The therapeutic relationship from the perspective of patients and nurses in the first days of admission: A cross-sectional study in acute mental health units.

The therapeutic relationship (TR) is essential in mental health nursing care and plays a fundamental role in the understanding and treatment of the patient's health status. Despite being a bidirectional construct, limited evidence is available to shed light on this issue in mental health units and even less so in the first days of admission. This study aimed to examine the association and differences between nurses' and patients' perspectives on the establishment of the therapeutic relationship in acute mental health units during the first days of hospitalization. A cross-sectional study was carried out in 12 Spanish mental health units. Data were collected from patients and nurses using the Working Alliance Inventory-Short (WAI-S) questionnaire. A total of 234 cases were analysed, including 234 patients and 58 nurses. The results showed a positive association between nurses' and patients' perspectives on the therapeutic relationship, but also revealed significant differences on each WAI-S dimension. Nurses assigned higher scores compared to patients on the perception of the quality of the therapeutic relationship. The dimensions with the greatest weight from the patients' perspective regarding the quality of the therapeutic relationship were the perception of greater agreement on goals and tasks among nurses. This study demonstrates the importance of establishing shared goals and tasks with nurses from the first days of hospitalization to improve the quality of the therapeutic relationship as perceived by patients. These findings underline the need to consider the different perspectives of both parties to promote a high-quality therapeutic relationship.

Treatment of abdominal fistulas in Crohn's disease and monitoring with abdominal ultrasonography.

OBJECTIVE: to assess the usefulness of medical treatment to achieve closure of internal fistulas detected on abdominal ultrasound in a series of patients with fistulizing Crohn's disease. MATERIAL AND METHODS: a retrospective analysis was performed of the medical records of patients with Crohn's disease with a fistula detected on abdominal ultrasound from 2010 to 2018. The study included patients who received medical treatment after the diagnosis of this complication and underwent ultrasonographic monitoring of the therapeutic response. The factors associated with the response to medical treatment or the need for surgery were investigated. RESULTS: forty-six patients were included in the study. Enteromesenteric (69.6 %) was the most common type of fistula and associated abscesses were found in 14 (30.4 %) patients. Fistulas were classified as complex in 20 patients. Treatment with immunosuppressants was started in 14 (30.4 %) cases and a biologic drug was added in 18 (39.1 %) patients. Complete closure of the abdominal fistula was observed with ultrasonography in 24 (52.2 %) of the 46 patients. The only factor related to fistula closure was the type of fistula and was more likely to occur in patients with an enteromesenteric fistula. Thirteen (28 %) of the 46 patients needed a surgical resection. The only factor with a significant correlation with a lower need for surgery was fistula closure after treatment (8.3 % vs 50 %, p = 0.002). CONCLUSION: medical treatment achieves internal fistula closure in more than half of cases and almost a third require surgical treatment. Abdominal ultrasound can detect abdominal fistulas at an earlier stage and allow prompt treatment changes.

Experiencia del internado de medicina durante la pandemia por Covid-19 / Medical internship experience during the Covid-19 pandemic

Introducción: la pandemia por SARS-CoV-2 ha causado cambios en la formación médica a nivel mundial. Se han suspendido todas las actividades presenciales buscando reducir el contagio y, además, dada la creciente demanda hospitalaria, ha generado la necesidad de buscar nuevas formas de mantener la docencia y a la vez, balancear ésta con las necesidades hospitalarias. Desarrollo: revisamos la experiencia de estudiantes de medicina en otros países, tanto las similitudes como diferencias respecto a lo vivido en Chile, bajo nuestra formación. El interno de medicina, a diferencia del estudiante o del médico, se encuentra en un rol intermedio como práctica profesional y consideramos que tiene un rol positivo en el apoyo a los servicios de salud durante la crisis actual. Presentamos nuestra experiencia como internos de medicina voluntarios en los distintos campos clínicos que se encuentran bajo el alero de nuestra universidad y como hemos experimentado la creciente sobrecarga hospitalaria, incertidumbre, soledad y experiencia con la muerte en nuestra práctica. Conclusión: la experiencia como internos durante esta pandemia y como voluntarios en los distintos servicios de nuestros campos clínicos ha alterado profundamente nuestra formación médica. Nos ha permitido interiorizarnos no solo en aspectos técnicos, sino también en el área más humana de la medicina, en aprender sobre trabajo en equipo, la incertidumbre y el fin de la vida. Creemos que todo esto nos ha preparado y nos ha dado una experiencia invaluable para nuestra futura práctica médica.

