Knowledge and attitudes of health professionals in Chile towards people living with human immunodeficiency virus: A cross-national survey.

Introduction: People living with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) often experience discrimination from both other individuals and the health personnel who care for them. Chile has experienced a marked increase in the number of new HIV cases.Methods: Prospective cross-sectional study. The HIV/AIDS questionnaire for providers and health personnel was obtained from the International Planned Parenthood Federation, initially carrying out a pilot test and evaluating its validity.Results: A total of 784 health professionals answered the questionnaire correctly. Among them, 68.4% (n = 536) were women, and 36.2% (n = 284) were physicians. The study revealed that more than 90% of respondents had a positive attitude towards caring for people living with HIV, and more than 75% did not mind buying food from them or sharing services with them. Furthermore, more than 99% rejected the religiously endorsed labeling of people living with HIV/AIDS as immoral. Additionally, 95.5% (n = 749) mentioned that they did not feel anxious about knowing whether the next patient on their care list was living with HIV, and 76.9% (n = 603) of the respondents felt safe taking blood samples.Conclusions: Chilean health professionals have good knowledge about HIV infection and its mode transmission. Their attitudes towards people living with HIV are also generally positive.

Relationship between Duffy Genotype/Phenotype and Prevalence of Plasmodium vivax Infection: A Systematic Review.

The Duffy protein, a transmembrane molecule, functions as a receptor for various chemokines and facilitates attachment between the reticulocyte and the Plasmodium Duffy antigen-binding protein. Duffy expression correlates with the Duffy receptor gene for the chemokine, located on chromosome 1, and exhibits geographical variability worldwide. Traditionally, researchers have described the Duffy negative genotype as a protective factor against Plasmodium vivax infection. However, recent studies suggest that this microorganism's evolution could potentially diminish this protective effect. Nevertheless, there is currently insufficient global data to demonstrate this phenomenon. This study aimed to evaluate the relationship between the Duffy genotype/phenotype and the prevalence of P. vivax infection. The protocol for the systematic review was registered in PROSPERO as CRD42022353427 and involved reviewing published studies from 2012 to 2022. The Medline/PubMed, Web of Science, Scopus, and SciELO databases were consulted. Assessments of study quality were conducted using the STROBE and GRADE tools. A total of 34 studies were included, with Africa accounting for the majority of recorded studies. The results varied significantly regarding the relationship between the Duffy genotype/phenotype and P. vivax invasion. Some studies predominantly featured the negative Duffy genotype yet reported no malaria cases. Other studies identified minor percentages of infections. Conversely, certain studies observed a higher prevalence (99%) of Duffy-negative individuals infected with P. vivax. In conclusion, this systematic review found that the homozygous Duffy genotype positive for the A allele (FY*A/*A) is associated with a higher incidence of P. vivax infection. Furthermore, the negative Duffy genotype does not confer protection against vivax malaria.

Evolution of Plasmodium vivax and resistance patterns for infection based on Duffy genotype and phenotype.

The Duffy protein, a transmembrane molecule, acts as a receptor for various chemokines and facilitates binding between reticulocytes and the Plasmodium Duffy antigen binding protein. Duffy expression is associated with the Duffy chemokine receptor antigen genotype on chromosome 1 and exhibits variation across different geographic regions. Traditionally, the Duffy negative genotype and phenotype have been described to confer a certain level of protection against infection and symptom development. However, recent data suggest a shift in this behavior, with significantly higher prevalence observed in individuals with Duffy negative genotype or phenotype. Given that malaria is an endemic vector-borne disease in regions of Asia, Africa, and Latin America, posing a substantial global burden of disease and prioritizing public and global health, identifying evolutionary changes in infection and resistance patterns holds great importance for the design of strategies and reevaluation of conventional interventions. Hence, the aim of this review was to analyze the evolution of Plasmodium vivax and infection resistance patterns based on Duffy genotype and phenotype. The distribution of genotypes, phenotypes, and polymorphisms of P. vivax ligands and erythrocyte receptors varies geographically, notably resistance patterns of this microorganism in individuals with Duffy negative genotype and phenotype have significantly changed compared to studies conducted 30 years ago. The prevalence of vivax malaria in individuals with a Duffy negative status can reach up to 100%. Consequently, prioritizing research on this topic is essential for public health.

