Impact of the institutional model on psychiatric patients in Chile from the 19th to 21st centuries: a scoping review.

Introduction: Various mental health hospital models have been tested in Chile since its foundation. The institutional model with the Asylum and the Madhouse prevailed during the nineteenth century and much of the twentieth. But is deinstitutionalizing all psychiatric patients the solution? Evidence acquisition: A PubMed, Epistemonikos, Lilacs, and Google Scholar Scoping Review was carried out in the last 5 years using the PRISMA-P method and the Scoping review search strategy. The MeSH terms ("Psychiatry/history" AND "Chile") OR ("Mental disorders" AND "therapy") were used during the search. Finally, papers focused on clinical trial therapy evaluation were excluded, and we emphasized the effects of historical evidence. Evidence synthesis: We identified 35 primary studies, and we counted the number of articles included in the review that potentially met our inclusion criteria and noted how many studies had been missed by our search. We analyzed 10 primary studies and 10 primary historical resources that were included in this study. Conclusion: The state must become a guarantor and be responsible for its psychiatric patients and provide professional and humanitarian support to its patients, be it through community psychiatry, day hospitals, devices such as mental health clinics, or psychiatric institutes dedicated to teaching and research. Patients should not be left to the free will of their direct relatives, but rather the state should strengthen the primary care system.

La importancia del desarrollo de las habilidades comunicacionales en estudiantes del área de la salud / The importance of developing communication skills in students in the health área

INTRODUCION Estos últimos años la Educación Superior ha tenido que incorporar en su curricular el desarrollo de habilidades comunicacionales, siendo actualmente considerada por la Asociación de Colegios Médicos Americanos (AAMC), Asociación Americana de Escuelas de Medicina(AAME) y Escuela de aprendizaje, conductual y de habilidades (EACH) como una competencia básica del profesional del área salud y que en ocasiones determina el éxito o fracaso del proceso asistencial, existiendo evidencia que el proceso comunicativo que se da en los centros de atención médica referida a la interacción médico-paciente determina la precisión del diagnóstico, toma de decisiones y adherencia del tratamiento que permite una excelente práctica médica. Frente a esta necesidad las Universidades han implementado diversas actividades realizadas en países anglosajones que deben ser ajustadas a las necesidades y contexto social chileno.

In recent years, Higher Education has had to incorporate in its curriculum the development of communication skills, being currently considered by the Association of American Medical Colleges (AAMC), American Association of Medical Schools (AAME) and School of Learning, Behavioral and Skills (EACH) as a basic competence of the health professional and that sometimes determines the success or failure of the care process, there is evidence that the communicative process that occurs in health care centers related to doctor-patient interaction determines the accuracy of diagnosis, decision making and adherence to treatment that allows excellent medical practice. Faced with this need, the Universities have implemented various activities carried out in Anglo Saxon countries that must be adjusted to the needs and social context of Chile

Update on the diagnosis, management and treatment of fever of unknown origin: review article and case report / Actualización en el diagnóstico, manejo y tratamiento de la fiebre de origen desconocido: artículo de revisión y reporte de caso

INTRODUCTION Actually, there are more than 200 different causes of unknown fever, it is necessary for the doctor to identify the most prevalent causes of unknown fever in our Clinical boar. PRESENTATION A 52-year-old male patient with no history of chronic diseases, which was received in the Emergency Service of the Hospital San Pablo, Coquimbo, on 02/03/20 began a clinical picture characterized by fever up to 39 ºC associated with diaphoresis, evaluated several times in primary health care without response to symptomatic treatment. He denies dyspnea, cough, sputum production, headache, muscle weakness, myalgia, fainting, decreased visual acuity, nausea, vomiting, chest pain, abdominal pain, diarrhea, constipation, altered bowel movements, weight loss, dysuria, bladder tenesmus, pain lumbar, skin lesions. As relevant information, the patient reports having taken amoxicillin/clavulanate for 2 days on his own account. DISCUSSION Physicians should be aware of the rare extent of an unusual presentation of knowledge origin fever, probably associated with Still disease, as well as medical options for treatment. The literature does not conclude on a gold standard for the method of approach. CONCLUSION In our case, the etiological agent that could cause Fever of unknown origin (FUO) was Sars cov-2 given the presence of elevated inflammatory factors and acute phase proteins and the presence of neutrophilic infiltration

