluation of endodontic disinfecting therapies.

Engineering a microparticle-loaded rough membrane for guided bone regeneration modulating osteoblast response without inducing inflammation.

Guided bone regeneration (GBR) is a widely used procedure that prevents the fast in-growth of soft tissues into bone defect. Among the different types of membranes, the use of collagen membranes is the gold standard. However, these membranes are implanted in tissue location where a severe acute inflammation will occur and can be negatively affected. The aim of this study was to develop a collagen-based membrane for GBR that incorporated alginate-hydroxyapatite microparticles. Membranes were manufactured using collagen type I and gelatin and alginate-hydroxyapatite microparticles. Membranes were assessed in terms of topography by scanning electron microscopy and confocal microscopy; stability by swelling after an overnight incubation in saline and enzymatic degradation against collagenase and mechanical properties by tensile tests. Furthermore, the biological response was assessed with SaOs-2 cells and THP-1 macrophages to determine alkaline phosphatase activity and inflammatory cytokine release. Our results showed that the incorporation of different percentages of these microparticles could induce changes in the surface topography. When the biological response was analyzed, either membranes were not cytotoxic to THP-1 macrophages or to SaOs-2 cells and they did not induce the release of pro-inflammatory cytokines. However, the different surface topographies did not induce changes in the macrophage morphology and the release of pro- and anti-inflammatory cytokines, suggesting that the effect of surface roughness on macrophage behavior could be dependent on other factors such as substrate stiffness and composition. Collagen-gelatin membranes with embedded alginate-hydroxyapatite microparticles increased ALP activity, suggesting a positive effect of them on bone regeneration, remaining unaffected the release of pro- and anti-inflammatory cytokines.

Syphilis seroprevalence and associated factors: A cross-sectional study in formal female sex workers in a province of Peru.

Syphilis is a sexually transmitted infection (STI) considered a public health problem that affects vulnerable and at-risk populations, such as sex workers. We designed a retrospective cross-sectional study based on the review of health evaluation records of sex workers who attended consultations to obtain comprehensive health cards at a Health Center in the Province of San Vicente de Cañete in Peru during the year 2020. We obtained sociodemographic and employment information and the RPR (rapid plasma reagin) test results to diagnose syphilis. We evaluated 220 records of sex workers with a mean age of 27.9 ±â€…6.9 years and the initiation of sexual relations of 16.0 ±â€…1.6 years, while the accumulated time they had as sex workers was 2.9 ±â€…2.4 years. 85.9% of those evaluated reported being heterosexual. The prevalence of syphilis was 7.3% (CI95: 4.2%-11.5%). Being a homosexual sex worker was significantly associated with syphilis (OR: 19.6; 95% CI: 4.8-80.0) compared to heterosexuals. The prevalence of syphilis presented a value similar to that reported in other Latin American and national studies, and it is evident that it is a health problem among sex workers.

Survival according to the site of metastasis in triple-negative breast cancer patients: The Peruvian experience.

BACKGROUND: Evidence regarding differences in survival associated with the site of metastasis in triple-negative breast cancer (TNBC) remains limited. Our aim was to analyze the overall survival (OS), distant relapse free survival (DRFS), and survival since the diagnosis of the relapse (MS), according to the side of metastasis. METHODS: This was a retrospective study of TNBC patients with distant metastases at the Instituto Nacional de Enfermedades Neoplasicas (Lima, Peru) from 2000 to 2014. Prognostic factors were determined by multivariate Cox regression analysis. RESULTS: In total, 309 patients were included. Regarding the type of metastasis, visceral metastasis accounted for 41% and the lung was the most frequent first site of metastasis (33.3%). With a median follow-up of 10.2 years, the 5-year DRFS and OS were 10% and 26%, respectively. N staging (N2-N3 vs. N0, HR = 1.49, 95%CI: 1.04-2.14), metastasis in visceral sites (vs. bone; HR = 1.55, 95%CI: 0.94-2.56), the central nervous system (vs. bone; HR = 1.88, 95% CI: 1.10-3.22), and multiple sites (vs. bone; HR = 2.55, 95%CI:1.53-4.25) were prognostic factors of OS whereas multiple metastasis (HR = 2.30, 95% CI: 1.42-3.72) was a predictor of MS. In terms of DRFS, there were no differences according to metastasis type or solid organ. CONCLUSION: TNBC patients with multiple metastasis and CNS metastasis have an increased risk of death compared to those with bone metastasis in terms of OS and MS.

