Outcomes and Survival for Early-Stage Non-Small Cell Lung Cancer Following Wedge Resection or Lobectomy: A Propensity Score-Matched Analysis Using a Novel Peruvian Registry.

Background: Using a previously unreported Peruvian registry of patients treated for early-stage non-small cell lung cancer (NSCLC), this study explored whether wedge resection and lobectomy were equivalent regarding survival and impact on radiologic-pathologic variables. Methods: This observational, analytical, longitudinal study used propensity score-matched (PSM) analysis of a single-center retrospective registry of 2,570 patients with pathologic stage I-II NSCLC who were treated with wedge resection (n=1,845) or lobectomy (n=725) during 2000-2020. After PSM, 650 cases were analyzed (resection, n=325; lobectomy, n=325) through preoperative and clinical variables, including patients with ≥1 lymph node removed. Kaplan-Meier curves and multivariable Cox proportional hazard models were created for 5-year overall survival (OS), disease-free survival (DFS), and locoregional-recurrence-free survival (LRFS). Results: The principal complication was operative pain persisting >7 days for lobectomy versus wedge resection (58% vs. 23%, p=0.034) and shorter hospital stays for resection than for lobectomy (5.3 days vs. 12.8 days, p=0.009). The 5-year OS (84.3% vs. 81.2%, p=0.09) and DFS (79.1% vs. 74.1%, p=0.07) were similar and statistically insignificant between resections and lobectomies, respectively. LRFS was worse overall following wedge resection than lobectomy (79.8% vs. 91.1%, p<0.02). Nevertheless, in the PSM analysis, both groups experienced similar LRFS when the resection margin was >10 mm (90.9% vs. 87.3%, p<0.048) and ≥4 lymph nodes were removed (82.8% vs. 79.1%, p<0.011). Conclusion: Both techniques led to similar OS and DFS at 5 years; however, successful LRFS required a wedge resection with a surgical margin and adequate lymph node removal to obtain outcomes similar to lobectomy.

Atmospheric cold plasma as a novel approach to remediating microplastics pollution in water.

Microplastics (MPs) have become an environmental and health threat to aquatic species and humans because they are small and can easily reach water bodies for municipal and agricultural uses. MPs have been traced in food commodities and products derived from animals and even found in bottles of drinking water. Current treatment techniques for permanently destroying MPs require high energy inputs and thus are generally cost-inefficient. Atmospheric cold plasma (ACP) is a low-cost energy-efficient technology to produce highly reactive species that can induce physicochemical changes in plastic polymers. This study, for the first time, used ACP as a novel method for MPs treatment. Polypropylene (PP) and low-density polyethylene (LDPE) were used to prepare model MPs. The effects of plasma working gas (oxygen, nitrogen, or their mixture) and post-ACP treatment storage (24 h) on MPs were studied. ACP treatments for 30 min successfully degraded both MPs, by 1.4-11.3% in weight. PP MPs had larger weight reduction than LDPE and the ACP of mixture gas was most effective. PP MPs also showed increased carbonyl index after treatments, to up to 6.89, indicating hydrolytic degradation. For LDPE MPs, oxygen ACP caused more oxidation, but storage did not have an enhancing effect. The results of physicochemical analyses indicated that MPs degradation by ACP was possibly mainly through oxidative and hydrolytic reactions, but further characterizations are needed. This study proves that ACP is a promising strategy to remediate MPs pollution, and thus has great potential for addressing the severe challenges of MPs that the food and agriculture sectors are currently facing.

Presentación inusual de coriocarcinoma metastásico a hígado y pulmón: un reporte de caso / Unusual presentation of metastatic choriocarcinoma to liver and lung: a case report

La enfermedad trofoblástica gestacional (ETG) es un trastorno proliferativo del trofoblasto. Incluye la mola hidatidiforme, el coriocarcinoma, la mola invasiva, el tumor trofoblástico del lecho placentario y el tumor trofoblástico epitelioide. Las últimas cuatro hacen parte de la neoplasia trofoblástica gestacional, que agrupa menos del 1% de todos los tumores ginecológicos. La incidencia de la ETG puede variar, siendo aproximadamente de 1 a 3 de cada 1.000 embarazos en América del Norte y Europa. El coriocarcinoma es la forma más agresiva por su rápida invasión vascular y compromiso metastásico. Sin embargo, es un tumor muy quimiosensible con una alta tasa de respuestas y posibilidad de curación superior al 90%. Se presenta el caso de una paciente de 40 años quien ingresó al servicio de urgencias por disnea súbita secundaria a tromboembolia pulmonar y posteriormente tras el inicio de anticoagulación presentó hemoperitoneo debido a lesiones hepáticas metastásicas de un coriocarcinoma, además de compromiso metastásico pulmonar. Se presenta este caso por ser una patología poco frecuente, agresiva y con presentaciones inusuales, con el fin de mostrar la importancia de un diagnóstico y tratamiento oportuno.

