Visibilizando a las cirujanas en Chile / Making female surgeons visible in Chile

Resumen Introducción: La cirugía ha sido tradicionalmente considerada una especialidad masculina. Se desconoce si el aumento en el número de médicas en las últimas décadas ha producido un aumento significativo en el número de cirujanas. Objetivo: Analizar y visibilizar la participación actual e histórica de las mujeres en Medicina y en Cirugía General en Chile. Materiales y Método: Estudio retrospectivo de la cohorte de médicas/os y cirujanas/os egresados de escuelas de medicina chilenas desde el año 1970, complementado con estudio de corte transversal para conocer la información actual de las cirujanas y residentes. Las fuentes de datos fueron los Registros de la Superintendencia de Salud, CONACEM y el Catastro de la Asociación de Cirujanas. Resultados: Ha existido un aumento sostenido de médicas egresadas sobrepasando a sus pares masculinos a partir de 2018. Las cirujanas representan el 15% del total de cirujanas y cirujanos, y este número se ha duplicado por década a partir de los años 70. Actualmente, 33% de los residentes en formación son de género femenino. Las áreas más comunes de desarrollo son cirugía general (35%), y dentro de las subespecialidades: mama, plástica y cabeza y cuello. Conclusión: Las mujeres siguen siendo minoría en cirugía; sin embargo, se ha producido un aumento progresivo y se espera siga la misma tendencia. Es necesario visibilizar la importancia de las cirujanas para que sirvan como modelo a nuevas generaciones de estudiantes y así poder aumentar la representación femenina en la especialidad.

Introduction: Surgery traditionally has been considered a male discipline. It is unknown if the increase in the number of female doctors in the last decades has increased the number of female surgeons. Aim: Is to analyze and make visible the historical and current participation of women in Medicine and Surgery in Chile. Materials and Method: Retrospective cohort study of all medical doctors and surgeons graduated from chilean Universities since 1970 to date, and cross-sectional study to know current information of female surgeons and residents. Source of data were the Registries of Health Superintendence, CONACEM and the Registry of the Female Surgeon Association. Results: There has been a steady increase in the number of graduated female doctors in Chile, surpassing male doctors since 2018. Female surgeons are 15% of all surgeons, and the number has duplicated every decade since 1970s. Currently, 33% of the residents are female. Main area of developing is general surgery (35%), and within subspecialties: Breast, Plastics, and Head and Neck. Conclusions: Women are still underrepresented in Surgery: however, there has been a steady increase and that trend is expected to continue. It is necessary to make visible the importance of female surgeons to be able to increase female representation.

Selenium and cadmium in bioaccessible fraction of organic weaning food: Risk assessment and influence of dietary components.

BACKGROUND: The tendency of some sectors of the population to consume organic food has also come to include baby food. Nevertheless, it is necessary to develop studies to support the true nutritional and toxicological value of these products, making special emphasis in several trace elements. To our knowledge, no studies have been conducted on this type of organic food. METHODS: Weaning foods with different formulations categorized as organic were analyzed to determine Se and Cd contents as well as its bioaccesibility. The analyses were conducted by electro thermal atomic absorption spectroscopy (ET - AAS) after the treatment of the samples with acid mineralization. Besides, macronutrient analyses (protein, fat and dietary fiber) were also developed. Finally, a novelty statistic approach such as @Risk was used to evaluate contributions to DRI or PTWI of Se and Cd derived for consumption of these weaning foods. RESULTS: Se content ranged between 2.44-15.4 µg Kg 1. Samples with meat ingredients showed the highest Se contents, while weaning foods consisting of fruits or vegetables presented the lowest concentrations. Se bioccessible concentration ranged between 1.90-4.35 µg Kg-1 with a greater uniformity amongst analyzed samples. Regarding Cd, concentrations of this heavy metal ranged between 1.23 and 3.64 µg Kg-1. Furthermore, Cd bioaccessibility of organic weaning foods ranged between 0.17 and 1.38 µg Kg-1. The solubility of all samples studied was around 20% from the initial Cd concentration. A negative statistical correlation between fat content - Cd bioaccesible (p < 0.05; r = - 0.756) and Cd content - Se bioaccesible (p < 0.05; r = - 0.777) were also found. CONCLUSIONS: Cd concentrations are considerably lower than those reported in weaning formulas which were not categorized as organic. On the other hand, the analysed organic jars did not represent a significant source of Se. The probabilistic assessment developed, showed that contributions to DRI of Se for infants 1-3 years old by consumption of these weaning foods, are excessively low (15% at best).

