Impact of a Virtual Endoscopy Training Curriculum in Novice Endoscopists: First Experience in Argentina.

BACKGROUND: Virtual reality simulation in gastrointestinal endoscopy is an educational tool that allows repetitive instruction in a non-patient care environment. AIM: To determine the impact of a virtual endoscopy training curriculum applying an objective pre- and post-training analysis on trainee endoscopists. METHODS: A before-after training study was carried out. Subjects were first year fellows of gastroenterology, who completed a questionnaire and then performed two pre-training simulated cases. The virtual endoscopy training curriculum consisted of an 8-h workday utilizing two GI MENTOR™ in a specialized clinical simulation center. After the training, all subjects completed the same two cases they did in the pre-training. Pre- and post-training results' comparisons were made by paired t test. RESULTS: Totally, 126 subjects were included (mean age 30 years, 61% female). A significant improvement from pre- to post-training was observed in psychomotor skills (total time, percentage, and number of balloons exploded) and endoscopic skills (cecal intubation time, percentage of examined mucosa, and efficacy of screening). There was also an improvement in the quality of the endoscopic study; percentage of examined mucosa over 85% showed a significant improvement post-training with an adjusted OR of 2.72 (95% CI 1.51-4.89, p = 0.001). CONCLUSIONS: Virtual endoscopy training curriculum produces a significant improvement in the trainee endoscopists performance and their psychomotor skills and introduces the concept of a quality endoscopic study in a non-patient, risk-free environment.

Evaluación del conocimiento en dolor orofacial de los docentes de la Facultad de Odontología de la Universidad Finis Terrae / Evaluation of the orofacial pain knowledge of the Dental School professors of the University Finis Terrae

Introducción: El Dolor Orofacial (DOF) es una forma frecuente de dolor percibido en la cara y/o cavidad bucal. Puede ser causado por enfermedades o trastornos de las estructuras regionales, disfunción del sistema nervioso o por derivación de fuentes distantes." (International Association for the Study of Pain, s. f.) Esta condición presenta una alta prevalencia, y la literatura internacional demuestra una deficiencia en el conocimiento de los profesionales en DOF. Objetivo General: Determinar el conocimiento en Dolor Orofacial en los docentes de la Facultad de Odontología de la Universidad Finis Terrae en el año 2021. Material y Método: Se llevó a cabo un estudio descriptivo de corte transversal con componente analítico, utilizando un muestreo no probabilístico por conveniencia de voluntarios, a quienes se les realizó una encuesta validada de la literatura científica que fue adaptada a la lengua española, evaluando parámetros sociodemográficos, percepción y conocimiento respecto al diagnóstico, signos y síntomas clínicos de afecciones de DOF. Resultados: Se pudo observar un conocimiento aceptable de los participantes, en donde el 60% respondió al menos cinco enunciados de forma correcta. Se concluyó que el conocimiento de los docentes de la Facultad de Odontología de la Universidad Finis Terrae fue superior a los registros encontrados en la literatura científica. Si bien este estudio cuenta con algunas limitaciones, permite entregar una base para próximas investigaciones, fomentando la instauración de cursos actualizados en DOF, otorgando un nuevo enfoque a la odontología, en donde se desarrollen profesionales integrales y capaces de diagnosticar, tratar o manejar estas condiciones.

Introduction: Orofacial pain (OFP) is a common form of perceived pain in the face and/or oral cavity. It may be caused by disease or disorders of regional structures, dysfunction of the nervous system, or by referral from distant sources."(International Association for the Study of Pain, s. f.) This condition presents a high prevalence, and the international literature demonstrates a deficiency in the knowledge of OFP professionals. General Objective: To determine the knowledge of Orofacial Pain in the teachers of the Faculty of Dentistry of the Finis Terrae University in the year 2021. Material and Method: A descriptive cross-sectional study with an analytical component was carried out, using a non- probabilistic convenience sampling of volunteers, who were given a validated survey from the scientific literature that was adapted to the Spanish language, evaluating sociodemographic parameters, perception and knowledge regarding diagnosis, clinical signs and symptoms of OFP conditions. Results: It was possible to observe an acceptable knowledge of the participants, where 60% of them answered at least five statements correctly. It was concluded that the knowledge of the teachers of the Faculty of Dentistry of the Universidad Finis Terrae was superior to the records found in the scientific literature. Although this study has some limitations, it provides a basis for future research, encouraging the establishment of updated courses in OFP, providing a new approach to dentistry, in which comprehensive professionals capable of diagnosing, treating or managing these conditions are developed

[Incomplete Carney's Triad and arterial hypertension in a young woman]. / Triada de Carney incompleta e hipertension arterial en una mujer joven.

The case of young woman with arterial hypertension diagnosed two years before, is here presented; she had a ferropenic anemia caused by digestive loss of blood. Multiple gastric tumors and pararenal non functioning paraganglioma were found. No chondromas were detected. An incomplete Carney's Triad was diagnosed. We remark that multiple gastric tumors in a young adult suggest the possibility of gastrointestinal stromal tumors (GIST) Endoscopic biopsy frequently is not effective because these tumors are deep placed in the muscular gastric layers. The importance of specific techniques for a positive diagnosis are emphasized. Continuous follow up is needed because these tumors have uncertain prognosis. Lung chondromas may appear years later after the GIST was removed and might be confused with GIST metastases.

[Oesophageal candidiasis: clinical and mycological analysis]. / Candidiasis esofágica: análisis clínico y micológico.

