Survival after curative pancreaticoduodenectomy for ampullary adenocarcinoma in a South American population: A retrospective cohort study.

BACKGROUND: Ampullary adenocarcinoma (AAC) is a rare neoplasm that accounts for only 0.2% of all gastrointestinal cancers. Its incidence rate is lower than 6 cases per million people. Different prognostic factors have been described for AAC and are associated with a wide range of survival rates. However, these studies have been exclusively conducted in patients originating from Asian, European, and North American countries. AIM: To evaluate the histopathologic predictors of overall survival (OS) in South American patients with AAC treated with curative pancreaticoduodenectomy (PD). METHODS: We analyzed retrospective data from 83 AAC patients who underwent curative (R0) PD at the National Cancer Institute of Peru between January 2010 and October 2020 to identify histopathologic predictors of OS. RESULTS: Sixty-nine percent of patients had developed intestinal-type AAC (69%), 23% had pancreatobiliary-type AAC, and 8% had other subtypes. Forty-one percent of patients were classified as Stage I, according to the AJCC 8th Edition. Recurrence occurred primarily in the liver (n = 8), peritoneum (n = 4), and lung (n = 4). Statistical analyses indicated that T3 tumour stage [hazard ratio (HR) of 6.4, 95% confidence interval (CI) of 2.5-16.3, P < 0.001], lymph node metastasis (HR: 4.5, 95%CI: 1.8-11.3, P = 0.001), and pancreatobiliary type (HR: 2.7, 95%CI: 1.2-6.2, P = 0.025) were independent predictors of OS. CONCLUSION: Extended tumour stage (T3), pancreatobiliary type, and positive lymph node metastasis represent independent predictors of a lower OS rate in South American AAC patients who underwent curative PD.

Renal liposarcoma: case report and review of systemic treatment.

Liposarcomas are malignant mesenchymal tumours usually located in the retroperitoneum, rarely occurring as a single lesion in the kidney. We present a case of a 59-year-old male patient with a left renal mass detected by computed tomography scan. He underwent radical nephrectomy and the histopathological study reported a primary undifferentiated liposarcoma of the kidney without nodal involvement. After 15 months of surgery, he remained asymptomatic and without evidence of disease recurrence. The objective of this report is to present a case and literature review with current evidence of treatment options and prognostic factors for survival.

Impacto económico de la adopción de tecnología para la producción de frijol en condiciones de temporal en el norte centro de México / Economic impact of technology adoption on bean production under rainfed conditions in northern central Mexico

Resumen La asignación de recursos públicos a la investigación agropecuaria es un factor de desarrollo para el sector agroalimentario del país, pero deben estar orientados eficientemente hacia la generación de productos tecnológicos que otorguen beneficios a la población. El objetivo de este trabajo fue evaluar el beneficio económico a nivel sistema de producción y sociedad, derivado de la inversión pública en investigación y desarrollo, del paquete tecnológico para la producción de frijol en zonas de temporal de la región norte centro de México. Para evaluar el impacto en los sistemas de producción, se aplicaron 42 encuestas a productores adoptantes del paquete tecnológico en municipios de Aguascalientes y San Luis Potosí; mientras que, para el impacto a nivel sociedad, se estimó el retorno económico que produjo la inversión pública utilizada en el proceso de generación y adopción de la tecnología en el periodo 2009a 2025. La medición se realizó a través del valor actual neto (VAN), la tasa interna de retorno (TIR) y la relación beneficio costo (R B/C). El costo de producción de los adoptantes fue mayor en 36.3 % comparado con la tecnología tradicional; en tanto que, el rendimiento aumentó en 102 % y el ingreso neto incrementó en 322.6 %. A nivel sociedad, la evaluación reveló un VAN de $ 10.9 millones, lo que representó 4.1 veces lo invertido en la generación de la tecnología. La R B/C fue de 5.1 y la TIR fue mayor a la tasa media real de rendimiento considerada (9.5 %). El desarrollo y transferencia del paquete tecnológico para la siembra de frijol representó una buena inversión de recursos públicos, beneficiando a la población y a los productores, porque incrementa la producción alimentaria y el ingreso neto del agricultor.