CHARACTERISATION OF TLDS-200 AND OSLDS AT LOW X-RAY ENERGIES AND DETERMINATION OF EYE LENS DOSE, THYROID DOSE AND MEAN GLANDULAR DOSE DURING STANDARD MAMMOGRAPHY AND TOMOSYNTHESIS.

The objective of this study was to characterise thermoluminescent (TLDs) and optically stimulated luminescent dosimeters (OSLDs) at low X-ray energies and estimate the eye lens (DL), thyroid (DT) and mean glandular (DG) doses received during Full-Field Digital Mammography (FFDM) and Digital Breast Tomosynthesis (DBT). The dosimeters were characterised in mammography energies. DL, DT and DG were estimated in FFDM and DBT mode taping dosimeters on the skin of the thyroid gland and on the left eye lens of an Alderson phantom. Dosimeters were also placed on the top of a NORMI PAS phantom simulating a compressed breast. The accuracy, precision and lower limit of detection (LLD) for TLDs and OSLDs were 5 and 8%, 6 and 3%, and 38 and 11 µSv, respectively. The linearity of the kerma response had an R2 > 0.99 and energy dependence was lower than 40%. DT ranged from 0.40 to 2.87 µGy for FFDM and 1.27 to 5.99 µGy for DBT. DG was between 0.50 and 1.27 mGy for FFDM and 1.07 and 1.60 mGy for DBT. DL was below the LLD. Dosimeters showed good performance. DG values were lower than those found in the literature, whereas DT value agreed with references. Differences between DG and DT determined with OSLDs and TLDs were lower than 10% and 200%.

Economic evaluation of sunitinib versus pazopanib and best supportive care for the treatment of metastatic renal cell carcinoma in Chile: cost-effectiveness analysis and a mixed treatment comparison.

Background: Sunitinib and Pazopanib are two metastatic renal cell carcinoma (MRCC) treatment alternatives, however the health system in Chile does not consider coverage for any. The cost-effectiveness versus relevant comparator was assessed to support evidence-based decision making. Methods: A four health states Markov model was built: first, second line treatments, BSC and death. Benefits were measured in QALYs, and efficacy estimates were obtained from an indirect treatment comparison. A 10-year time horizon and a 3% undifferentiated discount rate were considered. Deterministic and probabilistic sensitivity analyses were performed. Results: The costs of treating MRCC with Sunitinib were higher than Pazopanib and BSC. When comparing Sunitinib versus Pazopanib, the incremental benefit is small favoring Sunitinib (0.03 QALYs). The base case scenario shows an average ICER of PA versus BSC of US$62,327.11/QALY and of US$85,885/QALY for Sunitinib versus Pazopanib. The ICER was most sensitive to the OS relative to BSC, where evidence was associated to important bias. Conclusions: Sunitinib or Pazopanib can be considered cost-effective if a 3 GDP per-capita threshold is assumed. The decision between SU or PA is highly sensitive to the price of the drugs, rather than the outcomes. Therefore, the decision might be made based on cost-minimization exercise.

Assessment of in vitro pharmacological effect of Neotropical Piperaceae in GABAergic bioassays in relation to plants traditionally used for folk illness by the Yanesha (Peru).