Aprendizaje Basado en Casos Clínicos (CCBL): una metodología activa aplicable a carreras de ciencias de la salud / Clinical Case-based Learning (CCBL): an active methodology applicable to health sciences careers

Se realizó un análisis bibliográfico sobre la utilización de casos clínicos como estrategia didáctica en las carreras de medicina, enfermería, kinesiología y nutrición. Es fundamental para los docentes estar innovando continuamente en las estrategias de aprendizaje, y promover una flexibilización curricular, para mejorar los procesos de enseñanza universitaria, impulsando un cambio en las metodologías docentes en función del estudiante de manera activa, dando paso a un proceso de enseñanza-aprendizaje dinámico que se adapta a las circunstancias históricas sociales. El objetivo de esta revisión es analizar las evidencias disponibles sobre la utilización de casos clínicos y su aporte a las habilidades y competencias exigidas en los perfiles de estas cuatro carreras de la salud

A bibliographical analysis was carried out on the use of clinical cases as a didactic strategy in medicine, nursing, kinesiology and nutrition undergraduate programs. Is essential for teachers to be continuously innovated in learning strategies, and promote curricular flexibility, to improve university teaching processes, promoting a change in teaching methodologies based on the student in an active way, giving way to a teaching process -dynamic learning that adapts to historical-social circumstances. The objective of this review was to analyze the available evidence on the use of clinical cases and their contribution to the skills and competencies required in the profiles of these four health undergraduate programs

Educación, cultura y diversidad ¿son objeto de reflexión en carreras de ciencias de la salud? / Education, culture and diversity, are they the object of reflection in careers in health sciences?

La educación universitaria está experimentando modificaciones en sus prácticas, La educación médica sin embargo y la educación médica y ciencias de la salud está transitando desde el modelo de Flexner a nuevos enfoques que han dado el paso desde un centro en las disciplinas hacia un equilibrio entre ese centro y el reconocimiento de la necesidad de enfoques centrados en el aprendizaje. Las nuevas generaciones son más demandantes y presentan nuevas necesidades educativas que requieren al menos ser reflexionadas para facilitar el aprendizaje. El contexto educativo merece más atención para responder a la sociedad con la entrega de profesionales de la salud debidamente preparados para asumir un liderazgo positivo. Entre las variables que se deberían considerar se encuentran dos conceptos que no se pueden separar, cultura y educación. Estos conceptos serán abordados en este ensayo. Hoy no se comprende el concepto de cultura y tampoco el de educación. Ambos conceptos son comprendidos en su acepción restringida. Al restringir el significado de educación a transmisión de saberes y el de cultura a las bellas artes, se pone en desmedro la importancia de ambos conceptos y se debilita su estrecha vinculación, ello acarrea un descuido de los desafíos que articulan ambos conceptos, educación y cultura y con ello se olvida preparar a las nuevas generaciones de estudiantes de ciencias de la salud que están ingresando con nuevos perfiles de necesidades educativas para resolver los desafíos esenciales de la vida y la sociedad: subsistencia, convivencia, coexistencia, autoridad y sentido

Hernia of De Garengeot an up to date of diagnosis, initial management and treatment: a narrative review and a case study report / Hernia de De Garengeot: diagnóstico, manejo inicial y tratamiento actualizados: una revisión narrativa y un informe de estudio de caso

INTRODUCTION A De Garengeot hernia is defined by a femoral hernia containing the appendix. Acute appendicitis within a femoral hernia is an extremely rare surgical presentation and occurs in only 0.08-0.013% of cases cited in the literature and 5 to 15% of all femoral hernias. CASE PRESENTATION A 53-year-old woman presented to the emergency room of our hospital in our ward with acute onset of a right-sided inguinal swelling that occurred earlier that day after performing a heavy lift. Her examination revealed acute appendicitis contained within an incarcerated right femoral hernia. The patient underwent laparoscopic appendectomy with open femoral hernia repair. Intraoperatively, the tip of the appendix was incarcerated within the hernial sac. She was removed through the open inguinal incision after the base of the appendix has been divided laparoscopically. The final pathology showed acute inflamed appendicitis with no evidence of neoplasm. DISCUSSION Physicians should be aware of the rare extent of an unusual presentation of appendicitis such as well as surgical options for treatment. The literature does not conclude on a gold standard for the method of approach. CONCLUSION De Garengeot's hernia remains a rare and unusual surgical presentation of femoral hernia, and the complication of the case by incarceration leading to acute appendicitis provides a challenging surgical approach that should be personalized for each patient

[Retrospective analysis of the work of a medical education office]. / Gestión de una oficina de educación médica: evidencia de 10 años y planteamientos de nuevos desafíos para el siglo XXI.