Silver coating on dental implant-abutment connection screws as potential strategy to prevent loosening and minimizing bacteria adhesion.

Introduction: One of the main problems for the long-term behavior of dental implants are loosening of the implant-abutment connection screws and bacterial infiltration. The aim of this work is to increase the screw fixation by silver coating, providing superior mechanical retaining and antibacterial effect. Methods: Eighty dental implants with their abutments and screws have been studied. Twenty screws were not coated and were used as a control while the rest of screws were silver coated by sputtering, with three different thickness: 10, 20 and 40 µm and 20 screws per each thickness. Coating morphology and thickness were determined by scanning electron microscopy using image analysis systems. The screws were tightened for each of the thicknesses and the control with two torques 15 Ncm and 20 Ncm and tested under mechanical fatigue simulating oral stresses up to a maximum of 500,000 cycles. The remaining torques at different cycles were determined with a high-sensitivity torquemeter. Cell viability assays were performed with SaOs-2 osteoblasts and microbiological studies were performed against Streptococcus gordonii and Enterococcus faecalis bacteria strains, determining their metabolic activity and viability using live/dead staining. Results: It was observed a decrease in torque as cycles increase. For a preload of 15 Ncm at 100,000 cycles, the loosening was complete and, for 20 Ncm at 500,000 cycles, 85% of torque was lost. The silver coatings retained the torque, especially the one with a thickness of 40 µm, retaining 90% of the initial torque at 500,000 cycles. It was observed that osteoblastic viability values did not reach 70%, which could indicate a slight cytotoxic effect in contact with cells or tissues; however, the screw should not be in direct contact with tissue or living cells. Silver coating induced a significant reduction of the bacteria metabolic activity for Streptococcus gordonii and Enterococcus faecalis, around 90% and 85% respectively. Discussion: Therefore, this coating may be of interest to prevent loosening of implant systems with a worthy antibacterial response.

Eosinophil cationic protein (ECP) correlates with eosinophil cell counts in the induced sputum of elite swimmers.

Introduction: Swimming practice has been associated with eosinophilic inflammation, however, the underlying mechanisms are not fully understood. The eosinophil cationic protein (ECP) in induced sputum may be used as a potential biomarker to assess airway eosinophilic inflammation among elite swimmers. The objective of this study is to characterize ECP levels in sputum supernatant in elite swimmers and evaluate ECP as an eosinophilic inflammatory marker. Material and methods: Elite swimmers annually screened in our department (n = 27) were invited to participate in this cross-sectional study. Swimmers who agreed to participate (n = 24, 46% girls) performed lung function and skin-prick tests. Induced sputum was also collected and analyzed for differential cell counts and ECP measurements in sputum supernatant (ImmunoCAPTM 100, ECP, Thermo Fisher Scientific, Uppsala, Sweden). Results: The median ECP level was 15.60 µg/L (6.02-38.75 µg/L) and higher levels were found among boys (27.90 (11.20-46.30) µg/L vs 6.65 (2.82-22.80) µg/L, P = .02). In addition, ECP levels in the sputum supernatant were positively correlated with eosinophil cell counts in the induced sputum (r = 0.583, P = .08). Conclusions: ECP levels correlated positively with eosinophil counts in the induced sputum in elite swimmers. The measurement of ECP in sputum supernatant may be a useful marker to assess and manage eosinophilic inflammatory changes in the airways of elite swimmers.

