Percepción y prioridades respecto al proceso de consentimiento informado quirúrgico; un análisis mediante métodos mixtos

Objetivo: Identificar las principales preocupaciones antes y después de realizarse un procedimiento quirúrgico, e identificar diferencias basadas en género, edad y nivel de escolaridad. Material y Método: Mediante un muestreo no probabilístico incidental se aplicaron 201 encuestas semiestructuradas a personas en la sala de espera del HSJD. Las respuestas fueron procesadas mediante un análisis mixto donde se organizaron categorías por unidades de significancia y se ordenaron de forma decreciente para luego comparar según edad, género y escolaridad. Resultados: Respecto a los aspectos que las personas consideran relevante conocer previo a la cirugía, 4 categorías concentran el 71 % del total: 1. Riesgos, complicaciones y secuelas, 2. Explicación del procedimiento, 3. Beneficios y pronóstico, 4. Cuidados y evaluaciones previas. En relación con lo que le gustaría que le explicaran después, se prioriza: 1. Conocer los resultados del procedimiento (19,3%), 2. Control, derivaciones y cuidados paliativos (15%), 3. Tiempo de recuperación (13,7%). Diferencias significativas: una mayor necesidad de acompañamiento y explicación de la patología expresada por hombres, el interés por conocer y los aspectos relacionados con funcionalidad postoperatoria en personas entre 18-65 años, el interés de conocer los cuidados y evaluaciones previas, conocer los resultados del procedimiento, los cuidados de la herida y la funcionalidad posoperatoria según nivel educacional. Discusión y conclusión: Existen variaciones significativas en contenido prioritario según edad, género y nivel educacional. Finalmente, el presente artículo proporciona evidencia en cuanto a las principales prioridades de pacientes en el sistema público chileno para el consentimiento informado.

Aim: To identify the main concerns before and after undergoing a surgical procedure, and to identify differences based on gender, age and level of education. Material and Method: 201 semi-structured surveys were administered to people in the waiting room of the HSJD by means of incidental non-probabilistic sampling. The responses were processed by means of a mixed analysis in which categories were organized by units of significance and ordered in decreasing order to then compare according to age, gender and schooling. Results: Regarding the aspects that people considered relevant to know before surgery, 4 categories accounted for 71% of the total: 1. Risks, complications and sequels, 2. Explanation of the procedure, 3. Benefits and prognosis, 4. Prior care and evaluations. In relation to what you would like to have explained to you afterwards, priority is given to: 1. knowing the results of the procedure (19.3%), 2. Monitoring, referrals and palliative care (15%), 3. Recovery time (13.7%). Significant differences: a greater need for accompaniment and explanation of the pathology expressed by men, interest in knowing and aspects related to postoperative functionality in persons between 18-65 years of age, interest in knowing the previous care and evaluations, knowing the results of the procedure, wound care and postoperative functionality according to educational level. Discussion and conclusion: There are significant variations in priority content according to age, gender and educational level. Finally, the present article provides evidence regarding the main priorities of patients in the chilean public system for informed consent.

Rendimiento diagnóstico y morbimortalidad de las biopsias pulmonares quirúrgicas en enfermedad pulmonar intersticial difusa

Introducción: Se denomina Enfermedad Pulmonar Intersticial Difusa (EPID) a un conjunto heterogéneo de patologías caracterizadas por inflamación y fibrosis pulmonar. El diagnóstico basado en patrones clínicos o radiológicos puede, ocasionalmente, ser insuficiente para iniciar un tratamiento. La biopsia pulmonar quirúrgica es una alternativa cuando se requiere aumentar la precisión diagnóstica luego de discusión multidisciplinaria. Objetivo: Describir el rendimiento diagnóstico, morbilidad y mortalidad de las biopsias quirúrgicas pulmonares en un hospital público chileno. Pacientes y Método: Cohorte retrospectiva de todos los pacientes a quienes se realizó biopsia quirúrgica por diagnóstico de EPID entre los años 2010 y 2020, indicada por un comité multidisciplinario. Se excluyen procedimientos similares o biopsias con diagnóstico de EPID como hallazgo incidental. Resultados: 38 pacientes intervenidos, mediana de edad de 63 años, 47% femenino. Solo 1 (2,6%) paciente operado de urgencia, y 34 (89,5%) por videotoracoscopía. 5 (13,1%) pacientes presentaron morbilidad, en 4 de ellos fuga aérea, ninguno requiriendo intervención adicional. No hubo rehospitalización, reoperación ni mortalidad a 90 días. En el 95% de los casos se alcanzó un diagnóstico preciso de la EPID tras discusión multidisciplinaria. Discusión: Se observa un alto rendimiento diagnóstico y una baja morbimortalidad en los pacientes estudiados. La baja frecuencia de procedimientos de urgencia y la adecuada indicación en comité multidisciplinario puede haber contribuido a la baja morbilidad. Conclusión: La biopsia pulmonar quirúrgica en un hospital general tiene un alto rendimiento diagnóstico cuando se discute en comité multidisciplinario para precisar el diagnostico en EPID, con una baja morbimortalidad si se seleccionan adecuadamente los pacientes.

