Sentinel lymph node biopsy before and after neoadjuvant chemotherapy in cN0 breast cancer patients: impact on axillary morbidity and survival-a propensity score cohort study.

PURPOSE: In patients with clinically lymph node-negative (cN0) breast cancer, performing sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NACT) has been preferentially embraced in comparison to before NACT. However, survival outcomes associated with both strategies remain understudied. We aimed to compare the axillary lymphadenectomy (ALND) rate, disease-free survival (DFS), and overall survival (OS), between two strategies. METHODS: We included 310 patients in a retrospective observational study. SNLB was performed before NACT from December 2006 to April 2014 (107 cases) and after NACT from May 2014 to May 2020 (203 patients). An inverse probability of treatment weighting (IPTW) method was applied to homogenize both groups. Hazard ratios (HR) and odd ratios (OR) are reported with 95% confidence intervals (95%CI). RESULTS: The lymphadenectomy rate was 29.9% before NACT and 7.4% after NACT (p < 0.001), with an OR of 5.35 95%CI (2.7-10.4); p = .002. After 4 years of follow-up, SLNB after NACT was associated with lower risk for DFS, HR 0.42 95%CI (0.17-1.06); p = 0.066 and better OS, HR 0.21 CI 95% (0.07-0.67); p = 0.009 than SLNB before NACT. After multivariate analysis, independent adverse prognostic factors for OS included SLNB before NACT, HR 3.095 95%CI (2.323-4.123), clinical nonresponse to NACT, HR 1.702 95% CI (1.012-2.861), and small tumors (cT1) with high proliferation index, HR 1.889 95% (1.195-2.985). CONCLUSION: Performing SLNB before NACT results in more ALND and has no benefit for patient survival. These findings support discontinuing the practice of SLNB before NACT in patients with cN0 breast cancer.

Seed production determines the entrance to dormancy of the inflorescence meristem of Pisum sativum and the end of the flowering period.

Flowering plants adjust their reproductive period to maximize the success of the offspring. Monocarpic plants, those with a single reproductive cycle that precedes plant senescence and death, tightly regulate both flowering initiation and flowering cessation. The end of the flowering period involves the arrest of the inflorescence meristem activity, known as proliferative arrest, in what has been interpreted as an evolutionary adaptation to maximize the allocation of resources to seed production and the viability of the progeny. Factors influencing proliferative arrest were described for several monocarpic plant species many decades ago, but only in the last few years studies performed in Arabidopsis have allowed to approach proliferative arrest regulation in a comprehensive manner by studying the physiology, hormone dynamics, and genetic factors involved in its regulation. However, these studies remain restricted to Arabidopsis and there is a need to expand our knowledge to other monocarpic species to propose general mechanisms controlling the process. In this work, we have characterized proliferative arrest in Pisum sativum, trying to parallel available studies in Arabidopsis to maximize this comparative framework. We have assessed quantitatively the role of fruits/seeds in the process, the influence of the positional effect of these fruits/seeds in the behavior of the inflorescence meristem, and the transcriptomic changes in the inflorescence associated with the arrested state of the meristem. Our results support a high conservation of the factors triggering arrest in pea and Arabidopsis, but also reveal differences reinforcing the need to perform similar studies in other species.

Effects of grazing on soil properties in mediterranean forests (Central-Eastern Spain).

Traditional management practices, such as grazing, can have adverse impact on soils. Despite an extensive body of literature exploring the effects of grazing on soil and plants worldwide, there is a notable lack of research on its impacts in Mediterranean forests within the Iberian Peninsula Furthermore, there is a knowledge gap on the enzymatic activities and basal respiration of soil in forest after grazing. To address these gaps, this study aimed to investigate the impact of grazing on various important physicochemical and biological soil properties along with vegetation richness in a Mediterranean forest located in Castilla-La Mancha (Central Eastern Spain). Relative to undisturbed sites, grazing significantly reduced soil water content (-53%) and available water (-59%). However, soil hydraulic conductivity remained unaffected by animal trampling and the soil water repellency observed in ungrazed sites disappeared. Grazed soils experienced a slight increase in pH (+18%). Among the biochemical properties studied, only dehydrogenase showed a significant increase (+100%) while basal respiration exhibited a notable decrease (-24%). Grazing resulted in a reduction of plant species richness (-34%) indicating a loss of biodiversity in grazed areas. The observed significant alterations in key soil and plant properties due to livestock activity suggest that grazing has the potential to modify the overall soil quality of these sites. Certain variables that exhibited noteworthy differences between grazed and ungrazed sites could serve as indicators of grazing impacts in Mediterranean forests. These indicators may be considered proxies for establishing effective land management strategies to mitigate degradation in the Mediterranean forest ecosystem.