Introduction: The SARS-Cov-2 pandemic has changed medical training worldwide. All face-to-face activities have been suspended seeking to reduce contagion, and also, given the growing hospital demand, it has generated the need to find new ways to keep tea-ching and, at the same time, balance it with hospital needs. Body: We review the experience of medical students in other countries, both similarities and differences from what has been experienced in Chile under our training. Medical interns, unlike other students or physicians, are in an intermediate role in their professional practice, and we consider that we have a positive role in supporting health services during the current crisis. We present our experience as volunteer medical interns in the different clinical facilities that are as-sociated with our university and how we have experienced the increasing hospital overload, uncertainty, loneliness, and experience with death in our practice. Conclusion: The experience as interns during this pandemic and as volunteers in the different departments from our clinical facilities has profoundly affected our medical training. It has allowed us to understand not only technical aspects but also the most humanitarian areas of medicine, by learning about teamwork, living with uncertainty, and the end of life. We believe that all of this has prepared us and given us invaluable experience for our future medical practice.

Complement Component C3 Participates in Early Stages of Niemann-Pick C Mouse Liver Damage.

Niemann-Pick type C (NPC), a lysosomal storage disorder, is mainly caused by mutations in the NPC1 gene. Niemann-Pick type C patients and mice show intracellular cholesterol accumulation leading to hepatic failure with increased inflammatory response. The complement cascade, which belongs to the innate immunity response, recognizes danger signals from injured tissues. We aimed to determine whether there is activation of the complement system in the liver of the NPC mouse and to assess the relationship between C3 activation, a final component of the pathway, and NPC liver pathology. Niemann-Pick type C mice showed high levels of C3 staining in the liver which unexpectedly decreased with aging. Using an inducible NPC1 hepatocyte rescue mouse model, we restored NPC1 expression for a short time in young mice. We found C3 positive cells only in non-rescued cells, suggesting that C3 activation in NPC cells is reversible. Then, we studied the effect of C3 ablation on NPC liver damage at two postnatal time points, P56 and P72. Deletion of C3 reduced the presence of hepatic CD68-positive cells at postnatal day 56 and prevented the increase of transaminase levels in the blood of NPC mice. These positive effects were abrogated at P72, indicating that the complement cascade participates only during the early stages of liver damage in NPC mice, and that its inhibition may serve as a new potential therapeutic strategy for the disease.

Papel del digestólogo en el manejo del paciente obeso / Role of the gastroenterologist in the management of the obese patient

La obesidad es una enfermedad con una elevada prevalencia a nivel mundial en la que el digestólogo puede tener una labor importante. Por una parte, algunas enfermedades digestivas son más frecuentes en este grupo de pacientes y es posible que sea necesario evaluarlos antes de la cirugía. Por otra, la cirugía bariátrica puede presentar complicaciones digestivas a corto y largo plazo en las que sea imprescindible nuestra actuación. Además, no podemos olvidar el papel que el tratamiento endoscópico puede tener en la pérdida de peso. El objetivo de la presente revisión es destacar el papel del digestólogo en el manejo del paciente obeso candidato y/o sometido a tratamiento quirúrgico o endoscópico de la obesidad (AU)

Abstract Obesity is a highly prevalent disease worldwide, and one in which gastroenterologists can play an important role. Some digestive diseases are more common in obese patients, and preoperative evaluation may be required in some cases. Additionally, bariatric surgery can lead to digestive complications in the short and long term that require intervention, and endoscopic treatment can be an important factor in weight loss. The aim of this review is to highlight the role of the gastroenterologist in the management of obese patients who are either scheduled for or have undergone surgical or endoscopic treatment for obesity (AU)

Role of the gastroenterologist in the management of the obese patient. / Papel del digestólogo en el manejo del paciente obeso.

