[Scores obtained by physicians in the national health services admission contest between 2016 and 2020]. / Resultados del sistema de puntuación del Concurso Nacional de Ingreso a los Servicios de Salud entre 2016 y 2020.

BACKGROUND: Medical specialists are an essential resource for the functioning of the health system and in Chile there is a growing deficit of these specialists. To address this shortage, the government has strategies for training health professionals, such as a national public contest for medical scholarships, named CONISS, which stands out for its high capacity to produce medical specialists. The scoring system of this contest is used for the allocation of training resources to the best candidates. AIM: To describe the results of the CONISS scoring system between 2016 and 2020. MATERIAL AND METHODS: Analysis of public registries of physicians participating in the CONISS contest between 2016 and 2020. RESULTS: During the study period 7,373 physicians participated in this contest (49% females). Annual participation increased progressively. The participants graduated from 21 Chilean universities and a variable number from foreign universities. The scores obtained by participants improved by 1.47 points between the first and last year of the study period. CONCLUSIONS: Interpretation of these results is complicated by the characteristics and limitations of the measurements of the CONISS scoring system. This precludes establishing whether this system effectively filters out the best candidates for medical specialization programs.

Resultados del sistema de puntuación del Concurso Nacional de Ingreso a los Servicios de Salud entre 2016 y 2020

Background: Medical specialists are an essential resource for the functioning of the health system and in Chile there is a growing deficit of these specialists. To address this shortage, the government has strategies for training health professionals, such as a national public contest for medical scholarships, named CONISS, which stands out for its high capacity to produce medical specialists. The scoring system of this contest is used for the allocation of training resources to the best candidates. Aim: To describe the results of the CONISS scoring system between 2016 and 2020. Material and Methods: Analysis of public registries of physicians participating in the CONISS contest between 2016 and 2020. Results: During the study period 7,373 physicians participated in this contest (49% females). Annual participation increased progressively. The participants graduated from 21 Chilean universities and a variable number from foreign universities. The scores obtained by participants improved by 1.47 points between the first and last year of the study period. Conclusions: Interpretation of these results is complicated by the characteristics and limitations of the measurements of the CONISS scoring system. This precludes establishing whether this system effectively filters out the best candidates for medical specialization programs.

Iniciativas disponibles para el reporte de resultados en investigación biomédica con diferentes tipos de diseño / Initiatives for reporting biomedical research results with different types of designs

La calidad del reporte de los resultados de una investigación no es óptima, razón por la cual, se han desarrollado numerosas iniciativas tendientes a mejorar este aspecto a lo largo de los años. El objetivo de este artículo es mencionar y describir las iniciativas existentes para el reporte de resultados de investigación biomédica en diversos escenarios de investigación clínica y situaciones especiales. Se realizó una búsqueda en las bases de datos THE COCHRANE LIBRARY, MEDLINE, SciELO y Redalyc; y en los buscadores Clinical Evidence, TRIP database, Fisterra, Rafabravo, EQUATOR Network, portal de BIREME y Programa HINARI; para obtener las listas de verificación existentes. Los documentos recuperados fueron agrupados de la siguiente forma: relacionados con escenarios de terapia, diagnóstico, pronóstico, evaluaciones económicas y misceláneas. La búsqueda generó un total de 31 documentos. Doce para escenarios de terapia (CONSORT, QUOROM, MOOSE, STRICTA, TREND, MINCIR-Terapia, RedHot, REHBaR, PRISMA, REFLECT, Ottawa y SPIRIT), 5 para diagnóstico (STARD, QUADAS, QAREL, GRRAS y MINCIR-Diagnóstico), 3 para pronóstico (REMARK, MINCIR-Pronóstico y GRIPS), 4 para evaluaciones económicas (NHS-HTA, CHEERS, ISPOR RCT-CEA y NICE-STA,); y 7 misceláneos (STROBE, COREQ, GRADE, SQUIRE, STREGA, ORION y MINCIR-EOD). Existen diversas iniciativas y declaraciones. Estas deben ser conocidas y utilizadas por escritores, revisores y editores de revistas biomédicas; de forma tal de incrementar la calidad del reporte de resultados de la investigación biomédica.