Background: Interstitial Lung Disease (ILD) is a heterogeneous group of diseases characterized by inflammation and fibrosis of the lung. Diagnosis based exclusively on clinical or radiologic patterns may be inaccurate, and if a reliable diagnosis cannot be made, surgical lung biopsy can be strongly considered to increase the diagnostic yield after multidisciplinary committee. Objective: To review the diagnostic results, morbidity, and mortality of surgical biopsies in a chilean public health institution. Patients and Method: Retrospective cohort of patients operated for diagnostic purposes for ILD between 2010 - 2020. Surgical biopsies done for other diagnoses were excluded. Results: 38 patients were included, with a median age of 63 years, 47% were female. Only 1 patient (2.6%) underwent emergency surgery and 89.5% underwent minimally invasive surgery techniques. 5 patients had some morbidity (13.1%), 4 of them being air leak. All complications were successfully managed conservatively. We had no readmission, reoperations, or 90-day mortality in this cohort. In 95% of the cases an accurate diagnosis of ILD was reached after multidisciplinary discussion. Discussion: In our experience surgical lung biopsy has a high diagnostic yield and a low morbidity and mortality. A low number of emergency procedures and accurate surgical indication by an expert committee could explain the low morbidity. Conclusion: Surgical lung biopsy in a general hospital reach a high diagnostic performance when discussed in a multidisciplinary committee to specify the diagnosis in ILD, with low morbidity and mortality if patients are properly selected.

Primary Cutaneous Lymphoma Registry of the Spanish Academy of Dermatology and Venereology (AEDV): Data for the First 5 Years. / Registro de linfomas cutáneos primarios (RELCP) de la AEDV: datos tras 5 años de funcionamiento.

BACKGROUND AND OBJECTIVE: Primary cutaneous lymphomas (PCL) are uncommon. Observations based on the first year of data from the Spanish Registry of Primary Cutaneous Lymphomas (RELCP, in its Spanish abbreviation) of the Spanish Academy of Dermatology and Venereology (AEDV) were published in February 2018. This report covers RELCP data for the first 5 years. PATIENTS AND METHODS: RELCP data were collected prospectively and included diagnosis, treatments, tests, and the current status of patients. We compiled descriptive statistics of the data registered during the first 5 years. RESULTS: Information on 2020 patients treated at 33 Spanish hospitals had been included in the RELCP by December 2021. Fifty-nine percent of the patients were men; the mean age was 62.2 years. The lymphomas were grouped into 4 large diagnostic categories: mycosis fungoides/Sézary syndrome, 1112 patients (55%); primary B-cell cutaneous lymphoma, 547 patients (27.1%); primary CD30+lymphoproliferative disorders, 222 patients (11%), and other T-cell lymphomas, 116 patients (5.8%). Nearly 75% of the tumors were registered in stage I. After treatment, 43.5% achieved complete remission and 27% were stable at the time of writing. Treatments prescribed were topical corticosteroids (1369 [67.8%]), phototherapy (890 patients [44.1%]), surgery (412 patients [20.4%]), and radiotherapy (384 patients [19%]). CONCLUSION: The characteristics of cutaneous lymphomas in Spain are similar to those reported for other series. The large size of the RELCP registry at 5 years has allowed us to give more precise descriptive statistics than in the first year. This registry facilitates the clinical research of the AEDV's lymphoma interest group, which has already published articles based on the RELCP data.

A singular value decomposition entropy approach to assess the impact of Covid-19 on the informational efficiency of the WTI crude oil market.