Compositional and functional analysis of the bacterial community of Mediterranean Leptosols under livestock grazing.

The composition and functioning of soil bacterial communities, as well as their responses to multiple perturbations, are not well understood in the terrestrial ecosystems. Our study focuses on the bacterial community of erosive and poorly developed soils (Haplic Leptosols) in Mediterranean rangelands of Extremadura (W Spain) with different grazing intensities. Leptosols from similar natural conditions were selected and sampled at two depths to determine the soil properties as well as the structure and activity of bacterial communities. As grazing intensified, the soil C and N content increased, as did the number and diversity of bacteria, mainly of fast-growing lineages. Aridibacter, Acidobacteria Gp6 and Gp10, Gemmatimonas, and Segetibacter increased their abundance along the grazing-intensity gradient. Firmicutes such as Romboutsia and Turicibacter from livestock microbiome also increased. In functional terms, the KEGG pathways enriched in the soils with moderate and high grazing intensity were ABC transporters, DNA repair and recombination proteins, the two-component system, and the degradation of xenobiotics. All of these proved to be related to stronger cell division and response mechanisms to environmental stressors such as drought, warming, toxic substances, and nutrient deprivation. Consequently, the bacterial community was affected by grazing, but appeared to adapt and counteract the effects of a high grazing intensity. Therefore, a clearly detrimental effect of grazing was not detected in the bacterial community of the soils studied.

Breast Cancer Patient's Outcomes after Neoadjuvant Chemotherapy and Surgery at 5 and 10 Years for Stage II-III Disease.

Introduction: Neoadjuvant chemotherapy in breast cancer offers the possibility to facilitate breast and axillary surgery; it is a test of chemosensibility in vivo with significant prognostic value and may be used to tailor adjuvant treatment according to the response. Material and Methods: A retrospective single-institution cohort of 482 stage II and III breast cancer patients treated with neoadjuvant chemotherapy based on anthracycline and taxans, plus antiHEr2 in Her2-positive cases, was studied. Survival was calculated at 5 and 10 years. Kaplan-Meier curves with a log-rank test were calculated for differences according to age, BRCA status, menopausal status, TNM, pathological and molecular surrogate subtype, 20% TIL cut-off, surgical procedure, response to chemotherapy and the presence of vascular invasion. Results: The pCR rate was 25.3% and was greater in HER2 (51.3%) and TNBC (31.7%) and in BRCA carriers (41.9%). The factors independently related to patient survival were pathology and molecular surrogate subtype, type of surgery, response to NACT and vascular invasion. BRCA status was a protective prognostic factor without reaching statistical significance, with an HR 0.5 (95%CI 0.1-1.4). Mastectomy presented a double risk of distant recurrence compared to breast-conservative surgery (BCS), supporting BCS as a safe option after NACT. After a mean follow-up of 126 (SD 43) months, luminal tumors presented a substantial difference in survival rates calculated at 5 or 10 years (81.2% compared to 74.7%), whereas that for TNBC was 75.3 and 73.5, respectively. The greatest difference was seen according to the response in patients with pCR, who exhibited a 10 years DDFS of 95.5% vs. 72.4% for those patients without pCR, p < 0001. This difference was especially meaningful in TNBC: the 10 years DDFS according to an RCB of 0 to 3 was 100%, 80.6%, 69% and 49.2%, respectively, p < 0001. Patients with a particularly poor prognosis were those with lobular carcinomas, with a 10 years DDFS of 42.9% vs. 79.7% for ductal carcinomas, p = 0.001, and patients with vascular invasion at the surgical specimen, with a 10 years DDFS of 59.2% vs. 83.6% for those patients without vascular invasion, p < 0.001. Remarkably, BRCA carriers presented a longer survival, with an estimated 10 years DDFS of 89.6% vs. 77.2% for non-carriers, p = 0.054. Conclusions: Long-term outcomes after neoadjuvant chemotherapy can help patients and clinicians make well-informed decisions.

