Efectividad de la formación teórico-práctica en soporte vital básico a monitoras de comedores escolares desde Atención Primaria / Effectiveness of theoretical-practical training in basic life support for school canteen monitors from Primary Care

Introducción: las enfermedades cardiovasculares constituyen un problema de salud pública a nivel mundial y dentro de ellas destaca la parada cardiorrespiratoria (PCR). Los comedores escolares son espacios con potencial riesgo de presenciar una PCR. Materiales y métodos: estudio analítico cuasiexperimental de intervención. Las participantes recibieron formación mediante una plataforma virtual interactiva y una sesión de simulación clínica presencial sobre maniobra de Heimlich, reanimación cardiopulmonar (RCP) básica y uso del desfibrilador externo semiautomático (DESA). Se realizó un análisis descriptivo de la población a estudio y un análisis estadístico comparativo entre el resultado obtenido en un test previo y otro posterior a la formación virtual. Se creó una variable restando la puntuación obtenida antes de la formación a la obtenida después de la misma. Se analizó mediante observación directa la simulación clínica. Se definió la significación estadística con una p <0,05. Análisis estadístico con SPSS versión 19.0. Se siguieron los principios de la Declaración de Helsinki y las directrices sobre buenas prácticas clínicas. Resultados: la totalidad de la muestra eran mujeres con edad mediana de 48,50 años. La nota mediana del test previo fue de 6,7/10 y el test posterior tuvo un resultado constante de 10/10. La diferencia entre el test posterior y el previo tuvo una mediana de 3,3 (p 0,01) y se constató en la simulación que el aprendizaje fue óptimo. Conclusiones: la formación en RCP es una estrategia de impacto social, relacionada con una mejora en la respuesta ante un caso de PCR, disminuyendo la morbimortalidad que esta implica. (AU)

Introduction: cardiovascular diseases constitute a public health problem worldwide, among which cardiopumonary arrest (CPA) stands out. School canteens are spaces where there is a possibility of witnessing CPA. Materials and methods: quasi-experimental interventional and analytical study. Participants received training through an interactive virtual platform and a face-to-face clinical simulation session on the Heimlich manoeuvre, basic cardiopulmonary resuscitation (CPR) and the use of the semiautomatic external defibrillator (SAED). We carried out a descriptive analysis of the study population and a comparative statistical analysis of the results obtained in the tests conducted before and after the virtual training. We created variable corresponding to the subtraction of the pre-training score from the post-training score. Clinical simulation was analysed by direct observation. Statistical significance was defined as p < 0.05. The statistical analysis was carried out with SPSS version 19.0. The study adhered to the principles of the Declaration of Helsinki and the guidelines on good clinical practice. Results: the entire sample consisted of women with a median age of 48.50 years. The median score in the pre-test was 6.7/10, and the score in the post-test was uniformly 10/10. The median difference between the pre- and post-training tests was of 3.3 points (p 0.01) and the simulation evinced that the learning was optimal. Conclusions: training in CPR is a strategy that has social impact in terms of the improvement in the response to a CPA events, achieving a reduction in the associated morbidity and mortality. (AU)

Latent Microsporidia Infection Prevalence as a Risk Factor in Colon Cancer Patients.

Microsporidia are opportunistic intracellular parasites, generating serious pathology in individuals with a compromised immune system. Infection by microsporidia inhibits p53 and Caspase 3, proteins involved in apoptosis and the cell cycle, which are vital in the malignant process of epithelial cells. The presence of microsporidia in the intestinal tissues of 87 colon cancer (CC) patients and 25 healthy controls was analyzed by real-time PCR and an immunofluorescence antibody test. Anti-Encephalitozoon antibodies were analyzed in serum samples by ELISA (enzyme linked immunosorbent assay). In 36 (41.3%) CC cases, microsporidia infections were identified in their tissues vs. no cases among control subjects (p < 0.0001). An increase in IgG and IgE anti-Encephalitozoon antibodies was found in patients with CC, which would demonstrate continuous and previous contact with the parasite. The high prevalence of microsporidia in tissues and the seroprevalence in patients with CC suggest a relationship between microsporidia and the etiopathogenesis of CC.

Alopecic and Aseptic Nodules of the Scalp: A New Entity or a Minor Form of Dissecting Cellulitis?

