Efectos de la pandemia por COVID-19 en determinantes sociales de familias del área metropolitana de Bucaramanga

Introducción: La pandemia por COVID-19 trajo consigo grandes cambios a nivel socioeconómico, producto de las medidas tomadas para mitigar su expansión, que implicó cierre de colegios y dificultad para el acceso a servicios de salud. Sin embargo, no se cuenta con mucha información respecto al impacto que estas medidas han tenido en la salud y el bienestar de niños y adolescentes, por lo cual se desarrolló una encuesta virtual para conocer la dimensión de los efectos de la pandemia en el bienestar integral de los menores y sus familias. Metodología: Estudio observacional de corte transversal que se realizó mediante la aplicación de una encuesta en formato electrónico a padres de familia de niños y adolescentes del Área Metropolitana de Bucaramanga. Resultados: Se obtuvieron 960 respuestas. El 25,63 % de los encuestados refieren cancelación de citas médicas. El 98 % de los estudiantes pudo continuar las actividades académicas durante el aislamiento. El factor económico fue la principal causa de preocupación en el periodo de la encuesta. Discusión: Durante el periodo de aislamiento, los problemas de salud mental, las dificultades para el acceso a herramientas para la educación virtual y las barreras para la atención, propias de la emergencia sanitaria, causaron efectos significativos en la calidad de vida de los menores. Conclusiones: Ante emergencias sanitarias, se deben mantener los servicios de atención en salud de la misma forma que se hacía previo a la ocurrencia del evento, como los programas de vacunación, crecimiento y desarrollo, promoción y prevención, además de la continuidad de la escolaridad.

Introduction: The COVID-19 pandemic has brought great changes along with, some of those were at the socioeconomic level, as a result of the actions taken to mitigate the virus expansion, which involved the closure of schools and restriction in accessing to some health services. However, there is not much information regarding the impact that these measures have had on the health and well-being of children and adolescents, for this reason, a virtual survey was developed to find out the dimension of the pandemic's effect on the comprehensive welfare of minors and families. Methodology: Cross-sectional observational study, which was carried out by applying a survey in electronic format to parents of children and adolescents in the Metropolitan Area of Bucaramanga. Results: A total of 960 responses were obtained. Of those surveyed, 25,63% refer cancellation of medical appointments. The 98% of students were able to continue academic activities during isolation. The economic factor was the main cause of concern in the survey period. Discussion: During the isolation period, mental health problems, difficulties in accessing tools for virtual education and barriers to care, typical of the health emergency, caused a significant effects on the quality of life of youngsters. Conclusions: In the event of health emergencies, health care services should be maintained in the same way as before the occurrence of the event, such as vaccination, growth and development, promotion and prevention programs, in addition to the continuity of schooling.

Arthroscopic Needling Technique for the Treatment of Wrist Ganglia.

Background Synovial cysts (SCs) are the most frequent wrist tumors; the arthroscopic treatment presents good results when surgery is indicated for symptomatic or patients with cosmetic concerns. The tumoral lesion should be arthroscopically decompressed or drained toward the inside of the joint through pedicle opening and resection of a small portion of the capsule. Hence, the cyst pedicle must be found for the success of this technique. Description of Technique Some tricks have already been described to facilitate SC location during arthroscopy. We describe an indirect technique that employs an 18-G needle to enhance SC pedicle location and drainage. The technique involves a puncture on the interval of the carpal extrinsic ligaments where the pedicle is suspected to be remain. When found, cyst is drained with a single-puncture motion of the need which promotes cyst content extravasation due to pressure toward the joint. Patients and Methods This method has been employed in 16 patients, including 9 with dorsal cysts, and seven with volar cysts. Results All patients presented complete recovery and symptom improvement in up to 30 days, with total disappearance of the cyst. There were no relapses or severe complications within the 12-month follow-up. Conclusion This is a safe, useful technique that facilitates location of intra-articular cyst pedicle, thus avoiding unnecessary damage in healthy tissues with no increased costs.

Identification and management of tomato brown rugose fruit virus in greenhouses in Mexico.

Tomato brown rugose fruit virus (ToBRFV) has become a cause of great concern in the global tomato agro-industry since its first report in Israel in 2014. Global tomato production is affected by ToBRFV, and management practices are being evaluated. We tested seed lots from international producers as well as greenhouse substrates and water wells as possible sources of virus contamination. We identified a second introduction of ToBRFV in Mexico by a strain closely resembling isolates from the Netherlands and the Middle East. ToBRFV was detected by RT-PCR in seed coats and epicotyls (from commercial seeds and seedlings obtained from infected tomato plants), indicating a transmission rate of 9%. Virus-like particles (VLPs) were found in wells used for irrigation in greenhouses, but these exhibited low infectivity. These findings suggest that water sources could serve as ToBRFV reservoirs. We evaluated four chemical and six thermal methods for sanitizing substrates, plasticware, and other greenhouse utensils, using detached leaf bioassays in Nicotiana rugosa. The most effective chemical sanitization method was treatment with glutaraldehyde plus quaternary ammonium salts and pentapotassium salts. The most effective heat treatment was at 92°C for 30 minutes, which inactivated the virus. Tomato producers could implement these sanitization methods to control ToBRFV.