Gestational trophoblastic disease (GTD) is a condition in which the trophoblast, a layer of cells surrounding the embryo, develops abnormally. GTD includes both pre-malignant and malignant pathologies, such as hydatidiform mole, choriocarcinoma, invasive mole, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. Although GTD is rare, it affects about 1 to 3 out of every 1,000 pregnancies in North America and Europe. Choriocarcinoma is the most aggressive form of GTD, as it can quickly invade blood vessels and metastasize to other parts of the body. However, it is highly responsive to chemotherapy, with a cure rate of over 90%. In this case, a 40-year-old patient presented to the emergency department with sudden dyspnea due to pulmonary embolism. After starting anticoagulation therapy, she developed hemoperitoneum due to the spread of choriocarcinoma to her liver, as well as pulmonary metastases. This case is noteworthy because of its unusual presentation and aggressive nature, underscoring the importance of early diagnosis and treatment.

Resección laparoscópica de quiste de duplicación gástrica asistida por endoscopia / Laparoscopic resection of gastric duplication cyst assisted by endoscopy

Introducción. Las duplicaciones gástricas son entidades congénitas poco frecuentes que se diagnostican principalmente en las etapas tempranas de la vida, y rara vez en pacientes adultos. El objetivo de este artículo fue presentar el caso de un adulto con esta patología, tratado exitosamente mediante cirugía. Caso clínico. Mujer de 26 años de edad con epigastralgia crónica refractaria a manejo médico, a quien durante endoscopia digestiva superior se le identificó una lesión quística sugestiva de tumor estromal gastrointestinal, confirmada por ultrasonido endoscópico. Resultados. Se realizó una resección quirúrgica laparoscópica asistida por endoscopia, con buena evolución postoperatoria. El estudio anatomo-patológico informó la presencia de un quiste de duplicación gástrica. Conclusiones. A pesar de las ayudas diagnósticas disponibles en la actualidad, esta patología representa un reto diagnóstico importante que, en muchas ocasiones solo puede ser confirmado mediante el estudio anatomo-patológico. En paciente asintomático, continúa la controversia entre observarlo o llevarlo a cirugía, por el riesgo de malignidad. Actualmente, el manejo de las duplicaciones gástricas en adultos se considera eminentemente quirúrgico. Las resecciones laparoscópicas y el uso de endoscopia intraoperatoria permiten garantizar la resección completa de la lesión, preservando la mayor cantidad de tejido sano adyacente y previniendo estenosis o deformidades gástricas que afecten su adecuado funcionamiento.

Introduction. Gastric duplications are rare congenital entities that are diagnosed primarily in early life, and rarely in adult patients. The objective of this article was to present the case of an adult with this pathology, successfully treated by surgery. Clinical case. A 26-year-old woman with chronic epigastralgia refractory to medical management, who during upper digestive endoscopy was identified with a cystic lesion suggestive of gastro-intestinal stromal tumor, confirmed by endoscopic ultrasound. Results. A laparoscopic surgical resection assisted by endoscopy was performed, with good postoperative evolution. The anatomopathological study reported the presence of a gastric duplication cyst. Conclusions. Despite the diagnostic adjuncts currently available, this pathology represents an important diagnostic challenge that, in many cases, can only be confirmed through pathology. In asymptomatic patients, the controversy continues between observing them or taking them to surgery due to the risk of malignancy. Currently, the management of gastric duplications in adults is considered eminently surgical. Laparoscopic resections and the use of intraoperative endoscopy ensure complete resection of the lesion, preserving the greatest amount of adjacent healthy tissue and preventing gastric stenosis or deformities that affect its proper functioning.

Azido-mediated intermolecular interactions of transition metal complexes.

The coordinated azido ligand has a variety of ways to establish intermolecular contacts whose nature is computationally analysed in this work on dimers of the [N3-Hg(CF3)] complex with different interactions involving only N⋯N contacts, or with an additional Hg⋯N contact. The applied tools include the molecular electrostatic map of the monomer, an energy decomposition analysis (EDA), a topological AIM analysis of the electron density and the study of NCI (non-covalent interactions) isosurfaces. The interactions between two azido ligands are found to be weakly stabilizing (by 0.2 to 2.7 kcal mol-1), topology-dependent and require dispersion forces to complement orbital and electrostatic stabilization. Those interactions are supplemented by the formation of simultaneous Hg⋯N secondary interactions by about -1 kcal mol-1, and by the ability of the monomer to simultaneously interact with several neighbours in the crystal structure.

Accelerating Pharmaceutical Process Development with an Acoustic Droplet Ejection-Multiple Reaction Monitoring-Mass Spectrometry Workflow.