Quality of results reporting is not perfect, many initiatives tending to improve this aspect of clinical research have been developed in the last decade. The aim of this manuscript is to mention and describe the existent initiatives for reporting biomedical research results in different scenarios and special situations. To obtain check-lists, a search in THE COCHRANE LIBRARY, MEDLINE, SciELO y Redalyc; Clinical Evidence, TRIP database, Fisterra, Rafabravo, EQUATOR Network, BIREME and HINARI Program was developed. Identified documents were grouped in relation with clinical research scenarios (therapy, diagnosis, prognosis and economic evaluations) and miscellaneous. The search allows finding 31 documents. Twelve for therapy (CONSORT, QUOROM, MOOSE,STRICTA, TREND, MINCIR-Therapy, RedHot, REHBaR, PRISMA,REFLECT, Ottawa and SPIRIT), 5 for diagnosis (STARD, QUADAS, QAREL, GRRAS and MINCIR-Diagnosis), 3 for prognosis (REMARK, MINCIR-Prognosis and GRIPS), 4 for economic evaluations (NHS-HTA, CHEERS, ISPOR RCT-CEA and NICE-STA,) and 7 miscellaneous (STROBE, COREQ, GRADE, SQUIRE, STREGA, ORION and MINCIR-EOD). Different initiatives and statements were found. These must be noted and used by writers, reviewers and editors of biomedical journals, in order to improve the quality of reporting results.

Indicaciones y resultados de retrasplante hepático: experiencia del hospital universitario La Fe (1.181 pacientes) / Indications and results of liver retransplantation: experience with 1181 patients in the hospital universitario La Fe

Resumen El retrasplante hepático (ReTH) constituye la única opción terapéutica para el fracaso irreversible de un injerto hepático y corresponde a un 2,9–24,0% de todos los trasplantes hepáticos (TH). Técnicamente es difícil y conlleva un elevado índice de morbilidad inmediata y una menor supervivencia que el TH primario. Nuestro objetivo fue determinar la tasa de ReTH y las indicaciones, morbilidad, mortalidad postoperatoria y supervivencia actuarial del paciente retrasplantado. Pacientes y método Estudio de cohorte histórica de 1.181 pacientes trasplantados entre los años 1991 y 2006.ResultadosDe los 1.260 TH realizados, 79 fueron ReTH. Al momento del primer TH, no hubo diferencias con aquellos pacientes que no necesitaron ReTH. La tasa de ReTH fue del 6,3% y las causas más frecuentes fueron: trombosis de la arteria hepática (31,6%), recidiva de la cirrosis por VHC (30,4%) y fallo primario del injerto (21,5%). Los tiempos de isquemia, síndrome de reperfusión y congestión hepática no difieren entre el TH primario y el ReTH. Por el contrario, la transfusión de hematíes fue mayor en el ReTH (6,3±4,9 vs 3,5±3,0 unidades, p<0,001). La morbilidad y mortalidad postoperatoria (hasta los 30 días posterior al TH) fue mayor en los pacientes retrasplantados (68,4 vs 57,0%, p=0,04 y 25,3 vs 10,9%, p<0,001; respectivamente). La supervivencia actuarial a 1 y 5 años fue 83% y 69% en aquellos sin ReTH, 71% y 61% en ReTH precoz y 64% y 34% en ReTH tardío (p<0,001).Conclusiones Pese a una elevada morbilidad y mortalidad del ReTH, parece que esta alternativa terapéutica continúa siendo válida en aquellos pacientes con una pérdida precoz del injerto hepático. Por el contrario, cuando la pérdida del injerto es tardía, se hace necesario definir, cuales serían los resultados mínimos aceptables para indicar el ReTH y qué pacientes se pueden beneficiar con este tratamiento (AU)