This work investigates the impact of the Covid-19 outbreak on crude oil market efficiency. The approach is based on the singular value decomposition (SVD) entropy. Iso-distributional surrogate data test was used to contrast the results against random patterns, and phase randomization based on Fourier transform was used to assess nonlinearities. The analysis considered the WTI market and focused on the Covid-19 pandemic period January 2020-November 2021 and contrasted with the long preceding period from January 2000 to date. It was found that the crude oil market was informationally efficient most of the time with small sporadic deviations from efficiency in the pre-Covid-19 years. The Covid-19 period exhibited the largest deviations from efficiency, mainly in the first months of the outbreak, accompanied by a marked reduction of nonlinear components. The analysis was conducted for different scales, and the results showed that the deviations from efficiency were more pronounced for quarterly scales. For the sake of comparison, the analysis was also carried out on the trading volume dynamics and the results showed that the market activity is not fully random. The dynamics of the trading volume exhibited significant deviations from the randomness behavior when the crude oil market was efficient, and a behavior that was consistent with nonlinear patterns. The opposite behavior was noted for stages when the crude oil market showed strong deviations from efficiency. Overall, the findings of this study suggest an increasing opportunity for crude oil price predictions and abnormal returns during the Covid-19 pandemic.

Glucose biosensor based on disposable electrochemical paper-based transducers fully fabricated by screen-printing.

This paper describes a new approach for the massive production of electrochemical paper-based analytical devices (ePADs). These devices are fully fabricated by screen-printing technology and consist of a lineal microfluidic channel delimited by hydrophobic walls (patterned with diluted ultraviolet screen-printing ink in chromatographic paper grade 4) and a three-electrode system (printed with carbon and/or Ag/AgCl conductive inks). The printing process was characterised and optimized for pattern each layer with only one squeeze sweep. These ePADs were used as transducers to develop a glucose biosensor. Ionic strength/pH buffering salts, electrochemical mediator (ferricyanide) and enzyme (glucose dehydrogenase FAD-dependent) were separately stored along the microfluidic channel in order to be successively dissolved and mixed after the sample dropping at the entrance. The analyses required only 10 µl and the biosensors showed good reproducibility (RSD = 6.2%, n = 10) and sensitivity (0.426 C/M cm2), wide linear range (0.5-50 mM; r2 = 0.999) and low limit of detection (0.33 mM). Furthermore, the new biosensor was applied for glucose determination in five commercial soft-drinks without any sample treatment before the analysis. These samples were also analysed with a commercial enzymatic-kit assay. The results indicated that both methods provide accurate results.

Evaluación del estado nutricional mediante el índice de masa corporal y el método de Chang en pacientes ambulatorios con VIH/SIDA en el Hospital Carlos Andrade Marín / Evaluation of nutritional status by body mass index and the Chang method in outpatients with HIV / AIDS at Carlos Andrade Marín Hospital

Introducción: El virus de la inmunodeficiencia humana ha provocado una alta morbilidad y mortalidad en todo el mundo. El VIH/SIDA causa alteraciones nutricionales por enfermedades relacionadas o por ciertos síntomas secundarios al tratamiento antirretroviral que ameritan una valoración nutricional temprana, que es el objetivo de este estudio. Materiales y Métodos: Estudio observacional de corte transversal, con una muestra de 213 personas con diagnóstico de VIH/ SIDA y otra de 75 personas que fueron utilizadas para comparar los dos métodos empleados (IMC y el método de Chang). Todos fueron atendidos en el área de Infectología del Hospital Carlos Andrade Marín y se registró sus datos antropométricos. Los reportes bioquímicos (albúmina y perfil lipídico) e inmunológicos (linfocitos totales) fueron tomados de la historia clínica. Resultados: Mediante el IMC se detectó peso normal 53%, bajo peso 7%, sobrepeso 32%, obesidad 8%. Por el método de Chang 61% presentaban peso normal; Kwashiorkor leve 23%, kwashiorkor grave 3%, desnutrición mixta leve 8%, mixta moderada 3% marasmo leve 1.3% y marasmo grave 1.3%. Discusión: El Método de Chang permitió una identificación más temprana de los casos de desnutrición a diferencia del IMC, que subestima casos la desnutrición y se enfoca más en sobrepeso y obesidad.

Introduction: The human immonodeficiency virus has caused high morbidity and mortality all over the world. HIV/AIDS causes nutritional disorders due to related disease or antiretroviral treatment, turning out crucial to provide early nutritional assessment, which is the main goal of this study. Methods: Cross-sectional study that enrolled 213 HIV/AIDS patients and a subsample of 75 persons to compare both nutritional assessment methods (IMC and Chang´s method). They were all treated in the Infectious Diseases Unit at Carlos Andrade Marín Hospital. Anthropometric data was measured from each subject. Biochemical (albumin, and lipid profile) and immunologica (total lymphocyte) data were obtained from the medical records. Results: BMI assessment results were: normal weight 53 %, low weight 7%, overweight 32%, obesity 8%, whereas, using Chang´s method: normal weight 61%, mild kwashiorkor 23%, severe kwashiorkor 3% mild mixed 8%, moderate mixed 3%, mild marasmus 1.3% and severe malnutrition marasmus 1.3%. Discusion: The method Chang allowed earlier identification of malnutrition unli8ke BMI that underestimates malnutrition since its main focus is overweight and obesity.