Beneficios del consumo de dieta mediterránea en individuos con elevado riesgo cardiovascular: un patrón que debe convertirse en el común denominador

Las enfermedades cardiovasculares siguen siendo la principal causa de morbilidad y mortalidad en el mundo. Y aunque existen herramientas terapéuticas y farmacológicas que ayudan a controlar la incidencia de desenlaces cardiovasculares con la reducción del riesgo cardiovascular, las inequidades en el acceso oportuno a servicios de salud y de determinantes sociales de la salud impiden que toda la población con esta necesidad pueda recibir esta ayuda terapéutica. Es así, como se da prioridad a las intervenciones no farmacológicas, dentro de las que se destaca, la dieta, la cual ha demostrado influir significativamente en la salud cardiovascular y en la expectativa de vida del ser humano. Particularmente, la dieta mediterránea, basada esencialmente en el consumo de frutas, vegetales, granos, legumbres, aceite de oliva, especias, seguido de proteína derivada de pescado y comida de mar, ha demostrado proveer cierto grado de protección frente a enfermedades cardiometabólicas. Sin embargo, se desconoce con certeza cuál es el impacto en la población con elevado riesgo cardiovascular y, por ende, enfermedad cardiovascular establecida. Considerando la evolución de la evidencia en los patrones dietarios, así como la necesidad de conocer qué tanto impactan las dietas viables en nuestro medio, sobre todo en aquellos con mayor riesgo de morbilidad y mortalidad por enfermedad cardiovascular, el objetivo de esta revisión consiste en exponer evidencia actualizada sobre los beneficios de la dieta mediterránea en individuos con elevado riesgo cardiovascular. Para esto, se realizó una búsqueda bibliográfica en las bases de datos PubMed, Science Direct y Scielo.

Cardiovascular diseases continue to be the leading cause of morbidity and mortality worldwide. Although there are therapeutic and pharmacological tools that help control the incidence of cardiovascular outcomes by reducing cardiovascular risk, inequities in timely access to healthcare services and social determinants of health prevent the entire population in need from receiving this therapeutic assistance. Thus, non-pharmacological interventions are prioritized, among which the diet stands out, as it has been shown to significantly influence cardiovascular health and life expectancy. Particularly, the Mediterranean diet, primarily based on the consumption of fruits, vegetables, grains, legumes, olive oil, spices, followed by fish and seafood-derived protein, has demonstrated a certain degree of protection against cardiometabolic diseases. However, the impact on a population with high cardiovascular risk and established cardiovascular disease remains uncertain. Considering the evolving evidence on dietary patterns and the need to understand how viable diets in our context affect individuals with a higher risk of morbidity and mortality from cardiovascular disease, the objective of this review is to present updated evidence on the benefits of the Mediterranean diet in individuals with high cardiovascular risk. For this purpose, a literature search was performed in the PubMed, Science Direct, and Scielo databases.

Terapia de estrógenos vaginales y riesgo de recurrencia en mujeres con antecedente de cáncer de mama

El cáncer de mama sigue siendo la neoplasia maligna más frecuente y una de las mortales en mujeres, considerándose un importante objetivo de la salud global y prioridad en salud pública. Con el uso de terapias innovadoras, ha mejorado la supervivencia, apareciendo condiciones asociadas, como el síndrome genitourinario menopaúsico. La terapia hormonal, se utiliza para el manejo de esta condición, mejorando sustancialmente la sintomatología, e incluso, siendo en algunos casos la única solución. La más utilizada, es la terapia de estrógenos vaginales. Sin embargo, se ha descrito un posible riesgo de recurrencia de cáncer de mama con su uso. En habla hispana, no existe evidencia que haya discutido este tópico. Se llevó a cabo una búsqueda en las bases PubMed, ScienceDirect y MEDLINE, utilizando los términos "Terapia de estrógenos vaginales", "Recurrencia" y "Cáncer de mama". Se encontró, que, de forma global, la terapia de estrógenos vaginales es una opción terapéutica eficaz y segura en el manejo del síndrome genitourinario menopaúsico en mujeres con antecedente de cáncer de mama, sin incrementar el riesgo de recurrencia, a excepción de aquellas tratadas con inhibidores de la aromatasa, en quienes se recomienda el uso de otras terapias para evitar acarrear este riesgo.