Characteristics of the bachelor thesis in dentistry, satisfaction and motivations of the students / Características de las tesis de licenciatura en odontología, satisfacción y motivaciones de los tesistas

Objective: To describe the characteristics of under-graduate theses, satisfaction and reasons for choosing a topic of study. Materials and Methods: Cross-sectional study that included two populations, theses and thesis students who were able to support their work from 2015 to 2021 in the Faculty of Dentistry of the Universidad Nacional Mayor de San Marcos (Lima, Peru). Documentary analysis was used at first to record bibliometric data. The survey was used in a second stage to collect information related to the reasons why the thesis students chose their topic and the degree of satisfaction. Results: A total of 269 theses were examined. The theses corresponded to more women (n=142; 52.8%). All had a quantitative approach. The cross-sectional/descriptive design was the most frequent (n=207; 77%). Of the 114 respondents, the majority of them indicated that their thesis topic decision was influenced by a faculty member outside of their advisor (n= 26; 22.8%). A total of 49.1% of thesis students were in complete agreement about what they had learned about research at the end of their thesis. Conclusions: The undergraduate theses evidenced to be developed mainly by women, most of the thesis students were satisfied with the elaboration and execution of their academic work; it was evidenced that the thesis topics are mainly influenced by a teacher different from the thesis advisor, this indicates that the advisors should be more conscious when guiding the student and influencing the thematic, methodological and writing decisions together with the advised.

Objetivo: Describir las características de las tesis de licenciatura, satisfacción y motivos para la elección de un tema de estudio. Materiales y Métodos: Estudio transversal que incluyó a dos poblaciones, las tesis y a los tesistas que lograron sustentar sus trabajos desde el año 2015 al 2021 en la Facultad de Odontología de la Universidad Nacional Mayor de San Marcos (Lima, Perú). Se utilizó el análisis documental en un primer momento para registrar datos bibliométricos. La encuesta se utilizó en un segundo momento para recabar información relacionada a los motivos por los cuales escogieron su tema los tesistas y el grado de satisfacción. Resultados: Se examinaron 269 tesis. La mayoría de ellas fueron realizadas por mujeres (n=142; 52,8%). Todas tuvieron un enfoque cuantitativo. El diseño transversal/descriptivo fue el más frecuente (n=207; 77%). De los 114 encuestados, la mayoría de ellos indicó que la decisión de su tema de tesis fue influida por un docente ajeno a su asesor (n= 26; 22,8%). El 49,1% de tesistas estuvo totalmente de acuerdo respecto a lo aprendido sobre investigación al culminar su tesis. Conclusión: Las tesis de licenciatura evidenciaron ser desarrolladas principalmente por mujeres, la mayoría estuvo satisfecho con la elaboración y ejecución de su trabajo académico; se evidenció que los temas de tesis son influenciados principalmente por un docente diferente al asesor de tesis, esto indica que los asesores deben ser más conscientes al momento de guiar al estudiante e influir en las decisiones temáticas, metodológicas y de redacción junto con el asesorado

Perspectivas de los graduados de Odontología sobre la supervisión (asesoría) de la tesis de licenciatura

Resumen Se identificó las perspectivas que tienen los graduados sobre los procesos de supervisión que tuvieron con sus asesores de tesis. Estudio cualitativo cuya población fueron graduados del pregrado de la Facultad de Odontología de la Universidad Nacional Mayor de San Marcos (Lima. Perú), a través de entrevistas semiestructuradas. Las categorías de estudio estuvieron relacionadas con la planificación de las actividades con el supervisor, decisiones del supervisor y percepciones generales sobre el supervisor. De los 20 entrevistados, 12 (60%) fueron mujeres. La planificación fue indicada como uno de los elementos que poco se discutió con el asesor, la mayoría indicó que nunca tuvieron una primera reunión para coordinar cómo serían las sesiones de asesoría. La percepción que se tiene de los supervisores de tesis no es adecuada por parte de los estudiantes de Odontología. Los principales aspectos negativos estuvieron relacionados a la falta de planificación de las actividades y reuniones.

