[Breaking bad news in clinical practice]. / Entrega de malas noticias en la práctica clínica.

Breaking bad news is a complex task that requires multiple communication skills from health professionals. Clinical practice demands to communicate all type of bad news, from a diagnosis of cancer to adverse effects of a treatment. On the other hand, since the beginning of the health reform in 2003, the need to improve the quality of services was proposed, among which the concern about the rights and duties of patients stands out. Therefore, the health care provider-patient relationship becomes again the subject of discussion and study, and a topic of great importance for clinical work. We revise the consequences of breaking bad news for the patient and for the health care provider, as well as the current protocols available for this purpose. The importance of developing communication skills both for future health professionals as for those who currently work in the area is emphasized.

Complex Reoperation for Late Complications After Acute Type A Aortic Dissection Surgery.

The correct management of acute Type A dissection continues to be a challenge. The primary goal is to save the patient´s life. However, the decision regarding the surgical approach determines possible later complications. We present the case of a 59-year-old female patient with a past history of emergent surgery for acute Type A dissection treated by supracoronary ascending and aortic valve replacement 19 years previously. Later, in a second endovascular approach, the descending aorta was treated by a thoracic endoprosthesis. During follow-up a dilated aortic root and a Type I endoleak were observed, and complex reoperation was required. We performed a total aortic arch replacement with a 4-branched graft and a complete aortic root replacement using the Cabrol technique for the reinsertion of the coronary arteries. The mechanical aortic normally functioning valve was preserved. The patient was discharged 30 days postoperatively.

Dental Experience, Anxiety, and Oral Health in Low-income Chilean Children.

PURPOSE: The purpose of this study was to evaluate the relationship between early dental experiences and clinical indicators of oral health and dental anxiety upon admission to a comprehensive oral health program for six-year-old children in Chile. METHODS: One hundred twenty-nine six-year-old children were enrolled in the Recreo Family Health Center of the Municipality of San Miguel, Santiago, Chile. Oral health status was assessed based on the decayed, extracted, or filled teeth index, simplified oral hygiene index, and Streptococcus mutans score. Dental anxiety was assessed using the facial image scale and Frankl scale. Early dental experience was classified as: no previous dental visits; preventive control; restorative treatment; and emergency visit. RESULTS: Children who had previous experience of restorative treatment and emergency visits showed greater dental caries damage (Kruskal-Wallis, P <.01). Those who had emergency visits had the highest S. mutans score. There was no relationship between the type of prior dental experience and the anxiety level or oral hygiene index. CONCLUSIONS: Invasive dental treatment resulted in greater susceptibility to dental caries damage; however, these experiences did not influence dental anxiety levels.

Primeros implantes de la válvula sin sutura Perceval S® en Argentina / First Perceval S™ Sutureless Aortic Valve Prosthesis Implantations in Argentina

RESUMEN El reemplazo valvular aórtico con prótesis sin sutura es una alternativa innovadora para el tratamiento de la estenosis aórtica en los ancianos y en los pacientes de alto riesgo. Aunque la experiencia mundial con estas prótesis lleva ya varios años, solo recientemente comenzó a comercializarse en Argentina el modelo Perceval S®. Se trata de una prótesis autoexpandible sin sutura hecha de pericardio bovino y montada en un stent de nitinol. En este estudio se presentan los primeros tres casos de reemplazo valvular aórtico con la bioprótesis Perceval realizados en Argentina. La técnica sin sutura es una alternativa prometedora para el reemplazo valvular aórtico quirúrgico con una bioprótesis, y, posiblemente, pueda competir con la terapéutica intravascular en los pacientes de alto riesgo.

ABSTRACT Aortic valve replacement with sutureless prostheses is an innovative alternative for the treatment of aortic stenosis in the el-derly and in high-risk patients. Although the world experience with these prostheses has been going on for several years, only recently, the Perceval S™ model, consisting of a self-expanding sutureless prosthesis made of bovine pericardium and mounted on a nitinol stent, has begun to be commercialized in Argentina. In this study, we present the first three cases of aortic valve replacement with Perceval bioprostheses performed in Argentina. The sutureless technique is a promising alternative for surgi-cal aortic valve replacement with a bioprosthesis, and may possibly compete with intravascular therapy in high-risk patients.

La cirugía miniinvasiva de la válvula mitral, ¿es posible en pacientes complejos? / Is Minimally Invasive Mitral Valve Surgery Possible in Complex Patients?

Introducción: Los pacientes con riesgo preoperatorio alto de morbimortalidad, endocarditis mitral y aquellos con cirugía cardíaca previa son considerados "limitantes" para ser operados por vía cirugía miniinvasiva. Objetivos: Evaluar resultados en pacientes complejos sometidos a cirugía miniinvasiva. Primario: mortalidad posoperatoria dentro de los 30 días. Secundario: resultados técnico-quirúrgicos y complicaciones posoperatorias tempranas. Material y métodos: Análisis retrospectivo de las cirugías mitrales realizadas en el Hospital Italiano de Buenos Aires desde enero de 2010 hasta abril de 2016. Se realizaron 135 cirugías mitrales, 63 de ellas mediante técnica miniinvasiva (46,6%). Los pacientes considerados "complejos" fueron 45 (71,4%), incluyéndose aquellos con riesgo > 10% del STS PROMM, los pacientes con endocarditis activa y/o los pacientes con cirugía cardíaca previa. Resultados: El 73,3% (n = 33) fueron cirugías electivas, el 22,2% (n = 10) de urgencia y el 4,4% (n = 2) de emergencia. El STS PROM% y el STS PROMM% fueron de 6,08 ± 10,8 y de 26,7 ± 16,8, respectivamente. Se incluyen 6 pacientes con cirugía cardíaca previa, 5 pacientes con endocarditis en tratamiento activo. Se realizaron reemplazo valvular mitral (14 reumáticas) en el 62% (n = 28) y plástica mitral en el 38% (n = 17). No se constataron óbitos en plástica mitral ni mediastinitis. La mortalidad a los 30 días fue del 4,4% (n = 2). Hubo conversión a esternotomía en un caso. Conclusiones: La mortalidad observada es inferior a la calculada por puntaje de riesgo (STS PROMM%: 6,08 ± 10,8 vs. 4,4). La minitoracotomía derecha videoasistida nos ofreció una excelente exposición e interpretación de la patología. La técnica de cirugía miniinvasiva puede ser utilizada en pacientes con cirugía cardíaca previa, endocarditis y/o pacientes con puntaje alto de riesgo preoperatorio.

