Spinal gunshot wounds: A retrospective, multicenter, cohort study. / [Artículo traducido] Lesiones vertebrales por proyectil de arma de fuego: estudio de cohorte retrospectivo, multicéntrico.

INTRODUCTION AND OBJECTIVE: To describe the demographic and clinical characteristics and treatment of patients with spinal gunshot wounds across Latin America. MATERIAL AND METHODS: Retrospective, multicenter cohort study of patients treated for gunshot wounds to the spine spanning 12 institutions across Latin America between January 2015 and January 2022. Demographic and clinical data were recorded, including the time of injury, initial assessment, characteristics of the vertebral gunshot injury, and treatment. RESULTS: Data on 423 patients with spinal gunshot injuries were extracted from institutions in Mexico (82%), Argentina, Brazil, Colombia, and Venezuela. Patients were predominantly male civilians in low-risk-of-violence professions, and of lower/middle social status, and a sizeable majority of gunshots were from low-energy firearms. Vertebral injuries mainly affected the thoracic and lumbar spine. Neurological injury was documented in 320 (76%) patients, with spinal cord injuries in 269 (63%). Treatment was largely conservative, with just 90 (21%) patients treated surgically, principally using posterior open midline approach to the spine (79; 87%). Injury features distinguishing surgical from non-surgical cases were neurological compromise (P = 0.004), canal compromise (P < 0.001), dirty wounds (P < 0.001), bullet or bone fragment remains in the spinal canal (P < 0.001) and injury pattern (P < 0.001). After a multivariate analysis through a binary logistic regression model, the aforementioned variables remained statistically significant except neurological compromise. CONCLUSIONS: In this multicenter study of spinal gunshot victims, most were treated non-surgically, despite neurological injury in 76% and spinal injury in 63% of patients.

Análisis de eventos adversos en los servicios de cirugía general y aparato digestivo. Estudio multicéntrico / Analysis of adverse events in general surgery: A multicenter study

Introducción: El conocimiento de los eventos adversos (EA) en los hospitales de agudos es un aspecto de especial relevancia en la seguridad del paciente. Su incidencia oscila entre un 3-17% y la cirugía se relaciona con la aparición de entre un 46-65% de todos los EA. Material y métodos: Se realiza un estudio observacional, descriptivo, retrospectivo y multicéntrico, con la participación de 31 hospitales de agudos españoles, para la determinación y análisis de los EA en los servicios de cirugía general. Resultados: La prevalencia de EA fue del 31,53%. Los tipos de EA más frecuentes fueron de tipo infeccioso (35%). Los pacientes con mayores grados de ASA, mayor complejidad y un tipo de ingreso urgente son factores asociados a la presencia de EA. A la mayoría de los pacientes se les atribuyó una categoría de daño F (daño temporal al paciente que requiera iniciar o prolongar la hospitalización) (58,42%). El 14,69% de los EA son considerados graves. El 34,22% de los EA se consideraron evitables. Conclusiones: La prevalencia de EA en los pacientes de cirugía general y del aparato digestivo (CGAD) es elevada. La mayor parte de los EA fueron de tipo infeccioso. El EA más frecuente fue la infección de herida o sitio quirúrgico. Los pacientes con mayores grados de ASA, mayor complejidad y un tipo de ingreso urgente son factores asociados a la presencia de EA. La mayoría de los EA detectados han supuesto un daño leve o moderado sobre los pacientes. Alrededor de un tercio de EA fueron evitables.(AU)

Introduction: Knowledge of adverse events (AE) in acute care hospitals is a particularly relevant aspect of patient safety. Its incidence ranges from 3% to 17%, and surgery is related to the occurrence of 46%-65% of all AE. Material and methods: An observational, descriptive, retrospective, multicenter study was conducted with the participation of 31 Spanish acute-care hospitals to determine and analyze AE in general surgery services. Results: The prevalence of AE was 31.53%. The most frequent types of AE were infectious (35%). Higher ASA grades, greater complexity and urgent-type admission are factors associated with the presence of AE. The majority of patients (58.42%) were attributed a category F event (temporary harm to the patient requiring initial or prolonged hospitalization); 14.69% of AE were considered severe, while 34.22% of AE were considered preventable. Conclusions: The prevalence of AE in General and GI Surgery (GGIS) patients is high. Most AE were infectious, and the most frequent AE was surgical site infection. Higher ASA grades, greater complexity and urgent-type admission are factors associated with the presence of AE. Most detected AE resulted in mild or moderate harm to the patients. About one-third of AE were preventable.(AU)

Analysis of adverse events in general surgery. Multicenter study.

INTRODUCTION: Knowledge of adverse events (AE) in acute care hospitals is a particularly relevant aspect of patient safety. Its incidence ranges from 3% to 17%, and surgery is related to the occurrence of 46%-65% of all AE. MATERIAL AND METHODS: An observational, descriptive, retrospective, multicenter study was conducted with the participation of 31 Spanish acute-care hospitals to determine and analyze AE in general surgery services. RESULTS: The prevalence of AE was 31.53%. The most frequent types of AE were infectious (35%). Higher ASA grades, greater complexity and urgent-type admission are factors associated with the presence of AE. The majority of patients (58.42%) were attributed a category F event (temporary harm to the patient requiring initial or prolonged hospitalization); 14.69% of AE were considered severe, while 34.22% of AE were considered preventable. CONCLUSIONS: The prevalence of AE in General and GI Surgery (GGIS) patients is high. Most AE were infectious, and the most frequent AE was surgical site infection. Higher ASA grades, greater complexity and urgent-type admission are factors associated with the presence of AE. Most detected AE resulted in mild or moderate harm to the patients. About one-third of AE were preventable.