Resumo Foram identificadas as perspectivas que os egressos têm sobre os processos de supervisão que tiveram com seus orientadores de tese. Estudo qualitativo cuja população foram graduandos da Faculdade de Odontologia da Universidad Nacional Mayor de San Marcos (Lima, Peru), por meio de entrevistas semiestruturadas. As categorias do estudo foram relacionadas ao planejamento das atividades com o supervisor, decisões do supervisor e percepções gerais sobre o supervisor. Dos 20 entrevistados, 12 (60%) eram mulheres. O planejamento foi apontado como um dos elementos pouco discutidos com a assessoria, a maioria indicou que nunca teve uma primeira reunião para coordenar como seriam as sessões de assessoria. A percepção dos orientadores de tese não é adequada por parte dos alunos de Odontologia. Os principais aspectos negativos foram relacionados à falta de planejamento das atividades e reuniões.

Abstract We identified graduates' views on their thesis supervision process as led by their thesis advisors. A qualitative study of graduates of the School of Dentistry of Universidad Nacional Mayor de San Marcos (Lima, Peru) included semi-structured interviews. The study categories were planning activities with the advisor, the advisor's decisions, and general views on the advisor. Of the 20 interviewees, 12 (60%) were women. Planning was insufficiently discussed with the advisor; most interviewees said that they never had a first meeting to coordinate what the advisory sessions would be like. Dental students do not have a favorable view of thesis advisors. The main negative aspects were the lack of planning of activities and meetings.

Comparación del módulo de elasticidad y resistencia de la resina acrílica de termocurado y la resina flexible superpoliamida. Estudio in vitro / Comparison of the module of elasticity and resistance of thermal curing acrylic resin and flexible superpolyamide resin. An in vitro study

Objetivo: Comparar el módulo de elasticidad y resistencia de la resina acrílica de termocurado y la resina flexible superpoliamida. Métodos: Se diseñó un estudio experimental que empleó dos tipos de resinas acrílicas preparadas en cera para obtener una forma rectangular de 64 mm de largo, 10 mm de ancho y 2,5 mm de grosor, pasadas a acrílico de termocurado y resina flexible superpoliamida. Se emplearon 10 bloques de resina acrílica de cada tipo sometidas a compresión por la máquina de ensayos universal, que generó una fuerza de aproximación de 0,001 N sobre los bloques con un avance de 0,01 mm/min. El módulo de resistencia y el módulo de elasticidad se analizaron mediante la prueba de flexión de tres puntos. Resultados: El módulo de elasticidad de la resina acrílica de termocurado fue de 2501,83 ± 139,42, mientras que el módulo de resistencia fue de 78,36 ± 11,69 MPa. Por otro lado, el módulo de elasticidad de la resina flexible superpoliamida fue de 1020,59 ± 92,95, mientras que el módulo de resistencia fue de 36,04 ± 2,71 MPa. El módulo de elasticidad de la resina acrílica de termocurado fue mayor al de la resina flexible superpoliamida, esta diferencia fue de 1481,24 MPa. El módulo de resistencia de la resina acrílica de termocurado fue mayor al de la resina flexible superpoliamida. Conclusiones: Se concluyó que el módulo de elasticidad (rigidez) y resistencia fue mayor en la resina acrílica de termocurado en comparación a la resina flexible superpoliamida(AU)

Objective: Compare the module of elasticity and resistance of thermal curing acrylic resin and flexible superpolyamide resin. Methods: An experimental study was conducted of two types of acrylic resins molded in wax to obtain a 64 mm long, 10 mm wide and 2.5 mm thick rectangular shape, and then transferred to thermal curing acrylic resin and flexible superpolyamide resin. Ten acrylic resin blocks of each type were used. The blocks were compressed by the universal testing machine, which generated an approximation force of 0.001 N on the blocks at a forward speed of 0.01 mm/min. The resistance module and the elasticity module were analyzed with the three point flexural test. Results: The elasticity module of the thermal curing acrylic resin was 2501.83 ± 139.42, whereas the resistance module was 78.36 ± 11.69 MPa. The elasticity module of the flexible superpolyamide resin was 1020.59 ± 92,95, whereas the resistance module was 36.04 ± 2.71 MPa. The elasticity module of the thermal curing acrylic resin was greater than that of the flexible superpolyamide resin, the difference being 1481.24 MPa. The resistance module of the thermal curing acrylic resin was greater than that of the flexible superpolyamide resin. Conclusions: The elasticity (rigidity) and resistance module was greater in the thermal curing acrylic resin than in the flexible superpolyamide resin(AU)