The Facial Nerve: Anatomy and Pathology.

The facial nerve is the seventh cranial nerve and consists of motor, parasympathetic and sensory branches, which arise from the brainstem through 3 different nuclei (1). After leaving the brainstem, the facial nerve divides into 5 intracranial segments (cisternal, canalicular, labyrinthine, tympanic, and mastoid) and continues as the intraparotid extracranial segment (2). A wide variety of pathologies, including congenital abnormalities, traumatic disorders, infectious and inflammatory disease, and neoplastic conditions, can affect the facial nerve along its pathway and lead to ​​weakness or paralysis of the facial musculature (1,2). The knowledge of its complex anatomical pathway is essential to clinical and imaging evaluation to establish if the cause of the facial dysfunction is a central nervous system process or a peripheral disease. Both computed tomography (CT) and magnetic resonance imaging (MRI) are the modalities of choice for facial nerve assessment, each of them providing complementary information in this evaluation (1).

Sequential application of small molecule therapy enhances chondrogenesis and angiogenesis in murine segmental defect bone repair.

The increasing incidence of physiologic/pathologic conditions that impair the otherwise routine healing of endochondral bone fractures and the occurrence of severe bone injuries necessitate novel approaches to enhance clinically challenging bone fracture repair. To promote the healing of nonunion fractures, we tested an approach that used two small molecules to sequentially enhance cartilage development and conversion to the bone in the callus of a murine femoral segmental defect nonunion model of bone injury. Systemic injections of smoothened agonist 21k (SAG21k) were used to stimulate chondrogenesis through the activation of the sonic hedgehog (SHH) pathway early in bone repair, while injections of the prolyl hydroxylase domain (PHD)2 inhibitor, IOX2, were used to stimulate hypoxia signaling-mediated endochondral bone formation. The expression of SHH pathway genes and Phd2 target genes was increased in chondrocyte cell lines in response to SAG21k and IOX2 treatment, respectively. The segmental defect responded to sequential systemic administration of these small molecules with increased chondrocyte expression of PTCH1, GLI1, and SOX9 in response to SAG and increased expression of hypoxia-induced factor-1α and vascular endothelial growth factor-A in the defect tissues in response to IOX2. At 6 weeks postsurgery, the combined SAG-IOX2 therapy produced increased bone formation in the defect with the bony union over the injury. Clinical significance: This therapeutic approach was successful in promoting cartilage and bone formation within a critical-size segmental defect and established the utility of a sequential small molecule therapy for the enhancement of fracture callus development in clinically challenging bone injuries.

Integración de la vinculación-investigación en la carrera de Medicina de la Universidad Regional Autónoma de Los Andes

Introducción: La integración de la investigación científica y la vinculación es clave para la contribución de las universidades a la solución de los problemas de la sociedad mediante la transferencia de conocimientos y la innovación. Objetivo: Caracterizar el proceso de integración entre vinculación e investigación en la carrera de Medicina de UNIANDES. Método: Se realizó una investigación predominantemente cualitativa y descriptiva con la utilización del análisis documental y la entrevista. Se revisaron documentos rectores, lineamientos, y políticas, aplicadas en la carrera de Medicina. Se aplicaron entrevistas a los coordinadores en la carrera para buscar volumen informativo acerca de estas dos actividades y las proyecciones concretas de transversalización. Resultados: Se denotó una debilidad en cuanto a la gestión de la vinculación con la sociedad, ausencia de una visión más amplia de una gestión integral donde no solo se imbrique vinculación con docencia en las prácticas preprofesionales sino en los proyectos integradores y la existencia de la voluntad de los directivos institucionales en gestar desde la investigación una verdadera vinculación universidad-sociedad. Conclusiones: Falta una visión más amplia de la integración entre los tres procesos claves universitarios, se evidencia solo la relación entre docencia y vinculación a partir de las prácticas preprofesionales, dejando fuera la base y génesis que deben ser los proyectos integradores de saberes. En aras del perfeccionamiento de esta integración se deben proponer proyectos de innovación social donde se unan vinculación e investigación, garantizar la publicación de los resultados de los proyectos de innovación social en las revistas internas de UNIANDES y en otras de impacto regional o mundial.