Since the original report in 1992 and revised nomenclature in 2009, pseudocysts of the scalp and alopecic and aseptic nodules of the scalp (AANS), respectively, have been regarded as a new entity that is rare and not understood in its pathogenesis. We observed 26 cases of AANS. Except for the extent and severity of disease, we found no single feature that justifies distinguishing AANS as a nosologic entity in its own right from dissecting cellulitis of the scalp (DCS). The scarring alopecias represent a diverse group of disorders with the potential of permanent destruction of the pilosebaceous unit and hair loss. Within the maze of varied conditions leading to scarring alopecia, the most important is to keep a neat nosologic classification in mind, based both on morphology and a pathogenic understanding. We believe that AANS represents a minor form of DCS, so far predominantly observed in patients of non-African origin, and therefore, is a disease of follicular occlusion with a favorable prognosis.

Determinación de la morfología del canal incisivo mandibular mediante tomografía computarizada de haz cónico (CBCT) en población de Valdivia, Chile / Determination of mandibular incisor canal morphology by cone beam computed tomography (CBCT) in a population of Valdivia, Chile

RESUMEN: El canal incisivo mandibular (MIC) es un canal neural que contiene una de las ramas inferiores del nervio alveolar inferior, llamado nervio incisivo mandibular, que puede resultar dañado durante intervenciones quirúrgicas y causar complicaciones postoperatorias. Estudio descriptivo de corte transversal. Se identificó el MIC en la imagen transversal del canino en 83 hemiarcadas. Se registró edad, sexo, hemiarcada, longitudes desde reborde alveolar vestibular de canino a MIC, cortical lingual y vestibular de canino a MIC, base mandibular de canino a MIC y ubicación del MIC (tercio lingual, medio, vestibular). Medidas se registraron en milímetros. Se aplicó test T-student para muestras independientes para variables de longitud y Chi-cuadrado para ubicación espacial del MIC, en relación con grupo etario y sexo. Se evaluó el MIC en todas las muestras (100 %). El MIC fue encontrado mayormente en el tercio medio mandibular (p <0,05). La media desde el MIC a la cortical lingual es de 5,25 mm ? 1,42 mm (derecho) y 5,24 mm ? 1,18 mm (izquierdo). La media desde el MIC a la cortical vestibular fue de 4,42 mm ? 1,29 mm (derecho) y 4,53 mm ? 1,24mm (izquierdo). La media entre centro del canal y reborde alveolar vestibular fue 18,89 mm ? 2,68mm (derecho) y 18,20 mm ? 3,06 mm (izquierdo), media desde centro del MIC al margen basal fue de 9,77 mm ? 1,93 (derecho) y 10,12 mm ? 1,92 mm (izquierdo). Se encontró mayor distribución del MIC en el tercio medio mandibular. Se identificó el MIC en el 100 % de las muestras a través de CBCT por lo que su uso como examen complementario debe ser considerado al planificar cirugías en el sector anterior mandibular.

SUMMARY: The objective of the study was to determine the morphology of the mandibular incisive canal (MIC) and its location using cone beam computed tomography (CBCT) in the population of Valdivia, Chile. Descriptive cross-sectional study. MIC was identified in the canine cross image in 83 quadrants. Age, gender, quadrants, length from buccal alveolar ridge of canine to MIC, lingual and buccal cortical of canine to MIC, mandibular base of canine to MIC, and location of MIC (lingual, middle and buccal third) were recorded. Measurements were recorded in millimeters. Independent sample Student-T test was performed to determine length variables and Chi-square test was performed to determine spatial location of MIC, in relation to age group and gender. MIC was evaluated in all samples (100 %). MIC was found mainly in the mandibular third quadrant (p < 0.05). The mean from the MIC to the lingual cortex is 5.25 mm ? 1.42 mm (right) and 5.24 mm ? 1.18 mm (left). The mean from the MIC to the buccal cortex was 4.42 ? 1.29 mm (right) and 4.53 mm ? 1.24 mm (left). The mean between the center of the canal and the buccal alveolar ridge was 18.89 mm ? 2.68mm (right) and 18.20 mm ? 3.06 mm (left), the mean from the center of the MIC to the basal edge was 9.77 mm ? 1.93 (right) and 10.12 mm ? 1.92 mm (left). A greater distribution of MIC was found in the mandibular third quadrant. MIC was identified in 100 % of the samples through CBCT, therefore, its use as a complementary examination should be considered when planning surgeries in the anterior mandibular area.