Breast cancer remains the most common malignant neoplasm and one of the leading causes of mortality in women, making it a significant target for global health efforts and a public health priority. Through the use of innovative therapies, survival rates have improved, leading to the emergence of associated conditions such as genitourinary menopausal syndrome. Hormonal therapy is employed for managing this condition, significantly alleviating its symptoms and, in some cases, serving as the sole solution. The most commonly utilized approach is vaginal estrogen therapy. Nevertheless, there have been reports of a potential risk of breast cancer recurrence associated with its use. In the Spanish-speaking context, there is limited evidence discussing this topic. A search was conducted across PubMed, ScienceDirect, and MEDLINE databases, using the terms "Vaginal Estrogen Therapy", "Recurrence" and "Breast Cancer." It was determined that, on a global scale, vaginal estrogen therapy is an effective and safe therapeutic option for managing genitourinary menopausal syndrome in women with a history of breast cancer. This therapy does not appear to increase the risk of recurrence, with the exception of those undergoing treatment with aromatase inhibitors. For these individuals, alternative therapies are recommended to mitigate this potential risk.

Research and Publication Trends in Pediatric Surgery in Latin America: A Bibliometric and Visual Analysis from 2012 to 2021.

INTRODUCTION: Pediatric surgery is a developing specialty with increasing volume in Latin America. However, the research and scientific activity trends carried out in this region in recent years are unknown. This study aimed to analyze and visualize Latin American research in pediatric surgery from 2012 to 2021. MATERIAL AND METHODS: Bibliometric cross-sectional study of scientific articles on pediatric surgery published by Latin American authors from 2012 to 2021 in Scopus was performed. Statistical and visual analysis was performed with R programming language and VOS viewer. RESULTS: 449 articles were found. Observational studies (44.7%; n = 201), case reports (20.4%; n = 92) and narrative reviews (11.4%; n = 51) were found to be the most common study designs. The published articles were predominantly monocentric (73.1%; n = 328), only 17% (n = 76) involved authors from 2 or more countries, and mostly there was no collaboration with high-income countries (80.6%; n = 362). The Journal of Pediatric Surgery was the journal with the highest volume of articles published (n = 37). The most used terms were Laparoscopy, Complications, and Liver Transplantation, and the countries with the highest number of articles published were Brazil and Argentina. CONCLUSIONS: This study found a progressive increase in the scientific activity of Latin authors in pediatric surgery from 2012 to 2021. The evidence produced was mainly from observational studies and case reports, predominantly conducted in Brazil. Multinational and international collaboration was low; the most frequent topics of interest were laparoscopy and minimally invasive surgery. LEVELS OF EVIDENCE: IV.

Surgical research in Colombia part 3: Authorship and publications of Colombian medical students in surgery in Colombian medical journals-cross-sectional study.

Research training, scientific activity and publications are cornerstones of academic surgery. Knowing the activity and trends of medical students aspiring to become surgeons it allows to identify gaps and skills to be strengthened. Currently, there is no data on the authorship and scientific activity of medical students in surgery in Latin America and Colombia. Methods: A bibliometric cross-sectional study was carried out, in which the Colombian medical journals were reviewed from 2010 to 2020. The articles with topics in general surgery and subspecialties where the authorship of medical students could be identified, were selected. Data on the sociodemographic and scientific characteristics of the authors and their publications were extracted and analyzed. Results: A total of 14 383 articles from 34 Colombian medical journals were reviewed. From 2010 to 2020, 807 articles related to surgery were published in Colombia. The most frequent typology of these articles was original articles (n=298; 37%), followed by case reports (n=222; 28.2%) and reviews (n=137; 17.3%). A total of 132 medical students and 141 authorships and were found, specifically in 9.9% (n=80/807) of these publications, with a higher frequency in original articles (n=32; 40%) and case reports (n=29; 36.2%). Collaboration of students with professors or surgeons was evidenced in 97.5% of the publications. Conclusions: The authorship of Colombian medical students in scientific publications in surgery in Colombian medical journals was low. From 2010 to 2020, student authors were found in 1 out of every 10 publications, mainly in original articles and clinical cases.