Abstract The allocation of public resources to agricultural research is a factor of development for the agri-food sector of the country and should be efficiently oriented towards the generation of technological products that provide benefits to the population. The aim of this work was to evaluate the economic benefit at a level of production system and society, derived from public investment in research and development of the technological package for dry bean crop production in rainfed areas in north central Mexico. To evaluate the impact on the production systems, 42 questionnaires were administered to users of the technological package in municipalities of Aguascalientes and San Luis Potosí. Likewise, in order to assess the impact at a society level, the economic return produced by the public investment used in the generation and adoption process of technology in the 2009 to 2025 period was estimated. The evaluation was performed through the net present value (NPV), the internal rate of return (IRR) and the cost benefit ratio (B/C R). The production cost for adopters was 36.3 % higher compared to traditional technology; however, the yield increased by 102 % and the net income increased by 3226 %. At a society level, the evaluation revealed an NPV of $ 10.9 million, which represented 4.1 times more than what was invested in the generation of technology; the B/C R was 5.1 and the IRR was higher than the real average rate of return considered (9.5 %). The development and transfer of the technological package for sowing beans represented a good investment of public resources, benefiting the population and producers, because it increases food production and farmers' net income.

Dolor crónico en el paciente reumático / Chronic pain in the rheumatic patient

Introducción: el dolor en el paciente reumático puede presentarse, en forma de dolor agudo o crónico, de carácter más complejo, de mayor duración (a partir de 3 meses) o que permanece una vez solucionada la lesión. Objetivo: precisar algunas regularidades sobre este tipo de dolor en el paciente reumático. Desarrollo: es de alta significación considerar en la evaluación del enfermo con dolor crónico el rol de las vías de afrontamiento. Conclusiones: el carácter del manejo del dolor es multifactorial, lo que obliga a implementar intervenciones multifactoriales complejas para perfeccionar el tratamiento apropiado(AU)

Introduction: the pain in the rheumatic patient can present, in the form of acute or chronic pain, more complex nature, of greater duration (from 3 months) or that remains after the injury has been resolved. Objective: to focus on some regularities on this type of pain in the rheumatic patient. Development: it is highly significant to consider in the evaluation of the patient with chronic pain the role of the coping ways. Conclusions: the character of pain management is multifactorial, which requires the implementation of complex multifactorial interventions to perfect the appropriate treatment(AU)

Conocimientos de los estudiantes de medicina sobre las afecciones oftalmológicas más frecuentes en la práctica de la reumatología / Medical student´s knowledge about the most common ophthalmological conditions in the practice of rheumatology

Introducción: en la formación de pregrado debe concederse la debida importancia a la enseñanza de la reumatología dado su carácter multidisciplinar, que demanda un futuro profesional de la salud capaz de valorar y reconocer aún desde aulas y laboratorios, las implicaciones sociales y de salud entre enfermedades reumáticas y oculares ya que el diagnóstico correcto de estas, puede ayudar a destacar el rol del proceso sistémico y viceversa. Objetivo: evaluar el nivel de conocimientos de estudiantes de medicina sobre las afecciones oftalmológicas más frecuentes en la práctica de la reumatología. Métodos: la investigación se realizó en la facultad de Medicina perteneciente a la Universidad Regional Autónoma de los Andes en el período comprendido de marzo a mayo de 2017. Se trata de un estudio descriptivo, transversal y analítico. El universo estuvo constituido por 166 estudiantes de VI y VII semestres y la muestra de estudio la constituyeron 75 estudiantes de cada semestre seleccionados al azar. Resultados: la presencia mayoritaria de mujeres caracteriza a la muestra objeto de estudio (53.3 por ciento, contra 46,7 por ciento de hombres). Las edades máximas y mínimas fueron 21 y 26 años respectivamente, con edad promedio superior en el VII semestre. Se aplicó una encuesta validada previamente que permitió evaluar el conocimiento relacionado con las manifestaciones oftalmológicas más frecuentes. Conclusiones: el nivel de conocimiento sobre las manifestaciones oftalmológicas en la práctica de la reumatología no es bueno, por lo que se sugiere redimensionar el proceso docente, privilegiando la formación práctica que debe caracterizar la enseñanza de pregrado al profundizar en el manejo de estas entidades(AU)

