High linoleic acid levels in red blood cells predict a poor response to neoadjuvant chemotherapy in human epidermal growth factor receptor type 2-positive breast cancer patients.

OBJECTIVE: Polyunsaturated fatty acids are categorized as ω-3 or ⍵-6. Previous studies demonstrate that breast cancers display a high expression of fatty acid synthase and high fatty acid levels. Our study sought to determine if changes in plasma or red blood cell membrane fatty acid levels were associated with the response to preoperative (neoadjuvant) chemotherapy in non-metastatic breast cancer patients. METHODS: Our prospective study assessed fatty acid levels in plasma and red blood cell membrane. Response to neoadjuvant chemotherapy was evaluated by the presence or absence of pathologic complete response and/or residual cancer burden. RESULTS: A total of 28 patients were included. First, patients who achieved pathologic complete response had significantly higher neutrophil-to-lymphocyte ratio versus no pathologic complete response (P = 0.003). Second, total red blood cell membrane polyunsaturated fatty acids were higher in the absence of pathologic complete response (P = 0.0028). Third, total red blood cell membrane ⍵-6 polyunsaturated fatty acids were also higher in no pathologic complete response (P < 0.01). Among ⍵-6 polyunsaturated fatty acids, red blood cell membrane linoleic acid was higher in the absence of pathologic complete response (P < 0.01). Notably, plasma polyunsaturated fatty acid, ⍵-6, and linoleic acid levels did not have significant differences. A multivariate analysis confirmed red blood cell membrane linoleic acid was associated with no pathologic complete response; this was further confirmed by receiver operating characteristic analysis (specificity = 92.3%, sensitivity = 76.9%, and area under the curve = 0.855). CONCLUSIONS: Pending further validation, red blood cell membrane linoleic acid might serve as a predictor biomarker of poorer response to neoadjuvant chemotherapy in non-metastatic human epidermal growth factor receptor type 2-positive breast cancer. Measuring fatty acids in red blood cell membrane could offer a convenient, minimally invasive strategy to identifying patients more likely to respond or those with chemoresistance.

Resiliencia en estudiantes universitarios de ciencias de la salud chilenos en el contexto de la telesimulación / Resilience in Chilean university health science students in the context of telesimulation

Introducción: El presente trabajo tuvo como propósito conocer el nivel de resiliencia en contexto pandémico en una muestra de estudiantes de pregrado de ciencias de la salud y cómo ésta se comporta en escenarios de telesimulación. Sujetos y métodos: El estudio tuvo un enfoque cuantitativo, con diseño observacional y temporalidad transversal. Se incluyó a 192 estudiantes pertenecientes a cinco carreras de las ciencias de la salud, cuyas edades oscilaron entre los 20 y los 49 años. Para medir la variable de interés se utilizó el cuestionario de resiliencia adaptado a 44 ítems con respuestas en escalamiento de tipo Likert. Resultados: Los resultados muestran niveles altos de resiliencia en carreras con programas de estudio que incluyen la telesimulación y las diferencias entre cada una de estas carreras. Conclusiones: Se sugiere la ampliación de la línea de investigación en otros contextos situacionales e intervención de metodologías de enseñanza-aprendizaje, con el fin de potenciar los procesos de adaptación de los estudiantes de salud y evaluar competencias esperadas del perfil de egreso, directamente relacionadas con su desempeño en su quehacer profesional.(AU)

Introduction: The purpose of this work was to know the level of resilience in a pandemic context in a sample of undergraduate students of health sciences, and how it behaves in tele-simulation scenarios. The study had a quantitative approach, with observational design, cross-sectional temporality and prospective.Subjects and methods: We included 192 students belonging to 5 careers in health sciences, whose ages ranged between 20 and 49 years. To measure the variable of interest, the resilience questionnaire adapted to 44 items with Likert-type scaling responses was used. Results: The results show high levels of resilience in careers with study programs that include tele-simulation and the differences between each of these careers. Conclusions: It is suggested to expand the line of research in other situational contexts and intervention of teachinglearning methodologies, to enhance the adaptation processes of health students and evaluate expected competencies of the graduation profile, directly related to their performance in their professional work.(AU)

Transición social en niñas, niños, niñes y adolescentes con incongruencia de género: revisión y sugerencias de intervención a profesionales / Social transition in children and adolescents with gender incongruence: review and intervention recommendations for professionals