Seroprevalence and parasite load of Toxoplasma gondii in Mexican hairless pig (Sus scrofa) tissues from the Southeast of Mexico.

This study aimed to estimate the seroprevalence and determine the parasite load of Toxoplasma gondii (T. gondii) in the heart and tongue tissues and the semimembranosus/gracilis muscles in a population of Mexican hairless pig (MHP). A cross-sectional study was conducted in 81 MHP, 9-12 weeks of age, from 10 municipalities in Yucatan, Mexico. The prevalence was estimated by the detection of T. gondii IgG antibodies via an indirect ELISA assay. The parasite burden was also determined by testing genomic DNA from sampled tissues using quantitative real-time PCR (qPCR), which amplified a 62bp product from the B1 gene of T. gondii. The seroprevalence was 53% (43/81), ranging from 0 to 100% seropositivity rate depending on the municipalitie of origin. The qPCR allowed detection of T. gondii in 5.3% (9/168) of the tissue samples, with an average of 2.5±2.71 parasites per gram (0.17±0.18 parasite equivalent) for the leg muscle tissue, 0.26±0.39 (0.01±0.02 parasite equivalent) for the heart tissue and 0.31±0.37 (0.021±0.025 parasite equivalent) for the tongue tissue. No significant difference (p>0.05) was observed in the proportion and parasite burden among the different types of tissues evaluated. As shown by the ELISA, a high seroprevalence of T. gondii exists in MHP from the Yucatán Peninsula. The parasite burden found in the tissues showed similar tropism; therefore, the consumption of these tissues involves the same risk of acquiring infection if not properly cooked.

Reconstrucción de carcinoma espinocelular en región malar infraorbitaria mediante colgajo de rotación-avance / Rotation Advancement Flap Reconstruction Following Excision of a Squamous Cell Carcinoma in the Infraorbital Malar Region

No disponible

Matricectomía ungueal parcial con láser de CO 2 / Partial Nail Matricectomy with Carbon Dioxide Laser

No disponible

Colgajo glabelar combinado con colgajo de transposición para la reconstrucción de 2 defectos nasales discontinuos / Combination of a Glabellar Flap and a Transposition Flap for the Reconstruction of 2 Noncontiguous Nasal Defects

No disponible

Doble colgajo combinado de rotación en la mejilla / Combined Double Rotation Flap on the Cheek

No disponible

Análisis de variables epidemiológicas, clínicas e histopatológicas del cáncer de piel en el Hospital Regional de Arica, Chile (2007-2011) / Analysis of epidemiological, clinical and histopathological variables of skin cancer in the Regional Hospital of Arica, Chile (2007-2011)

Introducción: el cáncer cutáneo es un problema de salud pública. Múltiples factores influyen en el desarrollo de esta neoplasia. El nortede Chile y particularmente Arica, tienen condiciones diferentes al restodel país, presentan mayores niveles de radiación solar, elevada foto exposición y un importante número de población amerindia. Objetivo: Determinar las tasas de incidencia de Carcinoma Basocelular (CBC),Carcinoma Espinocelular CEC y Melanoma Maligno (MM) en la población beneficiaria del Hospital Regional de Arica entre 2007 y 2011 ycaracterizar los tumores utilizando variables clínicas e histopatológicas. Metodología: Se analizaron 22.787 informes histopatológicos de biopsiasen el Hospital Regional de Arica, durante los años 2007 - 2011.Se obtuvieron 288 informes compatibles con cáncer de piel. Se analizaronlas variables de sexo, edad, raza, localización anatómica y tipo histológico. El análisis estadístico se realizó mediante test de Fisher considerando un valor de p menor a 0,05 significativo. Resultados: Se obtuvieron 183 pacientes (64%) con CBC, 93 (32%) con CEC y 12 (4%)de MM. Las tasas de incidencia en total presentaron fluctuaciones,con un patrón decreciente, en CBC (44,03/ 100.000 en 2007, a 13.68/100.000 en 2011) y CEC (16,08/100.000 en 2007 a 8,92/ 100.000 en2011). La localización más frecuente fue cabeza y cuello, 154 pacientespara CBC (84%) y 44 con CEC (47%). En cuanto MM la ubicación más frecuente fue tronco en varones y extremidades superiores e inferiores,en mujeres...

