Fear of COVID-19 among Peruvian People Living in Disadvantaged Communities: A Cross-Sectional Study.

BACKGROUND: The COVID-19 crisis is fuelling a state of fear among the human population at global level. Especially, those living in informal settlements and slums worldwide have been profoundly impacted by this pandemic. Individuals living in these places are already leading underprivileged lives. Thus, the economic and mental health problems caused by the COVID-19 crisis have further exacerbated their living standards, which has resulted, for instance, in tragedies such as suicides. OBJECTIVE: In this study, we have sought to identify those individuals most at risk of displaying high levels of fear of COVID-19 in an informal settlement located in the capital city of Peru. METHODS: A questionnaire was administered to 449 inhabitants living in the Carmen Alto informal settlement. The questionnaire was made up of two parts: the first one inquired about demographic data and the second part consisted of the Fear of COVID-19 Scale. RESULTS: The demographic variables of age, gender, marital status, educational level, occupation, whether a relative from the household was infected with COVID-19, and whether one of them died of this showed significant differences. It could be observed as well that the groups of females, stable workers, unemployed and those having completed a workforce education are at higher odds of displaying high levels of fear of COVID-19. As expected, the groups that had either a relative infected with COVID-19 or a relative death by this had the highest levels of fear towards the virus. CONCLUSION: The female participants are more likely to display higher levels of fear of COVID-19 due to the terrible effect that unfavorable events have on them. In the cases of the unemployed and stable workers, their proneness to show high levels of fear towards the virus is because they have lost their incomes, due to the loss of their jobs, and because of fear of infection, respectively. Hence, we hope that this work serves Peruvian (and other) health authorities to develop strategies that help individuals living in informal settlements and are in urgent need of mitigating mental health problems.

Efficacy and safety of radiofrequency ablation in patients with unresectable malignant biliary strictures.

INTRODUCTION: previous studies have shown that endoscopic radiofrequency ablation in unresectable biliary duct tumors prolongs survival. METHODS: this was an observational study of patients with an unresectable malignant stricture. The aim was to evaluate survival, stent patency and adverse events of radiofrequency compared with a matched control group. RESULTS: the study included 40 patients, 12 with radiofrequency. There were no differences between baseline parameters in both groups. The survival time was longer in the radiofrequency group with no statistically significant difference (217 vs 129 days, log-rank 0.31). There was no difference in stent permeability or adverse events. CONCLUSION: the radiofrequency group had a three-month increase in survival, which did not reach statistical significance.

Guided bone regeneration at dehiscence comparing synthetic bone substitute versus bovine bone mineral: A multicenter, noninferiority, randomized trial.

AIM: To evaluate the efficacy of guided bone regeneration (GBR) for the treatment of peri-implant dehiscence defects using a synthetic bone substitute (SBS) or a deproteinized bovine bone mineral (DBBM) as a bone substitute. METHODS: Patients with expected dehiscence defects following implant placement were randomized to use either SBS or DBBM together with a bioabsorbable collagen membrane over dehiscenced implant surfaces aimed for GBR. The changes in the bone defect size were measured before the GBR procedure and 6 months after implant placement at the re-entry surgery. Secondary outcomes included peri-implant health outcomes, implant cumulative survival rates, bone level changes, and patient-reported outcomes (PROMs) at prosthesis delivery and 1-year follow-up. RESULTS: Of the 49 included patients, 24 were treated with SBS and 25 with DBBM. In the SBS group, the defect height (DH) at implant insertion was 5.1 ± 2.6 mm and was reduced at re-entry to 1.3 ± 2.0 mm (74.5%). In the DBBM group, the respective changes in DH were 4.1 ± 1.7 mm and 1.5 ± 1.9 mm (63.4%). These differences were not statistically significant (p = 0.216). The complete defect resolution rate was also comparable in both groups without statistical difference (62.5% of patients (15/24) vs. 44% of patients (11/25)). Overall, the marginal bone levels remained stable during the 1-year follow-up in both groups. CONCLUSION: The SBS is noninferior to DBBM for simultaneous GBR to implant placement at implant sites with buccal dehiscences in terms of defect resolution and evaluated secondary outcomes (KCT0008393 - this clinical trial was not registered before participant recruitment and randomization).