Introducción: la transición social en niñas (os, es) y adolescentes con incongruencia de género, es una intervención no médica, com-pletamente reversible, que genera beneficios en la salud mental, pero que ha sido poco estudiada. El objetivo es realizar una revisión bibliográfica al respecto y desde ahí derivar recomendaciones a las(os) profesionales que intervienen en el apoyo a estas (os, es) niñas (os, es), adolescentes y sus familias. Métodos: ll presente trabajo corresponde a una revisión entre los años 2010 ­ 2021 en revistas científicas en habla inglesa e hispana indexadas en PUBMED, SciELO y en Google Académico. Resultados: se describe la trayectoria en el desarrollo de la incongruencia de género. En las (os, es) prepúberes el interés está centrado en la persistencia y desistencia de la incongruencia de género y las distintas trayectorias. La transición social y la persistencia se pueden manifestar diferencialmente para niñas y niños trans. Realizar transición social en niñas (os, es) que lo solicitan favorece la salud mental. La familia y la comunidad viven sus propias transiciones. En Chile se han ido dando las condiciones en salud, educación y a nivel legislativo para apoyar la afirmación de género de las niñas (os, es) y adolescentes, pero falta educación respecto a la transición social en infancia y adolescencia. Conclusiones:dado los beneficios que genera la transición social en niñas (os, es) y adolescentes transgénero, se requiere que las(os) profesionales se eduquen e intervengan adecuadamente.

Introduction: Social transition for boys, girls, and adolescents with gender incongruence is a completely reversible non-medical inter-vention that generates important mental health benefits, but reviews lack studies. The objective here is to do a bibliographic review regarding the matter, and from there, formulate recommendations for professionals who intervene to support these boys, girls, and adolescents, as well as their families. Method:This work reviews English and Spanish journals, published between 2010 and 2020, indexed in PUBMED, SciELO, and Google Scholar.Results: The trajectory of the development of gender incongruence is described. For children in the ́re-puberty stage, the interest is focused on the persistence and desistence of gender incongruence. Social transition and persistence can manifest differentially for trans boys and trans girls. Making a social transition for the boys and girls who request it benefits their mental health. The family and the community undergo their transformations. In Chile, conditions at a health, education, and legislative level, to support the gender affirmation of boys, girls and adolescents, have appeared. Still, there is a lack of education regarding the social transition in childhood and adolescence.Conclusions: Given the benefits that social transition generates for trans-gender boys, girls, and adolescents, it is required that professionals educate themselves and intervene accordingly.

[Predictive validity of a functional classification method in older adultsValidação preditiva de método de classificação funcional em idosos]. / Validación predictiva de un método de clasificación funcional en adultos mayores.

OBJECTIVE: Evaluate the predictive validity of a functional classification (FC) method for the use of emergency services and hospitalization, mortality, and health care costs among older adults. METHODS: Retrospective cohort study that included 2 168 older adults in a chronic noncommunicable disease (CNCD) care program in Medellin, Colombia. Patients were stratified according to a FC method based on functional status, presence of risk factors, and control of comorbidity. During one year of follow-up, the predictive validity of the FC method was assessed for the studied outcomes. Discrimination and calibration were measured with the C-statistic and Hosmer-Lemeshow (HL) test, respectively. RESULTS: The average age was 74.6 ± 7.9 years; 40.8% (n = 884) were men and 7.7% (n = 168) died. The risk of death (odds ratio [OR]: 1.767; 3.411; 8.525), hospitalization (OR: 1.397; 2.172; 3.540) and high cost of health care (OR: 1.703; 2.369; 5.073) increased in proportion to a deterioration in functional classification (classes 2B, 3, and 4, respectively). The predictive model for the outcome of death showed good capacity for discrimination (C-statistic = 0.721) and calibration (HL statistic 10.200; P = 0.251). CONCLUSION: There is a dose-response relationship between deterioration in FC and a higher risk of death, hospitalization, and high cost. FC has predictive validity for the mortality rate and could be used to stratify older adults in CNCD care programs with a view to guiding interventions.