ETHNOPHARMACOLOGICAL RELEVANCE: A previous pilot ethnobotanical and ethnopharmacological study with the Q'echi׳ Maya identified the family Piperaceae, as an important taxonomic group traditionally used for the treatment of epileptic and culture-bound anxiety disorders and possessing activity in the GABA system. Following that lead, a botanical survey was conducted in Peru, where 47 species of Piperaceae were collected including 21 plants traditionally used for folk illnesses by the Yanesha of Peru, an indigenous Amazonian group. MATERIALS AND METHODS: Two high throughput bioassays were used to quantify the in vitro activity of botanical extracts on the GABA system. RESULTS: Plant extracts demonstrated moderate to high affinity to the γ-aminobutyric acid benzodiazepine (GABA-BZD) receptor. In addition, extracts demonstrated low to moderate activity in the inhibition of the GABA-transaminase, with select plants exhibiting significant activity. Plants indicated by the Yanesha showed comparable activity to the other Piperaceae plants collected. Piper cremii was the most active plant in the GABA-BZD receptor assay, and Drymaria cordata (Caryophyllaceae) in the GABA-T assay. CONCLUSION: The study provides evidence that there is a pharmacological basis behind the use of plants in the treatment of susto and mal aire in both Central and South America, and we propose that the possible mechanism of action includes an interaction with the GABA-T enzyme and/or the GABAA-BZD receptor.

Preliminary nutritional assessment of the Ecuadorian diet based on a 24-h food recall survey in Ecuador.

INTRODUCTION: Ecuador is a country with limited nutritional information, with exception of some general studies supported by Food Agriculture Organization (FAO). AIMS: To carry out a nutritional assessment of the Ecuadorian diet and determine the percentage of contribution to the intake of different nutrients according to the order of the meal (breakfast, morning snack, lunch, afternoon snack, and dinner snack) and Dietary Reference Intake (DRI). METHODS: For that purpose a pilot survey based on 24-h food recall method was carried out in three specific regions in Ecuador and collected information was processed, analyzed statistically and compared with DRIs established for Latin-American population. RESULTS: The study found significant differences for energy and certain vitamins in men and women in addition to determining that the highest energy contribution was obtained in lunch, followed by the afternoon snack and breakfast. Intermediate meals (morning snack, afternoon snack and dinner snack) contributed significantly less in the daily diet in comparison with other types of meal. Furthermore, it was observed that analyzed intakes did not meet the DRI for Carbohydrates, some vitamins (Thiamin, Pantothenic, Biotin, Folate Vitamin D and Vitamin E) and minerals (Ca, K, Cu, Mn, I and Fe). The Na intakes were quite above the DRI and Tolerable Upper Limit given by USDA, indicating a Public Health problem in relation with this electrolyte. CONCLUSIONS: The present pilot survey can be considered as a starting point to get insight into the Ecuadorian diet. This will allow to determine consumption patterns affecting population welfare and to evidence attendant positive and adverse effects.

Objetivos: Realizar una evaluación nutricional de la dieta ecuatoriana y determinar el porcentaje de contribución de la ingesta de diferentes nutrientes en función del tipo de comida (desayuno, almuerzo, comida, merienda, y cena) y de la Referencia de Ingesta Dietética (RID). Métodos: Se realizó una encuesta piloto basada en el método del recordatorio de alimentación de 24 h en tres regiones concretas de Ecuador y se procesó la información recogida, se analizó y se comparó con las RID establecidas para la población latinoamericana. Resultados: El estudio encontró diferencias significativas para energía y ciertas vitaminas en hombres y en mujeres, además de determinar que la mayor contribución energética se obtenía en la comida, seguida de la merienda y el desayuno. Las comidas intermedias (almuerzo, merienda y cena) contribuían de una manera significativamente menor en la dieta diaria en comparación con otros tipos de comidas. Además, se observó que las ingestas analizadas no alcanzaban las RID para hidratos de carbono, algunas vitaminas (tiamina, ácido pantoténico, biotina, folato, vitamina D y vitamina E) y minerales (Ca, K, Cu, Mn, I y Fe). La ingesta de NA estaba bastante por encima de las RID y el Límite Superior Tolerable proporcionado por la USDA, lo que indica un problema de salud pública en relación con este electrolito. Conclusiones: Esta encuesta piloto puede considerarse como un punto de partida para obtener una visión más profunda de la dieta ecuatoriana. Esto permitirá determinar los patrones de consumo que afectan al bienestar de la población y establecer efectos positivos y efectos adversos del patrón de consumo en Ecuador.