Introduction: The integration of scientific research and linkage is key for the contribution of universities to the solution of society's problems through the transfer of knowledge and innovation. Objective: Characterize the integration process between linkage and research in the UNIANDES Medicine degree. Method: A predominantly qualitative and descriptive research was carried out with the use of documentary analysis and interviews. Governing documents, guidelines, and policies applied in the Medicine career were reviewed. Interviews were carried out with the coordinators in the program to search for volume of information about these two activities and the specific projections of mainstreaming. Results: A weakness was noted in terms of the management of the link with society, absence of a broader vision of comprehensive management where not only linkage with teaching is intertwined in pre-professional practices but also in integrative projects and the existence of will of institutional directors to create a true university-society link through research. Conclusions: A broader vision of the integration between the three key university processes is missing, only the relationship between teaching and connection is evident from pre-professional practices, leaving out the basis and genesis that knowledge-integrating projects should be. In order to perfect this integration, social innovation projects must be proposed where linkage and research come together, guaranteeing the publication of the results of social innovation projects in the internal journals of UNIANDES and in others with regional or global impact.

Introdução: A integração e articulação da investigação científica é fundamental para a contribuição das universidades na solução dos problemas da sociedade através da transferência de conhecimento e inovação. Objetivo: Caracterizar o processo de integração entre vinculação e pesquisa na graduação em Medicina da UNIANDES. Método: Foi realizada uma pesquisa predominantemente qualitativa e descritiva com utilização de análise documental e entrevistas. Foram revisados documentos normativos, diretrizes e políticas aplicadas à carreira de Medicina. Foram realizadas entrevistas com os coordenadores do programa para buscar volume de informações sobre essas duas atividades e as projeções específicas de mainstreaming. Resultados: Constatou-se uma fragilidade na gestão do vínculo com a sociedade, ausência de uma visão mais ampla de uma gestão integral onde não só o vínculo com o ensino esteja entrelaçado nas práticas pré-profissionais, mas também nos projetos integradores e na existência de vontade de instituições diretores para criar um verdadeiro vínculo universidade-sociedade através da pesquisa. Conclusões: Falta uma visão mais ampla da integração entre os três principais processos universitários, apenas a relação entre ensino e conexão é evidente nas práticas pré-profissionais, deixando de fora a base e a gênese que os projetos integradores de conhecimento deveriam ser. Para aperfeiçoar esta integração, devem ser propostos projetos de inovação social onde a articulação e a investigação se unam, garantindo a publicação dos resultados dos projetos de inovação social nas revistas internas da UNIANDES e em outras com impacto regional ou global.

Contrasting effects of Ksr2, an obesity gene, on trabecular bone volume and bone marrow adiposity.

Pathological obesity and its complications are associated with an increased propensity for bone fractures. Humans with certain genetic polymorphisms at the kinase suppressor of ras2 (KSR2) locus develop severe early-onset obesity and type 2 diabetes. Both conditions are phenocopied in mice with Ksr2 deleted, but whether this affects bone health remains unknown. Here we studied the bones of global Ksr2 null mice and found that Ksr2 negatively regulates femoral, but not vertebral, bone mass in two genetic backgrounds, while the paralogous gene, Ksr1, was dispensable for bone homeostasis. Mechanistically, KSR2 regulates bone formation by influencing adipocyte differentiation at the expense of osteoblasts in the bone marrow. Compared with Ksr2's known role as a regulator of feeding by its function in the hypothalamus, pair-feeding and osteoblast-specific conditional deletion of Ksr2 reveals that Ksr2 can regulate bone formation autonomously. Despite the gains in appendicular bone mass observed in the absence of Ksr2, bone strength, as well as fracture healing response, remains compromised in these mice. This study highlights the interrelationship between adiposity and bone health and provides mechanistic insights into how Ksr2, an adiposity and diabetic gene, regulates bone metabolism.

Our bones are living tissues which constantly reshape and renew themselves. This ability relies on stem cells present in the marrow cavity, which can mature into the various types of cells needed to produce new bone material, marrow fat, or other components. Obesity and associated conditions such as type 2 diabetes are often linked to harmful changes in the skeleton. In particular, these metabolic conditions are associated with weight-bearing bones becoming more prone to facture and healing poorly. Mice genetically modified to model obesity and diabetes could help researchers to study exactly how these conditions ­ and the genetic changes that underlie them ­ impact bone health. Gomez et al. aimed to address this question by focusing on KSR2, a gene involved in energy consumption and feeding behavior. Children who carry certain KSR2 mutations are prone to obesity and type 2 diabetes; mice lacking the gene also develop these conditions due to uncontrolled eating. Closely examining mutant mice in which Ksr2 had been deactivated in every cell revealed that the weight-bearing bones of these animals were also more likely to break, and the fractures then healed more slowly. This was the case even though these bones had higher mass and less marrow fat compared to healthy mice. Non-weight bearing bones (such as the spine) did not exhibit these changes. Further experiments revealed that, when expressed normally in the skeleton, Ksr2 skews the stem cell maturation process towards marrow fat cells instead of bone-creating cells. This suggests a new role for Ksr2, which therefore seems to independently regulate both feeding behavior and bone health. In addition, the work by Gomez et al. demonstrate that Ksr2 mutant mice could be a useful model to better understand how obesity and diabetes affect human bones, and to potentially develop new therapies.