OBJETIVO: Avaliar a validade preditiva de um método de classificação funcional (CF) para a utilização de serviços de emergência e internação hospitalar, mortalidade e custos da atenção de saúde em idosos. MÉTODOS: Estudo de coorte retrospectivo com 2 168 idosos atendidos em um programa de atenção de doenças crônicas não transmissíveis (DCNT) em Medellín, Colômbia. Um método de CF foi usado para estratificar os participantes segundo o estado funcional, presença de fatores de risco e controle de comorbidades. No período de acompanhamento de um ano, a validade preditiva da CF foi avaliada para os desfechos de interesse. A capacidade discriminatória (estatística C) e a calibração (teste de Hosmer-Lemeshow [H-L]) do modelo foram avaliadas. RESULTADOS: A média de idade dos participantes do estudo foi 74,6 ± 7,9 anos, 40,8% (n = 884) eram do sexo masculino e 7,7% (n = 168) vieram a óbito. Houve aumento do risco de óbito (odds ratio [OR] 1,767; 3,411­8,525), internação hospitalar (OR 1,397; 2,172-3,540) e custo elevado da atenção de saúde (OR 1,703; 2,369­5,073) com o declínio funcional ­ classes funcionais 2B, 3 e 4, respectivamente. O modelo preditivo para o desfecho de óbito demonstrou boa capacidade discriminatória (estatística C = 0,721) e calibração (estatística H-L = 10,200; P = 0,251). CONCLUSÃO: Há uma relação de dose-resposta entre o declínio da CF e risco maior de óbito, internação hospitalar e custo elevado da atenção. A CF tem validade preditiva para a taxa de mortalidade e poderia ser utilizada na estratificação de idosos em programas de atenção de DCNT para ajudar a direcionar as medidas de intervenção.

Incongruencia de género en niñas, niños y adolescentes: intervenciones transafirmativas en Hospital las Higueras Talcahuano / Gender incongruity in girls, boys and adolescents: transaffirmative intervention at Las Higueras Hospital, Talcahuano

Introducción: incongruencia de género (IG) en niñas, niños y adolescentes (NNA), es un tema que se ha ido visibilizando cada vez más y es definida como una marcada discordancia entre la identidad de género y el sexo asignado al nacer. El objetivo es realizar una revisión de la evidencia en relación a la IG en NNA, las intervenciones recomendadas basadas en evidencia y finalmente dar a conocer la experiencia local en el Hospital las Higueras de Talcahuano. Métodos:se realizó una búsqueda en PUBMED artículos en inglés y español, desde 2011 a 2019. De los artículos encontrados, se revisó además la bibliografía de ellos, sumando a la revisión las publicaciones que fueran pertinentes. En la revisión práctica se realizó una sistematización de las intervenciones que se llevan a cabo a nivel endocrinológico y en salud mental. Resultados: los resultados indican que la prevalencia ha ido en aumento, al igual que la prevalencia hombre trans. Existen indicadores específicos para poder diferenciar la desistencia o persistencia de la IG. Las condiciones asociadas tales como ansiedad, depresión, ideación y conducta suicidas son generadas por el estrés de minorías y la intervención más apropiada es la afirmativa. Existe alta varianza de género en personas de condición trastorno de espectro autista (TEA), siendo mayor en las niñas que en los niños. Desde marzo 2019 Hospital las Higueras de Talcahuano inicia intervención transafirmativa con IG en NNA. Conclusiones: es necesario visibilizar el tema y despatologizarlo para que las(os) NNA tengan mayor acceso a apoyo transafirmativo.

Introduction: Gender incongruity (GI) in boys, girls, and adolescents (BGA), is becoming an ever more visible issue. It is defined as a marked misalignment between gender identity and the sex assigned at birth. Objective: to make a review of evidence regarding GI in BGA, the recommended evidence-based interventions and, ultimately, to show the local experience at Las Higueras Hospital in Tal-cahuano. Methods: A search of articles written in English and Spanish between 2011 and 2019 was performed in PUBMED and, from the articles found, their biblographies were also revised, adding the pertinent publications to the revision process. In the practical revision, a systematization of the interventions performed at an endocrinological level and in mental health, was also made. Results: the results indicate that prevalence has been increasing, as has male trans prevalence. There are specific indicators to differentiate GI desistance or persistance. The associated conditions such as anxiety, depression, suicidal ideation and conduct, are generated by the stress minorities suffer and the most appropriate intervention is the affirmative one. There is a high gender variance in people within the autism spectrum disorder (ASD), which is higher in girls than in boys. In 2019, Las Higueras Hospital in Talcahuano started with a trans-afirmative intervention with GI in BGA. Conclusions: It is necessary to make GI visible and depathologize it so that BGA have greater access to trans-affirmative support.