Fast-paced pharmaceutical process developments (e.g., high-throughput experimentation, directed evolution, and machine learning) involve the introduction of fast, sensitive, and accurate analytical assays using limited sample volumes. In recent years, acoustic droplet ejection (ADE) coupled with an open port interface has been invented as a sampling technology for mass spectrometry, providing high-throughput nanoliter analytical measurements directly from the standard microplates. Herein, we introduce an ADE-multiple reaction monitoring-mass spectrometry (ADE-MRM-MS) workflow to accelerate pharmaceutical process research and development (PR&D). This systematic workflow outlines the selection of MRM transitions and optimization of assay parameters in a data-driven manner using rapid measurements (1 sample/s). The synergy between ADE sampling and MRM analysis enables analytical assays with excellent sensitivity, selectivity, and speed for PR&D reaction screenings. This workflow was utilized to develop new ADE-MRM-MS assays guiding a variety of industrial processes, including (1) screening of Ni-based catalysts for C-N cross-coupling reaction at 1 Hz and (2) high-throughput regioisomer analysis-enabled enzyme library screening for peptide ligation reaction. ADE-MRM-MS assays were demonstrated to deliver accurate results that are comparable to conventional liquid chromatography (LC) experiments while providing >100-fold throughput enhancement.

Engineering Hydroxylase Activity, Selectivity, and Stability for a Scalable Concise Synthesis of a Key Intermediate to Belzutifan.

Biocatalytic oxidations are an emerging technology for selective C-H bond activation. While promising for a range of selective oxidations, practical use of enzymes catalyzing aerobic hydroxylation is presently limited by their substrate scope and stability under industrially relevant conditions. Here, we report the engineering and practical application of a non-heme iron and α-ketoglutarate-dependent dioxygenase for the direct stereo- and regio-selective hydroxylation of a non-native fluoroindanone en route to the oncology treatment belzutifan, replacing a five-step chemical synthesis with a direct enantioselective hydroxylation. Mechanistic studies indicated that formation of the desired product was limited by enzyme stability and product overoxidation, with these properties subsequently improved by directed evolution, yielding a biocatalyst capable of >15,000 total turnovers. Highlighting the industrial utility of this biocatalyst, the high-yielding, green, and efficient oxidation was demonstrated at kilogram scale for the synthesis of belzutifan.

Implementación de las curvas de densidad electrónica relativa al sistema de planificación de tratamiento en teleterapia mediante la calibración estequiométrica

Objetivos: el objetivo de este trabajo fue integrar curvas de densidad electrónica relativa al sistema de planificación de tratamiento CAT3D utilizando el método alternativo de la calibración estequiométrica. Métodos: se utilizó aluminio como material de calibración y un maniquí torácico con insertos y se consideraron 3 casos en la planificación del tratamiento: campo directo 10x10cm2, campo directo 20x20cm2 y campo lateral 10x10cm2 con cuña, donde se puso a prueba el sistema de planificación basado en el algoritmo Pencil Beam. Resultados: se encontró que el uso incorrecto de estas curvas afecta significativamente la dosis absorbida hasta en un 6% en regiones de cambios bruscos de densidad, excediendo la tolerancia recomendada de ±5% en la entrega de dosis adsorbida en regiones de equilibrio electrónico. Conclusiones: se concluyó que la implementación y uso correcto de estas curvas mejora la aproximación en medios heterogéneos, reduciendo la desviación de sus resultados.

Objectives: the objective of this work was to integrate relative electron density curves to the CAT3D treatment planning system using the alternative method of stoichiometric calibration. Methods: aluminum was usec as calibration material and a thoracic mannequin with inserts and 3 cases were considered in the treatment planning: direct field 10x10cm2, direct field 20x20cm2 and lateral field 10x10cm2 with wedge, where the planning system based on the Pencil Beam algorithm was tested. Results: it was found that incorrect use of these curves significantly affects the absorbed dose by up to 6% in regions of sudden changes in density exceeding the recommended tolerance of ±5% in the delivery of adsorbed dose in regions of electronic equilibrium. Conclusions: it was concluded that the implementation and correct use of these curves improves the approximation in heterogeneous media, reducing the deviation of their results.

Effectiveness of Five Antibiotic Regimens for the Treatment of Intra-Abdominal Infection in Bogotá.

Background: Intra-abdominal infection (IAI) results in prolonged in-hospital length-of-stay, critical care unit requirements, and multiple surgical procedures. Several antimicrobial agents are available for treatment of IAI. In Colombia, there are no data on the comparative effectiveness of the different regimens used. Patients and Methods: A multicenter retrospective cohort study was completed in four third-level hospitals by comparing treatment effectiveness of five different antibiotic protocols (ampicillin-sulbactam, clindamycin-amikacin, piperacillin-tazobactam, amikacin-metronidazole, and cefuroxime-metronidazole) in patients with a diagnosis of IAI. Analysis was based on a composed outcome of therapeutic failure (change of antibiotic because of no clinical improvement, requirement of surgical re-intervention, post-operative infection, change of antibiotic because of antimicrobial resistance, and in-hospital mortality). Association of each antibiotic protocol to therapeutic failure was assessed through logistic regression analysis. Results: Five hundred ninety-three individuals were included. Two hundred twenty-nine were prescribed ampicillin-sulbactam; 170, clindamycin-amikacin; 77, amikacin-metronidazole; 83, piperacillin-tazobactam; and 34, cefuroxime-metronidazole. Therapeutic failure rate was 22%. Multivariable analysis showed none of the evaluated antibiotic protocols had an association with the primary outcome. Variables having an association for higher risk were age >70 years old (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.04-4.18); complicated IAI (OR, 3.36; 95% CI, 1.4-8.07); and World Society of Emergency Surgery (WSES) Sepsis Severity Score (OR, 1.31; 95% CI, 1.18-1.45). Adequate source control (OR, 0.16; 95% CI, 0.05-0.45) and hospitalization at Health Center 2 (OR, 0.30; 95% CI, 0.14-0.63) were identified as protective factors. Conclusions: There are no differences between the rate of therapeutic failure among the different antibiotic protocols evaluated. This outcome depends heavily on risk factors related to disease severity when surgical intervention occurs.