Tapachula-7, a new genetic sexing strain of the Mexican fruit fly (Diptera: Tephritidae): sexual compatibility and competitiveness.

A new genetic sexing strain of the Mexican fruit fly, Anastrepha ludens (Loew), was evaluated in tests of sexual behavior to determine its possible application using the sterile insect technique. Tests in field cages measuring time to sexual maturity, compatibility with wild flies, and competitiveness were compared between the genetic sexing strain, Tapachula-7, and the mass-reared standard bisexual strain. The results indicated that the onset of sexual maturity was similar for both laboratory strains. Males from the Tapachula-7 strain do not differ from the standard bisexual strain in compatibility and competitiveness with wild insects. The results indicate that the release of Tapachula-7 males in the field would be viable in programs that use the sterile insect technique for the control of the Mexican fruit fly.

Comparative Analysis of Psychological Well-Being and Emotional Education in Graduate Students.

Background: The growing importance of emotional intelligence in academic and professional contexts has generated a need to explore its linkage with psychological well-being. Furthermore, understanding how various demographic and academic factors can influence students' emotional perception and management is crucial for optimizing educational and intervention strategies. In this context, the primary purpose of this study was to analyze the existing relationship between emotional education and psychological well-being in graduate students. Methods: The objective was to conduct a comparative analysis of perceived emotional intelligence (PEI) in different study programs offered at a specific university. The methodology, framed within a positivist paradigm, was based on a quantitative approach and examines the responses of 1,522 university students using the Trait Meta-Mood Scale (TMMS-24). Results: This tool, which is divided into three dimensions (emotional attention, emotional clarity, and emotional repair), was analyzed using descriptive statistics, correlation analysis, and ANOVA tests to determine demographic and academic influences on the scores. The findings indicate deficiencies in the areas of Emotional Attention and Emotional Repair, contrasting with a marked prevalence in Emotional Clarity. Variables such as sex, age, and field of study demonstrated an influence on the dimensions of PEI. Notably, significant differences in emotional perception were found between sex and academic fields. Conclusions: Specifically, training directed towards empathy proved to be a prominent factor in the perception of emotional competencies. This study highlights the influence of demographic and academic variables on emotional competencies, underscoring the need to adapt strategies in education and therapy.

Catalase overexpression reduces the germination time and increases the pathogenicity of the fungus Metarhizium anisopliae.

Catalases and peroxidases are the most important enzymes that degrade hydrogen peroxide into water and oxygen. These enzymes and superoxide dismutase are the first lines of cell defense against reactive oxygen species. Metarhizium anisopliae displays an increase in catalase-peroxidase activity during germination and growth. To determine the importance of catalase during the invasion process of M. anisopliae, we isolated the cat1 gene. cat1 cDNA expression in Escherichia coli and the subsequent purification of the protein confirmed that the cat1 gene codes for a monofunctional catalase. Expression analysis of this gene by RT-PCR from RNA isolated from fungus grown in liquid cultures showed a decrease in the expression level of the cat1 gene during germination and an increase during mycelium growth. The expression of this gene in the fungus during the infection process of the larvae of Plutella xylostella also showed a significant increase during invasive growth. Transgenic strains overexpressing the cat1 gene had twice the catalase activity of the wild-type strain. This increase in catalase activity was accompanied by a higher level of resistance to exogenous hydrogen peroxide and a reduction in the germination time. This improvement was also observed during the infection of P. xylostella larvae. M. anisopliae transgenic strains overexpressing the cat1 gene grew and spread faster in the soft tissue of the insect, reducing the time to death of the insect by 25% and the dose required to kill 50% of the population 14-fold.