La importancia del desarrollo de las habilidades comunicacionales en estudiantes del área de la salud / The importance of developing communication skills in students in the health área

INTRODUCION Estos últimos años la Educación Superior ha tenido que incorporar en su curricular el desarrollo de habilidades comunicacionales, siendo actualmente considerada por la Asociación de Colegios Médicos Americanos (AAMC), Asociación Americana de Escuelas de Medicina(AAME) y Escuela de aprendizaje, conductual y de habilidades (EACH) como una competencia básica del profesional del área salud y que en ocasiones determina el éxito o fracaso del proceso asistencial, existiendo evidencia que el proceso comunicativo que se da en los centros de atención médica referida a la interacción médico-paciente determina la precisión del diagnóstico, toma de decisiones y adherencia del tratamiento que permite una excelente práctica médica. Frente a esta necesidad las Universidades han implementado diversas actividades realizadas en países anglosajones que deben ser ajustadas a las necesidades y contexto social chileno.

In recent years, Higher Education has had to incorporate in its curriculum the development of communication skills, being currently considered by the Association of American Medical Colleges (AAMC), American Association of Medical Schools (AAME) and School of Learning, Behavioral and Skills (EACH) as a basic competence of the health professional and that sometimes determines the success or failure of the care process, there is evidence that the communicative process that occurs in health care centers related to doctor-patient interaction determines the accuracy of diagnosis, decision making and adherence to treatment that allows excellent medical practice. Faced with this need, the Universities have implemented various activities carried out in Anglo Saxon countries that must be adjusted to the needs and social context of Chile

Diagnostics of Infections Produced by the Plant Viruses TMV, TEV, and PVX with CRISPR-Cas12 and CRISPR-Cas13.

Viral infections in plants threaten food security. Thus, simple and effective methods for virus detection are required to adopt early measures that can prevent virus spread. However, current methods based on the amplification of the viral genome by polymerase chain reaction (PCR) require laboratory conditions. Here, we exploited the CRISPR-Cas12a and CRISPR-Cas13a/d systems to detect three RNA viruses, namely, Tobacco mosaic virus, Tobacco etch virus, and Potato virus X, in Nicotiana benthamiana plants. We applied the CRISPR-Cas12a system to detect viral DNA amplicons generated by PCR or isothermal amplification, and we also performed a multiplexed detection in plants with mixed infections. In addition, we adapted the detection system to bypass the costly RNA purification step and to get a visible readout with lateral flow strips. Finally, we applied the CRISPR-Cas13a/d system to directly detect viral RNA, thereby avoiding the necessity of a preamplification step and obtaining a readout that scales with the viral load. These approaches allow for the performance of viral diagnostics within half an hour of leaf harvest and are hence potentially relevant for field-deployable applications.

Aprendizaje Basado en Casos Clínicos (CCBL): una metodología activa aplicable a carreras de ciencias de la salud / Clinical Case-based Learning (CCBL): an active methodology applicable to health sciences careers

Se realizó un análisis bibliográfico sobre la utilización de casos clínicos como estrategia didáctica en las carreras de medicina, enfermería, kinesiología y nutrición. Es fundamental para los docentes estar innovando continuamente en las estrategias de aprendizaje, y promover una flexibilización curricular, para mejorar los procesos de enseñanza universitaria, impulsando un cambio en las metodologías docentes en función del estudiante de manera activa, dando paso a un proceso de enseñanza-aprendizaje dinámico que se adapta a las circunstancias históricas sociales. El objetivo de esta revisión es analizar las evidencias disponibles sobre la utilización de casos clínicos y su aporte a las habilidades y competencias exigidas en los perfiles de estas cuatro carreras de la salud

A bibliographical analysis was carried out on the use of clinical cases as a didactic strategy in medicine, nursing, kinesiology and nutrition undergraduate programs. Is essential for teachers to be continuously innovated in learning strategies, and promote curricular flexibility, to improve university teaching processes, promoting a change in teaching methodologies based on the student in an active way, giving way to a teaching process -dynamic learning that adapts to historical-social circumstances. The objective of this review was to analyze the available evidence on the use of clinical cases and their contribution to the skills and competencies required in the profiles of these four health undergraduate programs