Determinantes para una lactancia materna exitosa: intervención integral vs cuidado estándar: ensayo clínico aleatorio controlado / Randomized controlled clinical trial evaluating determinants of successful breastfeeding: follow-up two months after comprehensive intervention versus standard care delivery

Introducción: Lactancia materna exclusiva (LME) es la mejor alternativa para alimentar a los recién nacidos y lactantes, reportándose beneficios para el niño(a), la madre, familia y sociedad. Existen "co-variables" positivas y negativas que influyen en el inicio y mantención de LME. Objetivo: Evaluar los efectos de las "co-variables" en la mantención de LME a los dos meses, según modalidad de atención. Pacientes y Método: Ensayo clínico aleatorio controlado con seguimiento de puérperas e hijos(as), respecto de prevalencia de LME a las 8 sem, y las co-variables positivas y negativas para LME en dos modalidades de asistencia de parto. Muestra: 649 puérperas (330 modalidad integral y 319 modalidad tradicional). Resultados: Prevalencia de LME a las 8 sem correspondió a 56,1 por ciento en modalidad integral y 48,9 por ciento en modalidad tradicional (p = 0,06). Existen diferencias significativas en resultados de LME a las 8 sem según edad, paridad, escolaridad, entre ambas modalidades. Las "co-variables" positivas para LME se presentan en mayor proporción en modalidad integral (p < 0,0001). Conclusión: Si bien, no existen variables que afecten de manera independiente el inicio y duración de LME a las 8 sem, la modalidad integral en su conjunto actuaría a su favor.

Introduction: Exclusive breastfeeding (EBF) is the best alternative for feeding newborns and infants, benefiting the child, the mother, family and society. There are positive and negative covariates influencing the initiation and maintenance of EBF. Objective: To assess the effects of covariates in maintaining EBF after two months, according to type of care received. Patients and Method: Randomized controlled clinical trial with follow-up of women and children regarding prevalence of EBF after 8 weeks, and positive and negative EBF covariates in the two forms of delivery. Sample: 649 postpartum women (330 received comprehensive care and 319 traditional form of care). Results: Prevalence of EBF at 8 weeks corresponded to 56.1 percent in comprehensive mode and 48.9 percent in traditional mode (p = 0.06). There are significantly different EBF results at 8 weeks according to age, birth type and education between both cares. The positive EBF covariates are greater reported for the comprehensive care (p < 0.0001). Conclusion: Although there are no variables that independently affect the EBF initiation and duration at 8 weeks, the comprehensive care benefits them.

Prevalence and socioeconomic differences of risk factors of cardiovascular disease in Ecuadorian adolescents.

PURPOSE: The aim of this paper is to report the prevalence of cardiovascular risk factors and socioeconomic differences in school-going Ecuadorian adolescents. METHODS: A cross-sectional study was performed from January 2008 until April 2009 in 770 adolescents aged 10 to 16 years old, who attend secondary schools in an urban (Cuenca), and rural area (Nabón) in Ecuador. Data collected for the overall sample included anthropometric variables (weight, height and waist circumference), blood pressure and socio-demographic characteristics. Fasting blood glucose and lipid profile determinations were collected in a subsample of 334 adolescents. RESULTS: The most prevalent cardiovascular risk factors were dyslipidemia (34.2%), abdominal obesity (19.7%) and overweight (18.0%). The prevalence of the remaining cardiovascular risk factors were high levels of blood pressure (6.2%) and obesity (2.1%). Boys were 3.3 times (P < 0.001) more likely to have risk levels of blood pressure. Compared to their peers from lower socioeconomic groups, children from better off socioeconomic strata were 1.5 times (P = 0.048) more likely to be overweight/obese and 1.5 times (P = 0.046) more likely to have abdominal obesity. Overweight and obese children were 4.4 times more likely to have dyslipidemia (P < 0.001). Children living in the rural area were 2.8 times (P = 0.002) more likely to have dyslipidemia than those from the urban area. CONCLUSIONS: Our results demonstrate the advanced levels of the nutrition transition in this Ecuadorian adolescent population. Primary health care should monitor and take actions to address this public health problem in adolescents.