Validación predictiva de un método de clasificación funcional en adultos mayores

[RESUMEN]. Objetivo. Evaluar la validez predictiva de un método de clasificación funcional (CF) sobre el uso de los servicios de urgencias y hospitalización, mortalidad y costos de la atención en salud en adultos mayores. Métodos. Estudio de cohorte retrospectivo que incluyó 2 168 adultos mayores en un programa de atención de las enfermedades crónicas no transmisibles (ECNT) en Medellín (Colombia). Los pacientes fueron estratificados según un método de CF con base en el estado funcional, presencia de factores de riesgo y control de la comorbilidad. Durante un año de seguimiento, se evaluó la validez predictiva de la CF sobre los desenlaces estudiados; se midieron la discriminación y la calibración con el estadístico-C y de Hosmer-Lemeshow (H-L), respectivamente. Resultados. El promedio de edad fue 74,6 ± 7,9 años; el 40,8% (n = 884) fueron hombres y 7,7% (n = 168) murieron. El riesgo de muerte (razón de posibilidades [OR, por su sigla en inglés]: 1,767; 3,411; 8,525), hospitalización (OR: 1,397; 2,172; 3,540) y un costo elevado de la atención en salud (OR: 1,703; 2,369; 5,073) aumentaron en la medida que hubo un deterioro en la CF, clases 2B, 3 y 4, respectivamente. El modelo predictivo para el desenlace muerte mostró una buena capacidad de discriminación (estadístico-C = 0,721) y calibración (estadístico de H-L = 10,200; P = 0,251). Conclusión. Existe una relación de dosis y respuesta entre el deterioro de la CF y un riesgo más elevado de muerte, hospitalización y costo elevado. La CF tiene validez predictiva para la tasa de mortalidad y podría utilizarse para la estratificación de adultos mayores en programas de atención de las ECNT con miras a dirigir las acciones de intervención.

[ABSTRACT]. Objective. Evaluate the predictive validity of a functional classification (FC) method for the use of emergency services and hospitalization, mortality, and health care costs among older adults. Methods. Retrospective cohort study that included 2 168 older adults in a chronic noncommunicable disease (CNCD) care program in Medellin, Colombia. Patients were stratified according to a FC method based on functional status, presence of risk factors, and control of comorbidity. During one year of follow-up, the predictive validity of the FC method was assessed for the studied outcomes. Discrimination and calibration were measured with the C-statistic and Hosmer-Lemeshow (HL) test, respectively. Results. The average age was 74.6 ± 7.9 years; 40.8% (n = 884) were men and 7.7% (n = 168) died. The risk of death (odds ratio [OR]: 1.767; 3.411; 8.525), hospitalization (OR: 1.397; 2.172; 3.540) and high cost of health care (OR: 1.703; 2.369; 5.073) increased in proportion to a deterioration in functional classification (classes 2B, 3, and 4, respectively). The predictive model for the outcome of death showed good capacity for discrimination (C-statistic = 0.721) and calibration (HL statistic 10.200; P = 0.251). Conclusion. There is a dose-response relationship between deterioration in FC and a higher risk of death, hospitalization, and high cost. FC has predictive validity for the mortality rate and could be used to stratify older adults in CNCD care programs with a view to guiding interventions.

[RESUMO]. Objetivo. Avaliar a validade preditiva de um método de classificação funcional (CF) para a utilização de serviços de emergência e internação hospitalar, mortalidade e custos da atenção de saúde em idosos. Métodos. Estudo de coorte retrospectivo com 2 168 idosos atendidos em um programa de atenção de doenças crônicas não transmissíveis (DCNT) em Medellín, Colômbia. Um método de CF foi usado para estratificar os participantes segundo o estado funcional, presença de fatores de risco e controle de comorbidades. No período de acompanhamento de um ano, a validade preditiva da CF foi avaliada para os desfechos de interesse. A capacidade discriminatória (estatística C) e a calibração (teste de Hosmer-Lemeshow [H-L]) do modelo foram avaliadas. Resultados. A média de idade dos participantes do estudo foi 74,6 ± 7,9 anos, 40,8% (n = 884) eram do sexo masculino e 7,7% (n = 168) vieram a óbito. Houve aumento do risco de óbito (odds ratio [OR] 1,767; 3,411–8,525), internação hospitalar (OR 1,397; 2,172-3,540) e custo elevado da atenção de saúde (OR 1,703; 2,369–5,073) com o declínio funcional – classes funcionais 2B, 3 e 4, respectivamente. O modelo preditivo para o desfecho de óbito demonstrou boa capacidade discriminatória (estatística C = 0,721) e calibração (estatística H-L = 10,200; P = 0,251). Conclusão. Há uma relação de dose-resposta entre o declínio da CF e risco maior de óbito, internação hospitalar e custo elevado da atenção. A CF tem validade preditiva para a taxa de mortalidade e poderia ser utilizada na estratificação de idosos em programas de atenção de DCNT para ajudar a direcionar as medidas de intervenção.