Producción científica relacionada a las Sociedades Científicas de Estudiantes en las ciencias de la salud / Scientific production about health sciences published by students scientific societies

Objetivo: Describir la producción científica mundial relacionada a las Sociedades Científicas Estudiantiles en los programas de las ciencias de la salud. Métodos: Se realizó un estudio descriptivo que incluyó a los artículos científicos publicados en las bases de datos Scopus, MedLine, ScienceDirect, SciELO, Redalyc y el buscador Google académico en el periodo 2010 a 2020. Los términos incluyeron: Sociedad Científica de Estudiantes, Sociedad Estudiantil, Sociedad Científica Estudiantil y Asociación estudiantil. De los artículos seleccionados se recolectó las categorías de: tipo de publicación, año, nombre de la revista, país de origen, colaboración internacional, programa de estudios y autoría. Los datos fueron analizados de forma descriptiva a través de frecuencias. Resultados: Se encontraron 51 publicaciones, el país que más publicaciones tuvo fue Perú (37,3 por ciento). Los principales tipos de artículos fueron las cartas al editor (41,2 por ciento) y los artículos originales (29,4 por ciento). Los investigadores Cvetkovic Vega y Mejia constituyeron los autores con mayor número de artículos. La revista con mayor cantidad de publicaciones fue Ciencia e Investigación Médica Estudiantil Latinoamericana (11,8 por ciento), mientras que la mayoría de artículos estuvieron en el programa de Medicina humana (90,2 por ciento). Conclusiones: La producción científica relacionada a las Sociedades Científicas de Estudiantes en las ciencias de la salud tiene como principal temática a la producción que realizan sus integrantes; Perú es el país con más artículos que ha publicado sobre el tema y la mayoría de fuentes de información son artículos del tipo carta al editor(AU)

Objective: Describe the scientific production published in health sciences programs by students scientific societies worldwide. Methods: A descriptive study was conducted of scientific articles published in the databases Scopus, MEDLINE, ScienceDirect, SciELO and Redalyc, and the search engine Google Scholar in the period 2010-2020. The search terms used were students scientific society, student society student scientific society and students association. The following data were collected from the articles retrieved: publication type, year, journal name, country of origin, international collaboration, syllabus and authorship. Descriptive data analysis was based on frequency estimation. Results: A total 51 publications were retrieved. The most productive country was Peru (37.3 percent). The main article types were letters to the editor (41.2 percent) and original articles (29.4 percent). Researchers Cvetkovic Vega and Mejia were the most productive authors. The journal with the largest number of publications was Ciencia e Investigación Médica Estudiantil Latinoamericana (11.8 percent), whereas most articles were related to the Human Medicine program (90.2 percent). Conclusions: Scientific production about health sciences published by students scientific societies is mainly concerned with production generated by their members. Peru is the country with the most articles published about the subject. Most information sources are articles of the letter to the editor type(AU)

Diseño de un programa educativo sobre interacciones entre alimentos y medicamentos en ancianos con enfermedades cardiovasculares