Asociación del índice de masa corporal con ventilación mecánica invasiva prolongada en pacientes con infección por SARS-CoV-2 en la Unidad de Cuidados Intensivos / Association of body mass index with prolonged invasive mechanical ventilation in patients with infection by SARS-CoV-2 in the Intensive Care Unit / Associação do índice de massa corporal com ventilação invasiva mecânica prolongada em pacientes com infecção por SARS-CoV-2 na Unidade de Terapia Intensiva

Resumen: Introducción: la infección por SARS-CoV-2 es un problema de salud pública a nivel mundial. Resulta de gran importancia conocer las diferentes presentaciones clínicas, principalmente la forma grave de la enfermedad, ya que produce el síndrome de dificultad respiratoria aguda, responsable de millones de muertes. Diversos estudios relacionados con la infección por SARS-CoV-2 asocian la infección grave con la obesidad y la inmunosupresión. Objetivo: analizar la relación del índice de masa corporal (IMC) con la ventilación mecánica invasiva prolongada en pacientes con infección por SARS-CoV-2 de la unidad de cuidados intensivos. Material y métodos: tipo de estudio retrospectivo correlacional y observacional. Resultados: se encontró asociación significativa entre el grado de obesidad (IMC > 30 kg/m2) y la mortalidad en pacientes diagnosticados con SARS-CoV-2 bajo ventilación mecánica invasiva por más de 20 días. Los grados I (p = 0.001) y II (p = 0.008) de obesidad tienen mayor influencia en la mortalidad de pacientes con ventilación mecánica inducida. Conclusiones: en los pacientes con obesidad (IMC > 30 kg/m2), principalmente grado I y II presentaron mayor mortalidad y riesgo de ventilación mecánica invasiva prolongada; por lo que es importante diagnosticar y tratar de forma temprana y adecuada a estos pacientes con la finalidad de disminuir su mortalidad.

Abstract: Introduction: SARS-CoV-2 infection is a health problem worldwide. It's highly important to identify new clinical manifestations, mainly the serious form of the disease, because it produces severe acute respiratory syndrome, which is responsible for millions of deaths. Several studies associate the serious form of SARS-CoV-2 with high obesity and immune suppression. Objective: to analyze body mass index (BMI) with prolonged invasive mechanical ventilation (IMV) in patients with SARS-CoV-2 from Intensive Care Unit. Material and methods: retrospective correlational and observational study. Results: a significant association between obesity grade (BMI > 30 kg/m2) and mortality was found in patients diagnosed with SARS-CoV-2 under invasive mechanical ventilation through more than 20 days. Obesity grade I (p = 0.001) and II (p = 0.008) showed higher influence on patient's mortality with induced mechanical ventilation. Conclusions: patients with obesity (BMI > 30 kg/m2), mainly grades I and II showed higher mortality and risk of prolonged invasive mechanical ventilation, so it is important to diagnose and apply early and proper treatment to this type of patients in order to reduce mortality.

Resumo: Introdução: a infecção por SARS-CoV-2 é um problema de saúde pública em todo o mundo. É de grande importância conhecer as diferentes apresentações clínicas, principalmente a forma grave da doença, pois produz a síndrome de dificuldade respiratória aguda, responsável por milhões de mortes. Vários estudos relacionados à infecção por SARS-CoV-2 associam infecção grave com obesidade e imunossupressão. Objetivo: analisar a relação do índice de massa corporal (IMC) com ventilação mecânica invasiva prolongada em pacientes com infecção por SARS-CoV-2 da unidade de terapia intensiva. Material e métodos: tipo de estudo retrospectivo correlacional e observacional. Resultados: encontrou-se uma associação significativa entre o grau de obesidade (IMC > 30 kg/m2) e a mortalidade em pacientes diagnosticados com SARS-CoV-2 com ventilação mecânica invasiva por mais de 20 dias. Graus I (p = 0.001) e II (p = 0.008) de obesidade têm a maior influência na mortalidade de pacientes com ventilação mecânica induzida. Conclusões: em pacientes com obesidade (IMC > 30 kg/m2) principalmente os graus I e II apresentaram maior mortalidade e risco ventilação mecânica invasiva prolongada; portanto, é importante diagnosticar e tratar precocemente e adequadamente esses pacientes, a fim de reduzir sua mortalidade.

[Biosimulator training and its impact on skill in laparoscopic cholecystectomy]. / Entrenamiento en un biosimulador y su impacto sobre la destreza en colecistectomía laparoscópica.