Obesity is a highly prevalent disease worldwide, and one in which gastroenterologists can play an important role. Some digestive diseases are more common in obese patients, and preoperative evaluation may be required in some cases. Additionally, bariatric surgery can lead to digestive complications in the short and long term that require intervention, and endoscopic treatment can be an important factor in weight loss. The aim of this review is to highlight the role of the gastroenterologist in the management of obese patients who are either scheduled for or have undergone surgical or endoscopic treatment for obesity.

[Our experience with the Nesbit technique for the treatment of Peyronie's disease]. / Nuestra experiencia en la enfermedad de Peyronie con la técnica de Nesbit.

OBJECTIVES: The Nesbit technique is the reference technique for the surgical correction of the penile incurvation of Peyronie's disease. We report our experience at the Centro Urológico San Ignacio. METHODS: 68 patients with stable penile incurvation who requested surgical correction. Correction of the curvature is defined as > or = 80% rectification of the pathologic angle. Mean patient age was 44 years (31-77). 53% of the patients presented difficulties for penetration, 20% partner's discomfort on intercourse, and 27% requested surgery for aesthetic reasons. Penile deviation was dorsal in 42% of the patients, to the left in 46% and to the right in 12%. The curvature angle was less than 30 degrees in 28%, between 30 degrees-45 degrees in 36%, between 45 degrees-60 degrees in 37% and > 60 degrees in 7%. RESULTS: Mean follow-up of the series was 36 months. 20% of the patients had a penile shortening longer than 1.5 cm. 85% of the patients are satisfied with the results. The most frequent complaint was penile shortening. Correction was achieved in 92% of the patients. Four patients were reoperated: two of them for significant phimosis three months after surgery, and the other two for curvature recurrence. CONCLUSIONS: The Nesbit technique is a simple technique, with a low complication rate, and good results both in curvature correction and patient satisfaction.

Nuestra experiencia en la enfermedad de Peyronie con la técnica de Nesbit / Our experience with the Nesbit technique for the treatment of Peyronie´s disease

OBJETIVO: La técnica de Nesbit esa la técnica de referencia en la cirugía correctora de la incurvaciónpenenana en la enfermedad de Peyronie. Presentamos nuestra experiencia en el Centro Urológico san Ignacio.MÉTODO: 68 pacientes con incurvación peneana establey que deseaban corrección quirúrgica de la misma. Se considera corrección de la curvatura cuando la rectificaciónes igual o superior al 80% de la angulación patológica. La edad media de los pacientes es de 44 años (31-77). Un 53% presentaban dificultad para la penetración, un 20% molestias en su pareja, un 27% se intervinieron por razones estéticas. La desviación peneanaera dorsal en el 42%, izquierda en el 46% y derecha en el 12%. El ángulo de incurvación medido en grados era menor de 30º en el 28%, entre 30 y 45 en el 36%, entre 45 y 60 en el 37% y mayor de 60% en el 7%.RESULTADOS: El seguimiento medio de la serie es de 46 meses. Acortamiento peneano superior a 1,5 cm en el 20% de los enfermos. El 85% de los enfermos están satisfechos con los resultados obtenidos. La queja más frecuente es el acortamiento peneano. Se ha corregidola desviación en el 92% de los pacientes. Hemos reintervenido a cuatro pacientes, A dos por fimosis marcadaa los tres meses de la intervención, los otros dos enfermos presentaron recidiva de la curvatura.CONCLUSIONES: La técnica de Nesbit es una técnica sencilla, con escasas complicaciones y buenos resultadostanto en corrección de curvatura como en satisfaccióndel enfermo