Risk assessment of the lead intake by consumption of red deer and wild boar meat in Southern Spain.

The presence of heavy metals in big game meat may pose a risk to human health. The main objective of this paper is to carry out a risk assessment study (using a probabilistic and point-estimate approach) of lead intake by consumption of red deer and wild boar meat in Southern Spain based on Spanish data collected in the period 2003-2006. In general, the concentration levels found for wild boar meat (mean = 1291 µg kg(-1)) were much higher than those observed in red deer meat (mean = 326 µg kg(-1)). The results from a point-estimate risk assessment showed that the estimated average intake of lead among different exposure scenarios varied from 0.1 to 6.5 and from 0.3 to 38 µg kg(-1) week(-1) for red deer and wild boar meat, respectively; and from 0.3 to 35 µg kg(-1) week(-1) for individuals consuming both red deer and wild boar meat, and that the estimated intake of lead by consumption of big game meat differed significantly between hunters and non-hunters, it being higher for hunters. Besides this, results from the probabilistic risk assessment study corroborated the fact that risk is greater in hunter populations, reaching a maximum in individuals consuming only wild boar and both types of meat, with 0.4% and 0.2% of the population above the provisional tolerable weekly intake (PTWI), respectively. Likewise, the hunter populations consuming wild boar and both types of big game meat (red deer and wild boar meat) were exposed to the maximum lead level (56 µg kg(-1) week(-1)), which corresponded approximately to 224% of the PTWI. Further data and studies will be needed to give a complete risk estimation in which it will be crucial to consider the contribution to the lead intake level of other foods in the diet of both population groups.

Antileishmanial sesquiterpene lactones from Pseudelephantopus spicatus, a traditional remedy from the Chayahuita Amerindians (Peru). Part III.

ETHNOPHARMACOLOGICAL RELEVANCE: The study of traditional remedies used by the Chayahuita, an ethnic group from the Peruvian Amazonia, has prompted us to investigate in detail the ethanolic extract of Pseudelephantopus spicatus (Juss. ex Aubl.) C.F. Baker, which has demonstrated strong biological activity towards Leishmania amazonensis. Our goal was to discover the active compound of this plant-based remedy. MATERIALS AND METHODS: A bioguided fractionation of the crude extract was undertaken based on the biological activity recorded against Leishmania amazonensis axenic amastigotes in in vitro bioassays. RESULTS: Three strongly to moderately active compounds were isolated: two hirsutinolides (the 8,13-diacetyl-piptocarphol and the 8-acetyl-13-O-ethyl-piptocarphol) and ursolic acid. IC(50) against Leishmania amazonensis axenic amastigotes are respectively 0.2, 0.37 and 0.99 µM (while IC(50) of amphotericin B is 0.41 µM). These compounds have never been isolated from this plant species, and germacranolides have never been identified as potential antileishmanial agents. CONCLUSIONS: The compounds isolated from Pseudelephantopus spicatus account for the antileishmanial activity of the plant, thus giving support to its use by the Chayahuita in Peru.

Organization of a tumor bank: the experience of the National Cancer Institute of Mexico.

A tumor bank (TB) is an ordered collection of neoplastic samples, normal tissue, and/or fluids preserved under optimal conditions, as well as storing patients' clinical information. The objective of this article is to outline the planning and logistics necessary for the functioning of the Instituto Nacional de Cancerología (INCan) TB in Mexico City. For the planning and logistics of a TB, several technical, legal, medical, structural, and physical aspects were considered, which can be grouped under four headings: (1) design and structure, (2) equipping the area and informatics, (3) ethical-legal aspects, and (4) sample collection, preservation, and quality control. One crucial element of interinstitutional interest will be the transfer of these concepts to the different oncological centers, integrating in this manner a network that enables the exploration of the different pathologies from therapeutic, epidemiological, and molecular points of view.