Protocolización de estudios clínicos multicéntricos en la era digital. ¿Tiene utilidad la centralización de datos por un data-manager? / Protocolization of multicenter clinical studies in the digital era. Is useful data centralization by a data-manager?

Introducción En los estudios multicéntricos la protocolización de los datos es una fase crítica que puede generar sesgos, sobre todo en estudios clínicos con presupuesto limitado. El objetivo es analizar la concordancia y la confiabilidad de los datos obtenidos en un estudio multicéntrico clínico entre la protocolización del centro de origen y la protocolización centralizada mediante un data-manager. Método Estudio clínico multicéntrico de prevalencia nacional sobre un carcinoma familiar infrecuente, realizándose una doble protocolización de los datos: a)en el centro de origen, y b)centralizada con un data-manager. La concordancia se analiza para el global de los datos y para los dos subgrupos del proyecto: a)grupo a estudio (carcinoma familiar; protocolizan 30 investigadores) y b)grupo control (carcinoma esporádico; protocolizan 4). Las diferencias interobservador se evalúan mediante el índice de Kappa de Cohen. Resultados Se incluyen 689 pacientes: 252 del grupo a estudio y 437 del grupo control. Respecto al análisis de concordancia del estadio tumoral, se han objetivado un 2,5% de discordancias, siendo alta la concordancia entre protocolizadores (Kappa=0,931). Respecto a la valoración del riesgo de recidiva, las discordancias fueron del 7% de los casos, siendo alta la concordancia (Kappa=0,819). Respecto a la clasificación ecográfica TIRADS, las discordancias son del 6,9% y la concordancia es alta (Kappa=0,922). Se han detectado un 4,6% de errores de transcripción. Conclusiones En los estudios multicéntricos clínicos la protocolización centralizada de los datos por un data-manager parece presentar resultados similares a la protocolización directa en la base de datos en el centro de origen. (AU)

Introduction In multicenter studies, the protocolization of data is a critical phase that can generate biases. The objective is to analyze the concordance and reliability of the data obtained in a clinical multicenter study between the protocolization in the center of origin and the centralized protocolization of the data by a data-manager. Methods National multicenter clinical study about an infrequent carcinoma. A double protocolization of the data is carried out: (i)center of origin; and (ii)centralized by a data manager. The concordance between the data is analyzed for the global data and for the two groups of the project: (i)study group (familiar carcinoma, 30 researchers protocolize); (ii)control group (sporadic carcinoma, 4 people protocolize). Interobserver variability is evaluated using Cohen's kappa coefficient. Results The study includes a total of 689 patients with carcinoma: 252 in the study group and 437 in the control group. Regarding the concordance analysis of the tumor stage, 2.5% of disagreements were observed and the concordance between people who protocolize was near perfect (Kappa=0.931). Regarding the evaluation of the recurrence risk, disagreements occurred in 7% of the cases and the concordance was near perfect (Kappa=0.819). Regarding the sonography evaluation (TIRADS), the disagreements were 6.9% and the concordance was near perfect (Kappa=0.922). Also, 4.6% of transcription errors were detected. Conclusions In multicenter clinical studies, the centralized data protocolization by a data-manager seems to present similar results to the direct protocolization in the database in the center of origin. (AU)

Protocolization of multicenter clinical studies in the digital era. Is useful data centralization by a data-manager?

INTRODUCTION: In multicenter studies, the protocolization of data is a critical phase that can generate biases.The objective is to analyze the concordance and reliability of the data obtained in a clinical multicenter study between the protocolization in the center of origin and the centralized protocolization of the data by a data -manager. METHODS: National multicenter clinical study about an infrequent carcinoma. A double protocolization of the data is carried out: (a) center of origin; and (b) centralized by a data manager: The concordance between the data is analyzed for the global data and for the two groups of the project: (a) study group (Familiar carcinoma, 30 researchers protocolize); (b) control group (Sporadic carcinoma, 4 people protocolize). Interobserver variability is evaluated using Cohen's kappa coefficient. RESULTS: The study includes a total of 689 patients with carcinoma, 252 in the study group and 437 in the control group. Regarding the concordance analysis of the tumor stage, 2.5% of disagreements were observed and the concordance between people who protocolize was near perfect (Kappa = 0.931). Regarding the evaluation of the recurrence risk, disagreements occurred in 7% of the cases and the concordance was near perfect (Kappa = 0.819). Regarding the sonography evaluation (TIRADS), the disagreements were 6.9% and the concordance was near perfect (Kappa = 0.922). Also, 4.6% of transcription errors were detected. CONCLUSIONS: In multicenter clinical studies, the centralized data protocolization o by a data-manager seems to present similar results to the direct protocolization in the database in the center of origin.