Abstract Liver retransplantation (LrT) is the only therapeutic option for irreversible failure of a hepatic graft and accounts for 2.9&%#x02013;24.0% of all liver transplantations (LT). It is technically difficult and has a high level of immediate morbidity and a lower survival than primary LT. Our aim was to determine the rate of LrT and its indications, morbidity, post-operative mortality and actuarial survival in the retransplanted patient.Patients and method A historical cohort study of 1181 patients transplanted between 1991 and 2006.ResultsOf the 1260 LT performed, 79 were LrT. At the time of the first LT there were no differences between those patients and those that did not require an LrT. The LrT rate was 6.3% and the most frequent causes were: hepatic artery thrombosis (31.6%), recurrence of cirrhosis due the HVC (30.4%) and primary graft (21.5%). The ischemia times, perfusion syndrome and hepatic congestion were no different between the primary LT and the LrT. On the other hand, red cell transfusions were higher in LrT (6.3±4.9 vs. 3.5±3.0 units, P<0.001). The post-operative morbidity and morbidity (up to 30 days after the LT) was higher in retransplanted patients (68.4% vs. 57.0%, P=0.04 and 25.3% vs. 10.9%, P<0.001; respectively). The actuarial survival at 1 and 5 years was 83% and 69% in those without LrT, 71% and 61% in early LrT and 64% and 34% in delayed LrT (P<0.001).Conclusions Despite the increased morbidity and mortality of LrT, it appears that this treatment alternative is still valid in those patients with an early loss of the liver graft. On the other hand, when the graft loss is delayed, it needs to be defined, what would be the minimum acceptable results to indicate LrT and which patients could benefit from this treatment (AU)

[Indications and results of liver retransplantation: experience with 1181 patients at the University Hospital La Fe]. / Indicaciones y resultados de retrasplante hepático: experiencia del hospital universitario La Fe (1.181 pacientes).

UNLABELLED: Liver retransplantation (LrT) is the only therapeutic option for irreversible failure of a hepatic graft and accounts for 2.9%-24.0% of all liver transplantations (LT). It is technically difficult and has a high level of immediate morbidity and a lower survival than primary LT. Our aim was to determine the rate of LrT and its indications, morbidity, post-operative mortality and actuarial survival in the retransplanted patient. PATIENTS AND METHOD: A historical cohort study of 1181 patients transplanted between 1991 and 2006. RESULTS: Of the 1260 LT performed, 79 were LrT. At the time of the first LT there were no differences between those patients and those that did not require an LrT. The LrT rate was 6.3% and the most frequent causes were: hepatic artery thrombosis (31.6%), recurrence of cirrhosis due the HVC (30.4%) and primary graft (21.5%). The ischemia times, perfusion syndrome and hepatic congestion were no different between the primary LT and the LrT. On the other hand, red cell transfusions were higher in LrT (6.3+/-4.9 vs. 3.5+/-3.0 units, P<0.001). The post-operative morbidity and morbidity (up to 30 days after the LT) was higher in retransplanted patients (68.4% vs. 57.0%, P=0.04 and 25.3% vs. 10.9%, P<0.001; respectively). The actuarial survival at 1 and 5 years was 83% and 69% in those without LrT, 71% and 61% in early LrT and 64% and 34% in delayed LrT (P<0.001). CONCLUSIONS: Despite the increased morbidity and mortality of LrT, it appears that this treatment alternative is still valid in those patients with an early loss of the liver graft. On the other hand, when the graft loss is delayed, it needs to be defined, what would be the minimum acceptable results to indicate LrT and which patients could benefit from this treatment.

Diagnostic properties of a symptoms scale for diagnosing reflux esophagitis.