Efectos de un Programa de Ejercicios y Educación en Dolor mediante Tele-rehabilitación en la Calidad de Vida de Mujeres Jóvenes con Dismenorrea Primaria / Effects of an Exercise and Pain Education Program via Telerehabilitation on the Quality of Life of Young Women with Primary Dysmenorrhea

Introducción. La dismenorrea primaria afecta la calidad de vida de mujeres jóvenes. Este estudio investiga los efectos de un protocolo de ejercicios y educación en dolor mediante telerehabilitación. Objetivo. Determinar los efectos de un protocolo de ejercicios y educación en dolor y su impacto en la calidad de vida mediante tele-rehabilitación en mujeres jóvenes con dismenorrea primaria. Métodos. Se realizó un estudio experimental pre y post test con un grupo control, utilizando tele-rehabilitación. Participaron 21 mujeres jóvenes con dismenorrea primaria, asignadas aleatoriamente a dos grupos: el grupo experimental (10 mujeres) y el grupo control (11 mujeres). Se utilizaron cuestionarios específicos de calidad de vida relacionada con la menstruación y dolor (cuestionario breve de McGill) para evaluar los efectos del programa de ejercicios y educación en dolor. Resultados. En el grupo control, no se observaron diferencias significativas en las puntuaciones de calidad de vida relacionada con la menstruación ni en la intensidad del dolor antes y después de la intervención (p>0,05). En contraste, el grupo experimental experimentó mejoras significativas en ambas áreas después de la intervención (todos los p<0,001). Conclusiones. Este estudio demuestra que un protocolo de ejercicios y educación en dolor realizado mediante telerehabilitación tiene un impacto positivo y significativo en la calidad de vida y la intensidad del dolor percibido en mujeres jóvenes con dismenorrea primaria. Estos resultados sugieren que la telerehabilitación puede ser una estrategia efectiva para abordar este problema de salud en esta población.

Background. Primary dysmenorrhea impacts the quality of life of young women. This study investigates the effects of an exercise and pain education protocol through telerehabilitation. Objective: To determine the effects of an exercise and pain education protocol and its impact on the quality of life through telerehabilitation in young women with primary dysmenorrhea. Methods: A pre and post-test experimental study with a control group was conducted using telerehabilitation. Twenty-one young women with primary dysmenorrhea participated, randomly assigned to two groups: the experimental group (10 women) and the control group (11 women). Specific questionnaires related to menstruation-related quality of life and pain (McGill short-form questionnaire) were used to assess the effects of the exercise and pain education program. Results: In the control group, no significant differences were observed in menstruation-related quality of life scores or pain intensity before and after the intervention (p>0.05). In contrast, the experimental group experienced significant improvements in both areas after the intervention (all p<0.001). Conclusion: This study demonstrates that an exercise and pain education protocol conducted through telerehabilitation has a positive and significant impact on the perceived quality of life and pain intensity in young women with primary dysmenorrhea. These results suggest that telerehabilitation can be an effective strategy for addressing this health issue in this population.

Diagnóstico de la vigilancia, prevención y control de la COVID-19 en el trabajo minero peruano

Introducción: En Perú, las empresas mineras debían registrar e implementar el plan para la vigilancia, prevención y control de la COVID-19 en el trabajo (requerido por el Ministerio de Salud), previo al reinicio de actividades suspendidas debido a la pandemia. Objetivo: Describir el estado situacional de los planes para la vigilancia, prevención y control de la COVID-19 en el trabajo del sector minero (1ra y 2da fase de reactivación económica, 2020). Métodos: Se realizó un estudio transversal de la base de datos del sistema SISCOVID-Empresas. Se reportaron frecuencias y proporciones de las características de los planes (región de procedencia, número de trabajadores, número de profesionales de salud, existencia de comité o supervisor de seguridad y salud en el trabajo, estado de registro y reporte de presupuesto) según el número de trabajadores de la empresa. Resultados: Se revisaron 2 236 registros de planes. El 6,2 % indica no contar con supervisor o comité de seguridad y salud en el trabajo y el 71,5 % no cuenta con profesional de la salud. El 81,2 % de las empresas con más de 500 trabajadores contaban con profesionales de medicina y enfermería. El 89,2 % de las empresas con 1 a 20 trabajadores no contaban con profesionales de la salud. Conclusiones: Tres de cada 4 empresas del sector minero incumplen lo requerido en el plan para la vigilancia, prevención y control de la COVID-19 en el trabajo.