Características clínicas y evolutivas de adenomas hipofisarios incidentales: estudio multicéntrico retrospectivo / Clinical and evolutionary characteristics of incidental pituitary adenomas: retrospective multicenter study

Resumen Introducción : Los incidentalomas hipofisarios (IH) son lesiones halladas fortuitamente en la hipófisis mediante imágenes realizadas por motivos no relacionados con enfermedad hipofisaria. Métodos : Se realizó un estudio transversal, retros pectivo y descriptivo con el objetivo de analizar las características clínicas y evolutivas de una población de pacientes portadores de IH en la ciudad de Córdoba. Resultados : Se incluyeron 67 pacientes, 67% del sexo femenino, con una mediana de edad al diagnóstico de 44 años. Entre los motivos que llevaron a solicitar la primera imagen, la cefalea crónica o recurrente fue el más prevalente (34%). La mediana del tamaño tumoral fue de 12 mm. El 58% fueron macroincidentalomas. Los hombres tuvieron lesiones significativamente más grandes (p = 0.04). Al diagnóstico, considerando ambos sexos, el 30% evidenció extensión extraselar y el 45% invasión a senos cavernosos. Se detectó compromi so neurooftalmológico en el 21%. Se halló correlación positiva entre la edad al momento del diagnóstico y el tamaño tumoral (r = +0.31, p = 0.001). El 91% fueron tumores no funcionantes y en su presentación, el 21% de los pacientes presentaron una o más deficiencias hormonales. El 26% del total requirió cirugía. La ma yoría de aquellos que continuaron sin tratamiento no evidenciaron cambios en el tamaño tumoral al final del seguimiento (mediana 42 meses). Conclusión : Destacamos la elevada frecuencia de macroincidentalomas en nuestra serie, siendo los de fectos del campo visual y el hipopituitarismo frecuentes al diagnóstico. Si bien la mayoría de los IH no operados permanecieron estables, existió una alta frecuencia de lesiones clínicamente significativas.

Abstract Introduction : Pituitary incidentalomas (PIs) are le sions found incidentally in the pituitary on imaging performed for reasons unrelated to pituitary disease. Methods : A cross-sectional, retrospective and descrip tive study was carried out with the aim of analyzing the clinical and evolutionary characteristics of a population of patients with PIs in the city of Córdoba. Results : A total of 67 patients were included, 67% fe male, with a median age at diagnosis of 44 years. Among the reasons that led to requesting the first image, chron ic or recurrent headache was the most prevalent (34%). The median tumor size was 12 mm. Fifty-eight percent were macroincidentalomas. Men had significantly larger lesions (p = 0.04). At diagnosis, including both sexes, 30% showed extrasellar extension and 45% invasion of the cavernous sinuses. Neuro-ophthalmological compromise was detected in 21%. A positive correlation was found between age at diagnosis and tumor size (r= +0.31, p = 0.001). Ninety-one percent were non-functioning tumors and at presentation, 21% of patients had one or more hormonal deficiencies. Of the total, 26% required surgery. Most of those who continued without treatment showed no change in tumor size at the end of follow-up (median 42 months). Conclusion : We highlight the high frequency of mac roincidentalomas in our series, with visual field defects and hypopituitarism being frequent at diagnosis. Al though most non-operated PIs remained stable, there was a high frequency of clinically significant lesions.

Spinal gunshot wounds: A retrospective, multicenter, cohort study.

INTRODUCTION AND OBJECTIVE: To describe the demographic and clinical characteristics and treatment of patients with spinal gunshot wounds across Latin America. MATERIAL AND METHODS: Retrospective, multicenter cohort study of patients treated for gunshot wounds to the spine spanning 12 institutions across Latin America between January 2015 and January 2022. Demographic and clinical data were recorded, including the time of injury, initial assessment, characteristics of the vertebral gunshot injury, and treatment. RESULTS: Data on 423 patients with spinal gunshot injuries were extracted from institutions in Mexico (82%), Argentina, Brazil, Colombia, and Venezuela. Patients were predominantly male civilians in low-risk-of-violence professions, and of lower/middle social status, and a sizeable majority of gunshots were from low-energy firearms. Vertebral injuries mainly affected the thoracic and lumbar spine. Neurological injury was documented in n=320 (76%) patients, with spinal cord injuries in 269 (63%). Treatment was largely conservative, with just 90 (21%) patients treated surgically, principally using posterior open midline approach to the spine (n=79; 87%). Injury features distinguishing surgical from non-surgical cases were neurological compromise (p=0.004), canal compromise (p<0.001), dirty wounds (p<0.001), bullet or bone fragment remains in the spinal canal (p<0.001) and injury pattern (p<0.001). After a multivariate analysis through a binary logistic regression model, the aforementioned variables remained statistically significant except neurological compromise. CONCLUSIONS: In this multicenter study of spinal gunshot victims, most were treated non-surgically, despite neurological injury in 76% and spinal injury in 63% of patients.

Reporting antimicrobial susceptibilities and phenotypes of resistance to vancomycin in vancomycin-resistant Enterococcus spp. clinical isolates: A nationwide proficiency study / Informe de sensibilidad antimicrobiana y fenotipos de resistencia a vancomicina en aislados clínicos de Enterococcus spp. resistentes a vancomicina: estudio multicéntrico nacional