Hernia of De Garengeot an up to date of diagnosis, initial management and treatment: a narrative review and a case study report / Hernia de De Garengeot: diagnóstico, manejo inicial y tratamiento actualizados: una revisión narrativa y un informe de estudio de caso

INTRODUCTION A De Garengeot hernia is defined by a femoral hernia containing the appendix. Acute appendicitis within a femoral hernia is an extremely rare surgical presentation and occurs in only 0.08-0.013% of cases cited in the literature and 5 to 15% of all femoral hernias. CASE PRESENTATION A 53-year-old woman presented to the emergency room of our hospital in our ward with acute onset of a right-sided inguinal swelling that occurred earlier that day after performing a heavy lift. Her examination revealed acute appendicitis contained within an incarcerated right femoral hernia. The patient underwent laparoscopic appendectomy with open femoral hernia repair. Intraoperatively, the tip of the appendix was incarcerated within the hernial sac. She was removed through the open inguinal incision after the base of the appendix has been divided laparoscopically. The final pathology showed acute inflamed appendicitis with no evidence of neoplasm. DISCUSSION Physicians should be aware of the rare extent of an unusual presentation of appendicitis such as well as surgical options for treatment. The literature does not conclude on a gold standard for the method of approach. CONCLUSION De Garengeot's hernia remains a rare and unusual surgical presentation of femoral hernia, and the complication of the case by incarceration leading to acute appendicitis provides a challenging surgical approach that should be personalized for each patient

Optic pathway gliosarcoma: A very rare location for a rare disease.

Gliosarcoma, a variant of glioblastoma, is a rare and aggressive tumor of the central nervous system (CNS) composed of glial and sarcomatous tissues. Up to now, there are only 2 reported cases of gliosarcoma of the optical pathway. We report a case from March 2018 of a 53-year-old male patient presented with 6 months' of right fronto-orbital pulsatile headache, behavior changes, and visual loss. The MRI study showed an expansile optic pathway lesion involving the chiasm and right optic nerve. The diagnosis of gliosarcoma was obtained by open brain biopsy and immunohistochemical analysis. Although gliosarcoma is rare, it should be considered a differential diagnosis even in optic pathway tumors in older patients. The experience of the neuropathologist with a trained eye can be the differential in the accurate diagnostic process. Optic pathway, Gliosarcoma, Glioblastoma, Magnetic resonance imaging.

Localization accuracy of a common beamformer for the comparison of two conditions.

The linearly constrained minimum variance beamformer is frequently used to reconstruct sources underpinning neuromagnetic recordings. When reconstructions must be compared across conditions, it is considered good practice to use a single, "common" beamformer estimated from all the data at once. This is to ensure that differences between conditions are not ascribable to differences in beamformer weights. Here, we investigate the localization accuracy of such a common beamformer. Based on theoretical derivations, we first show that the common beamformer leads to localization errors in source reconstruction. We then turn to simulations in which we attempt to reconstruct a (genuine) source in a first condition, while considering a second condition in which there is an (interfering) source elsewhere in the brain. We estimate maps of mislocalization and assess statistically the difference between "standard" and "common" beamformers. We complement our findings with an application to experimental MEG data. The results show that the common beamformer may yield significant mislocalization. Specifically, the common beamformer may force the genuine source to be reconstructed closer to the interfering source than it really is. As the same applies to the reconstruction of the interfering source, both sources are pulled closer together than they are. This observation was further illustrated in experimental data. Thus, although the common beamformer allows for the comparison of conditions, in some circumstances it introduces localization inaccuracies. We recommend alternative approaches to the general problem of comparing conditions.

Hop stunt viroid: A polyphagous pathogenic RNA that has shed light on viroid-host interactions.

TAXONOMY: Hop stunt viroid (HSVd) is the type species of the genus Hostuviroid (family Pospiviroidae). The other species of this genus is Dahlia latent viroid, which presents an identical central conserved region (CCR) but lacks other structural hallmarks present in Hop stunt viroid. HSVd replication occurs in the nucleus through an asymmetric rolling-circle model as in the other members of the family Pospiviroidae, which also includes the genera Pospiviroid, Cocadviroid, Apscaviroid, and Coleoviroid. PHYSICAL PROPERTIES: Hop stunt viroid consists of a single-stranded, circular RNA of 295-303 nucleotides depending on isolates and sequence variants. The most stable secondary structure is a rod-like or quasi-rod-like conformation with two characteristic domains: a CCR and a terminal conserved hairpin similar to that of cocadviroids. HSVd lacks a terminal conserved region. HOSTS AND SYMPTOMS: HSVd infects a very broad range of natural hosts and has been reported to be the causal agent of five different diseases (citrus cachexia, cucumber pale fruit, peach and plum apple apricot distortion, and hop stunt). It is distributed worldwide. TRANSMISSION: HSVd is transmitted mechanically and by seed.