Validación predictiva de un método de clasificación funcional en adultos mayores / Predictive validity of a functional classification method in older adults / Validação preditiva de método de classificação funcional em idosos

RESUMEN Objetivo. Evaluar la validez predictiva de un método de clasificación funcional (CF) sobre el uso de los servicios de urgencias y hospitalización, mortalidad y costos de la atención en salud en adultos mayores. Métodos. Estudio de cohorte retrospectivo que incluyó 2 168 adultos mayores en un programa de atención de las enfermedades crónicas no transmisibles (ECNT) en Medellín (Colombia). Los pacientes fueron estratificados según un método de CF con base en el estado funcional, presencia de factores de riesgo y control de la comorbilidad. Durante un año de seguimiento, se evaluó la validez predictiva de la CF sobre los desenlaces estudiados; se midieron la discriminación y la calibración con el estadístico-C y de Hosmer-Lemeshow (H-L), respectivamente. Resultados. El promedio de edad fue 74,6 ± 7,9 años; el 40,8% (n = 884) fueron hombres y 7,7% (n = 168) murieron. El riesgo de muerte (razón de posibilidades [OR, por su sigla en inglés]: 1,767; 3,411; 8,525), hospitalización (OR: 1,397; 2,172; 3,540) y un costo elevado de la atención en salud (OR: 1,703; 2,369; 5,073) aumentaron en la medida que hubo un deterioro en la CF, clases 2B, 3 y 4, respectivamente. El modelo predictivo para el desenlace muerte mostró una buena capacidad de discriminación (estadístico-C = 0,721) y calibración (estadístico de H-L = 10,200; P = 0,251). Conclusión. Existe una relación de dosis y respuesta entre el deterioro de la CF y un riesgo más elevado de muerte, hospitalización y costo elevado. La CF tiene validez predictiva para la tasa de mortalidad y podría utilizarse para la estratificación de adultos mayores en programas de atención de las ECNT con miras a dirigir las acciones de intervención.

ABSTRACT Objective. Evaluate the predictive validity of a functional classification (FC) method for the use of emergency services and hospitalization, mortality, and health care costs among older adults. Methods. Retrospective cohort study that included 2 168 older adults in a chronic noncommunicable disease (CNCD) care program in Medellin, Colombia. Patients were stratified according to a FC method based on functional status, presence of risk factors, and control of comorbidity. During one year of follow-up, the predictive validity of the FC method was assessed for the studied outcomes. Discrimination and calibration were measured with the C-statistic and Hosmer-Lemeshow (HL) test, respectively. Results. The average age was 74.6 ± 7.9 years; 40.8% (n = 884) were men and 7.7% (n = 168) died. The risk of death (odds ratio [OR]: 1.767; 3.411; 8.525), hospitalization (OR: 1.397; 2.172; 3.540) and high cost of health care (OR: 1.703; 2.369; 5.073) increased in proportion to a deterioration in functional classification (classes 2B, 3, and 4, respectively). The predictive model for the outcome of death showed good capacity for discrimination (C-statistic = 0.721) and calibration (HL statistic 10.200; P = 0.251). Conclusion. There is a dose-response relationship between deterioration in FC and a higher risk of death, hospitalization, and high cost. FC has predictive validity for the mortality rate and could be used to stratify older adults in CNCD care programs with a view to guiding interventions.

RESUMO Objetivo. Avaliar a validade preditiva de um método de classificação funcional (CF) para a utilização de serviços de emergência e internação hospitalar, mortalidade e custos da atenção de saúde em idosos. Métodos. Estudo de coorte retrospectivo com 2 168 idosos atendidos em um programa de atenção de doenças crônicas não transmissíveis (DCNT) em Medellín, Colômbia. Um método de CF foi usado para estratificar os participantes segundo o estado funcional, presença de fatores de risco e controle de comorbidades. No período de acompanhamento de um ano, a validade preditiva da CF foi avaliada para os desfechos de interesse. A capacidade discriminatória (estatística C) e a calibração (teste de Hosmer-Lemeshow [H-L]) do modelo foram avaliadas. Resultados. A média de idade dos participantes do estudo foi 74,6 ± 7,9 anos, 40,8% (n = 884) eram do sexo masculino e 7,7% (n = 168) vieram a óbito. Houve aumento do risco de óbito (odds ratio [OR] 1,767; 3,411-8,525), internação hospitalar (OR 1,397; 2,172-3,540) e custo elevado da atenção de saúde (OR 1,703; 2,369-5,073) com o declínio funcional - classes funcionais 2B, 3 e 4, respectivamente. O modelo preditivo para o desfecho de óbito demonstrou boa capacidade discriminatória (estatística C = 0,721) e calibração (estatística H-L = 10,200; P = 0,251). Conclusão. Há uma relação de dose-resposta entre o declínio da CF e risco maior de óbito, internação hospitalar e custo elevado da atenção. A CF tem validade preditiva para a taxa de mortalidade e poderia ser utilizada na estratificação de idosos em programas de atenção de DCNT para ajudar a direcionar as medidas de intervenção.