Introduction: skin cancer is a public health problem. Multiplefactors contribute to its appearance. Northern Chile, particularly Arica, has different conditions to the rest of the countryand showed higher levels of solar radiation, a higher sunexposure and a significant number of Amerindian population. Objetive: Determine the incidence rates of Basal Cell Carcinoma( BCC), Squamous cell carcinoma (SCC) and Malignantmelanoma (MM ) in the target population of Arica RegionalHospital, between 2007 and 2011 and characterize the skintumors according to the clinical and histopathological variables. Methodology: 22,787 histopathological reports from the Regional Hospital of Arica, during 2007-2011 were analyzed.288 reports compatible with skin cancer (BCC, SCC and MM)were obtained. For each tumor the variables of sex, age, race,anatomical location and histological type were analyzed. The statistical analysis was performed by the test of Fisher. Results:183 patients, 64% BCC, 32 % SCC and 4% MM wereobtained. Incidence rates of all skin cancer showed fluctuations with decreasing pattern in BCC (ranging from 44.03 /100,000 in 2007, to 13.68 / 100,000 in 2011) and SCC (rangingfrom 16.08 / 100,000 the year 2007 to 8.92 / 100,000 in2011). The most frequent location was head and neck, 154for BCC (84%) and 44 with SCC (47%). The most frequent location of MM was trunk in males and upper and lower limbsin females...

Global interactions, information flow, and chaos synchronization.

We investigate the relationship between the emergence of chaos synchronization and the information flow in dynamical systems possessing homogeneous or heterogeneous global interactions whose origin can be external (driven systems) or internal (autonomous systems). By employing general models of coupled chaotic maps for such systems, we show that the presence of a homogeneous global field, either external or internal, for all times is not indispensable for achieving complete or generalized synchronization in a system of chaotic elements. Complete synchronization can also appear with heterogeneous global fields; it does not requires the simultaneous sharing of the field by all the elements in a system. We use the normalized mutual information and the information transfer between global and local variables to characterize complete and generalized synchronization. We show that these information measures can characterize both types of synchronized states and also allow us to discern the origin of a global interaction field. A synchronization state emerges when a sufficient amount of information provided by a field is shared by all the elements in the system, on the average over long times. Thus, the maximum value of the top-down information transfer can be used as a predictor of synchronization in a system, as a parameter is varied.

Acute generalized exanthematous pustulosis due to dextromethorphan.

Acute generalized exanthematous pustulosis (AGEP) is a rare, severe, pustular, cutaneous reaction. We report a case in which a patient developed AGEP after the intake of 3 different antitussive agents containing dextromethorphan as the only ingredient in common.

Frecuencia de trastornos alimentarios en los alumnos de una facultad de medicina de Lambayeque, durante el año 2012 / Frequency of eating disorders among students attending a Medicine School in Lambayeque, 2012

Objetivo: Estimar la frecuencia de trastornos alimentarios en los alumnos de la facultad de medicina de la Universidad Católica Santo Toribio de Mogrovejo en el año 2012. Diseño: Estudio descriptivo transversal. Material y métodos: Se empleó el Test de actitudes alimentarias (EAT-26) a 292 alumnos de la facultad de Medicina de la Universidad Católica Santo Toribio de Mogrovejo (USAT) en el año 2012, seleccionados por un muestreo aleatorio por conglomerados y estratificado por escuelas profesionales, en la Facultad de Medicina de la Universidad Católica Santo Toribio de Mogrovejo en Lambayeque ­ Perú. Resultados: La tasa de respuesta fue 100%. 63 de los participantes fueron varones (21,5%) y 229, mujeres (78,5%). La edad promedio de los participantes fue 19,7 ±1,2 años. 3 (1,02%) alumnas encuestadas obtuvieron un resultado positivo, todas ellas mujeres y pertenecientes a la escuela de enfermería. Conclusiones: La frecuencia de trastornos alimentarios en nuestro estudio confirma hallazgos previos en poblaciones similares.

Diffusion in one-dimensional channels with zero-mean time-periodic tilting forces.

We investigate the motion of overdamped Brownian particles in a one-dimensional channel under a zero-mean time-periodic tilting force F(t). By introducing a simple harmonic signal, strong enhancement of diffusion is possible for relatively large values of the Peclet number. Direct numerical simulations over the corresponding Fokker-Planck equation show that the diffusion enhancement is induced by a type of nonlinear resonance effect involving the tilting force and the density gradient.