RESUMEN Introducción: Las interacciones entre alimentos y fármacos pueden ser provocadas por alteraciones en los mecanismos farmacocinéticos. La mayoría de los problemas ocurren durante la absorción del fármaco. Su resultado puede ser una variación en la biodisponibilidad, lo que puede tener repercusiones clínicas. Es importante que los profesionales sanitarios reciban educación continuada para optimizar el tratamiento. Objetivo: Identificar posibles interacciones entre fármacos y alimentos en pacientes con enfermedades cardiovasculares, y elaborar un programa educativo para aumentar el nivel de información. Método: Se realizó un estudio descriptivo sobre las características de la administración de fármacos y alimentos en el anciano, se analizaron las historias clínicas de 35 pacientes con enfermedades cardiovasculares de un Hogar de Ancianos; se realizó entrevista individual con pacientes y trabajadores de la salud. Se analizaron los fármacos y los alimentos que ingieren, así como el horario de administración de ambos, y se diseñó un programa educativo. Resultados: La enfermedad cardiovascular más frecuente fue la hipertensión arterial (77,2%), por lo que los fármacos más prescriptos son los antihipertensivos; y, en la mayoría de los casos, son administrados juntos con los alimentos (80,0%). Se diseñó un programa educativo a partir de las deficiencias encontradas, donde se conformó un plegable y se impartieron charlas educativas a los pacientes sobre aspectos generales de tema. Además, se impartió un curso de postgrado, para el personal de salud, sobre farmacocinética y los alimentos que la modifican, así como los horarios de administración. Conclusiones: Existe administración conjunta de fármacos y alimentos, el programa educativo diseñado estuvo basado en estos aspectos dirigido a pacientes y personal de salud.

ABSTRACT Introduction: Food-drug interactions may be caused by alterations in pharmacokinetic mechanisms. Most problems occur during drug absorption. The result may be a variation in bioavailability and could have clinical repercussions. Healthcare professionals should receive ongoing education to optimize treatment. Objective: To identify possible drug-food interactions in patients with cardiovascular diseases and develop an educational program to increase the level of information. Methods: We conducted a descriptive study on the characteristics of drug and food administration in the elderly. We analyzed the medical records of 35 patients with cardiovascular disease from a Nursing Home and conducted an individual interview with patients and healthcare workers. We also analyzed the drugs and food prescribed, as well as their respective administration schedules. Finally, an educational program was designed. Results: High blood pressure was the most frequent cardiovascular disease (77.2%), which is why antihypertensive drugs are the most frequently prescribed. In most cases, they are administered together with food (80.0%). Based on the deficiencies found, we began the design of an educational program. We created a poster and agreed to hold educational talks for the patients on general aspects of the subject. Moreover, we offered a postgraduate course for the healthcare staff on pharmacokinetics, foods that modify it, and administration schedules. Conclusions: We were able to ascertain the co-administration of drugs and food. Both patients and healthcare personnel received an educational program based on this aspect.

Tesis sustentadas y publicadas por estudiantes de las ciencias de la salud en Perú / Theses supported and published by health sciences students in Peru

RESUMEN Fundamento: la tesis universitaria culmina los estudios de pregrado y/o posgrado, es inédita y original, consolida la formación académica y permite obtener un título profesional. Objetivo: cuantificar la cantidad de tesis universitarias publicadas como artículo científico en las ciencias de la salud: Medicina Humana, Odontología, Farmacia y Bioquímica, Medicina Veterinaria y Psicología, de la Universidad Nacional Mayor de San Marcos; Lima, Perú. Métodos: se realizó un estudio con enfoque cuantitativo, básico, observacional, de nivel descriptivo y diseño retrospectivo que evaluó 1954 tesis realizadas por estudiantes de pregrado registradas en el portal web Cybertesis, entre 2010-2018. Se analizaron las variables: productividad por facultad/escuela profesional, tiempo y lugar de publicación, experiencia del asesor y género de los tesistas. Resultados: fueron publicadas 134 (6,9 %) tesis en revistas científicas. El promedio del tiempo que demoró publicar una tesis en formato de artículo científico fue de 1,72 ± 1,05 años. 124 (92,5 %) tesis publicadas presentaron asesores que incursionaban en publicaciones científicas. En 133 artículos (99,3 %) los estudiantes fueron los autores principales. 123 tesis (91,8 %) aparecieron en revistas científicas peruanas. El 6,9 % de tesis sustentadas fueron publicadas en formato artículo original; la Facultad de Medicina Veterinaria fue la de mayor producción científica. Conclusiones: el estudio realizado permitió diagnosticar el porciento de tesis publicadas con respecto a las sustentadas, lo que aporta una herramienta para su incremento a partir de estudios donde se delimiten las causas que inciden en los porcientos encontrados.