OBJECTIVE: We undertook this study to determinate the educational impact of training in an inanimate biosimulator in terms of effectiveness, time and complications in performing laparoscopic cholecystectomy. METHODS: We used a comparative, experimental cohort, prospective and longitudinal. Three first-postgraduate-year residents and one pre-grade internship physician were trained and assessed in basic laparoscopic skills using a biosimulator (fiberglass "dummy" where animal organs are introduced ex-vivo). The participants acted as their own control, performing a procedure to determine surgical time, complications and effectiveness. Later they observed a short video demonstrating the suitable development of laparoscopic cholecystectomy. The video defined the specific deviations from the ideal cholecystectomy, which were considered as errors. Every procedure was videotaped, beginning with the careful dissection of cystic structures and clipping them, continuing with the dissection of the gallbladder from the liver with the standardized method. Each participant performed ten procedures. RESULTS: There were no differences in baseline assessment of basic skills. All participants completed all proposed procedures. Surgical time was 61% faster at the end of the study (p<0.001), as well as demonstrating a lower rate of complications of 0.67% (p<0.009). CONCLUSIONS: Skills training in endoscopic surgery by means of an inanimate biosimulator is superior to traditional training because it decreases surgical time and surgical complications without ethical considerations and the effect of a learning curve in the operating room.

Biometric analysis of healthy coronary arteries in a Chilean population: an angiographic study / Análisis biométrico de arterias coronarias sanas en población chilena: un estudio angiográfico

SUMMARY: Thorough knowledge and understanding of coronary arteries and their anatomy is essential when performing cardiac surgery such as a coronary bypass. Coronary angiography is a minimally invasive method used to evaluate the anatomy and obtain different measurements of the coronary arteries. This study was designed to evaluate the endoluminal diameter, trunk length and anatomical distribution of coronary arteries in Chilean subjects without apparent angiographic lesions. Measurements were carried out by 3 trained examiners using Leonardo® software program in 238 Chilean subjects of both sexes with an age-range of 45 to 78 years. Ostium and the distal luminal segments diameters were measured, as well as trunk length of both right and left coronary arteries. Ostium of the anterior interventricular artery, dominance and tortuosity were also registered. In the right coronary artery, the diameters (3.8 ± 1.2 mm and 3.6 ± 1.0 mm) differed according to sex and dominance, and the length (35.2 ± 12.5 mm) differed according to age. In the left coronary artery, the diameters (4.9 ± 1.1 mm and 4.7 ± 1.0 mm) were greater in males than in females. The left coronary artery showed greater diameters and length than the right coronary artery. The prevalence of right arterial dominance was 88.0 %. Patients with right arterial dominance presented greater distal caliber in the right coronary artery than those with left arterial dominance (p<0.05), especially in older patients. Significant arterial tortuosity was observed in seven subjects.

RESUMEN: Un factor clave durante los procedimientos quirúrgicos cardiacos tal como el bypass coronario, es el conocimiento exhaustivo de las arterias coronarias y su anatomía. La angiografía coronaria es un método mínimamente invasivo que se utiliza para evaluar la anatomía y obtener diferentes medidas. El presente estudio fue diseñado para evaluar el diámetro endoluminal, la longitud del tronco y la distribución anatómica de las arterias coronarias en sujetos chilenos sin lesiones angiográficas significativas. Las mediciones fueron realizadas en 238 sujetos chilenos de ambos sexos con un rango etario entre 45 a 78 años. Tres examinadores preparados llevaron a cabo las mediciones utilizando el software Leonardo®. Se midieron los ostios y los diámetros luminales distales de los troncos coronarios derecho e izquierdo, como también las longitudes del tronco de las arterias coronarias derecha e izquierda. Además, se identificaron los ostios de la arteria interventricular anterior, dominancia y tortuosidad. En la arteria coronaria derecha, los diámetros (3,8 ± 1,2 mm y 3,6 ± 1,0 mm) se observaron variaciones según el sexo y la dominancia, y la longitud (35,2 ± 12,5 mm) difirió según la edad. En la arteria coronaria izquierda, los diámetros (4,9 ± 1,1 mm y 4,7 ± 1,0 mm) fueron mayores en los hombres que en las mujeres. La arteria coronaria izquierda mostró mayor diámetro y longitud que la arteria coronaria derecha. La prevalencia de dominancia arterial derecha fue del 88,0 %. Los pacientes con dominancia arterial derecha presentaron mayor calibre distal en la arteria coronaria derecha que aquellos con dominancia arterial izquierda (p <0,05), especialmente en pacientes mayores. En siete sujetos se observó una tortuosidad arterial significativa.