Surgical treatment in oligometastatic breast cancer.

Metastatic breast cancer (MBC) management is based on systemic treatment (ST), while the local therapy role remains controversial. We present the case of a 36-year-old woman with a diagnosis of hormone receptor-positive and human epidermal growth factor receptor type 2-positive breast cancer and isolated sternal metastasis, who received neoadjuvant ST with complete remission and later primary tumour surgery. Oligometastatic patients are a subgroup of MBC that can benefit from aggressive local therapies, even with curative intent.

SURVIVAL AND PERIOPERATIVE MORBIDITY OF TOTALLY LAPAROSCOPIC VERSUS OPEN GASTRECTOMY FOR EARLY GASTRIC CANCER: ANALYSIS FROM A SINGLE LATIN AMERICAN CENTRE.

BACKGROUND: Laparoscopic gastrectomy has numerous perioperative advantages, but the long-term survival of patients after this procedure has been less studied. AIM: To compare survival, oncologic and perioperative outcomes between completely laparoscopic vs. open gastrectomy for early gastric cancer. METHODS: This study was retrospective, and our main outcomes were the overall and disease-specific 5-year survival, lymph node count and R0 resection rate. Our secondary outcome was postoperative morbidity. RESULTS: Were included 116 patients (59% men, age 68 years, comorbidities 73%, BMI 25) who underwent 50 laparoscopic gastrectomies and 66 open gastrectomies. The demographic characteristics, tumour location, type of surgery, extent of lymph node dissection and stage did not significantly differ between groups. The overall complication rate was similar in both groups (40% vs. 28%, p=ns), and complications graded at least Clavien 2 (36% vs. 18%, p=0.03), respiratory (9% vs. 0%, p=0.03) and wound-abdominal wall complications (12% vs. 0%, p=0.009) were significantly lower after laparoscopic gastrectomy. The lymph node count (21 vs. 23 nodes; p=ns) and R0 resection rate (100% vs. 96%; p=ns) did not significantly differ between groups. The 5-year overall survival (84% vs. 87%, p=0.31) and disease-specific survival (93% vs. 98%, p=0.20) did not significantly differ between the laparoscopic and open gastrectomy groups. CONCLUSION: The results of this study support similar oncologic outcome and long-term survival for patients with early gastric cancer after laparoscopic gastrectomy and open gastrectomy. In addition, the laparoscopic approach is associated with less severe morbidity and a lower occurrence of respiratory and wound-abdominal wall complications.

Survival and perioperative morbidity of totally laparoscopic versus open gastrectomy for early gastric cancer: analysis from a single latin american centre / Comparação da sobrevida e morbidade perioperatória da gastrectomia totalmente laparoscópica vs. laparotômica para tratamento do câncer gástrico precoce em um centro latino-americano

ABSTRACT Background: Laparoscopic gastrectomy has numerous perioperative advantages, but the long-term survival of patients after this procedure has been less studied. Aim: To compare survival, oncologic and perioperative outcomes between completely laparoscopic vs. open gastrectomy for early gastric cancer. Methods: This study was retrospective, and our main outcomes were the overall and disease-specific 5-year survival, lymph node count and R0 resection rate. Our secondary outcome was postoperative morbidity. Results: Were included 116 patients (59% men, age 68 years, comorbidities 73%, BMI 25) who underwent 50 laparoscopic gastrectomies and 66 open gastrectomies. The demographic characteristics, tumour location, type of surgery, extent of lymph node dissection and stage did not significantly differ between groups. The overall complication rate was similar in both groups (40% vs. 28%, p=ns), and complications graded at least Clavien 2 (36% vs. 18%, p=0.03), respiratory (9% vs. 0%, p=0.03) and wound-abdominal wall complications (12% vs. 0%, p=0.009) were significantly lower after laparoscopic gastrectomy. The lymph node count (21 vs. 23 nodes; p=ns) and R0 resection rate (100% vs. 96%; p=ns) did not significantly differ between groups. The 5-year overall survival (84% vs. 87%, p=0.31) and disease-specific survival (93% vs. 98%, p=0.20) did not significantly differ between the laparoscopic and open gastrectomy groups. Conclusion: The results of this study support similar oncologic outcome and long-term survival for patients with early gastric cancer after laparoscopic gastrectomy and open gastrectomy. In addition, the laparoscopic approach is associated with less severe morbidity and a lower occurrence of respiratory and wound-abdominal wall complications.