BACKGROUND: Training of health care students at universities is a great challenge for Medical Education Offices. Our office made clear and explained the teaching-learning process from the perspective of teachers, programs, and students. AIM: To report a ten years' analysis of a Medical Education Office (MEO) work, describing the different processes and systematized decisions aimed to improve the quality of the programs and learning results. MATERIAL AND METHODS: A 10 years retrospective analysis of the Medical Education Office processes directed to Medicine, Nursing, Physical Therapy, and Nutrition careers of a Faculty of Medicine. Flunks between 2013 and 2017 were compared. RESULTS: A progressive reduction in flunks was observed in the four careers. Specifically, the proportion of flunks in Nutrition decreased from 30 to 9%. When comparing flunks using a Chi-square test of homogeneity in the four careers, a significant decrease in four of six courses was observed. This led to a sustained increase in number of students who completed their career and obtained their title. Specifically, in Medicine there was a 7.5-fold increase in these figures. The Diploma course trained 90% of the teachers in charge of courses of the four careers. The master's degree generated research that allowed to increase the productivity in health sciences education. CONCLUSIONS: The Office of Medical Education created knowledge and management models for the education of health sciences students, enhancing the quality of training and learning processes.

Gestión de una oficina de educación médica: evidencia de 10 años y planteamientos de nuevos desafíos para el siglo XXI

Background: Training of health care students at universities is a great challenge for Medical Education Offices. Our office made clear and explained the teaching-learning process from the perspective of teachers, programs, and students. Aim: To report a ten years' analysis of a Medical Education Office (MEO) work, describing the different processes and systematized decisions aimed to improve the quality of the programs and learning results. Material and Methods: A 10 years retrospective analysis of the Medical Education Office processes directed to Medicine, Nursing, Physical Therapy, and Nutrition careers of a Faculty of Medicine. Flunks between 2013 and 2017 were compared. Results: A progressive reduction in flunks was observed in the four careers. Specifically, the proportion of flunks in Nutrition decreased from 30 to 9%. When comparing flunks using a Chi-square test of homogeneity in the four careers, a significant decrease in four of six courses was observed. This led to a sustained increase in number of students who completed their career and obtained their title. Specifically, in Medicine there was a 7.5-fold increase in these figures. The Diploma course trained 90% of the teachers in charge of courses of the four careers. The master's degree generated research that allowed to increase the productivity in health sciences education. Conclusions: The Office of Medical Education created knowledge and management models for the education of health sciences students, enhancing the quality of training and learning processes.

Mapping of estradiol binding sites through receptor micro-autoradiography in the endometrial stroma of early pregnant mice.

Estradiol triggers key biological responses in the endometrium, which rely on the presence and levels of its cognate receptors on target cells. Employing the receptor micro-autoradiography (RMAR) technique, we aimed to provide a temporal and spatial map of the functional binding sites for estradiol in the mouse endometrial stroma during early pregnancy. Uterine samples from days 1.5 to 7.5 of pregnancy were collected 1 h after tritiated- (3H-) estradiol administration and prepared for RMAR analysis. Autoradiographic incorporation of 3H-thymidine (after 1-h pulse) was evaluated over the same gestational interval. Combined RMAR with either histochemistry with Dolichus biflorus (DBA) lectin or immunohistochemistry for detection of the desmin further characterized 3H-estradiol binding pattern in uterine Natural Killer (uNK) and decidual cells, respectively. 3H-estradiol binding levels oscillated in the pregnant endometrial stroma between the mesometrial and antimesometrial regions as well as the superficial and deep domains. Although most of the endometrial stromal cells retained the hormone, a sub-population of them, as well as endothelial and uNK cells, were unable to do so. Rises in the levels of 3H-estradiol binding preceded endometrial stromal cell proliferation. 3H-estradiol binding and 3H-thymidine incorporation progressively decreased along the development of the antimesometrial decidua. Endothelial proliferation occurred regardless of 3H-estradiol binding, whereas pericytes proliferation was associated with high levels of hormone binding. Endometrial cell populations autonomously control their levels of 3H-estradiol binding and retention, a process associated with their proliferative competence. Collectively, our results illustrate the intricate regulatory dynamic of nuclear estrogen receptors in the pregnant mouse endometrium.