Oesophageal candidiasis is an epithelial infection which requires an immune deficiency. C. albicans is commonly the cause, although other species may also be responsible. Resistance to fluconazole, drug of choice for treatment, is an emerging problem. The objectives of the current paper were: to determine the frequency of oesophageal candidiasis in patients submitted to upper gastrointestinal endoscopy, analyze risk factors, identify Candida species and determine in vitro susceptibility to fluconazole. During 12 months, 34 patients with oesophageal candidiasis were detected. Out of 1.230 HIV negative and 91 HIV positive patients submitted to upper endoscopy, 11 (0.9%) and 23 (25.3%), respectively, had candidiasis. Risk factors for HIV negative patients were systemic antibiotic therapy in 2, deficient dental cleaning in 2 aged patients, use of proton pump inhibitors in 3, inhaled steroids in 2, malignancy in 1 and oral steroids in 1. The histopathologic diagnosis was confirmed in 48.6% of cases. Cultures were positive in 91.2% C. albicans was prevalent (93.5%), and was associated to other species in 5 cases (16.1%), (3 C. glabrata, 1 C. tropicalis and 1 C. parapsilosis). One case cultured only C. glabrata and 1, only C tropicalis. Out of 31 cultures, 25 were susceptible to fluconazole, 4 dose dependent (1 C. albicans, 3 C. glabrata), and 2 resistant (1 C. albicans, 1 C. glabrata). Frequency of oesophageal candidiasis was low, except for HIV positive patients. The most common etiologic agent was C. albicans, though other Candida species were also found. C. albicans and C. glabrata showed dose dependency and resistance to fluconazole.

[Endoscopic approach in HIV infected-patients with upper gastrointestinal symptoms]. / Evaluación endoscópica de pacientes VIH positivos con síntomas digestivos altos.

UNLABELLED: Upper gastrointestinal symptoms such as nausea, vomiting, upper abdominal pain, heartburn, early satiety, bloating and anorexia, are frequently reported by HIV positive patients; however, their prevalence and diagnostic approach are unknown. AIMS: To evaluate the frequency of endoscopic and histologic diagnosis in HIV positive patients with upper gastrointestinal symptoms referred to upper endoscopy, and to compare them with those found in a non-HIV infected group with similar symptoms. PATIENTS AND METHODS: Out of 132 HIV positive patients referred to upper endoscopy, 102 (75%) with upper gastrointestinal symptoms, and 177 non-HIV controls were prospectively included. All patients answered questionnaires assessing frequency, severity and impact of symptoms on quality of life, and underwent upper endoscopy with systematic mucosal biopsies from esophagus, stomach and distal duodenum. RESULTS: Upper abdominal pain, heartburn and bloating were the most common upper gastrointestinal symptom reported in both groups. Anorexia, nausea, vomiting and early satiety were more frequent among HIV positive patients (p = or < 0.01). Intensity and impact of symptoms quality of life were higher in this group (p = 0.0001). Opportunistic infections were detected in 29 (28.4%) HIV positive patients. This subgroup had a lower mean CD4 count (p = 0.0004). In 76 (75.4%) HIV positive non-opportunistic diseases were diagnosed, with similar frequency to HIV negative individuals. CONCLUSIONS: Upper endoscopy with biopsies detected opportunistic and non-opportunistic diseases in HIV positive patients with upper gastrointestinal symptoms. Opportunistic diseases were related to lower CD4 counts. Non-opportunistic diseases had similar frequency in both groups, HIV positive and negative controls.

Coinfection: Helicobacter pylori/human immunodeficiency virus.

To compare H. pylori infection prevalence and gastric mucosa damage in HIV-infected and non-HIV-infected patients, gastric biopsies were systematically taken in 209 individuals who underwent upper Gl endoscopy (102 HIV-infected and 107 non-HIV-infected). H. pylori was found in 42 (41.1%) HIV-infected patients and in 53 (49.5%) non-HIV patients (P = 0.22, chi2 = 1.47, NS). In HIV-positive patients infected with H. pylori the mean CD4 count was higher than in HIV-positive patients without H. pylori (364 and 228 cells/mm3, respectively; P = 0.0001). H. pylori gastritis was more severe in the HIV-positive group (chi2 = 15.02, P = 0.0001). The frequency of H. pylori in gastric mucosa in HIV-infected and non-HIV patients was similar. HIV-infected patients with H. pylori had a higher mean CD4 count than HIV-infected individuals without H. pylori. Gastric lesions associated with H. pylori were more severe in the HIV-positive population.

Triada de carney incompleta e hipertension arterial en una mujer joven / Incomplete Carney’s triad and arterial hypertension in a young woman

Se presenta una el caso de paciente joven, con tríada de Carney incompleta que cursa hipertensión arterial de dos años de evolución y anemia ferropénica grave por pérdida crónica de sangre por tubo digestivo, con tumores gástricos múltiples y paraganglioma pararrenal. No presenta aún desarrollo de condromas pulmonares visibles por tomografía axial computada. En nuestra paciente el paraganglioma no resultó funcionante. Resaltamos que la presencia de tumores gástricos múltiples en un adulto joven debe sugerir la posibilidad de tumores estromales (GIST), cuyo diagnóstico por biopsia endoscópica es difícil debido a su localización profunda, situada en las capas musculares de la pared gástrica. Asimismo queremos remarcar la importancia de las técnicas de marcación descriptas para el diagnóstico preciso. El seguimiento debe ser constante dado el pronóstico incierto de estos tumores. Los condromas pulmonares pueden aparecer años después de la resección del GIST y ser confundidos con metástasis del GIST.