Post-hemorrhoidectomy pain: can surgeons reduce it? A systematic review and network meta-analysis of randomized trials.

PURPOSE: Hemorrhoidectomy remains the gold standard treatment for grade III-IV hemorrhoids. However, despite strong recommendations for the suitability of outpatient surgery, post-operative pain has been a limitation to the widespread inclusion of this condition in day surgery programs. The aims of the study were to analyze and compare the post-operative pain of conventional open hemorrhoidectomy, considered the reference technique, against other surgical procedures such as closed hemorrhoidectomy, open hemorrhoidectomy using bipolar or ultrasonic sealant, hemorrhoidopexy, or HAL-RAR, when performed exclusively as outpatients. METHODS: A systematic review and meta-analysis was conducted according to PRISMA methodology. All prospective and randomized studies of patients operated on for hemorrhoids in day surgery and specifying the value of post-operative pain, using a validated scale, were included. Conventional meta-analyses and a random-effects network meta-analysis were carried out. RESULTS: Twenty-nine studies were included (3309 patients). None of the procedures described severe pain in the post-operative period. Hemorrhoidopexy was the least painful. Conventional open hemorrhoidectomy was the most painful on the first and seventh post-operative days. Pain was reduced after closed hemorrhoidectomy technique and when bipolar or harmonic scalpel was used. Furthermore, transfixive ligation of the hemorrhoidal pedicle was associated with increased post-operative pain. CONCLUSION: Hemorrhoidal surgery is feasible in day surgery units and post-operative pain can be adequately managed in an outpatient setting. Hemorrhoidopexy was the least painful; however, data should be carefully evaluated by the high rate of long-term recurrence described in literature. Closed hemorrhoidectomy, performed with bipolar or ultrasonic sealing, avoiding transfixive ligation of the hemorrhoidal pedicle, may improve post-operative pain control. TRIAL REGISTRATION: CRD42020185160.

D3-lymphadenectomy enhances oncological clearance in patients with right colon cancer. Results of a meta-analysis.

BACKGROUND: D3-Lymphadenectomy, together with complete mesocolic excision (CME), were introduced to provide oncological results after right colon cancer. The aim of this systematic review with meta-analysis was to assess the short and long-term outcomes of right-sided hemicolectomy with CME + D3 as compared with classic right hemicolectomy. Secondary aims included the prevalence of D3-metastasis and skip metastasis when performing CME + D3. MATERIAL AND METHODS: A systematic review with meta-analysis was conducted, according to PRISMA methodology. RESULTS: 29 studies were enrolled (2592 patients). No differences were accounted in morbidity variables associated with the measured techniques. CME + D3 was significantly associated with a greater distance between the tumour and the closest vascular tie, a longer colonic resection, a wider resection of mesentery and an increased number of harvested lymph nodes. Regarding to long-terms outcomes, we found a significant decrease in local recurrence in patients undergoing CME + D3 (HR:0.17) and a significant improvement in 3-year and 5-year overall survival rates (HR:0.53 vs. HR:0.57, respectively), as well as an improving survival in patients with stage II and III disease. Overall prevalence of patients with lymphatic metastases in D3-territory was of 8.6% and 2.2% of skip metastases. CONCLUSIONS: CME + D3 is a feasible surgical procedure that allows to obtain specimens with higher quality oncological resection, without greater associated morbidity, thus improving survival in patients with stage II and III right colon cancer.

Incorporating the recovered carbon black produced in an industrial-scale waste tire pyrolysis plant into a natural rubber formulation.

This paper presents the experimental results obtained after incorporating the recovered Carbon Black (rCB) produced in an industrial-scale waste tire pyrolysis plant into a Natural Rubber (NR) formulation. The purpose of this study is to increase the technical knowledge on the use of rCB as a sustainable raw material in the rubber industry. The rCB and virgin Carbon Black (vCB) (ref. N550) under study were characterized using elemental and proximate analyses, X-Ray Fluorescence (XRF), Fourier Transform Infrared (FTIR) spectroscopy, and Scanning Electron Microscopy (SEM) were used, and different measures, including the Brunauer-Emmett-Teller (BET) surface area (SBET), particle size distribution (PSD), specific gravity, and pH, were estimated. The effect of rCB incorporation on the rheological, thermal, structural, and mechanical properties of the NR composites was assessed and compared to those obtained with vCB alone. The NR composites were prepared using different loads of vCB (20, 30, 40, and 50 phr), which was also replaced with rCB at different proportions (0, 50, and 100%). According to the characterization results, rCB offers lower reinforcement properties than vCB, which is attributable to its higher volatile matter and ash contents, higher apparent PSD, lower presence of acidic functional groups, and lower SBET. Despite this, interesting performances can be achieved when rCB is partially incorporated into the formulations or by increasing its load in the composites. For instance, when 50% of vCB was replaced with rCB, the values of the aforementioned properties were found to be between those obtained with the NR composites prepared with vCB and rCB. In addition, when increasing the rCB loading, some properties matched the behavior exhibited by vCB alone, thus compensating for the low reinforcement properties of rCB. These results are expected to provide an important impetus to move towards circular economy strategies having very positive impacts from the sustainable perspective.