The Adh1 gene of the fungus Metarhizium anisopliae is expressed during insect colonization and required for full virulence.

Zymography of alcohol dehydrogenase (ADH) activity in the entomopathogenic fungus Metarhizium anisopliae grown under various conditions revealed that micro-aerobic growth was associated with increased ADH activity. The major ADH protein, AdhIp, was purified to homogeneity by affinity chromatography and has an estimated molecular weight of 41kDa and an isoelectric point (pI) of 6.4. Peptide mass fingerprint analysis allowed the identification and cloning of the gene that encodes this protein, Adh1, as annotated in the M. anisopliae genome database. AdhIp is related to the medium-chain dehydrogenase/reductase (MDR)/zinc-dependent alcohol dehydrogenase-like family and contains conserved ADH sequence motifs, such as the zinc-containing ADH signature, the FAD/NAD binding domain and amino acid residues that are conserved in most microbial ADHs. Semi-quantitative RT-PCR analysis revealed that Adh1 gene expression occurs at low levels during early Plutella xylostella infection and that the Adh1 gene was primarily expressed at larval death and as mycelia emerge from the insect cuticle before conidiation. Antisense-RNA experiments indicated that NAD(+)-dependent ADH activity was diminished by 20-75% in the transformants, and the transformants that had lower ADH activity showed allyl alcohol resistance, which indicates that reduction in ADH activity also occurs in vivo. Bioassays performed using antisense adh1 transformants, which have lower ADH activity, showed that LC50 values were two to five times higher than the wild-type, indicating that AdhIp is required for full capability of the fungus to penetrate and/or colonize the insect.

Echinococcus granulosus cattle strain identification in an autochthonous case of cystic echinococcosis in central Mexico.

Echinococcosis is a frequent hepatic parasitic disease in several countries but it is practically absent in Mexico. A cattle strain of Echinococcus granulosus was identified by RAPD, PCR-RFLP and mitochondrial CO1 gene analysis in an autochthonous case. The parasite was obtained after a laparoscopic excision of a liver cyst from a patient that was symptomatic for 6 years but mis-diagnosed before hospitalization.

[Identification and integral management of a case of autochthonous hydatidosis in Mexico]. / Identificación y manejo integral de un caso autóctono de hidatidosis en México.

OBJECTIVE: To describe a case of hydatid disease in Mexico. BACKGROUND: Liver hydatid disease is the most frequent hepatic parasitic disease in developed countries and is considered practically absent in Mexico. METHODS: In this paper we report identification, clinical management, and epidemiologic parasitologic, and molecular biological studies of an autochthonous case of hydatid disease in Mexico. RESULTS: Hepatic cyst was identified by imaging techniques. The patient received cestocidal treatment and the parasite was excised by laparoscopy. It was not possible to identify the origin of the Echinococcus strain neither by epidemiologic studies performed in the patient's household nor by RAPD pattern obtained with DNA of the protoscolices. Infection of a dog with protoscolices was not successful probably because they were damaged by the cestocidal drug. CONCLUSIONS: Care should be taken in the future to identify other possible autochthonous patients harboring liver hydatid cysts to treat them in an adequate and timely fashion, and to identify the strain of Echinococcus granulosus that infects patients in Mexico.

Isolation, characterization and expression analysis of the ornithine decarboxylase gene (ODC1) of the entomopathogenic fungus, Metarhizium anisopliae.

The gene ODC1, which codes for the ornithine decarboxylase enzyme, was isolated from the entomopathogenic fungus, Metarhizium anisopliae. The deduced amino acid sequence predicted a protein of 447 amino acids with a molecular weight of 49.3 kDa that contained the canonical motifs of ornithine decarboxylases. The ODC1 cDNA sequence was expressed in Escherichia coli cells; radiometric enzyme assays showed that the purified recombinant protein had ornithine decarboxylase activity. The optimum pH of the purified Odc1 protein was 8.0-8.5, and the optimum reaction temperature was 37°C. The apparent K(m) for ornithine at a pyridoxal phosphate concentration of 20mM was 22 µM. The competitive inhibitor of ODC activity, 1,4-diamino-2-butanone (DAB), at 0.25 mM inhibited 95% of ODC activity. The ODC1 mRNA showed an increase at the beginning of appressorium formation in vitro. During the M. anisopliae invasion process into Plutella xylostella larvae, the ODC1 mRNA showed a discrete increase within the germinating spore and during appressorium formation. The second expression peak was higher and prolonged during the invasion and death of the insect. The ODC1 gene complements the polyamine auxotrophy of Yarrowia lipolytica odc null mutant.