Computer Based Diagnosis of Some Chronic Diseases: A Medical Journey of the Last Two Decades.

Disease prediction from diagnostic reports and pathological images using artificial intelligence (AI) and machine learning (ML) is one of the fastest emerging applications in recent days. Researchers are striving to achieve near-perfect results using advanced hardware technologies in amalgamation with AI and ML based approaches. As a result, a large number of AI and ML based methods are found in the literature. A systematic survey describing the state-of-the-art disease prediction methods, specifically chronic disease prediction algorithms, will provide a clear idea about the recent models developed in this field. This will also help the researchers to identify the research gaps present there. To this end, this paper looks over the approaches in the literature designed for predicting chronic diseases like Breast Cancer, Lung Cancer, Leukemia, Heart Disease, Diabetes, Chronic Kidney Disease and Liver Disease. The advantages and disadvantages of various techniques are thoroughly explained. This paper also presents a detailed performance comparison of different methods. Finally, it concludes the survey by highlighting some future research directions in this field that can be addressed through the forthcoming research attempts.

Síndrome de Guillain Barré relacionados a infección por SARS - CoV 2 en Lima, Perú. Reporte de casos / Guillain Barre Syndrome cases related to SARS - CoV-2 infection in Lima, Peru. Case reports

RESUMEN La COVID -19 afecta predominantemente el sistema respiratorio, pero también se ha descrito compromiso extrapulmonar, incluido la afectación del sistema nervioso. Se describen los casos de dos pacientes con infección por SARS -CoV-2 que desarrollaron el síndrome de Guillain Barré.

SUMMARY COVID-19 predominantly affects the respiratory tract, but extrapulmonary involvement, including the nervous system has been reported. We report two patiets who presented SARS-COV-2 associated of Guillain-Barré syndrome

Histological and Histochemical Description of the Pancreas in the Adult Lesser Capybara (Hydrochoerus isthmius) / Descripción histológica e histoquímica del páncreas en cacós (Hydrochoerus isthmius) adultos

Abstract The aim of this study was to describe histologically and histochemically the pancreas of three adult Hydrochoerus isthmius, attacked by feral dog in Buenavista, Córdoba, Colombia. A complete necropsy was performed and pancreatic fragments were collected and stored in 10% buffered formalin and Bouin liquid. Then, they were dehydrated, diaphanized and embedded in paraffin, stained with Hematoxylin & Eosin, P.A.S., Gomori trichrome, Grimelius and Masson Fontana modified. The H. isthmius pancreas presented a duodenal mesenteric pattern. The exocrine portion was described as a composite tubuloacinar gland. The endocrine portion of the pancreas was constituted by pancreatic islets of Langerhans and a diffuse neuroendocrine system. The histological and histochemical techniques used allowed us to identify the exocrine and endocrine portion of the organ. It is suggested to complement this study with some special techniques for the identification of specific endocrine cells, such as Beta, Alpha, Delta, Epsilon, PP or Gamma.

Resumen El objetivo del presente estudio fue describir histológica e histoquímicamente el páncreas de tres individuos adultos de Hydrochoerus isthmius atacados por perros ferales en Buenavista, Córdoba, Colombia. Se realizó una necropsia completa y se recolectaron fragmentos pancreáticos, los cuales se almacenaron en formol tamponado al 10 % y líquido Bouin. Luego, fueron deshidratados, diafanizados y embebidos en parafina; teñidos con hematoxilina y eosina, P.A.S., tricrómico Gomori, Grimelius y Masson Fontana modificado. El páncreas de H. isthmius presentó un patrón mesentérico duodenal. La porción exocrina fue descrita como una glándula tubuloacinar compuesta. La porción endocrina del páncreas estaba constituida por islotes pancreáticos o Langerhans, y un sistema neuroendocrino difuso. En ese contexto, las técnicas histológicas e histoquímicas utilizadas permitieron identificar la porción exocrina y endocrina del órgano. Se sugiere complementar este estudio con algunas técnicas especiales para la identificación de células endocrinas específicas, como Beta, Alpha, Delta, Epsilon, PP o Gamma.