Introduction: The ability of Spanish microbiology laboratories to (a) determine antimicrobial susceptibility (AS), and (b) correctly detect the vancomycin resistance (VR) phenotype in vancomycin-resistant Enterococcus spp. (VRE) was evaluated. Methods: Three VRE isolates representing the VanA (E. faecium), VanB (E. faecium) and VanC (E. gallinarum) VR phenotypes were sent to 52 laboratories, which were asked for: (a) AS method used; (b) MICs of ampicillin, imipenem, vancomycin, teicoplanin, linezolid, daptomycin, ciprofloxacin, levofloxacin and quinupristin–dalfopristin, and high-level resistance to gentamicin and streptomycin; (c) VR phenotype. Results: (a) The most frequently used system was MicroScan; (b) according to the system, the highest percentage of discrepant MICs was found with gradient strips (21.3%). By antimicrobial, the highest rates of discrepant MICs ranged 16.7% (imipenem) to 0.7% (linezolid). No discrepant MICs were obtained with daptomycin or levofloxacin. Mayor errors (MEs) occurred with linezolid (1.1%/EUCAST) and ciprofloxacin (5.0%/CLSI), and very major errors (VMEs) with vancomycin (27.1%/EUCAST and 33.3%/CLSI) and teicoplanin (5.7%/EUCAST and 2.3%/CLSI). For linezolid, ciprofloxacin, and vancomycin, discrepant MICs were responsible for these errors, while for teicoplanin, errors were due to a misassignment of the clinical category. An unacceptable high percentage of VMEs was obtained using gradient strips (14.8%), especially with vancomycin, teicoplanin and daptomycin; (c) 86.4% of the centers identified VanA and VanB phenotypes correctly, and 95.0% the VanC phenotype. Conclusion: Most Spanish microbiology laboratories can reliably determine AS in VRE, but there is a significant percentage of inadequate interpretations (warning of false susceptibility) for teicoplanin in isolates with the VanB phenotype.(AU)

Introducción: Se evaluó la capacidad de los laboratorios de microbiología españoles para: (a) determinar la sensibilidad antimicrobiana (SA); y (b) detectar correctamente el fenotipo de resistencia a vancomicina (FRV) en Enterococcus spp. resistente a vancomicina (ERV). Métodos: Se enviaron 3 aislados de ERV (E. faecium/VanA, E. faecium/VanB y E. gallinarum/VanC) a 52 laboratorios, a los que se les solicitó: (a) método de SA; (b) CMI de ampicilina, imipenem, vancomicina, teicoplanina, linezolid, daptomicina, ciprofloxacino, levofloxacino y quinupristina-dalfopristina y resistencia de alto nivel a gentamicina y estreptomicina; y (c) fenotipo de resistencia a vancomicina. Resultados: (a) El sistema más utilizado fue MicroScan; y (b) el mayor porcentaje de CMI discrepantes se produjo con las tiras de gradiente (21,3%). Las tasas más elevadas de CMI discrepantes variaron entre el 16,7% (imipenem) y el 0,7% (linezolid). Se produjeron errores mayores con linezolid (1,1%/EUCAST) y ciprofloxacino (5,0%/CLSI) y errores máximos con vancomicina (27,1%/EUCAST y 33,3% CLSI) y teicoplanina (5,7%/EUCAST y 2,3%/CLSI). Para linezolid, ciprofloxacino y vancomicina las CMI discrepantes fueron las responsables de estos errores, mientras que para teicoplanina los errores se debieron a una asignación errónea de la categoría clínica. Se obtuvo un alto porcentaje de errores máximos utilizando tiras de gradiente (14,8%), especialmente con vancomicina, teicoplanina y daptomicina; y (c) el 86,4% de los centros identificaron correctamente los fenotipos VanA y VanB y el 95,0% el fenotipo VanC. Conclusión: La mayoría de los laboratorios de microbiología españoles determinan de forma fiable la SA en ERV, pero existe un porcentaje significativo de interpretaciones inadecuadas (falsa sensibilidad) para teicoplanina en aislados con fenotipo VanB.(AU)

Seguridad y eficacia de una nueva pauta de suplementación en pacientes con fibrosis quística e insuficiencia de vitamina D / Safety and efficacy of a new supplementation protocol in patients with cystic fibrosis and vitamin D deficiency

Objetivos: Basándonos en los documentos de consenso europeo y americano de fibrosis quística (FQ) se propone un incremento de la suplementación de vitamina D (VD) en pacientes con FQ y niveles insuficientes. El objetivo de nuestro estudio fue conocer la seguridad y la eficacia de este nuevo protocolo. Material y métodos: Estudio multicéntrico, experimental no aleatorizado ni controlado. A los pacientes con niveles insuficientes (<30ng/ml) se les administró dosis crecientes de VD (entre 800 y 10.000UI/día). Se realizó seguimiento durante 12 meses analizando estatus vitamínico, nutricional, función pulmonar y metabolismo fosfocálcico. Análisis estadístico: pruebas t para datos apareados y regresión logística con análisis multivariable. Resultados: Un total de 30 pacientes entre 1 y 39 años (mediana 9,1) completaron el estudio. Se retiraron 2 por niveles de 25 OH VD>100ng/ml a los 3 meses sin encontrarse signos clínicos ni analíticos de hipercalcemia. Tras 12 meses se observó un incremento de 7,6ng/ml (IC 95% 4,6-10ng/ml) de los niveles medios de 25 OH VD. El 37% alcanzaron niveles ≥30ng/ml, un 13% <20ng/ml y un 50% entre 20 y 30ng/ml. No se observó asociación de la mejoría de los niveles de VD con la función pulmonar. Conclusiones: Con el protocolo propuesto se consigue un incremento de los niveles séricos de VD y una disminución del porcentaje de pacientes con insuficiencia de la misma, aunque todavía muy lejos de alcanzar los porcentajes de suficiencia recomendados para esta entidad. (AU)