OBJECTIVE: To the objective of the study was to determine accuracy and predictive values of a symptoms scale for diagnosing reflux esophagitis (RE). STUDY DESIGN AND SETTING: Standard criterion study. All recruited patients from two centers in Chile underwent both digestive endoscopy (reference standard) and a symptoms scale known to be valid and reliable for diagnosing gastroesophageal reflux disease. The RE variable was dealt with dichotomously. A receiver operating characteristic curve was constructed. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of the scale were calculated. RESULTS: Two hundred and thirty eight (238) subjects (57.6% female), with an average age of 44.2+/-13.0 years were included. Of these, 57.1% presented with RE. With a cut-off score of six, association was confirmed between the symptoms scale and RE with an odds ratio of 7.26 and a correct classification i.e. diagnostic accuracy of 73.1%. Sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, of 74.3%, 71.6%, 77.7%, 67.6%, 2.61, and 0.36 respectively, were obtained. CONCLUSION: A seven-item symptoms scale when compared to endoscopy as gold standard was useful for diagnosing RE. Using a cutoff of six points, the diagnostic accuracy of the scale was 73.1%.

[Indications and results of liver retransplantations]. / Indicaciones y resultados del retrasplante hepático.

Liver retransplantation (re-LT) is the only therapeutic option for irreversible failure of the graft. It currently makes up 2.9% to 24.0% of all liver transplants. It is technically very difficult and has a high index of immediate complications, underlined by the fact that 50% of the deaths after this procedure occur in the first three months; and that in general, the results of re-LT are worse than those of primary LT. Re-LT can be early (when it is performed during the first 30 days) or delayed. The reasons for early re-LT are: loss of primary function of the graft, complications for technical reasons, acute resistant rejection and infection problems of biliary origin. Those of delayed are: chronic rejection, liver arterial thrombosis, biliary complications and recurrence of the primary disease. In general, when a patient has an irreversible rejection of the graft, the indication for a re-LT is indisputable, but there are discrepancies on whether or not the aetiology of the basic disease has to have a bearing on this. If we take into account the MELD scoring system, when considering the indications for re-LT, this only allows us to predict mortality, but not to give priority on a waiting list. Patients must be retransplanted early, in good physical condition, with a low bilirubin and creatine level; and the donors must be young. Taking into account the continuing increase in mortality as a direct result of the imbalance between the growing number of potential candidates and the number of donors, it seems necessary to define what are the minimally accepted results to indicate a re-LT and thus arrive at a consensus that will help us decide which subject is a candidate to receive it.

Indicaciones y resultados del retrasplante hepático / Indications and results of liver retransplantations

El retrasplante hepático (ReTH) es la única opción terapéutica para el fracaso irreversible del injerto. Actualmente constituye el 2,9-24% de todos los trasplantes hepáticos. Técnicamente es muy difícil y conlleva un elevado índice de complicaciones inmediatas; destaca que el 50% de las muertes tras este procedimiento se produce en los primeros 3 meses y, en general, los resultados del ReTH son peores que los de los TH primarios. El ReTH puede ser precoz (cuando se realiza durante los primeros 30 días) o tardío. Las causas de ReTH precoz son: falta de función primaria del injerto, complicaciones por causas técnicas, rechazo agudo resistente y problemas infecciosos de origen biliar, y las del tardío son: rechazo crónico, trombosis de arteria hepática, complicaciones biliares y recidiva de la enfermedad primaria. En general, cuando un sujeto presenta un fallo irreversible del injerto, la indicación de ReTH no se discute, pero hay discrepancias de si la etiología de la enfermedad de base incidiría o no en ésta. Si al momento de indicar un ReTH consideramos el sistema de puntuación MELD, éste sólo nos permitiría predecir mortalidad, pero no dar prioridad en la lista de espera. El retrasplante deber ser precoz, y los pacientes deben estar en buenas condiciones físicas, con bajas concentraciones de bilirrubina y creatinina, y los donantes deben ser jóvenes. Considerando el incremento progresivo de la mortalidad en lista de espera para TH, como consecuencia directa de un desequilibrio entre el número creciente de potenciales candidatos a trasplante y el número de donantes, parece necesario definir cuáles son los resultados mínimos aceptables para indicar ReTH y llegar así a un consenso que nos ayude a decidir qué sujeto es candidato a recibirlo (AU)