Comprehensive quality assurance for intracranial radiosurgery treatments using a postal system / Garantía de calidad para tratamientos de radiocirugía intracranial usando un sistema postal

Radiosurgery is a high-precision technique for delivering, in most cases, a single highly conformal dose to a stereotactically localized target. It can be indicated for small intracranial injury treatment, using either multiple sources of 60Co (γ rays) or high energy photon beams produced by linear accelerators. In order to minimize the impact of inaccurate localization of the target or dose delivery, a rigorous Quality Assurance (QA) program must be enforced, which should include an independent auditing system. This work proposes a simple and reliable postal QA phantom to be used as an independent evaluation. In it two important parameters were verified such as, the dosimetric precision of the planning system, by comparing the absorbed doses measured in the target volume using different dosimeters (ionization chamber, films, thermoluminescent dosimeters and L-alanine dosimeters) all calibrated against a small volume ion chamber. The exact positioning of the target volume was localized using air spaces and small steel spheres to find the appropriate target coordinates. The head phantom and the instruction sheets were extensively tested and sent by mail to selected institutions. The overall results were very encouraging and suggest that the proposed phantom may be used as a postal system as part of an independent QA tool in radiosurgery.

La radiocirugía es una técnica de alta precisión para administrar, en la mayoría de los casos, una sola dosis altamente conformada en un objetivo localizado estereotípicamente. Puede estar indicado para el tratamiento de pequeñas lesiones intracraneales, utilizando múltiples fuentes de 60Co (rayos γ) o haces de fotones de alta energía producidos por aceleradores lineales. Con el fin de minimizar el impacto de la ubicación inexacta de la administración de la meta o de la dosis, se debe aplicar un riguroso programa de control de calidad (QA), que debe incluir un sistema de auditoría independiente. Este documento propone un fantoma postal de control de calidad simple y fiable que se utilizará como evaluación independiente. Se verificó dos parámetros importantes, como la precisión dosimétrica del sistema de planificación, comparando las dosis absorbidas medidas en el volumen objetivo mediante diferentes dosis (cámara de ionización, películas, dosímetros Termoluminiscentes y dosímetros de L-alanina) todos calibrados con una pequeña cámara de iones de volumen. El posicionamiento exacto del volumen objetivo se localizó utilizando espacios aéreos y pequeñas esferas de acero para encontrar las coordenadas de destino adecuadas. El fantoma principal y las hojas de instrucciones fueron ampliamente probados y enviados por correo a instituciones seleccionadas. Los resultados generales fueron muy alentadores y sugieren que el fantoma propuesto puede utilizarse como sistema postal como parte de una herramienta independiente de control de calidad en radiocirugía.

Peer teaching, a didactic strategy for learning basic electrocardiography / La enseñanza por pares, una estrategia didáctica para el aprendizaje de la electrocardiografía básica

Abstract Teaching electrocardiography is a very important area in undergraduate student training. A constant concern of professors is for physicians in training to acquire competence in reading and interpreting electrocardiograms (EKGs). This study describes and explores how the didactic strat egy of peer teaching improves learning processes for second-year medical students. Evidence was found that peer teaching fosters significant learning of cardiac physiology and electrocardiograms, in particular, because it allows students to acquire abilities and skills in EKG reading, and improves the understanding and interpretation of this test. In addition, it promotes horizontal peer relationships which facilitate the development of autonomy, self-learning and teamwork. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.1971).

Resumen La enseñanza de la electrocardiografía es un área de gran importancia en la formación de los estudiantes de pregrado, para los docentes es una preocupación constante que los médicos en for mación adquieran las competencias para la lectura e interpretación del electrocardiograma (ECG). El presente estudio describe e indaga sobre cómo la estrategia didáctica de la enseñanza por pares mejora los procesos de aprendizaje de los estudiantes de segundo año de formación médica. Se halló evidencia de que la enseñanza por pares favorece el aprendizaje significativo de la fisiología cardiaca y del electrocardiograma, en particular, porque permite la adquisición de habilidades y destrezas a los estudiantes en la lectura del ECG y mejora la comprensión e interpretación de dicho examen; además, propicia relaciones horizontales entre pares que facilitan el desarrollo de la autonomía, el autoaprendizaje y el trabajo en equipo. (Acta Med Colomb 2021; 46. DOI:doi.org/10.36104/amc.2021.1971).

The resurgence of syphilis among pregnant women in southern Chile / Resurgencia de sífilis en mujeres embarazadas en una región del sur de Chile