Year 2000 status of MRI in Mexico.

The development of clinical magnetic resonance imaging in Mexico has followed a different course from that in the U.S. and Europe. The first clinical unit was installed in Mexico in the late 1980s at the very beginning of clinical applications worldwide. Since then, installations have proceeded at a sedate pace that now brings the installed total to 66 imagers. The largest fraction of these units (28, or 42%) is in Mexico City, with a broad distribution across the remaining 23 Mexican states. There is a noticeable increase of the number of units (20, or 30%) in the states bordering the U.S., while the states bordering nations to the south have no units. More than half the units (38, or 58%) are 0.5 T units, while a further 35% are 1.0 T or higher. Slower addition of units in Mexico relative to the U.S. is attributed to the higher fraction of public-funded hospitals and the inherent conservatism of such institutions when considering new technologies. Present public planning for health care development suggests that the coming decade will see more rapid installation of units to meet growing demand in Mexico for the latest medical technology. Experience over the past two decades indicates the need for more systematic training of technical and clinical personnel to implement these additions. The National University (Universidad Nacional Autónoma de México (UNAM) and the Metropolitan University (Universidad Autónoma Metropolitana (UAM) are collaborating with diverse clinical facilities to create such a program. J. Magn. Reson. Imaging 2001;13:813-817.

Educational contracts in family medicine residency training.

An educational contract for family medicine residency training and evaluation addresses many of the difficulties and challenges of current postgraduate medical education. This article identifies important principles for developing a contractual approach; describes the contract used in one program and its implementation; and discusses its theory, advantages, and limitations.

[Agrarian movements, development alternatives and food security in Central America: scenarios of transition]. / Mouvements paysans, alternatives de developpement et securite alimentaire en Amerique Centrale: les scenarios d'une transition.

PIP: This article, based on personal experiences with a network of organizations of small and medium agricultural producers in Central America, aims to present the views of peasant organizations concerning agrarian problems in the region. The 3 major sections of work define the place of peasant agriculture in the traditional agrarian structure and the new problems resulting from the structural adjustment programs of the 1980s; separately describe the new peasant movements emerging in Honduras, El Salvador, Nicaragua, Costa Rica, and Panama, identifying common themes an efforts at international collaboration; and explore the positions of the peasant organizations on the optimal strategies for agricultural development and agrarian change. Agriculture remains the backbone of the Central American economies. But because the economic model in the region is 1 of accumulation characterized by dependency, concentration of capital, and social marginalization, the agrarian structure is at the basis of social tensions. Efforts to develop peasant agriculture and to give small producers access to marketing and credit services have been weak and sporadic. The new peasant movements are less inclined than those of the past to employ tactics of confrontation in their efforts to secure access to land and better working conditions. The new movement is the expression of small market producers sometimes grouped into associations who are oriented to production of basic foodstuffs for the internal market. A new concern with adaptation and negotiation is evident. The new organizations have in common a belief in their ability to propose new solutions to regional problems. Their views are founded on a positive assessment of the ability of peasant agriculture to produce food and add dynamism to the regional economy after barriers to credit, technological progress, and modernization in general are removed. Signs of increased cooperation are evident between peasant organizations and other groups representing the masses, and with other countries in the region. The positions of the peasant organizations call for access to lands for small proprietors as well as landless agricultural laborers, and for new forms of organizing production that will respect the conservation and development of natural resources.^ieng

[Current evaluation of the classical Werner test and its correlation with current in vitro E.T.R. technics]. / Valoración actual de la clásica prueba de captación y test de Werner y su correlación con nuevas técnicas in vitro. E.T.R

The authors evaluated the current standing of the classical 131I uptake test, together with its subsidiary stimulation and suppression tests, and its correlation to clinical diagnosis and the in vitro ETR (Effective Thyroxine Ratio) technique. In the 349 cases studied, a good correlation was found between the previous diagnosis--made by means of 131I uptake test--and the clinics and symptomatology, and very particularly, the in vitro ETR test. The authors conclude that the combination of both tests is sufficiently reliable for the diagnosis of thyroid dysfunction.