Objectives: Based on the European and American cystic fibrosis (CF) consensus recommendations, an increase in vitamin D (VD) supplementation in patients with CF and insufficient or deficient levels was proposed. The objective of our study was to determine the safety and efficacy of this new protocol. Material and methods: Multicentre nonrandomized uncontrolled experimental study. Patients with insufficient levels (<30ng/mL) received increasing doses of VD (between 800 and 10,000IU/day). Patients were followed up for 12 months, during which their vitamin and nutritional status, pulmonary function and calcium and phosphate metabolism were assessed. Statistical analysis: t test for paired data and multivariate logistic regression analysis. Results: Thirty patients aged 1–39 years (median, 9.1) completed the follow-up. Two patients were dropped from the study on account of 25-OH VD levels greater than 100ng/mL at 3 months without clinical or laboratory signs of hypercalcaemia. At 12 months, we observed an increase of 7.6ng/mL (95% CI, 4.6–10ng/mL) in the mean 25-OH VD level and an improvement in vitamin status: 37% achieved levels of 30ng/mL or greater, 50% levels between 20 and 30ng/mL and 13% remained with levels of less than 20ng/mL. We found no association between improved VD levels and pulmonary function. Conclusions: The proposed protocol achieved an increase in serum VD levels and a decrease in the percentage of patients with VD insufficiency, although it was still far from reaching the percentages of sufficiency recommended for this entity. (AU)

Safety and efficacy of a new supplementation protocol in patients with cystic fibrosis and vitamin D deficiency.

OBJECTIVES: Based on the European and American Cystic Fibrosis (CF) consensus recommendations, an increase in vitamin D (VD) supplementation in patients with CF and insufficient or defficient levels was proposed. The objective of our study was to determine the safety and efficacy of this new protocol. MATERIAL AND METHODS: Multicentre nonrandomized uncontrolled experimental study. Patients with insufficient levels (<30 ng/mL) received increasing doses of VD (between 800 and 10 000 IU/day). Patients were followed up for 12 months, during which their vitamin and nutritional status, pulmonary function and calcium and phosphate metabolism were assessed. STATISTICAL ANALYSIS: t test for paired data and multivariate logistic regression analysis. RESULTS: Thirty patients aged 1-39 years (median, 9.1) completed the follow-up. Two patients were dropped from the study on account of 25-OH VD levels greater than 100 ng/mL at 3 months without clinical or laboratory signs of hypercalcaemia. At 12 months, we observed an increase of 7.6 ng/mL (95% CI, 4.6-10 ng/mL) in the mean 25-OH VD level and an improvement in vitamin status: 37% achieved levels of 30 ng/mL or greater, 50% levels between 20 and 30 ng/mL and 13% remained with levels of less than 20 ng/mL. We found no association between improved VD levels and pulmonary function. CONCLUSIONS: The proposed protocol achieved an increase in serum VD levels and a decrease in the percentage of patients with VD insufficiency, although it was still far from reaching the percentages of sufficiency recommended for this entity.

Reporting antimicrobial susceptibilities and phenotypes of resistance to vancomycin in vancomycin-resistant Enterococcus spp. clinical isolates: A nationwide proficiency study.

INTRODUCTION: The ability of Spanish microbiology laboratories to (a) determine antimicrobial susceptibility (AS), and (b) correctly detect the vancomycin resistance (VR) phenotype in vancomycin-resistant Enterococcus spp. (VRE) was evaluated. METHODS: Three VRE isolates representing the VanA (E. faecium), VanB (E. faecium) and VanC (E. gallinarum) VR phenotypes were sent to 52 laboratories, which were asked for: (a) AS method used; (b) MICs of ampicillin, imipenem, vancomycin, teicoplanin, linezolid, daptomycin, ciprofloxacin, levofloxacin and quinupristin-dalfopristin, and high-level resistance to gentamicin and streptomycin; (c) VR phenotype. RESULTS: (a) The most frequently used system was MicroScan; (b) according to the system, the highest percentage of discrepant MICs was found with gradient strips (21.3%). By antimicrobial, the highest rates of discrepant MICs ranged 16.7% (imipenem) to 0.7% (linezolid). No discrepant MICs were obtained with daptomycin or levofloxacin. Mayor errors (MEs) occurred with linezolid (1.1%/EUCAST) and ciprofloxacin (5.0%/CLSI), and very major errors (VMEs) with vancomycin (27.1%/EUCAST and 33.3%/CLSI) and teicoplanin (5.7%/EUCAST and 2.3%/CLSI). For linezolid, ciprofloxacin, and vancomycin, discrepant MICs were responsible for these errors, while for teicoplanin, errors were due to a misassignment of the clinical category. An unacceptable high percentage of VMEs was obtained using gradient strips (14.8%), especially with vancomycin, teicoplanin and daptomycin; (c) 86.4% of the centers identified VanA and VanB phenotypes correctly, and 95.0% the VanC phenotype. CONCLUSION: Most Spanish microbiology laboratories can reliably determine AS in VRE, but there is a significant percentage of inadequate interpretations (warning of false susceptibility) for teicoplanin in isolates with the VanB phenotype.