Introduction: In the undergraduate training must be given due importance to the teaching of rheumatology because of its multidisciplinary character, which demands a future health professional able to assess and recognize even from classrooms and laboratories, the social and health implications between rheumatic and ocular diseases because the correct diagnosis of these can help highlighting the role of the systemic process and vice versa. Objective: To assess the level of medical students´ knowledge about the most common ophthalmological conditions in the practice of rheumatology. Methods: The research was carried out in the Faculty of Medicine belonging to the Universidad Regional Autónoma de los Andes from March to May, 2017. It is a descriptive, transversal and analytical study. The universe was constituted by 166 students of sixth and seventh semesters and the sample of study was constituted by 75 students of each semester selected at random. Development: The majority presence of women characterizes the sample object of study (53.3 percent against 46.7 percent of men). The maximum and minimum wages were 21 and 26 years old respectively, with a higher average age in the seventh semester. A previously validated survey was applied that allowed evaluating the knowledge related to the most frequent ophthalmologic manifestations. Conclusions: The level of knowledge on the ophthalmologic manifestations in the practice of rheumatology is not good, so it is suggested to resize the teaching process, favoring the practical training that must characterize the teaching of undergraduate to deepen the management of these entities(AU)

Air pollution and mortality in São Paulo, Brazil: Effects of multiple pollutants and analysis of susceptible populations.

Health impacts of air pollution may differ depending on sex, education, socioeconomic status (SES), location at time of death, and other factors. In São Paulo, Brazil, questions remain regarding roles of individual and community characteristics. We estimate susceptibility to air pollution based on individual characteristics, residential SES, and location at time of death (May 1996-December 2010). Exposures for particulate matter with an aerodynamic diameter ≤ 10 µm (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), and ozone (O3) were estimated using ambient monitors. Time-stratified case-crossover analysis was used with individual-level health data. Increased risk of non-accidental, cardiovascular, and respiratory mortality were associated with all pollutants (P < 0.05), except O3 and cardiovascular mortality. For non-accidental mortality, effect estimates for those with > 11 years education were lower than estimates for those with 0 years education for NO2, SO2, and CO (1.66% (95% confidence interval: 0.23%, 3.08%); 1.51% (0.51%, 2.51%); and 2.82% (0.23%, 5.35%), respectively). PM10 cardiovascular mortality effects were (3.74% (0.044%, 7.30%)) lower for the high education group (> 11 years) compared with the no education group. Positive, significant associations between pollutants and mortality were observed for in-hospital deaths, but evidence of differences in air pollution-related mortality risk by location at time of death was not strong.

The impact of temperature on mortality in a subtropical city: effects of cold, heat, and heat waves in São Paulo, Brazil.

Understanding how weather impacts health is critical, especially under a changing climate; however, relatively few studies have investigated subtropical regions. We examined how mortality in São Paulo, Brazil, is affected by cold, heat, and heat waves over 14.5 years (1996-2010). We used over-dispersed generalized linear modeling to estimate heat- and cold-related mortality, and Bayesian hierarchical modeling to estimate overall effects and modification by heat wave characteristics (intensity, duration, and timing in season). Stratified analyses were performed by cause of death and individual characteristics (sex, age, education, marital status, and place of death). Cold effects on mortality appeared higher than heat effects in this subtropical city with moderate climatic conditions. Heat was associated with respiratory mortality and cold with cardiovascular mortality. Risk of total mortality was 6.1% (95% confidence interval 4.7, 7.6%) higher at the 99th percentile of temperature than the 90th percentile (heat effect) and 8.6% (6.2, 11.1%) higher at the 1st compared to the 10th percentile (cold effect). Risks were higher for females and those with no education for heat effect, and males for cold effect. Older persons, widows, and non-hospital deaths had higher mortality risks for heat and cold. Mortality during heat waves was higher than on non-heat wave days for total, cardiovascular, and respiratory mortality. Our findings indicate that mortality in São Paulo is associated with both cold and heat and that some subpopulations are more vulnerable.