Migration of human and mouse primordial germ cells and colonization of the developing ovary: an ultrastructural and cytochemical study.

This review is an account of the origin and migratory events of primordial germ cells until their settlement in the gonad before sexual differentiation in the human as well as mice. In this context, the morphodynamic characteristics of the migration of the primordial germ cells, the macromolecular characteristics of the extracellular matrix of the migratory pathway, and the factors involved in the germ cell guidance have been analyzed and discussed in the light of recent advances in this field, by means of immunocytochemical procedures. The events prior to gonadal morphogenesis and the origin of the somatic cell content of the human gonadal primordium have been also analyzed. In particular, evidences are presented showing that cells derived from the coelomic epithelium and mesenchyme are at the origin of the somatic components of the gonadal primordium, and that a mesonephric cell contribution to the generation of somatic cell components of the genital ridge in humans should be discarded due to the morphological stability of the different nephric structures during the period preceding the sexual differentiation of the gonad.

Intrauterine undernutrition in rats interferes with leukocyte migration, decreasing adhesion molecule expression in leukocytes and endothelial cells.

Experimental and epidemiologic data have shown that malnutrition predisposes individuals to infections. Immune responses are compromised, particularly in undernourished children. Therefore, we investigated the migratory capacity of leukocytes, using the intravital microscopy technique, in male Wistar rats (8-9 wk of age) that were undernourished in utero after their dams were fed 50% less food than the amount consumed by control dams. The number of leukocytes rolling along the venular endothelium, sticking after stimulation with leukotriene B4, tumor necrosis factor-alpha (TNF-alpha) or zymosan-activated plasma, or migrating after TNF-alpha stimulation was significantly reduced in the undernourished rat offspring. Compared with nourished rat offspring, undernourished offspring had significantly reduced numbers of circulating leukocytes, higher blood pressure, and higher leukocyte rolling velocity (V(WBC)), as well as a higher ratio between V(WBC) and RBC velocity (V(RBC)). Endothelial P-selectin and intercellular adhesion molecule-1 (ICAM-1) expression, analyzed by immunohistochemistry, and basal leukocyte L-selectin expression, analyzed by flow cytometry, were significantly reduced in the undernourished rat offspring. Because the groups did not differ in leukocyte CD11/18 expression, endothelial expression of platelet-endothelial cell adhesion molecule-1, or venular blood flow velocity and, consequently, venular shear rate, we conclude that intrauterine undernutrition in rats reduces leukocyte migration, downregulates endothelial expression of P-selectin and ICAM-1, as well as leukocyte expression of L-selectin, while reducing leukocyte counts. The higher V(WBC) and V(WBC)/V(RBC) ratio may also play a role in this reduced leukocyte migration. Our data suggest that this phenomenon is involved in the increased predisposition to infections in undernourished subjects.

Collagen and tenascin-C expression along the migration pathway of mouse primordial germ cells.

Primordial germ cells (PGCs) are the progenitor cells of the vertebrate germ line. These cells originate outside of the embryo and, through separation, migration, and colonization, arrive at the genital ridge, contributing to gonad development. Diverse extracellular matrix molecules are present along the PGC migratory pathway, permitting or inhibiting PGC displacement. Collagens and tenascin form the substratum for in vitro migration of neural crest cells and PGCs. However, little is known about the expression and distribution of these molecules during in situ PGC migration. Using immunohistochemistry, we identified tenascin-C and types I, III, and V collagen along the mouse PGC migration pathway. These molecules were spatiotemporally expressed in basement membranes of hindgut, coelomic epithelia, and mesonephric tubules and mesenchyme throughout the study. Our results complement previous data from our laboratory and contribute to building comprehension of the composition of the mouse PGC migratory pathway extracellular matrix, thereby enhancing understanding of the process.