Factores asociados a la publicación científica de estudiantes de Estomatología de siete universidades cubanas / Scientific production on Orthodontics published in biomedical journals belonging to Cuban medical universities

La publicación científica es la etapa final del ciclo investigativo, por lo que se deben estudiar los factores que se relacionan con su realización en el pregrado. El objetivo del estudio fue determinar los factores asociados a la publicación científica de estudiantes de Estomatología de siete universidades cubanas. Se diseñó un estudio multicéntrico, observacional y transversal con análisis de datos secundarios. Se investigó acerca del logro de las publicaciones científicas, otras variables socioeducativas y de participación en temas científicos. Se obtuvieron las razones de prevalencias ajustadas, los intervalos de confianza a 95 por ciento (IC 95 por ciento) y los valores p, mediante modelos lineales generalizados. De los 738 alumnos encuestados, el 9,3 por ciento declaró haber publicado, al menos, un artículo científico. El promedio de publicaciones fue de 9 por ciento entre todas las universidades; el porcentaje más elevado fue el de la Universidad de Ciencias Médicas de Camagüey (19 por ciento) y el más bajo el de la Universidad de Ciencias Médicas de Granma (4 por ciento) hubo una mayor frecuencia de publicación científica entre los que habían participado en proyectos (RPa: 1,85; IC 95 por ciento: 1,18-2,88; p =0,007) y habían obtenido premios en eventos científicos (RPa: 5,66; IC 95 por ciento: 2,16-14,85; p < 0,001), ajustando por cuatro variables. Se concluye que existió un bajo porcentaje de alumnos que publicaron, lo cual se asoció con la participación en proyectos y la obtención de premios en eventos científicos(AU)

Scientific publication is the final stage of the investigative cycle, so the factors that are related to its elaboration in the undergraduate should be studied. The objective of the study was to determine the associated factors with the scientific publication of Dentistry students from seven Cuban universities. A multicenter, observational, cross-sectional study with secondary data analysis was designed. The achievement of scientific publications, other socio-educational variables and participation in scientific matters were investigated. Adjusted prevalence ratios, 95percent confidence intervals (95percent CI) and p-values were obtained using generalized linear models. Seven hundred thirty-eight (738) students were surveyed; 9.3percent of them declared having published at least one scientific article. The average number of publications was 9percent among all universities; the highest percentage was that of Universidad de Ciencias Médicas de Camagüey (19%) and the lowest that of Universidad de Ciencias Médicas de Granma (4percent). There was a higher frequency of scientific publication among those who had participated in projects (RPa: 1.85; 95percent CI: 1.18-2.88; p =0.007) and had obtained prizes in scientific events (RPa: 5.66 95percent CI: 2.16-14.85, p < 0.001). It is concluded that there was low percentage of students who published, which was associated with participation in projects and obtaining prizes in scientific events(AU)

Emotional exhaustion in nursing students. A multicenter study / Fadiga emocional em estudantes de enfermagem. Estudo multicêntrico / Cansancio emocional en estudiantes de enfermería. Estudio multicéntrico

ABSTRACT Objective: To know emotional exhaustion in nursing students from four universities. Method: Cross-sectional, correlational study, carried out in Chile and Spain (2017-2018), with 1,368 students answering a self-applied instrument (sociodemographic/academic variables and the Emotional Exhaustion scale). Analysis with Stata 15, according to variables: Chi2 tests, Wilcoxon rank sum test (Mann Whitney U test), analysis of variance and multiple regression; confidence level 95% and significance 5% (p < 0.05). Approved by the Ethics Committee, Universidad de Girona. Results: Academic variables and perceived stress with Quite Much/Much classification: Exams, Problem-Based Learning, Laboratory/Simulation. Statistically significant differences in emotional exhaustion, according to sex, dependent people, workers, commuting time >30 minutes. Greater emotional exhaustion when taking courses for the second time and in academic activities where they declare perceived stress as Quite Much/Much (p < 0.005). Conclusion: All students present mean level of emotional exhaustion (>26 and <37 points). The variables sex and having dependents are relevant aspects. Stress perceived by methodologies is significantly related to levels of emotional exhaustion.

RESUMO Objetivo: Conhecer a fadiga emocional em estudantes de enfermagem de quatro universidades. Método: Estudo transversal, correlacional, realizado no Chile e na Espanha (2017-2018). Um total de 1.368 alunos respondeu a um instrumento autoaplicável (variáveis sociodemográficas/acadêmicas e Escala de Fadiga Emocional). Análise com Stata 15, de acordo com as variáveis: testes de Chi2, teste dos postos sinalizados de Wilcoxon (Mann Whitney), análise de variância e regressão múltipla; nível de confiança de 95% e significância de 5% (p < 0,05). Aprovado pelo Comitê de Ética da Universidade de Girona. Resultados: Variáveis acadêmicas e estresse percebido destaca Bastante/Muito: Exames, Aprendizagem Baseada em Problemas, Laboratório/Simulação. Diferenças estatisticamente significativas entre fadiga emocional, de acordo com o sexo, dependentes, trabalhadores, tempo de viagem > 30 minutos. Maior fadiga emocional ao cursar disciplinas pela segunda vez e em atividades acadêmicas em que declaram um estresse percebido como Bastante/Muito (p < 0,005). Conclusão: Todos os alunos apresentam fadiga emocional média (>26 e <37 pontos). As variáveis sexo, ter dependentes são aspectos relevantes. O estresse percebido pelas metodologias está significativamente relacionado com os níveis de fadiga emocional.