Prospective study of sexual function and analysis of risk factors after rectal cancer surgery.

AIM: The aim of this study was to assess the evolution of sexual function over time after rectal cancer surgery and to identify risk factors that may have an impact on the deterioration of postoperative function. METHOD: This was a prospective cohort study of sexual function after rectal cancer surgery using the International Index of Erectile Function (IIEF) and Female Sexual Function Index (FSFI) preoperatively and at 6 and 12 months after surgery. Predictive factors of worsening were identified by univariate and multivariate analysis. RESULTS: One hundred and one patients were included (56 men and 45 women). In men, the average IIEF showed decreased erectile function and intercourse satisfaction at 6 months (respectively 21.58 ± 7.18 to 16.60 ± 7.96, p = 0.002 and 10.87 ± 2.94, to 8.09 ± 4.45, p = 0.002) with recovery at 1 year. As a percentage, erectile dysfunction increased from the preoperative value to 6 months (64.5% vs 87.1%, p = 0.022) and was observed in 72% at 1 year. Patients with moderate to severe dysfunction increased from 22% preoperatively to 58% (p = 0.009) at 6 months and 44% at 1 year (p < 0.0001). Neoadjuvant chemoradiotherapy (OR 5.4, 95% CI 0.9-29.6; p = 0.041) and erectile worsening at 6 months (OR 20, 95% CI 1.6-238; p = 0.004) were independent factors for worse function at 6 or 12 months, respectively. No significant worsening of the FSFI was found, although there was an improvement in lubrication and orgasm. CONCLUSION: Temporary deterioration of erectile function in men is common at 6 months after surgery and chemoradiotherapy is the only predictive factor. Furthermore, patients who remain dysfunctional show an increase in the severity of symptoms in relation to the preoperative period.

Conductas de riesgo para la salud en adolescentes escolarizados del municipio de Tabio, Colombia / Health-risk behaviors in school-based adolescents in Tabio, Colombia

RESUMEN Objetivos Identificar los comportamientos de riesgo para la salud y describir su relación con las características sociodemográficas en los adolescentes de un colegio del municipio de Tabio, provincia de Sabana Centro, Cundinamarca, Colombia. Metodología Estudio descriptivo y de corte transversal en población adolescente escolar de 14 a 19 años, durante el año 2018, elegidos por medio de muestreo por conveniencia. Se obtuvo información mediante el cuestionario en español de la herramienta RAAPS (Rapid Assessment for Adolescent Preventive Services), que evaluó los comportamientos de riesgo, previa firma de consentimiento y asentimiento informado. Se realizó análisis estadístico en el programa STATA versión 14.0. Resultados Se incluyó una muestra de 217 estudiantes, con edad promedio de 15,8 años (53% mujeres y 47% hombres). La mayoría de zona rural y estrato 2. Dentro de los comportamientos de riesgo detectados se destacan la falta de uso de cinturón de seguridad y casco en casi la mitad de los participantes, síntomas de tristeza en 37,3% (que afecta más a las mujeres), consumo de alcohol en el 45,2% y actividad sexual en el 30,9% (son más frecuentes en el grupo de 17 a 19 años y en el sexo masculino). Conclusión Los hallazgos confirman la presencia de comportamientos de riesgo para la salud en los adolescentes de la población estudiada, que deben ser intervenidos a través de estrategias preventivas efectivas y que alertan sobre la necesidad de implementar un sistema periódico de vigilancia.