ABSTRACT Background: National rates of HIV, gonorrhoeae and syphilis have increased in Chile in recent years, but it is not known if syphilis among pregnant women (PW) is also escalating. Aim: To explore syphilis rates among PW in a southern Chilean region and to describe clinical features of mothers and offspring. Patients and Methods: We selected PW with positive VDRL or T. pallidum micro-he-magglutination (MHA-TP) reactive tests, referred to a high-risk obstetrical pathology center between 2011 and 2019. Clinical information of mothers and their offspring was obtained from their medical records. Results: Syphilis rates among PW increased from 0.4 to 7.2 per 1,000 live births in the reference center from 2013 to 2019, along with a national and regional increase in both sexes. Twenty-nine cases of PW with syphilis were identified with a median age of 28 years (interquartile range 23-32). Seventeen percent had a history of drug abuse, and 14% had previous sexually transmitted diseases. In seven cases (24%), the diagnosis occurred at delivery. Three percent of patients had a primary syphilis, 14% a secondary syphilis, 24% an early latent syphilis, and 59% a latent syphilis. All cases except one case were treated with benzathine penicillin G and the remaining with erythromycin due to allergy suspicion. Penicillin desensitization was required in two cases (7%). Treatment timing was inadequate in 10 cases (34.5%). Of 19 patients with available serological follow-up, 10 (53%) showed a significant decrease in VDRL titers (≥ 2 dilutions) and two cases had re-infection. Two patients (7%) had an abortion, two had congenital syphilis (7%), and six had premature births (21%), totaling 35% of adverse-pregnancy outcomes. Conclusions: Resurgence of syphilis among pregnant women is happening in southern Chile and is associated to adverse-pregnancy outcomes.

Antecedentes: Las tasas nacionales de VIH, gonorrea y sífilis han aumentado en Chile en los últimos años, pero no se sabe si la sífilis en mujeres embarazadas (ME) también está aumentando. Objetivo: Explorar las tasas de sífilis en ME en una región del sur de Chile y describir las características clínicas de las madres y los hijos. Pacientes y Métodos: Se seleccionaron ME con un VDRL o test de microhemaglutinación para T. pallidum positivos, referidas aun centro de alto riesgo obstétrico entre 2011 y 2019. La información clínica de las madres y sus hijos fue obtenida de fichas clínicas. Resultados: Las tasas de sífilis en ME aumentaron de 0,4 a 7,2 por 1000 nacidos vivos en el hospital de referencia entre 2013 y 2019, en paralelo a un aumento nacional y regional en ambos sexos. Se identificaron 29 casos de mujeres embarazadas con sífilis con mediana de edad 28 años, rango intercuartílico 23-32. Diecisiete por ciento tenía historia de abuso de drogas y 14% tenía una enfermedad de transmisión sexual previa. En siete casos, el diagnóstico ocurrió en el momento del parto (24,1%). Los estadios abarcaron sífilis primaria (3%), sífilis secundaria (14%), sífilis latente temprana (24%) y sífilis latente (59%). Todos, menos un caso, fueron tratados con penicilina G benzatina y el caso restante con eritromicina por sospecha de alergia a la penicilina. Se requirieron protocolos de desensibilización a penicilina en dos casos (7%). El momento del tratamiento fue inadecuado en 10 casos (35%). De 19 pacientes con seguimiento serológico disponible, 10 (53%) mostraron una disminución significativa en los títulos de VDRL (≥ 2 diluciones) y dos casos tuvieron reinfección. Dos pacientes (7%) evolucionaron con aborto, dos con sífilis congénita (7%, una asociada a terapia con macrólidos) y seis con parto prematuro o bajo peso al nacer (21%), totalizando 35% de resultados adversos durante el embarazo. Conclusiones: El resurgimiento de la sífilis entre las mujeres embarazadas está ocurriendo en el sur de Chile y está asociado a resultados adversos del embarazo.

Componente humano en estudiantes de un programa de ciencias de la salud en la Fundación Universitaria del Área Andina, Pereira, 2021 / Human component in students of a health sciences program at the Fundación Universitaria del Área Andina, Pereira, 2021 / Componente humana nos estudantes de um curso de ciências da saúde da Fundação Universitária da Área Andina, Pereira, 2021

La deshumanización es la reducción de las cualidades que distinguen a las personas como seres humanos, llevando al profesional a actuar sin ser capaz de experimentar empatía. La educación en ciencias de la salud enfrenta la dificultad que representa el desarrollar mecanismos que permitan implementar un componente humano óptimo desde la formación profesional. El propósito de no implicarse emocionalmente es, quizá, un mecanismo de defensa que aparta del sufrimiento ajeno. Esta actitud impersonal compromete la empatía, desgasta el ideal y promulga la necesidad de una educación afectiva para conservar la empatía durante los años de formación. Objetivo: identificar el componente humano en estudiantes de un programa de ciencias de la salud en la Fundación Universitaria del Área Andina, Pereira, 2021. Método: estudio cuantitativo, descriptivo, transversal, muestra de 146 estudiantes seleccionados en forma no probabilística. La captura y procesamiento de la información básica según las variables de estudio se realizó a través del programa STATA 15. Resultados: el puntaje de medición de empatía global obtenido en la investigación fue de 97 lo que indica un nivel sobresaliente (88-113). Conclusiones: es importante generar estrategias que impacten desde la academia, que promuevan la empatía y el factor humanístico.