Postoperative outcomes using Lichtenstein open hernioplasty versus Nyhus preperitoneal hernioplasty in inguinal hernia: A comparative analysis with 1-year follow-up.

Background and Aim: Inguinal hernia is the most common defect of the abdominal wall in 75% and their treatment consists of surgical repair. The technique of choice is laparoscopic because of its overall benefits. However, when this is not available, open approaches may be a viable option. Currently, the most commonly used open techniques are Lichtenstein and Nyhus. However, there are few medium- or long-term studies that have compared outcomes between these two techniques. Methods: This is a retrospective comparative study that included patients undergoing open inguinal hernia correction with mesh, using Lichtenstein open hernioplasty versus Nyhus preperitoneal hernioplasty, in two tertiary referral centers in Bogota, Colombia, during a period of 2 years. A bivariate analysis was performed to compare groups, according to the complications presented between the two techniques. Results: A total of 193 patients were included, of whom 53.36% were men and 112 (58.03%) were approached with the Nyhus technique versus 81 patients with the Lichtenstein technique. Nonabsorbable suture fixation was performed in 100% of patients. Among the main complications, seroma (5.18%), pain (4.14%), bleeding (2.07%), recurrence (10.88%), and reoperation (0.51%) were observed, of which only recurrence showed a statistically significant difference, which is lower in the Nyhus approach (3.57% vs. 20.67%; p < 0.001). No patients died. Conclusions: Both Nyhus and Lichtenstein hernioplasty techniques were shown to cause a low incidence of postoperative complications, with significantly lower recurrence using the Nyhus technique up to 1 year postoperatively.

Knowledge, attitudes and experience of physicians working in Chile toward the prescription of pre-exposure prophylaxis (PrEP): A cross-national survey.

BACKGROUND: Pre-exposure prophylaxis (PrEP) involves administering antiretroviral drugs to prevent human immunodeficiency virus (HIV) infection in at-risk subjects. Chile is considered one of the countries with the highest number of new cases per year of HIV infections. METHODS: A nationwide cross-sectional study was carried out in Chile. A questionnaire of physicians' attitudes toward the prescription of PrEP was used. RESULTS: 632 doctors responded correctly the survey. 58.5% (n = 370) were women, and median age was 34 years (IQR 25-43). 55.4% (n = 350) responded that they have never prescribed antiretrovirals for HIV-negative individuals to prevent HIV infection, and only 10.1% have prescribed PrEP. 60.8% (n = 384) mentioned having informed about the possibility of using antiretroviral post-exposure prophylaxis in case of risky sexual activity. 76.3% (n = 482) believed each institution should formulate internal protocols for administering these drugs, and 98.4% (n = 622) stated that with the currently available evidence, PrEP should be suggested to cope with the HIV pandemic. CONCLUSION: It was concluded that knowledge, attitudes and experience toward PrEP prescribing are variable and related to patient care. However, Chile has a marked tendency in favor of this therapy, which is similar to that reported in studies worldwide.

Riesgo cardiovascular en pacientes recuperados de COVID-19 a corto y mediano plazo: ¿qué concluye la evidencia actual?