RESUMEN Objetivo: Conocer cansancio emocional en estudiantes de enfermería de cuatro Universidades. Método: Estudio de corte transversal, correlacional, realizado en Chile y España (2017-2018). Respondieron instrumento autoaplicado 1368 estudiantes (variables sociodemográficas/académicas y escala de Cansancio Emocional). Análisis con Stata 15, según variables: Pruebas de Chi2, sumas y rangos de Wilcoxon (Mann Whitney), análisis de varianza y regresión múltiple; nivel de confianza 95% y significancia 5% (p < 0,05). Aprobado por Comité de Ética, Universidad de Girona. Resultados: Variables académicas y estrés percibido destacan Bastante/Mucho para: Exámenes, Aprendizaje Basado en Problemas, Laboratorio/Simulación. Diferencias estadísticamente significativas entre cansancio emocional según sexo, personas a cargo, trabajadores, tiempo traslado > a 30 minutos. Mayor cansancio emocional al cursar asignaturas por segunda vez y en actividades académicas donde declaran un estrés percibido como Bastante/Mucho (p < 0,005). Conclusión: Todos los estudiantes presentan cansancio emocional medio (>26 y <37 puntos). Las variables sexo y tener personas a cargo son aspectos relevantes. Estrés percibido por metodologías se relaciona de manera importante con niveles de cansancio emocional.

Implicações da atuação da enfermagem no enfrentamento da COVID-19: exaustão emocional e estratégias utilizadas / Implicaciones del trabajo de enfermería en la lucha contra el COVID-19: agotamiento emocional y estrategias utilizadas / Implications of nursing performance in coping with COVID-19: emotional exhaustion and strategies used

Resumo Objetivo analisar as implicações autopercebidas e as estratégias utilizadas por trabalhadores de enfermagem de unidades dedicadas e não dedicadas à COVID-19 acerca da atuação profissional no enfrentamento da pandemia. Método estudo multicêntrico, descritivo-exploratório, com abordagem qualitativa, desenvolvido em quatro hospitais do sul do Brasil, entre janeiro e maio de 2021. Foram entrevistados 19 trabalhadores da equipe de enfermagem, sendo 10 lotados em unidades dedicadas à COVID-19 e 9 em unidades não dedicadas. Fez-se análise de conteúdo do tipo temática. Resultados emergiram duas categorias: (1) Exaustão emocional e seu impacto no trabalho, devido à gravidade dos pacientes e ao elevado número de óbitos nas unidades dedicadas e às mudanças organizacionais e à sobrecarga de trabalho nas não dedicadas; e (2) Estratégias de enfrentamento utilizadas, semelhantes nas unidades quanto ao autocuidado, lazer, atividade física e espiritualidade, mas diferente quanto a realização profissional, presente nas unidades dedicadas à COVID-19. Conclusão e Implicações para a Prática a pandemia incrementou a exaustão dos trabalhadores da enfermagem que utilizaram estratégias atenuantes, com destaque para a diferença na compreensão da origem da exaustão e na realização com o trabalho sentido pelos trabalhadores das unidades dedicadas. Evidencia a necessidade de acompanhamento à saúde dos trabalhadores de enfermagem atuantes na pandemia.

Resumen Objetivo analizar las implicancias autopercibidas y las estrategias que utilizan los trabajadores de Enfermería de unidades dedicadas y no dedicadas a COVID-19 en la actuación profesional para enfrentar la pandemia. Método estudio multicéntrico y descriptivo-exploratorio con enfoque cualitativo, desarrollado en cuatro hospitales del sur de Brasil entre enero y mayo de 2021. Se entrevistó a 19 trabajadores del equipo de Enfermería, 10 de los cuales fueron asignados a unidades dedicadas a COVID-19 y 9 a unidades no dedicadas. Se realizó análisis de contenido temático. Resultados surgieron dos categorías: (1) Agotamiento emocional y su impacto en el trabajo, debido a la gravedad de los pacientes y a la alta cantidad de muertes en unidades dedicadas y a los cambios organizacionales y a la sobrecarga de trabajo en unidades no dedicadas; y (2) Estrategias de afrontamiento utilizadas, similares en las unidades en cuanto a autocuidado, ocio, actividad física y espiritualidad, pero diferentes en cuanto a la realización profesional, presentes en las unidades dedicadas a COVID-19. Conclusión e implicancias para la práctica la pandemia aumentó el agotamiento de los trabajadores de Enfermería que utilizaron estrategias para atenuarlo; se destaca la diferencia que hay en la comprensión del origen del agotamiento y en la realización que sienten los trabajadores de las unidades dedicadas con su trabajo. Cabe destacar que es necesario monitorear la salud de los trabajadores de Enfermería que actúan en la pandemia.

Abstract Objective to analyze the self-perceived implications and strategies used by Nursing workers from COVID-19 and non-COVID-19 units regarding professional performance in coping with the pandemic. Method a multicenter and descriptive-exploratory study with a qualitative approach, developed at four hospitals in southern Brazil between January and May 2021. 19 workers from the Nursing team were interviewed, 10 of which were assigned to COVID-19 units and 9 to non-COVID-19 units. Thematic content analysis was performed. Results two categories emerged: (1) Emotional exhaustion and its impact on work, due to severity of the patients and high number of deaths in COVID-19 units and organizational changes and work overload in non-COVID units; and (2) Coping strategies used, similar in the units in terms of self-care, leisure, physical activity and spirituality, but different in terms of professional fulfillment, present in the COVID-19 units. Conclusion and implications for the practice The pandemic increased exhaustion in the Nursing workers who used mitigating strategies, highlighting the difference in understanding the cause of exhaustion and in carrying out the work felt by workers in COVID-19 units. The need to monitor the health of Nursing workers that were active during the pandemic is highlighted.