OBJECTIVES: The Nesbit technique is the reference technique for the surgical correction of the penile incurvation of Peyronie’s disease. We report our experience at the Centro Urológico San Ignacio.METHODS: 68 patients with stable penile incurvation who requested surgical correction. Correction of the curvature is defined as ≥ 80% rectification of the pathologic angle. Mean patient age was 44 years (31-77). 53% of the patients presented difficulties for penetration, 20% partner`s discomfort on intercourse, and 27% requested surgery for aesthetic reasons. Penile deviation was dorsal in 42% of the patients, to the left in 46% and to the right in 12%. The curvature angle was less than 30 ° in 28%, between 30º-45 ° in 36%, between 45 °-60 ° in 37% and > 60 ° in 7%.RESULTS: Mean follow-up of the series was 36 months. 20% of the patients had a penile shortening longer than 1.5 cm. 85% of the patients are satisfied with the results. The most frequent complaint was penile shortening.Correction was achieved in 92% of the patients. Four patients were reoperated: two of them for significantphimosis three months after surgery, and the other two for curvature recurrence.CONCLUSIONS: The Nesbit technique is a simpletechnique, with a low complication rate, and good results both in curvature correction and patient satisfaction

Leiomioma vesical en paciente varón de diecisiete años / Bladder leiomyoma in a 17-year-old male patient

OBJETIVO: El leiomioma vesical es untumor de presentación rara, cifrándose su frecuencia enla literatura en menos de un 1% MÉTODO: Presentamos el caso de un varón de 17años, con dos pequeñas neoformaciones vesicales descubiertaspor hematuria y clínica irritativa miccional.RESULTADOS: Tras RTU de la lesión es diagnosticadode leiomioma vesical, sin recidiva en el periodo deseguimiento.CONCLUSIONES: El leiomioma vesical es un tumorbenigno, por lo que hay que realizar cirugía lo másconservadora posible. En la revisión realizada de lasrevistas urológicas españolas, es el caso más joven presentadohasta ahora

OBJECTIVES: Bladder leiomyoma is a rare tumor, its frequency being estimated below 1%. METHODS: We report the case of a 17-year-old male patient presenting with hematuria and lower urinary tract irritative symptoms whose work up discovered two small bladder tumors. RESULTS: After TUR of the lesions the diagnosis of bladder leiomyoma was established; no recurrences have appeared on follow-up. CONCLUSIONS: Bladder leiomyoma is a benign tumor, therefore surgery should be the most conservative. Bibliographic review of the Spanish urologic journals shows that this is the youngest patient reported to date

[Bladder leiomyoma in a 17-year-old male patient]. / Leiomioma vesical en paciente varón de diecisiete años.

OBJECTIVES: Bladder leiomyoma is a rare tumor, its frequency being estimated below 1%. METHODS: We report the case of a 17-year-old mole patient presenting with hematuria and lower urinary tract irritative symptoms whose work up discovered two small bladder tumors. RESULTS: After TUR of the lesions the diagnosis of bladder leiomyoma was established; no recurrences have appeared on follow-up. CONCLUSIONS: Bladder leiomyoma is a benign tumor, therefore surgery should be the most conservative. Bibliographic review of the Spanish urologic journals shows that this is the youngest patient reported to date.

[Erectile dysfunction in those under 40. Etiological and contributing factors]. / Disfunción eréctil en menores de 40 años. Factores etiológicos y contribuyentes.

OBJECTIVES: Although not very frequent, erectile dysfunction (ED) in patients younger than 40 years represents a disease to be kept in mind in our sanitary area. We propose a study of the various risk factors identified in this population group. METHODS: We studied a total of 736 patients with diagnosis of ED following our protocol, using as inclusion criteria being between 19 and 40 years of age. In this group, we have studied the incidence of various risk factors associated with the disease both globally and dividing the group into age subgroups also. RESULTS: Overall, we have diagnosed 64 patients with ED under the age of 40 years (8.7%). 25 of these patients were classified as psychogenic origin dysfunctions (39%), 26 organic (40.7%), and 13 of mixed origin (20.3%). Age subgroups analysis shows: between 19 and 25 years: 7 psychogenic, 2 mixed, and 5 organic; between 26 and 30: 1 psychogenic, 2 mixed, and 3 organic; between 31 and 35: 7 psychogenic, 3 mixed, and 8 organic; between 36 and 40: 11 psychogenic, 6 mixed, and 9 organic. We identified as risk factors, in order of prevalence: psychogenic (47%), diabetes (14.6%), cardiovascular (9.7%), toxic-alcohol, tobacco, and drugs--(12.1%), neurogenic (4.8%), and others (7.3%). CONCLUSIONS: ED under the age of 40 years causes a growing demand of medical care day by day, mainly due to the increasing prevalence of its etiologic factors. As other publications have shown psychogenic factors are the most frequently associated with the disease in younger patients globally, although when dividing by age groups we found different results than other publications in terms of association with various risk factors.