Análisis de series temporales respecto tasas de mortalidad general e intrahospitalaria en egresos hospitalarios, población pediátrica oncohematológico, Chile 1997-2016 / Analysis of time series related general and in-hospital mortality rates in hospital discharges, pediatric onco hematological population, Chile 1997-2016

INTRODUCTION: Before the start of the GES program in 2002, mortality was 128.2 deaths per million children under 15 years of age (RENCI). This public program managed to ensure the opportunity for diagnosis and treatment in children under 15 years of age and those less than 25 years of age who recur. Objective: To assess how GES has impacted on in-hospital mortality and lethality between1997and 2016. Methods: Retrospective case control study of 28,997 hospital discharges and 12,434 deaths analyzed using Prais-Weinstein time series between the years 1997 to 2016. They prepared contingency tables with data on: hospital discharges, age, sex and forecasts for 2001 and 2016. Fisher's p <0.05 test was used. Results: For the PreGes period an increase of 1.8% in the male crude mortality rate was observed, while for the Post Ges period an increase was observed with a breaking point at the end of 2008, with an increase of 11.04% compared to the PreGes period. An unexpected increase in the female mortality rate was observed. The odd's ratios associated with sex (higher mortality inmen than in women)0.816CI-0.679- 0.982; p <0.05; OR'S age 1,047 (0.981 per year) IC-1.044-1.051; p <0.0001 FORECAST (FONASA-1.942 IC 1.304-2.89 / ISAPRE = 2.186; IC = 1.267-3.773 p <0.005); Hospitalization days = 1.031 confirmed our research hypothesis 1.026-1.035 p <0.0001. Conclusion: This study found that there are statistically significant differences regarding hospital discharges between the public-private system, in relation to mortality andincreasein sustained crudemalemortality between the years1997 to 2016

INTRODUCCIÓN: Antes del inicio del programa GESen2002, la mortalidad era 128,2 muertes por millón de niños menores de 15 años (RENCI). Este programa público logró asegurar la oportunidad de diagnóstico y tratamiento en menores de15 años y aquellos menores de25añosque recidivan. Objetivo: Evaluar cómo el GES ha impactado en la mortalidad y letalidad intrahospitalaria entre1997a2016. Métodos: Estudio retrospectivo de control de casos en 28.997 egresos hospitalarios y 12.434 defunciones analizadas mediante series temporales de Prais-Weinstein entre los años 1997 a 2016. Se prepararon tablas de contingencia con datos sobre: egresos hospitalarios, edad, sexo y previsiones para2001y 2016.Se utilizóla prueba p <0.05de Fisher. Resultados: Se observó para el período PreGES un incremento de 1.8% en la tasa mortalidad cruda masculina, mientras que para el período Post GES se observó un incremento con punto de quiebre a fines del año 2008, con incremento del 11,04% respecto al período PreGES. Se observó incremento no sostenido en la tasa mortalidad femenina. Los odd's ratios asociados al sexo (mayor mortalidad en hombres que en mujeres) 0.816 IC-0.679-0.982; p <0,05; OR'S edad 1,047 (0.981 por año) IC-1.044-1.051; p<0.0001 PREVISIÓN (FONASA-1.942 IC 1.304-2.89 / ISAPRE =2.186; IC= 1,267-3,773 p<0.005); Días de Hospitalización=1,031 confirmó nuestra hipótesis de investigación 1,026-1,035 p<0.0001. Conclusión: Este estudio encontró que hay diferencias estadísticamente significativas respecto egresos hospitalarios entre el sistema público privado, en relación con la mortalidad e incremento en la mortalidad cruda masculina sostenida entre los años 1997 a 2016. acción en la función auditiva mediante audiometría tonal.

Ley nacional del cáncer Claudio Mora: metas y desafíos a futuro / Claudio Mora National Cancer Law: Goals and challenges for the future