ABSTRACT Objective to identify health-risk behavior and describe their correlation with sociodemo-graphic characteristics in a group of adolescents from a school located in Tabio, Sabana Centro, Cundinamarca. Methodology A descriptive and cross-sectional study was carried out in school adoles-cents from 14 to 19 years of age during 2018; chosen by convenience sampling. The information was collected using the Spanish version of the RAAPS questionnaire (Rapid assessment for preventive services for adolescents) that assesses risk behaviors, signing of informed consent and assent prior. The statistical analysis was performed in the STATA program, version 14.0. Results A sample of 217 students was included, the average age was 15.8 years, 53% were women and 47% were men, most of them from the rural area and socioeconomic status 2. Among the main risk behaviors were never wearing a belt of safety or helmet in almost half of the adolescents, symptoms of sadness in 37.3% with higher prevalence in women, alcohol consumption in 45.2% and sexual activity in 30.9%, both being more fre-quent in the group of 17 to 19 years old and male. Conclusion The results confirmed the presence of health risk behaviors in the adolescents of studied population, who must be intervened through effective preventive strategies and warn about the need to implement a periodic surveillance system.

Differences in circulating γδ T cells in patients with primary colon cancer and relation with prognostic factors.

Downregulation of the T cell system has been proposed as a mechanism to block immunity in colonic cancer (CC). However, little has been studied about circulating αß and γδ T cells and their immunological status in newly diagnosed patients. The aim of this study was to characterize the αß and γδ T cell subsets in peripheral blood of patients with CC matched with healthy volunteers. In this prospective case-control study, blood samples were obtained from 96 patients with newly diagnosed treatment-naïve infiltrating colonic adenocarcinoma and 48 healthy volunteers. Pathological report at surgery was obtained from all CC patients. A significant decrease in CD3+ γδ T cells and CD3+CD8+ γδ T cells (p<0.001) were observed in CC patients. Apoptosis was significantly increased in all conventional and both αß and γδ T cell subsets in patients with CC vs healthy subjects. γδ T cells were decreased in peripheral blood of patients with microscopic infiltration in tissues, history of cancer and synchronous colon cancer (p < 0.05). IFN-γ was significantly reduced in CC patients compared to controls. Cytotoxic effector γδ T cells TEMRA (CD8 and CD56) are the proportionally most abundant T cells in peripheral blood of CC patients. Patients with CC present a deep downregulation in the systemic T-cell immunity. These variations are evident through all tumor stages and suggest that a deficiency in γδ T cell populations could be preventing control of tumor progression. This fact prove the role of immunomodulation on CC carcinogenesis.

Long-term outcomes of stent-related perforation in malignant colon obstruction: a systematic review and meta-analysis.

PURPOSE: The placement of self-expandable metallic stents as a bridge to surgery in malignant colon obstruction is concerning due to the long-term oncological results reported in recent published studies. The aim of this study was to evaluate the oncological consequences of stent-related perforations in patients with malignant colon obstruction and potentially curable disease. METHODS: MEDLINE, Cochrane Library, Ovid and ISRCTN Registry were searched, with no restrictions. We performed five meta-analyses to estimate the pooled effect sizes by using a random-effect model. The outcomes were global, locoregional and systemic recurrence rate and 3 and 5 year-survival rate depending on the presence or absence of stent-related perforation. RESULTS: Thirteen studies (950 patients) were included. The overall rate of stent-related perforation was 8.9%. The global recurrence rate was significantly higher in stent-related perforation group (41.2 vs. 30.8%; OR 1.70; 95%CI: 1.02-2.84; p = 0.04). Locoregional recurrence rate was higher in the perforated group than in the non-perforated group (26.6 vs. 12.5%), with statistically significant differences (OR 2.41; 95% CI:1.33-4.34; p = 0.004). No significant differences were found in systemic recurrence rate (13.6 vs. 20.5%; OR 0.77; 95%CI: 0.35-1.7; p = 0.51); 3-year overall survival rate (65.4 vs. 74.8%; OR 0.63; 95% CI:0.29-1.39; p = 0.25) and 5-year overall survival rate (48.3 vs. 58.6%; OR 0.67; 95%CI: 0.27-1.65; p = 0.38). CONCLUSION: Stent-related perforation is associated with an increased risk of global and locoregional recurrence. The successful placement of the stent as a bridge to surgery in the curative purpose of patients with obstructed colon cancer does not exclude the presence of underlying perforation, with the consequent danger of disease spread. PROSPERO registration number: CRD42020152817.