Disfunción eréctil en menores de 40 años. Factores etiológicos y contribuyentes / Erectile dysfunction in patients younger than 40 years. Etiologic and contributing factors

OBJETIVO: La disfunción eréctil (DE) en menores de 40 años aunque no demasiado frecuente representa una afección a tener en cuenta en nuestra área sanitaria. Proponemos un estudio de los diferentes factores de riesgo identificados en este grupo de población. MÉTODOS: Estudiamos un total de 736 pacientes diagnosticados de según nuestro protocolo, utilizando como criterios de inclusión a aquellos pertenecientes al intervalo de edad comprendido entre 19 y 40 años. En este grupo hemos estudiado la incidencia de los diferentes factores de riesgo asociados con la enfermedad de manera global y también subdividiendo al grupo en subgrupos de edades. RESULTADOS: Globalmente, hemos diagnosticado un total de 64 pacientes con DE por debajo de 40 años de edad (8,7 por ciento. 25 de estos enfermos los hemos catalogado como disfunciones de origen psicógeno (39 por ciento), 13 con origen mixto (20,3 por ciento) y 26 como orgánicas (40,7 por ciento).Analizando por subgrupos de edades: entre 19 y 25 años: 7 psicógenas, 2 mixtas y 5 orgánicas; entre 26 y 30: 1 psicógena, 2 mixtas y 3 orgánicas; entre 31 y 35: 7 psicógenas, 3 mixtas y 8 orgánicas; entre 36 y 40: 11 psicógenas, 6 mixtas y 9 orgánicas. Como factores de riesgo en orden de prevalencia hemos identificado: psicógenos (47 por ciento), diabetes (14,6 por ciento), cardiovasculares (9,7 por ciento), tóxicos: alcohol, tabaco y fármacos (12,1 por ciento), neurogénicos (4,8 por ciento) y otros (7,3 por ciento).CONCLUSIONES: La DE en menores de 40 años ocasiona cada vez mayor aumento de la demanda de asistencia médica fundamentalmente debido al incremento en la prevalencia de sus factores etiológicos. En consonancia con otras publicaciones los factores psicógenos globalmente son los más frecuentemente asociados a esta enfermedad en pacientes jóvenes, si bien por subgrupos de edades tenemos resultados encontrados con otras publicaciones en cuanto a la asociación con los diferentes factores de riesgo (AU)

Enteritis eosinófila / Eosinofilic enteritis

Se sometió a un varón de 34 años, a un estudio endoscópico digestivo alto, debido a un dolor epigástrico, náuseas y diarrea de dos meses de evolución que no correspondía a medidas habituales de tratamiento. Se demostró un 70 por ciento de eosinófilos en sangre perférica. El estudio de vasculitis, enfermedades parasitarias y alérgicas fue negativo. Una biopsia de lesiones granulares duodenales, demostró un intenso infiltrado eosinófilo. Después de 40 días de terapia esteroidal el aspecto endoscópico e histológico fue normal.

Enfermedades autoinmunes en pacientes portadores de vitíligo / Autoimmune disease in patients with vitiligo

Se estudió 51 pacientes procedentes de Lima y otros lugares del Perú con vitíligo, enfermedad idiopática adquirida, que resulta de la destrucción gradual de melanocitos y disturbios inmunológicos. Los objetivos fueron establecer el diagnóstico temprano de otras enfermedades autoinmunes asociadas y realizar la correlación clínico patológica, incluyendo los antecedentes familiares. Se estudió autoanticuerpos circulantes e inmunomicroscopía de la biopsia de piel. El vitíligo más frecuente fue el generalizado vulgaris. El 33,3 por ciento del total de casos presentó otra enfermedad autoinmune asociada y el 37,2 por ciento, enfermedad por hipersensibilidad I. El 19,6 por ciento de familiares cercanos tuvieron vitíligo y 31,2 por ciento, otras enfermedades por autoinmunidad.