La violencia de género en la atención primaria / Gender violence in primary care

En este artículo presentamos la línea de investigación sobre violencia de género en mujeres atendidas en centros de atención primaria por parte de un equipo de profesionales que incluye médicos de familia, trabajadores sociales y personal de enfermería, y se orienta a la investigación-acción. Inicialmente, tras el contacto con mujeres residentes en casas de acogida y con sus hijos, se realizan estudios descriptivos sobre sus características y necesidades de salud, así como se evalúa la efectividad de las intervenciones orientadas a la mejora de la calidad y la adecuación de la atención que se les presta desde los centros de salud. La complejidad del problema y la tendencia a la intervención directiva y unidireccional de los profesionales sanitarios llevan a la necesidad de conocer la perspectiva de las mujeres, utilizando una metodología cualitativa (análisis de relatos biográficos grabados en audio, mediante teoría fundamentada) para responder preguntas de investigación, como los motivos para salir de la situación o permanecer en ella, la visión que de los agresores tienen las mujeres y la adecuación a modelos explicativos como el modelo de estadios de cambio. Como investigación en proyecto está el estudio con igual metodología,de la perspectiva de los hombres que han infligido violencia

In this assay, we present a line of research into gender violence against women as seen in primary care centers by a team of doctors, social workers and nurses who focus on a research-action approach. First, we contacted women and their children who were living in sheltered accommodation, and descriptive studies were made into their characteristics and health needs. In addition, the effectiveness of the actions designed to improve the quality and the adaptation of the attention in primary care centers for this population were evaluated. The complexity of the matter and the health professionals’ tendency to direct the interventions make it necessary to know the women’s views. Qualitative methodology was used (audio recordings were made of biographical narrations and analyzed by Grounded Theory) to answer the main research questions: reasons for leaving or remaining in the situation; the women’s view of their aggressors, and the adaptation to explanatory models, such as the Stages of Change Model. Another research project with the same methodology which focuses on the male aggressor’s view is currently being undertaken.

Spatial heterogeneity of PM10 and O3 in São Paulo, Brazil, and implications for human health studies.

Developing exposure estimates is a challenging aspect of investigating the health effects of air pollution. Pollutant levels recorded at centrally located ambient air quality monitors in a community are commonly used as proxies for population exposures. However, if ample intraurban spatial variation in pollutants exists, city-wide averages of concentrations may introduce exposure misclassification. We assessed spatial heterogeneity of particulate matter with an aerodynamic diameter < or = 10 microm (PM10) and ozone (O3) and evaluated implications for epidemiological studies in São Paulo, Brazil, using daily (24-hr) and daytime (12-hr) averages and 1-hr daily maximums of pollutant levels recorded at the regulatory monitoring network. Monitor locations were also analyzed with respect to a socioeconomic status index developed by the municipal government. Hourly PM10 and O3 data for the Sao Paulo Municipality and Metropolitan Region (1999-2006) were used to evaluate heterogeneity by comparing distance between monitors with pollutants' correlations and coefficients of divergence (CODs). Both pollutants showed high correlations across monitoring sites (median = 0.8 for daily averages). CODs across sites averaged 0.20. Distance was a good predictor of CODs for PM10 (p < 0.01) but not O3, whereas distance was a good predictor of correlations for O3 (p < 0.01) but not PM10. High COD values and low temporal correlation indicate a spatially heterogeneous distribution of PM10. Ozone levels were highly correlated (r > or = 0.75), but high CODs suggest that averaging over O3 levels may obscure important spatial variations. Of municipal districts in the highest of five socioeconomic groups, 40% have > or = 1 monitor, whereas districts in the lowest two groups, representing half the population, have no monitors. Results suggest that there is a potential for exposure misclassification based on the available monitoring network and that spatial heterogeneity depends on pollutant metric (e.g., daily average vs. daily 1-hr maximum). A denser monitoring network or alternative exposure methods may be needed for epidemiological research. Findings demonstrate the importance of considering spatial heterogeneity and differential exposure misclassification by subpopulation.