RESUMO Racional: A gastrectomia laparoscópica tem numerosas vantagens perioperatórias, mas a sobrevivência em longo prazo após este procedimento tem sido menos estudada. Objetivo: Comparar resultados de sobrevivência, oncológica e perioperatória entre a gastrectomia completamente laparoscópica vs. aberta para câncer gástrico precoce. Método: Este estudo foi retrospectivo e os principais resultados foram a sobrevivência global e específica de cinco anos, contagem de linfonodos e taxa de ressecção R0. Resultado secundário foi a morbidade pós-operatória. Resultados: Foram incluídos 116 pacientes (59% homens, idade 68 anos, comorbidades 73%, IMC 25) que foram submetidos a 50 gastrectomias laparoscópicas e 66 gastrectomias abertas. As características demográficas, a localização do tumor, o tipo de operação, a extensão da dissecção dos linfonodos e do estágio não diferiram significativamente entre os grupos. A taxa geral de complicações foi semelhante em ambos os grupos (40% vs. 28%, p=ns) e complicações classificadas Clavien 2 (36% vs. 18%, p=0,03), respiratórias (9% vs. 0%, p=0,03) e as da parede abdominal (12% vs. 0%, p=0,009) foram significativamente menores após a gastrectomia laparoscópica. A contagem de linfonodos (21 contra 23, p=ns) e a taxa de ressecção R0 (100% vs. 96%; p=ns) não diferiram significativamente entre os grupos. A sobrevida global de cinco anos (84% vs. 87%, p=0,31) e a sobrevida específica (93% vs. 98%, p=0,20) não diferiram significativamente entre os grupos de gastrectomia laparoscópica e aberta. Conclusão: Estes resultados suportam resultados oncológicos similares e sobrevida em longo prazo para pacientes com câncer gástrico precoce após gastrectomia laparoscópica e gastrectomia aberta. Além disso, a abordagem laparoscópica está associada com morbidade menos grave e menor ocorrência de complicações respiratórias e da parede abdominal.

Evaluación de competencia de pacientes antes de la cirugía / Assessment of mental competency of patients, before surgery

Resumen Objetivo: Evaluar las alteraciones de la competencia en pacientes entre 18 y 65 años programados a cirugía general en el Hospital Clínico UC-Christus. Se estudiaron las alteraciones en habilidades cognitivas asociadas a la competencia de los pacientes, en distintos momentos previos a una cirugía electiva, bajo la hipótesis de que la capacidad de tomar decisiones varía o fluctúa antes de una intervención quirúrgica. Material y métodos: Estudio observacional, de carácter transversal. Fueron evaluados 85 pacientes, 44 en la unidad preoperatoria y 41 en el pabellón quirúrgico, por medio del test Montreal cognitive asessment tool (MoCA). Resultados: No hubo diferencias significativas entre la evaluación en la unidad preoperatoria y en el pabellón quirúrgico (p = 0,19). Ni tampoco en cuanto a porcentaje de pacientes con puntaje MoCA menor a puntaje de corte de 26 puntos en ambos lugares (30 vs. 26%; p = 0,61). Discusión: Variables como edad y nivel educacional pueden estar asociadas a alteraciones en la competencia de los pacientes. El momento de evaluación de los pacientes no influye significativamente en los resultados del test MoCA. Conclusiones: No fue posible concluir que existan diferencias en la capacidad de consentir de los pacientes, evaluada según puntaje en escala MoCA, en momentos próximos a una intervención quirúrgica.

Abstract Objective: To evaluate competence related alterations, in patients between 18 and 65 years old, scheduled to surgery in the Hospital Clínico UC-Christus. Alteration of cognitive skills associated to patients competence were observed in the preoperatory service, and in the surgical theatre. The underlying hypothesis was than the skills related to decision making fluctuates in the previous moments to a surgical intervention. Material and methods: Observational study. A total of 85 patients were evaluated, 44 in the preoperatory room and 41 in the surgical theatre, using the Montreal Cognitive Asessment Tool (MoCA). Results: There were no differences between evaluations in the preoperatory room and the surgical theatre (P=.19). Neither were differences between the percentage of patients who achieved less than 26 points (the cutoff of the test) in both evaluated places (30 vs. 26%, P=.61). Discussion: Other associated variables, such as age and educational level, could be related to competence related alterations in patients. The patient evaluation moment does not influences the results of the MoCA test. Conclusions: It is not possible to conclude than there are no differences in the patients ability to consent, evaluated by the MoCA tool, in the moments prior to a surgical intervention.