Eficacia y seguridad de la ablación por radiofrecuencia endoscópica en pacientes con estenosis biliar maligna irresecable / No disponible

INTRODUCCIÓN: se ha observado que la ablación endoscópica por radiofrecuencia en tumores irresecables de vía biliar prolonga la sobrevida. OBJETIVO: evaluar sobrevida, permeabilidad de prótesis y efectos adversos de la ablación contra un grupo control. METODOLOGÍA: estudio observacional en pacientes con estenosis biliar maligna irresecable. RESULTADOS: cuarenta pacientes, 12 radiofrecuencia, no hubo diferencias entre variables basales de ambos grupos. Hubo mayor sobrevida en el grupo de radiofrecuencia sin diferencia estadísticamente significativa (217 vs. 129 días, log-rank 0,31). No hubo diferencia en permeabilidad de prótesis o efectos adversos. CONCLUSIÓN: se encontró ganancia de tres meses en sobrevida a favor de la radiofrecuencia sin alcanzar diferencia estadísticamente significativa

No disponible

Perspectiva de la relactancia, egreso del binomio y grupo de apoyo / Relactation outlook, exit the binomial and support group

La Organización Mundial de la Salud (OMS) recomienda la alimentación exclusiva al seno, durante al menos los primeros 6 meses de vida del niño, y continuar el amamantamiento junto con las comidas complementarias adecuadas hasta los 2 años de edad; muchos niños verán interrumpida la alimentación al seno en las primeras semanas o meses de vida. Durante décadas pasadas y aún en la actualidad, profesionales mal informados, han advertido a la madre del peligro de desnutrición derivado de la alimentación con leche materna, lo cual ha conducido, a un patrón de crecimiento "ideal", propiciado por la sobrealimentación con sucedáneos de la leche materna. Se plantean dos problemas en la relactación: 1) La decisión de no amamantar y 2) El abandono o destete precoz de la lactancia materna. Cuando las madres reciben un buen apoyo para amamantar, rara vez debería ser necesaria la relactación. Si esta necesidad ocurre frecuentemente, indica que el apoyo a la lactancia materna debe mejorarse. Es posible identificar los factores asociados al éxito o fracaso de la lactancia, así como las acciones que presentan mayor efectividad, acciones específicas realizadas en unidades de atención primaria pueden lograr el inicio y prolongar la duración de la lactancia materna.

The World Health Organization (WHO) recommends exclusive breast-feeding for at least the first 6 months of a child's life and continued breastfeeding with appropriate complementary foods until 2 years of age, many children will be interrupted breast feeding in the first weeks or months of life. During past decades and even today, professional misinformed mother warned of the danger of malnutrition resulting from breast-feeding, which has led to a growth pattern "ideal", led by overeating substitutes breast milk. There are two problems in relactation: 1) The decision not to breastfeed and 2) The abandonment or early weaning of breastfeeding. When mothers receive good support for breastfeeding should rarely be necessary relactation. If this necessity occurs often indicates that support for breastfeeding should be improved. It is possible to identify the factors associated with success or failure of breastfeeding, as well as the actions that have greater effectiveness, specific measures undertaken in primary care units can achieve the onset and prolong the duration of breastfeeding.

Benign fibrous histiocytoma with indeterminate cells and eosinophils: collision, differentiation, or involution?