El riesgo y enfermedades cardiovasculares en pacientes recuperados de COVID-19 es un campo de análisis reciente en la literatura médica mundial y de vital importancia, porque existe una gran cantidad de pacientes con complicaciones una vez terminada la fase aguda de la enfermedad. El gran espectro del daño al miocardio en esta enfermedad puede variar desde una elevación asintomática de los niveles de troponinas cardíacas, hasta la aparición de una miocarditis fulminante y/o shock circulatorio, lo que puede dejar secuelas significativas. A pesar de que no existe una estrategia clara para abordar los eventos cardíacos que aparecen durante la COVID-19, y teniendo en cuenta que el manejo se hace principalmente para controlar los síntomas del paciente a medida que surgen, el objetivo de este trabajo fue conocer y recopilar la evidencia actual en esta temática, de tal manera que se pueda ofrecer al lector una guía de consulta en español que contribuya al desarrollo de su profesión sanitaria. La metodología utilizada fue una búsqueda de literatura en bases de datos como Medline, Scopus, Science Direct, con una ventana de tiempo entre 2019 y 2022. Los principales resultados revelaron que dentro de los mecanismos moleculares y fisiopatológicos implicados en este síndrome pos-COVID, se encuentra la afectación del sistema renina-angiotensina-aldosterona, al estar ligado el tropismo del SARS-Cov-2 a la enzima convertidora de angiotensina 2. Esto ocasiona una alteración de la respuesta neuro-humoral del sistema cardiovascular, renal y digestivo, lo que genera déficit en las vías de señalización y ocasiona lesión directa sobre corazón, pulmones y otros órganos. El síndrome pos-COVID-19, en general, se define como la aparición o persistencia de los síntomas posteriores a 3 o 4 semanas de aparecida la fase aguda de la enfermedad. Entonces, esta podría considerarse como una ventana de tiempo de riesgo y seguimiento estricto, para valorar de forma personalizada el riesgo entre los distintos grupos de pacientes, sobre todo de aquellos con antecedentes personales de enfermedad cardiovascular. Los principales resultados revelaron la presencia de trastornos como la insuficiencia cardiaca, las arritmias, la pericarditis y la miocarditis, que requieren de detección precoz y que se presentan días e incluso semanas posteriores a la fase aguda de la COVID-19.

Cardiovascular risk and diseases among patients recovered from COVID-19 is a recent field of study in the world medical literature and is also of vital importance because a large number of patients develop complications once the acute phase of the disease is over. The broad spectrum of myocardial injury in cardiovascular diseases can range from the asymptomatic elevation of cardiac troponin levels to the development of fulminant myocarditis and/or circulatory shock, which can leave significant sequelae. Despite the fact that there is no clear strategy to treat cardiac events that occur during COVID-19 infection and taking into account that treatment is mainly aimed at relieving patients' symptoms as they arise, the objective of this work was to find out and collect current evidence on this subject, so that readers can be offered a reference guide in Spanish that contributes to the development of their health profession. The methodology used was a literature search in databases including Medline, Scopus and ScienceDirect within a time window between 2019 and 2022. The main results revealed that the molecular and pathophysiological mechanisms involved in post-COVID-19 syndrome include the renin-angiotensin-aldosterone system since SARS-CoV-2 tropism is linked to angiotensin-converting enzyme 2. This causes an alteration of the neurohumoral response of the cardiovascular, renal and digestive systems, generating deficits in the signaling pathways and causing direct damage to the heart, lungs and other organs. PostCOVID-19 syndrome, in general, is defined as the occurrence or persistence of symptoms three or four weeks after the acute phase of the disease. This could then be considered as a time window of risk and strict follow-up to assess in a personalized way the risk among the different groups of patients, especially those with a past history of cardiovascular disease. The main results revealed disorders such as heart failure, arrhythmias, pericarditis and myocarditis, which require early detection and occur days or even weeks after the acute phase of COVID-19.

Prophylactic surgical wound management with negative pressure therapy in emergency abdominal surgery: is it really useful? / Manejo profiláctico de herida quirúrgica con terapia por presión negativa en cirugía abdominal de emergencia: ¿realmente es útil?