ABSTRACT Background: the university thesis culminates undergraduate and / or postgraduate studies, it´s unpublished and original, it consolidates academic training and allows obtaining a professional degree. Objective: to quantify the amount of university thesis published as a scientific article in health sciences: Human Medicine, Dentistry, Pharmacy and Biochemistry, Veterinary Medicine and Psychology, of the National University of San Marcos; Lima Peru. Methods: a study was carried out with a quantitative, basic, observational, descriptive level and retrospective design approach that evaluated 1954 theses carried out by undergraduate students registered on the Cybertesis web portal, from 2010 to 2018. The variables were analyzed: productivity by faculty / professional school, time and place of publication, experience of the advisor and gender of the thesis students. Results: theses were published in scientific journals 134 (6.9%). The average time it took to publish a thesis in scientific article format was 1.72 ± 1.05 years. 124 (92.5%) published theses presented consultants who participated in scientific publications. In 133 articles (99.3%) the students were the main authors. 123 theses (91.8%) appeared in Peruvian scientific journals. 6.9% of theses supported were published in original article format; the Faculty of Veterinary Medicine was the one with the greatest scientific production. Conclusions: the study carried out allowed diagnosing the percentage of published theses with respect to the sustained ones, which provides a tool for its increase from studies where the causes that affect the found percentages are delimited.

Insuficiencia cardiaca derecha tras el implante de un marcapasos / Right heart failure after pacemaker implantation

Fundamento y objetivo: La insuficiencia tricuspídea (IT) grave secundaria a interferencia del cable del marcapasos (MCP) es una causa infrecuente de insuficiencia cardiaca (IC) derecha progresiva, que puede complicar la evolución del paciente. Material y métodos: Presentamos 3 casos clínicos de IC derecha secundaria a IT tras implantación de MCP. Resultados: En estos pacientes la clínica consiste en IC derecha, que puede aparecer de forma precoz, como en nuestra segunda paciente, o al cabo de años de la implantación del MCP, como en el primer y la tercera pacientes. El diagnóstico se confirma por ecocardiografía, siendo la más precisa la 3D, seguida de la transesofágica. La 2D transtorácica puede no detectarla, ya que tiene baja sensibilidad para la IT asociada a MCP. El tratamiento médico es siempre la primera opción, ya que cualquier otro procedimiento conlleva una morbimortalidad significativa. Conclusiones: Probablemente, esta es una patología que vamos a diagnosticar cada vez con más frecuencia, ya que cada vez hay más pacientes con dispositivos y, al mismo tiempo, están mejorando las herramientas diagnósticas (AU)

Conclusions: Severe tricuspid regurgitation (TR) secondary to interference pacemaker (PM) cable is a rare cause of progressive right heart failure (HF), which can worsen patient outcomes. This continuation/maintenance electroconvulsive therapy programme has shown to be clinically useful and to have a favourable economic impact, as well as high perceived quality. Introducción: We present 3 clinical cases of right HF secondary to TR after PM implantation. La terapia electroconvulsiva de continuación/mantenimiento ha demostrado su eficacia en la prevención de recaídas tanto en cuadros afectivos como psicóticos. Sin embargo, existen pocos estudios sobre variables de gestión clínica, costes asociados y calidad percibida. Results: In these patients the clinic is right HF, which can appear early, as in our second patient, or after years of implementation of the PM, as in the first and third patients. The diagnosis is confirmed by echocardiography, the most accurate 3D, followed by transesophageal. The 2D transthoracic can not detect it, because it has low sensitivity for TR associated with PM. Medical treatment is always the first choice, since any other procedure carries significant morbidity and mortality. Resultados: Probably this is a condition that we will diagnose with increasing frequency, because there are more and more patients with devices and, at the same time, the diagnostic tools are improving. Tras su inclusión en el programa, el 50,0% de los pacientes refirió encontrarse «mucho mejor», y el 37,5% «moderadamente mejor» en la Escala de Impresión Clínica Global-Mejoría Global. Además, una vez incluidos en el programa de terapia electroconvulsiva de continuación/mantenimiento, los pacientes tuvieron un total de 349 días de ingreso, 3 visitas a Urgencias y 2 ingresos urgentes, frente a los 690 días de ingreso (p = 0,012), 26 visitas a Urgencias (p = 0,011) y 22 ingresos urgentes (p = 0,010) en el mismo periodo, antes de su inclusión en el programa. Los costes directos asociados por estancia/día tras su inclusión en el programa se redujeron al 50,6% del coste previo, y los costes asociados a visitas a Urgencias disminuyeron al 11,5% del coste previo. Respecto a la calidad percibida, un 87,5% de los pacientes evaluaron la atención y tratamiento recibido como «muy satisfactorio», y un 12,5% como «satisfactorio» (AU)