Actualmente el cáncer es la segunda causa de muerte en la población chilena; sin embargo, en algunas regiones del país como Arica y Parinacota, Antofagasta, La Serena, Los Lagos y Aysén, en Atacama y La Araucanía ya es la primera (1), inmediatamente apenas por debajo de las afecciones al sistema circulatorio y cardiovascular, y se espera que, al final de la próxima década, llegue a ser la primera causa de muerte en el país (2). Por otra parte, con respecto a los años de vida perdidos en Chile, el cáncer es la primera causa de años de vida perdidos por muerte prematura (175.741 años equivalentes al 22,5% del total de años). Si a lo anterior sumamos los años de vida perdidos por discapacidad, el cáncer es responsable de 221.529 AVISA (Años de vida ajustados por discapacidad), ubicándolo en el séptimo lugar de grupos de causas de carga de enfermedad.(3) Por su incidencia, el cáncer se ha constituido en un problema de salud pública indiscutible e insoslayable, por cuya gravedad demanda al sistema de salud chileno la máxima atención y el mejor de los esfuerzos en las tareas de las pesquisas temprana en toda la población, con el fin de minimizarsusefectos combinados enlasociedad demanera transversal y en cualquier contexto en el que ocurra, debido a la dificultad que significa para el sistema de salud chileno su pesquisa temprana en todos los ciudadanos, sumado a la escasez de recursos tanto humanos como materiales, por lo costos involucrados en su abordaje, es un importante problema social y económico, con repercusión y costos que afectan a laspersonas, sus familiasy comunidades, así como al sistema de salud y al país en su conjunto. (2) A la fecha, en Chile, grandes esfuerzos se han hecho para reducir estas brechas. El mayor de ellos es el programa GES (Garantías explícitas enSalud), mediante el cual los pacientes de acuerdo a su diagnóstico e independientemente de su capacidad de pago o seguro de salud asociado, región geográfica o nivel educacional, son asegurados con una canasta de prestaciones estandarizada, con tiempos de atención antes definidos, asegurando así acceso, oportunidad, protección financiera y calidad delprestador. (4) No obstante luego de 15 años de iniciado elprograma de prestaciones GES, persisten estas diferencias tanto por nivel socioeconómico, y/o educacional, queinfluyen negativamente sobre los estándares de atención de los diferentes prestadores de salud, en razón que diversos estudios se han observado diferencias estadisticamente significativas en las tasas de mortalidad entre el sistema público y privado de 3,12 a 5,8 veces más mortalidad en los pacientes atendidos por FONASA (Fondo nacional de Salud) , respecto a los prestadores privados provenientes de ISAPRES (Instituciones de salud previsional). (5) La ley Nacional del Cáncer recibe el nombre del doctor Claudio Mora a modo de homenaje póstumo, pues él encarnó la dualidad de paciente oncológico y profesional al ser tratado por un cáncer de páncreas, junto al Dr. Jorge Jiménez de la Jara, y la senadora Carolina Goic, quienes fueron grandes impulsores de esta ley, que cuenta con $80 mil millones de pesos anuales ($20 mil millones para infraestructura y $60 mil millones para tratamientos que hoy no son cubiertos por el GES ni por la Ley Ricarte Soto), además de $200 millones anuales por ocho años para la construcción de la Red Nacional Oncológica.(6) La ley nacional del cáncer es un proyecto a largo plazo que requiere de una red oncológica integrada de profesionales y de la coordinación de un equipo interdisciplinario que presenta deficiencias tanto en el número como en la especializaciónde sus equipos médicos. En el presente contexto de la pandemia por coronavirus iniciada en Chile el 1 de marzo de 2020, contrapuesto a lo anterior la disminución de los diagnósticos de cáncer es un hecho, como consecuencia directa de la priorización de camas crítica como camas básicas y de intermedio para atender pacientes infectados por coronavirus, a pesar de lo anterior ha entrado en vigencia la Ley Nacional de Cáncer, es decir, la nueva Ley 21.258, que pretende asegurar que se proporcione un óptimo diagnóstico, tratamiento y seguimiento a los pacientes. (7)

Peritonitis en pacientes que reciben diálisis peritoneal en un hospital de Lima, Perú / Peritonitis in peritoneal dialysis patients from a hospital in Lima, Peru

RESUMEN Con el objetivo de determinar la tasa y factores relacionados con peritonitis en pacientes de una unidad de diálisis peritoneal (DP) atendidos en un hospital de Lima, Perú, se realizó un estudio retrospectivo de cohorte única durante el periodo de 2014 a 2016. Se incluyó a todos los pacientes con diagnóstico de enfermedad renal crónica del programa de DP del Hospital Cayetano Heredia. Se estimó la tasa de incidencia de peritonitis y se realizó un análisis bivariado para evaluar los factores relacionados. Se incluyó un total de 73 pacientes. La tasa de incidencia de peritonitis fue de 0,60 episodios por paciente al año; el 46,7% de los cultivos fueron positivos siendo el germen aislado más común el S. aureus. Los factores relacionados con peritonitis fueron menor valor de albúmina y hematocrito. La tasa de incidencia de peritonitis y de cultivos negativos se encontraron por encima del valor sugerido internacionalmente.

ABSTRACT In order to determine the rate and factors related to peritonitis in peritoneal dialysis (PD) patients treated at a hospital in Lima, Peru; a retrospective single-cohort study was conducted during the period 2014-2016. All patients diagnosed with chronic renal disease from the PD program at the Cayetano Heredia Hospital were included. The incidence rate of peritonitis was estimated and a bivariate analysis was performed to assess related factors. A total of 73 patients were included. The incidence rate of peritonitis was 0.60 episodes per patient per year; 46.7% of the cultures were positive and the most common isolated germ was S. aureus. Lower albumin and hematocrit values were found to be related to peritonitis. In this study, the incidence rate of peritonitis and negative cultures were found to be higher than the internationally estimated rate.