Mr Editor Infection at the operating site (ISO) is the most common postoperative surgical complication in general surgery. This is more frequent in cases of emergency interventions, compromises the patient's prognosis, causes high health costs, and signicantly increases the risk of reintervention. Negative pressure therapy (NPT) is an innovative strategy that was proposed about two decades ago, and has been gradually replicated around the world. This means that there are still many gaps in the evidence when it is used in many diseases and under different contexts. Nevertheless, it allows obtaining conclusive results in the time of healing, reduction of complications (mainly dehiscence and ISO), decrease in hospital stay, among other factors. In Latin America, there is very little evidence on the use of this strategy, and it is null regarding its use in emergency cases without being able to determine its impact on our environment. Recently, Lakhani et al 3 conducted a meta-analysis of 7 studies with a total of 1199 patients, where they evaluated the ISO rate in patients undergoing emergency laparotomy in whom NPT was used (n=566) vs. control group (standard care, n=633). The NPT group had a lower infection rate (13.6% vs. 25.1%), with a 57-percentage point reduction in the probability of presenting ISO (OR 0.43; 95% CI: 0.30 - 0.62).

Sr Editor La infección en el sitio operatorio (ISO), es la complicación quirúrgica postoperatoria más frecuente en cirugía general. Esta es más frecuente en casos de intervenciones de emergencias, compromete el pronóstico del paciente, ocasiona elevados costos en salud, y aumenta considerablemente el riesgo de reintervención. La terapia por presión negativa (TPN) es una estrategia innovadora que se planteó hace aproximadamente dos décadas, y que se ha reproducido paulatinamente en todo el mundo. Esto ocasiona que aún existan muchos vacíos en la evidencia cuando es utilizada en muchísimas enfermedades y bajo diferentes contextos. No obstante, permite obtener resultados contundentes en el tiempo de cicatrización, disminución de complicaciones (principalmente dehiscencia e ISO), disminución de estancia hospitalaria, entre otros factores.

Predictors for limb amputation in war vascular trauma: A 20-years retrospective analysis from the Colombian armed conflict.

BACKGROUND: The Latin American military vascular trauma is virtually unknown. The aim of this study was to describe severe war vascular trauma during the last 20 years of the Colombian armed conflict, and to identify predictors of limb amputation. METHODS: Retrospective analysis of a follow-up cohort from 1999 to 2019 of patients with associated severe vascular injuries (ISS >15) in the Colombian armed conflict treated at the Hospital Militar Central. RESULTS: Out of 5948 patients, 243 had military vascular trauma with 430 vascular injuries. The most frequent trauma mechanisms were gunshot wounds (n = 153; 63%). The most common injured vessels were femoral. 24 (10%) patients required amputations. Mortality was 4.1%. Amputation was associated with arteriovenous lesions (RR 4.82, p = 0.025), compartment syndrome (RR 4.2, p = 0.007), arteriovenous femoropopliteal injuries (RR 3.5, p = 0.0026), multiple arterial injuries (RR 3.35, p = 0.0218), associated fractures (RR 3.1, p = 0.0032). CONCLUSIONS: Concomitant arteriovenous injuries in popliteal and femoropopliteal lesions, multiple arterial lesions, bone fractures, and compartment syndrome are associated with amputation in severe vascular injury.

[Latin American research in heart failure: visual and bibliometric analysis of the last 20 years]. / Investigación latinoamericana en falla cardiaca: análisis visual y bibliométrico de los últimos 20 años.

Objective: To visually and bibliometrically analyze Latin American research on heart failure in the last 20 years. Materials and methods: A bibliometric study using the Scopus database. A non-systematic search was carried out to collect data, which were analyzed using Bibliometrix, a tool of the R programming language. Results: A total of 10204 documents were included in a period between 2003 to 2023. Of these, 66.9% (n=6824) corresponded to original articles, followed by review articles (15.5%; n=1583). International collaboration was present in 38.41% (n=3919) of the articles. Brazil stood out with the highest number of prolific authors and institutions (70% and 60%, respectively), consolidating its position as leader in the region, followed by Argentina and Mexico. These countries also presented the papers with the highest impact and most outstanding metrics. Conclusions: This study identified a significant increase in heart failure research in Latin America over the last two decades, with Brazil, Argentina, and Mexico being the main drivers of this trend. Extensive and strong collaboration, mainly with high-income countries, appears to be critical to the momentum and the advancement of research in this area. Data systematization and resynchronization therapy are some of the topics of greatest interest at present.