Dehumanization is the reduction of the qualities that distinguish people as human beings, leading the professional to act without being able to experience empathy. Health sciences education faces the difficulty of developing mechanisms to implement an optimal human component from professional training. The purpose of not getting emotionally involved is, perhaps, a defense mechanism that keeps away from the suffering of others. This impersonal attitude compromises empathy, wears out the ideal and promulgates the need for an affective education to preserve empathy during the formative years. Objective: to identify the human component in students of a health sciences program at the Fundación Universitaria del Área Andina, Pereira, 2021. Method: quantitative, descriptive, cross-sectional study, sample of 146 students selected in a non-probabilistic way. The capture and processing of the basic information according to the study variables was carried out through the STATA 15 program. Results: the global empathy measurement score obtained in the research was 97, which indicates an outstanding level (88-113). Conclusions: it is important to generate strategies that have an impact from the academy, which promote empathy and the humanistic factor.

A desumanização é a redução das qualidades que distinguem as pessoas como seres humanos, levando o profissional a atuar sem ser capaz de sentir empatia. O ensino das ciências da saúde enfrenta a dificuldade de desenvolver mecanismos para implementar uma componente humana óptima na formação profissional. O objetivo de não se envolver emocionalmente é, talvez, um mecanismo de defesa que se afasta do sofrimento dos outros. Esta atitude impessoal compromete a empatia, desgasta o ideal e promulga a necessidade de uma educação afectiva para preservar a empatia durante os anos de formação. Objetivo: identificar a componente humana nos estudantes de um curso de ciências da saúde da Fundación Universitaria del Área Andina, Pereira, 2021. Método: estudo quantitativo, descritivo, transversal, amostra de 146 estudantes seleccionados de forma não probabilística. A captura e o processamento das informações básicas de acordo com as variáveis do estudo foram realizados utilizando o programa STATA 15. Resultados: a pontuação global da medida de empatia obtida na investigação foi de 97, o que indica um nível excelente (88-113). Conclusões: É importante gerar estratégias que tenham impacto a partir da academia, que promovam a empatia e o fator humanístico.

CEO Duality and Firm Value: Evidence from Mexico / Dualidad del CEO y valor de la empresa: evidencia de México / Dualidade do CEO e valor da empresa: evidências do México

ABSTRACT Regulators and corporate governance activists are lobbying companies to eliminate the CEO duality; however the effectiveness of this recommendation is questioned given that empirical evidence has found conflicting results. This document studied the effects of the CEO's duality on the value of the company in a sample of 104 Mexican companies that were publicly traded between 2000 and 2013. For this, different regression models were estimated using the ordinary least squares technique. The firm value was measured through Tobin's Q and ROA. Empirical results showed that there is no relationship between CEO duality and value after controlling for board characteristics such as size and independence. JEL CLASSIFICATION M10, G32, G34

RESUMEN Los reguladores y los activistas del gobierno corporativo están presionando a las empresas para que eliminen la dualidad del CEO, sin embargo, la efectividad de esta recomendación es cuestionada dado que la evidencia empírica ha encontrado resultados contradictorios. Este documento estudió los efectos de la dualidad del CEO en el valor de la empresa en una muestra de 104 empresas mexicanas que cotizaron públicamente entre 2000 y 2013. Para esto, se estimaron diferentes modelos de regresión utilizando la técnica de mínimos cuadrados ordinarios. El valor de la empresa se midió a través de la Q de Tobin y el ROA. Los resultados empíricos mostraron que no existe una relación entre la dualidad del CEO y el valor de la empresa después de controlar las características de la junta, como el tamaño y la independencia. CLASIFICACIÓN JEL M10, G32, G34

RESUMO Os reguladores e os activistas do governo das sociedades estão a pressionar as empresas para eliminar a dualidade do Presidente da Comissão Executiva, no entanto, a eficácia desta recomendação é posta em causa, uma vez que provas empíricas têm encontrado resultados contraditórios. Este documento estudou os efeitos da dualidade dos CEO no valor da empresa numa amostra de 104 empresas mexicanas negociadas publicamente entre 2000 e 2013. Para tal, foram estimados diferentes modelos de regressão utilizando a técnica dos mínimos quadrados comuns. O valor da empresa foi medido pelo Q de Tobin e o ROA. Os resultados empíricos mostraram que não existe relação entre a dualidade do CEO e o valor da empresa depois de controlar para características do conselho como a dimensão e a independência. CLASSIFICAÇÃO JEL M10, G32, G34

Frontera dinámica: contraste urbano rural en el Borde oriental de Medellín Colombia / Dynamic Border: Rural Urban Contrast on the Eastern Edge in Medellin, Colombia

Resumen El límite de expansión urbana oriental de Medellín, Colombia, está dado por las zonas de protección ambiental y la frontera con el corregimiento de Santa Elena; sin embargo, esta delimitación es ambigua entre lo que se ha planteado en el Plan de Ordenamiento Territorial vigente y lo que se encuentra en la realidad: el barrio El Pacífico, último asentamiento de este borde se ha comenzado a expandir incluso, a la zona de protección y a los suelos de uso rural. Existe una clara distancia entre lo planteado y sentado en los instrumentos de planificación, con lo interpretado o percibido por la comunidad que habita el territorio en cuestión. Existe un contraste urbano rural dado por la dinámica que plantean los actores fronterizos.