Generación de un acuerdo Marco para una Nueva Política Educativa Médica Chilena / Generation of a Framework Agreement for a New Policy Chilean Medical Education

Desde el origen de la República, Chile ha probado diversos modelos educativos con el fin de responder a los requerimientos y necesidades de una población en un avanzada transición epidemiológica y demográfica y que requerirá un nuevo tipo de profesional que responda de forma versátil y adaptada a una sociedad en constante cambio, donde la migración, la adquisición de enfermedades foráneas y el acelerado proceso de envejecimiento y de industrialización de la sociedad llevarán a un incremento explosivo de las enfermedades neurodegenerativas, los cánceres y la emergencia de nuevas enfermedades de origen parasitaria, virales y bacterianas a las cuales la población no se encontraba adaptada

Since the origin of the Republic, Chile has tested different educational models in order to respond to the requirements and needs of a population in an advanced epidemiological and demographic transition and that will require a new type of professional who respond in a versatile way and adapted to a society constantly changing, where migration, acquisition foreign diseases and the accelerated process of aging and industrialization of society will lead to an explosive increase in diseases neurodegenerative drugs, cancers and the emergency of new diseases of parasitic, viral and bacteria to which the population was not adapted

Depuis l'origine de la République, le Chili a testé différents modèles éducatifs afin de répondre aux les besoins et les besoins d'une population une transition épidémiologique et démographique avancée et qui nécessitera un nouveau type de professionnel qui répondre de manière polyvalente et adaptée à une société en constante évolution, où la migration, l'acquisition maladies étrangères et le processus accéléré de vieillissement et industrialisation de la société conduira à une augmentation explosive des maladies médicaments neurodégénératifs, les cancers et l'urgence nouvelles maladies parasitaires, virales et bactéries auxquelles la population n'était pas Adapté

Implementación de la metodología indagatoria-mayéutica en la educación médica en Chile / Implementation of the inquiry-maieutic methodology in the medical education in Chile

La indagación científica se entiende como un "proceso en el cual se plantean preguntas acerca del mundo natural, se generan hipótesis, se diseña una investigación, y se colectan, analizan datos con el objeto de encontrar una solución al problema" (Windschitl, 2003: 113). La educación médica en Chile presenta un enfoque médico hegemónico que aún arrastra falencias en torno a un modelo mecanicista, segmentado y desigual. Esta manifestación se perpetúa a través de la educación desde el ciclo preescolar hasta la enseñanza secundaria. Acerca de este tópico la A. de Cs. de Chile expresó en 2005la Academia de Ciencias, durante el 2005 señaló que: "Ha girado tradicionalmente en torno de una enseñanza desagregada o disciplinaria del saber científico, una instrucción enciclopedista, un aprendizaje memorístico de conocimientos atomizados, datos fragmentarios e informaciones puntuales, con una comprensión de la ciencia descontextualizada del mundo cotidiano y de las necesidades de la vida social"

Vitamin D Level and Supplementation in Pediatric Atopic Dermatitis: A Randomized Controlled Trial.

BACKGROUND:: Atopic dermatitis (AD) is a chronic inflammatory skin condition characterized by a pruritic eczematous rash. Evidence surrounding the role of serum vitamin D (VD) in modifying disease severity is inconsistent. OBJECTIVES:: To determine whether VD levels are correlated with AD severity and the effects of VD supplementation on disease modification. METHODS:: This was a 2-phase study, using a cross-sectional design to evaluate the relationship between VD level and severity, as well as a double-blinded, randomized control trial to elucidate the effects of VD supplementation. Patients aged 0 to 18 years with AD were included in phase 1, and disease severity and serum VD levels were determined. Those with renal, liver, or other dermatologic conditions were excluded. Patients with abnormal (<72.7 nmol/L) VD levels were eligible for phase 2 and to be randomized to either VD supplementation of 2000 IU/d or placebo. VD level and severity were assessed at baseline and 3 months. RESULTS:: The 77 patients included in phase 1 had a mean (SD) age of 7.4 (4.5) years, and 45.5% (33/77) were female. Increased severity was significantly correlated with lower VD levels ( P = .015). Of the 45 patients included in phase 2, 21 and 24 were assigned to the supplementation and placebo arm, respectively. The mean (SD) change in severity did not differ significantly between the supplementation (15.35 [9.71]) and placebo (15.13 [8.97]) groups after 3 months of intervention ( P = .7). CONCLUSION:: Although VD levels correlated with AD severity, VD supplementation did not significantly improve disease severity.