Diagnóstico de la insuficiencia cardíaca aguda y relevancia de los biomarcadores en pacientes de edad avanzada / Diagnosis of acute heart failure and relevance of biomarkers in elderly patients

El diagnóstico de insuficiencia cardíaca (IC) aguda es difícil en pacientes de edad avanzada con múltiples comorbilidades. Las escalas y criterios de clasificación basados exclusivamente en manifestaciones clínicas, como los de Framingham, carecen de especificidad suficiente. Además de la clínica, el diagnóstico debe estar basado en otros 2 pilares: los péptidos natriuréticos y el ecocardiograma. Ante una sospecha clínica baja, la normalidad de los péptidos natriuréticos descarta la IC aguda. En aquellos con sospecha clínica consistente debe realizarse también un ecocardiograma. El diagnóstico de IC con fracción de eyección preservada (ICFEP) requiere la detección de una aurícula izquierda aumentada de tamaño o la presencia de parámetros de disfunción diastólica. La elevación de los biomarcadores cardíacos parece responder al daño del miocardio y a los mecanismos de compensación que tiene el organismo frente a este (respuesta hormonal, inflamatoria y mecanismos de reparación). En la clínica la elevación de los marcadores de daño cardíaco (troponinas y péptidos natriuréticos) ha demostrado utilidad tanto en el diagnóstico de la IC aguda como en su pronóstico. El MMP-2 podría ser útil en el diagnóstico de ICFEP. Además del valor diagnóstico, otros biomarcadores son de ayuda en el pronóstico en la fase aguda de IC, como los de fallo renal (eGFR, cistatina y urea), los de inflamación (citocinas y proteína C reactiva [PCR]) y el marcador de regeneración celular galectina-3. Una idea prometedora en estudio es el uso de combinaciones de biomarcadores para predecir de una forma más precisa tanto el diagnóstico como el pronóstico de la IC aguda (AU)

Diagnosis of acute heart failure (HF) is difficult in elderly patients with multiple comorbidities. Risk scales and classification criteria based exclusively on clinical manifestations, such as the Framingham scales, lack sufficient specificity. In addition to clinical manifestations, diagnosis should be based on two key factors: natriuretic peptides and echocardiographic study. When there is clinical suspicion of acute HF, a normal natriuretic peptide level will rule out this process. When a consistent clinical suspicion is present, an echocardiographic study should also be performed. Diagnosis of HF with preserved ejection fraction (HF/pEF) requires detection of an enlarged left atrium or the presence of parameters of diastolic dysfunction. Elevation of cardiac biomarkers seems to be due to myocardial injury and the compensatory mechanisms of the body against this injury (hormone and inflammatory response and repair mechanisms). Elevation of markers of cardiac damage (troponins and natriuretic peptides) have been shown to be useful both in the diagnosis of acute HF and in prediction of outcome. MMP-2 could be useful in the diagnosis of HF/pEF. In addition to biomarkers with diagnostic value, other biomarkers are helpful in prognosis in the acute phase of HF, such as biomarkers of renal failure (eGFR, cystatin and urea), inflammation (cytokines and CRP), and the cell regeneration marker, galectin-3. A promising idea that is under investigation is the use of panels of biomarkers, which could allow more accurate diagnosis and prognosis of acute HF (AU)

Mujer de 87 años con mal estado general, fiebre, hepatomegalia y hemofagocitosis / Eighty-seven-year-old woman with malaise, fever, hepatomegaly and hemophagocyctosis

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Duplicidad de la vesícula biliar / Duplication of the gallbladder

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