Introduction: In Peru, mining companies had to register and implement the Plan for the surveillance, prevention, and control of COVID-19 at work (requested by the Ministry of Health), prior to restarting activities suspended due to the pandemic. Objective: To describe the situational status of the plans for the surveillance, prevention, and control of COVID-19 at work in the mining sector (1st and 2nd phases of economic reactivation, 2020). Methods: A cross-sectional study was carried out of the database from the SISCOVID- Empresas system. Frequencies and proportions of the characteristics of the plans were reported (region of origin, number of workers, number of health professionals, existence of an occupational health and safety committee or supervisor, status of registration and budget report) according to the number of company workers. Results: In total 2,236 plan records were reviewed. Of the total, 6.2% of the registered plans indicate that they do not have an occupational health and safety supervisor or committee, and 71.5% do not have a health professional. Furthermore, 81.2% of the companies with more than 500 workers had medicine and nursing professionals, and 89.2% of companies with 1 to 20 workers did not have health professionals. Conclusions: Three out of 4 companies in the mining sector fail to comply with the requirements of the plan for the surveillance, prevention, and control of COVID-19 at work.

Positivización de la autoestima específica en el docente quirúrgico. Resultados del Curso 2CeQ Docencia Quirúrgica® / Positivization of specific self-esteem in the surgical teacher. Results of the grade 2CeQ Surgical Teaching®

Resumen Objetivo: Evidenciar la mejora en la autoestima específica docente y del conocimiento integral de los dominios cognitivos de Bloom en los participantes en el curso 2CeQ®, estimados a través del incremento y análisis comparativo en la puntuación obtenida en la Escala de Autoestima de Rosenberg (EAR) y ejercicios de evaluación pre y poscurso. Diseño, metodología o aproximación: Estudio analítico comparativo transversal, de datos correspondientes a los valores de las variables (puntuación obtenida) de dos cuestionarios (Escala de Autoestima de Rosenberg [EAR] y ejercicios de evaluación pre y poscurso) contestados por los participantes en el curso. Análisis estadístico: frecuencia relativa de ocurrencia, medidas de dispersión y prueba t (p<0.05 fue estadísticamente significativo). Resultados: Se incluyeron 21 individuos. Se observó una mejora significativa en la puntuación de la autoestima específica como docente quirúrgico según la EAR (16.3±5 [7-25] vs 20.9±5.2 [13-30]; p=0.003). En el ejercicio de evaluación, hubo una diferencia estadísticamente significativa en la puntuación pre y poscurso (38.5±14.3 [10.3-70.6] vs 72.4±17 [29.4-88.2]; p=0.006). Limitaciones del estudio o implicaciones: Serie unicéntrica, con limitado número del tamaño de la muestra, lo que impide validar los resultados. Originalidad o valor: Estudio en epistemología educativa quirúrgica nacional, único en su clase. Hallazgos o conclusión: La participación en el Curso "2CeQ Docencia Quirúrgica®" aumenta la autoestima específica para el ejercicio docente y la capacidad técnica para desarrollar el proceso de enseñanza aprendizaje, por lo cual puede coadyuvar a elevar la calidad de los programas educativos.