FREQUENCY OF ANTI- Toxocara spp. ANTIBODIES IN INDIVIDUALS ATTENDED BY THE CENTRO DE SALUD FAMILIAR AND ENVIRONMENTAL CONTAMINATION WITH Toxocara canis EGGS IN DOG FECES, IN THE COASTAL NIEBLA TOWN, CHILE.

The frequency of anti-Toxocara spp. antibodies in individuals attended by the Centro de Salud Familiar in the coastal Niebla town, Chile, was related to the host and to environmental factors. IgG anti- Toxocara antibodies were detected with a commercial ELISA kit (SCIMEDX Corporation, USA). Samples with undetermined absorbance values were subjected to an additional ELISA standardized by the Instituto de Salud Pública, Chilean Health Ministry, a commercial ELISA (NOVATEC, Germany), and a commercial Western blot kit (LDBio Diagnostics, France). Hematological exams were performed using an automated blood counter and blood smears. Dog feces were collected from the ground along the main road in Niebla, including rural and urban locations. Ninety (25.4%) of the 355 examined individuals were positive by the ELISA test. The frequency of anti-Toxocara antibodies and the infection risk were significantly higher (p < 0.05) among those individuals ≥ 40 years old with respect to the 20-39 years old group, in individuals from rural locations, those who did not have a safe drinking water supply in the house or who presented blood eosinophilia. The proportion of positive samples of dog feces and the mean number of Toxocara canis eggs/g of feces in urban and rural areas were similar (p > 0.05).

Manifestaciones cutáneas de enfermedades inflamatorias gastrointestinales / Cutaneous manifestations of intestinal inflammatory diseases

El término enfermedades inflamatorias intestinales agrupa principalmente dos tipos de entidades: la enfermedad de Crohn y la colitis ulcerativa; la amplia gama de manifestaciones extraintestinales ha llevado al reconocimiento de entidades dermatológicas que se encuentran asociadas a este tipo de patologías; este artículo hace una revisión sistemática de la literatura de las manifestaciones cutáneas relacionadas con la enfermedad de Crohn y la colitis ulcerativa de las bases de datos MEDLINE, PUBMED, OVID Y HINARI, con el fin de exponer de manera concisa las principales entidades dermatológicas asociadas a estas entidades gastrointestinales

El Asbesto y el Deterior de la Salud en el Ecuador / The Asbestos and the Deterioration of the Health in the Ecuador

El desarrollo de las fuerzas productivas en nuestro país en la década de los años sesenta, facilita que nuestra economía entre en un período de industrialización con creciente dependencia tecnológica, lo que nos enmarca en un contexto de transnacionalización y crecimiento industrial.Los consorcios multinacionales buscan en los países en desarrollo la posibilidad de obtener óptimas ganancias sea éstas actuales o potenciales, sin reparar en el daño orgánico que puede sufrir la población o los trabajadores que realizan la transforamción del objeto, esto ha dado lugar a la transferencia de riesgos que muchas veces aparece disimulada como transferencia de tecnología.Es a partir de las dos últimas décadas que los gobiernos han facilitado la instalación de fábricas dedicadas a la elaboración de productos de asbesto justificando su instalación enn el acelerado incremento de las construcciones

El asbesto y el deterior de la salud en el Ecuador / The asbestos and the deterioration of the health in the Ecuador

El desarrollo de las fuerzas productivas en nuestro país en la década de los años sesenta, facilita que nuestra economía entre en un período de industrialización con creciente dependencia tecnológica, lo que nos enmarca en un contexto de transnacionalización y crecimiento industrial.Los consorcios multinacionales buscan en los países en desarrollo la posibilidad de obtener óptimas ganancias sea éstas actuales o potenciales, sin reparar en el daño orgánico que puede sufrir la población o los trabajadores que realizan la transforamción del objeto, esto ha dado lugar a la transferencia de riesgos que muchas veces aparece disimulada como transferencia de tecnología.Es a partir de las dos últimas décadas que los gobiernos han facilitado la instalación de fábricas dedicadas a la elaboración de productos de asbesto justificando su instalación enn el acelerado incremento de las construcciones