Entrega de malas noticias en la práctica clínica / Breaking bad news in clinical practice

Breaking bad news is a complex task that requires multiple communication skills from health professionals. Clinical practice demands to communicate all type of bad news, from a diagnosis of cancer to adverse effects of a treatment. On the other hand, since the beginning of the health reform in 2003, the need to improve the quality of services was proposed, among which the concern about the rights and duties of patients stands out. Therefore, the health care provider-patient relationship becomes again the subject of discussion and study, and a topic of great importance for clinical work. We revise the consequences of breaking bad news for the patient and for the health care provider, as well as the current protocols available for this purpose. The importance of developing communication skills both for future health professionals as for those who currently work in the area is emphasized.

Planning in borderline personality disorder: evidence for distinct subpopulations.

OBJECTIVE: Borderline personality disorder is a severe mental disorder, whereas previous studies suggest executive functions may be impaired. The aim of this study was to evaluate executive planning in a sample of 85 individuals. METHODS: Planning was assessed by means of the Tower of London (Drexel University version) task. Latent class cluster analysis models were adjusted to the data. RESULTS: We identified two different subpopulations of borderline personality disorder patients, one of them with significantly reduced performance. CONCLUSION;. Neuropsychological mechanisms may be involved in borderline personality disorder, at least in a subgroup of patients.

Calidad de vida y condición de salud oral en embarazadas chilenas e inmigrantes peruanas / Oral health status and quality of life in pregnant Chilean and Peruvian immigrants women

Objetivo. Comparar la condición de salud bucal con calidad de vida en embarazadas chilenas e inmigrantes peruanas, en una Comuna de Santiago de Chile, con alta concentración de población peruana. Materiales y métodos. Se llevó a cabo un estudio analítico y transversal en una muestra de 58 mujeres chilenas y 50 inmigrantes peruanas en control de embarazo. Se midió la condición de salud oral aplicando los índices COPD, higiene oral (IHO) y gingival (IG) y la Calidad de Vida en Salud Oral mediante el cuestionario OHIP sp, validado en Chile. Se utilizó la prueba t de Studentpara diferencias en condición de salud oral y en calidad de vida y la prueba r de Pearson para asociaciones entrevariables clínicas y calidad de vida (p menor que 0,05). Resultados. El COPD fue 10,22, sin diferencias significativas entre ambos grupos, con más piezas perdidas en peruanas (p menor que 0,05) y más obturadas en chilenas (p menor que 0,05). Los índices (IHO) e (IG) son mejores en chilenas (p menor que 0,05). No hubo diferencias significativas en la percepción de calidad de vida en salud oral. Alrededor del 33 por ciento considera mala su calidad de vida oral. Aproximadamente 60 por ciento percibe que los problemasbucodentales le han acarreado incapacidad social y desventajas. Hay correlación significativa y directa sólo del OHIP-sp con el COPD (rho=0,358; p menor que 0,05) en chilenas. Conclusión. A pesar de su mala condición de salud bucal ninguno de los dos grupos percibe gran influencia en su calidad de vida, mostrando la necesidad del diagnóstico de los determinantes de conductas en salud oral previa a cualquier acción educativa.

Objective. Compare the Oral Health status and related quality of life in pregnant Chilean and Peruvian immigrant women,in a Chilean district of high Peruvian concentration. Material and methods. An analytical transversal study was carriedout on a sample of 58 Chilean and 50 Peruvian immigrant women under pregnancy control. Their oral health status was measured applying the Caries (DMF), Oral Hygiene (OHI), and the Gingival (GI) indexes, and the Quality of Life using theChilean validated version of the OHIPsp questionnaire. Student t and Pearson r tests were used to assess differencesin Oral Health status and association between clinical variables and Quality of Life (p minor that 0.05). Results. A DMF of 10,2 was found without significative differences between groups, with more missing teeth in the Peruvian group (P minor that 0.05) and more filled ones Chilean (P minor that 0.05). Both the (OHI) and the (GI) indexes were better in the Chilean group (P minor that 0.05).The Quality of Life Perception showed no significative differences between groups. Approximately 30 per cent perceived a bad Quality of Life related to Oral Health, about 60 per cent perceived that their dental problems had caused them social disabilities and handicap. Correlation of the OHIP sp and the clinical indexes showed significative and direct only with the Chilean DMF (rho=0.358; p minor that 0.05). Conclusion: Regardless of their poor oral health status both groups did not perceive a great influence on their Quality of Life, pointing out the necessity of diagnosing the oral health behaviors determinants before implementing any health education action.