Abstract Objetive: To show improvement in teaching-specific self-esteem and comprehensive knowledge on Bloom's cognitive domains, among participants in 2CeQ® Course, estimated through increase and comparative analysis of pre- and post-course scores obtained from Rosenberg's Self-esteem Scale (RSS) and evaluation-tests. Design, methodology and approximation: Transversal, analytic and comparative study of pre- and post-course values from data corresponding to RSS and evaluation tests scores, answered by participants. Statistics: Occurrence relative frequency, dispersion calculations, and t test (p<0.05 statistically significant). Results: 21 individuals were included. A significant improvement in surgical-teaching self-esteem from RSS (16.3±5 [7-25] vs 20.9±5.2 [13-30]; p=0.003) and a statistically significant difference between pre- and postcourse test's scores (38.5±14.3 [10.3-70.6] vs 72.4±17 [29.4-88.2]; p=0.006 were observed). Limitations and implications of study: Unicentric series and a limited sample, avoiding the validation of results. Originality or value: Study on national surgical education epistemology, one of a kind. Findings and conclusion: Participation in "2CeQ" Course increases specific self-esteem for teaching and technical ability to develop teaching and learning process, helping to optimize the quality of educational programs.

Prevención y detección precoz del cáncer de mama en atención primaria / Prevention and early detection of breast cancer in primary care

El cáncer de mama es el tipo de cáncer más común, no restrictivo por edad, condición social, sexo, que afecta la condición de salud de alrededor de 2,3 millones de mujeres con resultados desfavorables. Este tipo de enfermedad afecta gravemente a la población y se estima que a nivel mundial la pérdida de la funcionalidad supera a las de otros tipos de cánceres. La información pertinente al tema se pudiera considerar como aporte en el nivel de conocimientos, estrategias válidas para la prevención y el despistaje oportuno de esta patología clínica Objetivo: Describir las estrategias de prevención y detección precoz del cáncer de mamá en atención primaria. Materiales y Métodos: Esta investigación es del tipo descriptiva, observacional y transversal. Se aplica una técnica de abordaje al tema con la extracción de datos bibliográficos y la intervención de la misma mediante el análisis sistemático, donde se emplea el método y diseño descriptivo. Resultados: El tipo de estudio busca la correlación estilo de vida saludable y no prevalencia de cáncer mediante una actuación temprana y oportuna como una conducta saludable. Conclusiones: La inspección y la técnica de palpación son de gran importancia para evaluar la aparición de un bulto y su reconocimiento por parte médica especializada. Cabe resaltar que no todo bulto en las mamas se considera cáncer, sin embargo, el diagnóstico médico oportuno y las pruebas diagnóstico especializadas para la detección son claves en la detección precoz y prevención(AU)

Breast cancer is the most common type of cancer, not restricted by age, social condition, sex, which affects the health condition of around 2.3 million women with unfavorable results. This type of disease seriously affects the population and it is estimated that worldwide the loss of functionality exceeds that of other types of cancers. The information pertinent to the topic could be considered as contribution in the level of knowledge, valid strategies for prevention and screening of this clinical pathology. Objective: To describe the strategies of prevention and Early detection of breast cancer in primary care. Materials and methods: This The research is descriptive, observational and cross-sectional. A technique is applied approach to the subject with the extraction of bibliographic data and the intervention of the same through systematic analysis, where the method and descriptive design are used. Results: The type of study seeks the correlation of healthy lifestyle and not prevalence of cancer through early and timely action as a behavior healthy. Conclusions: Inspection and palpation technique are of great importance to evaluate the appearance of a lump and its recognition by a specialized medical part. It should be noted that not every lump in the breast is considered cancer, however, the Timely medical diagnosis and specialized diagnostic tests for screening are keys to early detection and prevention(AU)

Factores de riesgo y complicaciones cardiovasculares en pacientes por alteraciones de fosforo y calcio