Liver retransplantation (re-LT) is the only therapeutic option for irreversible failure of the graft. It currently makes up 2.9% to 24.0% of all liver transplants. It is technically very difficult and has a high index of immediate complications, underlined by the fact that 50% of the deaths after this procedure occur in the first 3 months; and that in general, the results of re-LT are worse than those of primary LT. Re-LT can be early (when it is performed during the first 30 days) or delayed.The reasons for early re-LT are: loss of primary function of the graft, complications for technical reasons, acute resistant rejection and infection problems of biliary origin. Those of delayed are: chronic rejection, liver arterial thrombosis, biliary complications and recurrence of the primary disease. In general, when a patient has an irreversible rejection of the graft, the indication for a re-LT is indisputable, but there are discrepancies on whether or not the aetiology of the basic disease has to have a bearing on this. If we take into account the MELD scoring system, when considering the indications for re-LT, this only allows us to predict mortality, but not to give priority on a waiting list.Patients must be retransplanted early, in good physical condition, with a low bilirubin and creatine level; and the donors must be young. Taking into account the continuing increase in mortality as a direct result of the imbalance between the growing number of potential candidates and the number of donors, it seems necessary to define what are the minimally accepted results to indicate a re-LT and thus arrive at a consensus that will help us decide which subject is a candidate to receive it (AU)

Expanded criteria for liver transplantation in patients with cirrhosis and hepatocellular carcinoma.

Orthotopic liver transplantation (OLT) selection for patients with hepatocellular carcinoma (HCC) is a matter of debate. The Milan criteria (MC) have been largely adopted by the international community. The main aim of this study was to evaluate the survival rates and recurrence probabilities of a new proposal for criteria (up to 3 tumors, each no larger than 5 cm, and a cumulative tumor burden

[Liver transplant in patients with hepatocellular carcinoma]. / Trasplante hepático en pacientes con carcinoma hepatocelular.

Liver transplant in patients with cirrhosis and hepatocellular carcinoma is indicated in the early stages of the disease, which can be achieved with early detection programs using liver ultrasound. Dynamic imaging techniques (ultrasound with contrast, magnetic resonance and tomography) are essential in the diagnosis of this tumour, being able to type the lesion clearly, and, in the majority of cases, lead to the therapy to follow. Surgery is the treatment of choice in these patients, and liver transplant, from a theoretical point of view, is the best. Currently, the size and number of nodes play an important role in the indication of a transplant. The best liver transplant results are obtained in these patients using the Milan criteria, with survivals that exceed 70% and recurrence indices of 15%, at 5 years. Nowadays we have the possibility of using neo-adjuvant treatments to transplant, such as arterial chemoembolisation, percutaneous ablation techniques, and even liver resection as a bridging technique. The survival of patients transplanted due to liver cancer is similar to that obtained for other non-tumour diseases. In Spain it is 1, 3 and 5 years and 82%, 70% and 60%, respectively. The recurrence is between 6.4% and 16%, micro- and macrovascular invasion being its highest risk variable.

Trasplante hepático en pacientes con carcinoma hepatocelular / Liver transplant in patients with hepatocellular carcinoma