Estradiol receptor binding to the epithelium of uterine lumen and glands: region- and time-related changes during preimplantation and periimplantation periods studied by autoradiography.

The presence and changes of estradiol nuclear binding and related functions in uterine luminal and glandular epithelium were studied before and after blastocyst implantation using receptor autoradiography with (3)H-estradiol-17beta in association with (3)H-thymidine incorporation and immunocytochemical binding of antibody to estrogen receptor ER-alpha. (3)H-estradiol nuclear binding is present but variable during days 1.5-7.5 of pregnancy. Sites of strong nuclear binding of (3)H-estradiol exhibit strong immunocytochemical staining with ER-alpha antibody. Qualitative and quantitative evaluation of autoradiograms reveal that there is a general increase of nuclear (3)H-estradiol binding during the first 3 days after fertilization in both luminal and glandular epithelium. The binding of estradiol is stronger in glandular epithelium from day 2.5 to day 7.5, paralleled by a rise in (3)H-thymidine incorporation on day 2.5. By comparison, in the epithelium of the uterine lumen (3)H-estradiol nuclear binding is low, but relatively high in epithelial cells at lateral branching of the lumen where the increase in (3)H-estradiol binding corresponds to an increased labeling index with (3)H-thymidine. A highly differentiated binding of (3)H-estradiol to luminal and glandular epithelium was demonstrated with region- and time-specific changes of related effects on cell proliferation, differentiation, and secretion, probably involving involution and remodeling. The strong (3)H-estradiol binding to glandular epithelium suggests that estradiol exerts pronounced effects on glandular activities in the periimplantation period.

Differential expression of glycosaminoglycans and proteoglycans in the migratory pathway of the primordial germ cells of the mouse.

Primordial germ cells are an embryonic cell line that give rise to gametes in vertebrates. They originate outside the embryo proper and migrate by a well-defined route to the genital ridges. Proteoglycans and glycosaminoglycans have distinctive properties that affect many of the characteristics of the extracellular microenvironment of migratory pathways in a variety of developmental systems. The purpose of this work was to identify the proteoglycans and glycosaminoglycans that are spatially and temporally expressed in the migratory pathway of primordial germ cells. We showed that the expression of proteoglycans and glycosaminoglycans in the primordial germ cells migratory pathway changes according to the different phases of the migratory process. Some molecules such as chondroitin-0-sulfate, decorin, and biglycan are present only in certain phases of the migratory process of primordial germ cells. Heparan sulfate, chondroitin-6-sulfate, versican, perlecan, and syndecan-4, although exhibiting some variation in expression were detected during all phases of the migratory process. Our results indicate that the successive steps of primordial germ cell migration require a coordinated expression of proteoglycans and glycosaminoglycans, that should be present in appropriate levels and in specific areas of the embryo, and that the sequential expression of these extracellular matrix molecules is under a genetic program that appears to be common to a variety of cell types during embryonic development.

Modulation of hyaluronan in the migratory pathway of mouse primordial germ cells.

In the present report we followed the distribution of hyaluronan during the phases of separation, migration, and colonization of the primordial germ cell migratory process. Hyaluronan was detected by the use of two cytochemical methods: (1) ruthenium hexammine trichloride (RHT) associated with enzymatic treatment with hyaluronate lyase and (2) a binding specific probe for hyaluronan. After RHT treatment the proteoglycans and/or glycosaminoglycans were observed as a meshwork formed by electron-dense granules connected by thin filaments. After enzymatic digestion, no filaments could be detected in the migratory pathway. Quantitative analysis showed a close correlation between cell migration and the concentration of RHT-positive filaments. It was also shown that high amounts of hyaluronan were expressed in the separation phase and migration phases whereas during the colonization phase the amount of hyaluronan was clearly diminished. This study showed that the presence of primordial germ cells in each compartment of the migratory pathway was always accompanied by a high expression of hyaluronan. These results indicate that hyaluronan is an important molecule in the migratory process, providing the primordial germ cells with a hydrated environment that facilitates their movement toward the genital ridges.