Resumen La enfermedad renal crónica es un problema de salud pública a nivel mundial y se define como una anormalidad patológica del riñón como hematuria o proteinuria, o una reducción de la tasa de filtrado glomerular menor a 60ml-min por más de tres meses. En todos los estudios la prevalencia a esta enfermedad va aumentando debido a que sus principales causas diabetes e hipertensión se han convertido en pandemias. Objetivo. Demostrar los factores de riesgo y complicaciones cardiovasculares en pacientes por alteraciones minerales y óseas. Métodos. Se realizó un estudio descriptivo transversal en los pacientes del Instituto del riñón INRIDI San Martin de Enero a Nov del 2019, los métodos de investigación implementados fueron analítico y cualitativo- cuantitativo. El universo estuvo constituido por los 253 pacientes de la clínica de diálisis San Martin se obtuvo como muestra 70 pacientes basado en los criterios de exclusión. Resultados. Se halló que el 94.2 % de los pacientes estudiados estuvieron en el grupo de casos sin hipercalcemia, así mismo 58.55% sentaron en el grupo con hiperfosfatemia. Entre los factores de riesgo se demostró la prevalencia en el sexo masculino, la hipertensión, diabetes y la dislipidemia. Conclusiones . La frecuencia de cambios en el metabolismo mineral y óseo en pacientes con ERC es muy variable, y este estudio revela aspectos epidemiológicos que permiten reconocer los problemas actuales de la enfermedad que viabilizaran reducir el riesgo de eventos cardiovasculares y mejorar la calidad de vida de los pacientes.

Abstract Chronic kidney disease is a worldwide public health problem and is defined as a pathological abnormality of the kidney such as hematuria or proteinuria, or a reduction of the glomerular filtration rate to less than 60 ml-min for more than three months. In all studies the prevalence of this disease is increasing because its main causes diabetes and hypertension have become pandemics. Objective. To demonstrate the risk factors and cardiovascular complications in patients with mineral and bone alterations. Methods. A cross-sectional descriptive study was conducted in patients of the Instituto del riñón INRIDI San Martin from January to Nov 2019, the research methods implemented were analytical and qualitative-quantitative. The universe was constituted by the 253 patients of the San Martin dialysis clinic, 70 patients were obtained as a sample based on the exclusion criteria. Results: Results. It was found that 94.2% of the patients studied were in the group of cases without hypercalcemia, and 58.55% were in the group with hyperphosphatemia. Among the risk factors, the prevalence in the male sex, hypertension, diabetes and dyslipidemia was demonstrated. Conclusions . The frequency of changes in bone and mineral metabolism in patients with CKD is highly variable, and this study reveals epidemiological aspects that allow us to recognize the current problems of the disease that will make it feasible to reduce the risk of cardiovascular events and improve the quality of life of patients.

Resumo A doença renal crónica (CKD) é um problema de saúde pública mundial e é definida como uma anomalia patológica do rim, como a hematúria ou proteinúria, ou uma redução da taxa de filtração glomerular para menos de 60ml-min durante mais de três meses. Em todos os estudos, a prevalência desta doença está a aumentar porque as suas principais causas de diabetes e hipertensão se tornaram pandemias. Objectivo. Demonstrar os factores de risco e as complicações cardiovasculares em doentes com doenças minerais e ósseas. Métodos. Foi realizado um estudo descritivo transversal em pacientes do instituto renal San Martin INRIDI de Janeiro a Novembro de 2019, os métodos de investigação implementados foram analíticos e qualitativos-quantitativos. O universo consistia em 253 pacientes da clínica de diálise de San Martin, 70 pacientes foram obtidos como amostra com base nos critérios de exclusão. Resultados. Verificou-se que 94,2% dos doentes estudados se encontravam no grupo de casos sem hipercalcemia, e 58,55% estavam no grupo com hiperfosfatemia. Entre os factores de risco, foi demonstrada a prevalência de hipertensão, diabetes e dislipidemia no sexo masculino. Conclusões . A frequência das alterações do metabolismo ósseo e mineral em doentes com CKD é altamente variável, e este estudo revela aspectos epidemiológicos que nos permitem reconhecer os problemas actuais da doença que tornarão viável a redução do risco de eventos cardiovasculares e a melhoria da qualidade de vida dos doentes.