El trasplante hepático para sujetos con cirrosis y carcinoma hepatocelular está indicado en estadios precoces de la enfermedad, que se puede conseguir con programas de detección precoz con ecografías de hígado. Las técnicas dinámicas de imagen (ecografía con contraste, resonancia magnética y tomografía) son fundamentales en el diagnóstico de este tumor, ya que pueden tipificar claramente la lesión e inducir, en la mayor parte de los casos, el tratamiento a seguir. El tratamiento de elección en estos pacientes es la cirugía, y el trasplante hepático, desde el punto de vista teórico, es el mejor. Actualmente, el tamaño y el número de nódulos tienen un importante papel en la indicación del trasplante. Los mejores resultados del trasplante hepático en estos pacientes se obtienen siguiendo los criterios de Milán, con supervivencias que exceden el 70% e índices de recidiva del 15% a 5 años. Hoy día tenemos la posibilidad de tratamientos neoadyuvantes al trasplante, como la quimioembolización arterial, las técnicas ablativas percutáneas e incluso la resección hepática como técnica puente. La supervivencia de los pacientes trasplantados por el hepatocarcinoma es similar a la obtenida por otras enfermedades no tumorales, que en nuestro país a 1, 3 y 5 años es del 82, el 70 y el 60%, respectivamente. La recurrencia está entre el 6,4 y el 16%, y destacan las invasiones microvascular o macrovascular como variables de más alto riesgo (AU)

Liver transplant in patients with cirrhosis and hepatocellular carcinoma is indicated in the early stages of the disease, which can be achieved with early detection programs using liver ultrasound. Dynamic imaging techniques (ultrasound with contrast, magnetic resonance and tomography) are essential in the diagnosis of this tumour, being able to type the lesion clearly, and, in the majority of cases, lead to the therapy to follow. Surgery is the treatment of choice in these patients, and liver transplant, from a theoretical point of view, is the best. Currently, the size and number of nodes play an important role in the indication of a transplant. The best liver transplant results are obtained in these patients using the Milan criteria, with survivals that exceed 70% and recurrence indices of 15%, at 5 years. Nowadays we have the possibility of using neo-adjuvant treatments to transplant, such as arterial chemoembolisation, percutaneous ablation techniques, and even liver resection as a bridging technique. The survival of patients transplanted due to liver cancer is similar to that obtained for other non-tumour diseases. In Spain it is 1, 3 and 5 years and 82%, 70% and 60%, respectively. The recurrence is between 6.4% and 16%, micro- and macrovascular invasion being its highest risk variable (AU)

[Liver transplantation in patients with benign hepatic lesions]. / Trasplante hepático en pacientes con lesiones hepáticas benignas.

Benign hepatic lesions are rare and liver transplantation in these cases is exceptional. We present a review of the subject, commenting on the aspects that have been subsidiary to liver transplantation, of which are highlighted: adenomatosis, polycystosis and hepatic epithelioid haemangioendothelioma (although this process may be a low to intermediate malignant grade). We assessed specific epidemiological, aetiopathogenic, clinical, diagnostic, therapeutic and aspects of the lesions as well as indication for transplantation, and the experiences of different authors on these pathologies.

Trasplante hepático en pacientes con lesiones hepáticas benignas / Liver transplantation in patients with benign hepatic lesions

Las lesiones benignas hepáticas son enfermedades poco frecuentes y el trasplante hepático en ellas es excepcional. Presentamos una revisión del tema, con comentarios sobre las entidades subsidiarias de trasplante hepático, de las que destacan: la adenomatosis, la poliquistosis y el hemangioendotelioma epitelioide hepático (aunque este proceso sea de grados bajo a intermedio de malignidad). Valoramos aspectos específicos de estas lesiones, desde el punto de vista epidemiológico, etiopatogénico, clínico, diagnóstico, terapéutico, indicación del trasplante y experiencia de los diferentes autores en estas afecciones (AU)

Benign hepatic lesions are rare and liver transplantation in these cases is exceptional. We present a review of the subject, commenting on the aspects that have been subsidiary to liver transplantation, of which are highlighted: adenomatosis, polycystosis and hepatic epithelioid haemangioendothelioma (although this process may be a low to intermediate malignant grade). We assessed specific epidemiological, aetiopathogenic, clinical, diagnostic, therapeutic and aspects of the lesions as well as indication for transplantation, and the experiences of different authors on these pathologies (AU)