Abstract The eastern urban expansion edge of Medellin, Colombia, is given by environmental protection zones and the border with the Santa Elena Village. However, this delimitation is ambiguous between what has been raised in the current Territorial Ordering Plan and what is in reality: The El Pacífico neighborhood. The last settlement of this border has even begun to expand to the protection zone and to rural-use soils. The re exists a clear distance between what is raised and what is seated in the planning instruments, with what is interpreted or perceived by the community, who inhabits the territory in question. There is a rural urban contrast given by the dynamics posed by bordering actors.

Cardiac arrest in adult intensive care units in the Medellin metropolitan area, Colombia: observational study / Paro cardiaco en las unidades de cuidado intensivo de adultos del área metropolitana de Medellín, Colombia. Estudio observacional

Abstract Introduction: In-hospital cardiac arrest (CA) is a rare but life-threatening event. However, the epidemiology of this event in intensive care units (ICU) is not clear. Objective: To determine the clinical characteristics of CA in adult patients hospitalized in several ICU of the Metropolitan Area of the Aburrá Valley, Colombia, over a period of 1 year. Methods: Observational study for a limited period of 1 year for adult patients with CA in the ICU of the hospitals of the Metropolitan Area of the Aburrá Valley, Colombia: San Vicente Foundation University Hospital, IPS University, and Manuel Uribe Ángel Hospital. Results: Of 3710 eligible patients who were treated in 91 beds, 646 CA events occurred during this period, of which 151 were candidates for resuscitation maneuvers. The overall incidence of CA in the ICU was 17.1%, without differences between the 3 hospitals included and the incidence of resuscitable CA was 39.9 cases per 1000 admissions to the ICU. The most common CA rhythm was asystole 54.3% and the overall survival at hospital discharge was 3.3%. Conclusion: In the analyzed ICU, CA was an infrequent event, but it presents a high mortality at discharge from the ICU and hospital. However, the few patients who survive have a good neurological prognosis.

Resumen Introducción: El paro cardiaco intrahospitalario es un evento poco frecuente, pero potencialmente mortal. No obstante, no es clara su epidemiología en las unidades de cuidado intensivos. Objetivo: Determinar las características clínicas del paro cardiorrespiratorio en pacientes adultos hospitalizados en varias unidades de cuidado intensivo (UCI) del Área Metropolitana del Valle de Aburrá, Colombia, en un período de 12 meses. Métodos: Estudio observacional por período limitado a un año para pacientes adultos con paro cardiorrespiratorio en las UCI de los hospitales del Área Metropolitana del Valle de Aburrá, Colombia: Hospital Universitario San Vicente Fundación, IPS Universitaria, y Hospital Manuel Uribe Ángel. Resultados: De 3710 pacientes elegibles que fueron atendidos en 91 camas se presentaron en este período 646 eventos de paro cardiorrespiratorio, de los cuales 151 fueron candidatos a man iobras de reanimación. La incidencia global de paro en UCI fue de 17,1% (IC 95%: 15,9%-18,3%), sin diferencias entre los tres hospitales incluidos y una incidencia de paro cardiorrespiratorio susceptible de recibir reanimación cardiopulmonar de 39,9 casos por cada 1000 admisiones a la UCI. El ritmo de paro más común fue la asistolia (54,3%) y la sobrevida global al alta hospitalaria fue de 3,3%. Conclusión: El paro cardiorrespiratorio no fue un evento frecuente en las UCI analizadas, pero presenta una alta mortalidad al alta de UCI y hospitalaria. Sin embargo, los pocos pacientes que logran sobrevivir tienen buen pronóstico neurológico.

Barriers and Opportunities of Oncofertility Practice in Nine Developing Countries and the Emerging Oncofertility Professional Engagement Network.

PURPOSE: Oncofertility practice continues to grow in developing countries despite the lack of health care services, especially those related to cancer care. The purpose of this study is to further explore oncofertility practice in these countries and identify opportunities for field-wide coalescence. METHODS: We generated a survey to learn more about oncofertility practice in nine developing countries within our Oncofertility Consortium Global Partners Network-Mexico, Colombia, Guatemala, Argentina, Chile, Nigeria, South Africa, Saudi Arabia, and India. Their responses were collected, reviewed, and discussed. RESULTS: Surveyed centers from the nine developing countries continue to experience a similar set of common challenges, including a lack of awareness among providers and patients, cultural and religious constraints, lack of insurance coverage and funding to help to support oncofertility programs, and high out-of-pocket costs for patients. Despite these barriers, many opportunities exist and there is great potential for the future. CONCLUSION: The current need is to unify the new technologies and best practices that emerge from rural communities and developing countries with those in large metropolitan cities, both domestically (US based) and abroad, into a functional unit: the Oncofertility Professional Engagement Network. The Oncofertility Professional Engagement Network will bridge the gap between domestic and international programs to establish a strong global network in which members share resources, methodologies and experiences and further build cultural competency.