This report describes the clinicopathologic, immunohistochemical, and ultrastructural features of a benign fibrous histiocytoma of 3 years' duration situated on the posterior right arm of a 17-year-old woman. To our knowledge, this is the first published description of an association between the histologic features of benign fibrous histiocytoma with proliferating dermal dendrocytes and solid clusters of indeterminate cells and inflammatory infiltrate containing numerous eosinophils. Cell type identification was confirmed by immunohistochemical demonstration of positivity of indeterminate cells for CD1a and S-100 protein, by absence of Birbeck granules in electron microscopy study, and by positivity of fibroblast-like cells for factor XIIIa and negativity for CD34. Mitosis or cytologically atypical cells were absent. The MIB1-measured proliferative index of the tumor cells was less than 5% in spindle cells and approximately 15% in indeterminate cells. Possible pathogenic pathways are discussed that could account for divergent differentiation or a combination of neoplasms of different lineages.

Entrenamiento en un biosimulador y su impacto sobre la destreza en colecistectomía laparoscópica / Biosimulator training and its impact on skill in laparoscopic cholecystectomy

Objetivo: determinar el impacto educacional del entrenamiento en un biosimulador inanimado en términos de efectividad, tiempo y complicaciones, respecto a la colecistectomía laparoscópica. Material y métodos: estudio comparativo, experimental de una cohorte, prospectivo y longitudinal. Tres médicos residentes de primer año de cirugía y un interno de pregrado, fueron entrenados y evaluados en habilidades laparoscópicas elementales mediante el empleo de un biosimulador (maniquí de fibra de vidrio en el que se introducen órganos de animales ex vivo). Los sujetos fueron su propio control: realizaron un procedimiento inicial en el que se determinó tiempo quirúrgico, complicaciones y efectividad. Posteriormente observaron un corto video que mostraba el desarrollo idóneo de la colecistectomía, y en el que se identificaban las desviaciones específicas del desempeño adecuado. Posteriormente cada sujeto realizó 10 procedimientos. Resultados: no existieron diferencias en la evaluación inicial de habilidades elementales. Los individuos completaron todos los procedimientos propuestos. Las disecciones de las estructuras císticas y de la vesícula biliar fueron 61 % más rápidas al finalizar el estudio (p < 0.001); la tasa de complicación fue de 0.67 % (p <0.009). Conclusión: el entrenamiento de habilidades en cirugía endoscópica por medio de un biosimulador inanimado es mejor que el entrenamiento tradicional, ya que disminuye el tiempo quirúrgico y las complicaciones en la sala de operaciones.

OBJECTIVE: We undertook this study to determinate the educational impact of training in an inanimate biosimulator in terms of effectiveness, time and complications in performing laparoscopic cholecystectomy. METHODS: We used a comparative, experimental cohort, prospective and longitudinal. Three first-postgraduate-year residents and one pre-grade internship physician were trained and assessed in basic laparoscopic skills using a biosimulator (fiberglass [quot ]dummy[quot ] where animal organs are introduced ex-vivo). The participants acted as their own control, performing a procedure to determine surgical time, complications and effectiveness. Later they observed a short video demonstrating the suitable development of laparoscopic cholecystectomy. The video defined the specific deviations from the ideal cholecystectomy, which were considered as errors. Every procedure was videotaped, beginning with the careful dissection of cystic structures and clipping them, continuing with the dissection of the gallbladder from the liver with the standardized method. Each participant performed ten procedures. RESULTS: There were no differences in baseline assessment of basic skills. All participants completed all proposed procedures. Surgical time was 61% faster at the end of the study (p<0.001), as well as demonstrating a lower rate of complications of 0.67% (p<0.009). CONCLUSIONS: Skills training in endoscopic surgery by means of an inanimate biosimulator is superior to traditional training because it decreases surgical time and surgical complications without ethical considerations and the effect of a learning curve in the operating room.

Acné grave pruriginoso en anciano con insuficiencia renal crónica / Severe pruritic acne in an elderly patient with renal insufficiency

No disponible

Pilomatrixoma cervical osificante / Ossifying cervical pilomatrixoma

El Pilomatrixoma o Tumor epitelial calcificante de Malherbe es un tumor dérmico o subcutáneo, que afecta mayormente a la población pediátrica, originado en la raíz pilosa o zonas adyacentes, generalmente benigno y de lento crecimiento. De ellos, menos de una tercera parte se osifican.La oportunidad de haber asistido en nuestro Servicio consecutivamente dos casos, en edad infantil, y de localización Cervical en Región Espinal, el primero de ellos osificado, nos plantea la descripción de los mismos y la revisión del tema (AU)