Factores asociados a la satisfacción estudiantil con docentes, infraestructura e investigación en escuelas médicas latinoamericanas

Introducción: La satisfacción estudiantil con los programas académicos es importante en la educación médica, para crear futuros galenos competentes. No hay estudios latinoamericanos multicéntricos que determinen sus factores asociados, pare mejorar el currículo médico. Objetivo: Determinar el porcentaje y factores asociados a la satisfacción estudiantil con docentes, infraestructura e investigación en 9 escuelas médicas latinoamericanas. Métodos: Estudio transversal descriptivo de datos secundarios obtenidos mediante cuestionario administrado a estudiantes de medicina de 9 universidades latinoamericanas; indagó variables socioeducativas y la satisfacción estudiantil respecto a docentes, infraestructura e investigación de las universidades. Para el análisis se usaron modelos lineales generalizados. Resultados: De 2 649 encuestados, 57 % eran mujeres con mediana de 22 años. Menos del 50 % estuvo satisfecho con infraestructura e investigación; solo frente a docencia hubo 66 % de satisfacción; Colombia fue el de mayor satisfacción con los docentes, con 82 % de encuestados satisfechos, mientras que Chile fue el país más satisfecho respecto a la infraestructura e investigación universitaria, con 67 % y 68 %, respectivamente. Estudiar en universidad privada se asoció a satisfacción con docentes (p= 0,002), infraestructura (p= 0,001) e investigación (p= 0,018), esta última mayor en mujeres (p= 0,033), pero menor en quienes sentían que les alcanzaba el dinero del mes (p= 0,001). Conclusiones: La satisfacción médico-estudiantil en universidades latinoamericanas tiende hacia la baja, están más satisfechos los de universidades privadas, tienen mayor satisfacción frente a la investigación las mujeres y menor quienes sienten que les alcanza el dinero hasta fin de mes.

Introduction: Student satisfaction with academic programs is important in medical education to create future competent doctors. There are not multicenter Latin American studies that determine its factors related, to improve medical curricula. Objective: To determine the percentage and factors associated with student satisfaction with teachers, infrastructure, and research in 9 Latin American medical schools. Methods: Descriptive cross-sectional study of secondary data obtained through an administered questionnaire to medical students from 9 Latin American universities between 2016-2017, which inquired about socio-educational variables and student satisfaction regarding teachers, infrastructure, and university research. Generalized Linear Models-GLM was used for the analysis. Results: Of 2 649 surveyed, 57% were women, the median was 22 years. Less than 50% were satisfied with infrastructure and research, only compared to teaching there was 66% satisfaction, Colombia ranking as the one with the highest satisfaction with teachers, with 82% of satisfied respondents, while Chile was the most satisfied country regarding infrastructure and university research with 67% and 68%, respectively. Studying at a private university was associated with teacher satisfaction (p= 0.002), infrastructure (p= 0.001) and research (p= 0.018), the latter was higher in women (p= 0.033), but lower in those who felt that the money of the month was reaching them (p= 0.001). Conclusions: Medical-student satisfaction with Latin American universities is tending downward, with those studying at private universities being more satisfied, women having greater satisfaction with research and less for those who feel that they have enough money until the end of the month.

The use of mechanical restraint in critical care units: Characterisation, application standards and related factors. Results of a multicentre study.

OBJECTIVES: To describe and characterise the use of mechanical restraint (MR) in critical care units (CCU) in terms of frequency and quality of application and to study its relationship with pain/agitation-sedation/delirium, nurse:patient ratio and institutional involvement. METHOD: Multicentre observational study conducted in 17 CCUs between February and May 2016. The observation time per CCU was 96 h. The main variables were the prevalence of restraint, the degree of adherence to MR recommendations, pain/agitation-sedation/delirium monitoring and institutional involvement (protocols and training of professionals). RESULTS: A total of 1070 patients were included. The overall prevalence of restraint was 19.11%, in patients with endotracheal tube (ETT) 42.10% and in patients without ETT or artificial airway it was 13.92%. Adherence rates between 0% and 40% were obtained for recommendations related to non-pharmacological management and between 0% and 100% for those related to monitoring of ethical-legal aspects. The lower prevalence of restraint was correlated with adequate pain monitoring in non-communicative patients (P < .001) and with the provision of training for professionals (P = .020). An inverse correlation was found between the quality of the use of MR and its prevalence, both in the general group of patients admitted to CCU (r = -.431) and in the subgroup of patients with ETT (r = -.521). CONCLUSIONS: Restraint is especially frequently used in patients with ETT/artificial airway, but is also used in other patients who may not meet the use profile. There is wide room for improvement in non-pharmacological alternatives to the use of MC, ethical and legal vigilance, and institutional involvement. Better interpretation of patient behaviour with validated tools may help limit use of MR.

Uso de contenciones mecánicas en unidades de cuidados críticos: caracterización, estándares de aplicación y factores relacionados. Resultados de un estudio multicéntrico / The use of mechanical restraint in critical care units: Characterisation, application standards and related factors. Results of a multicentre study

Objetivos: Describir y caracterizar el uso de contenciones mecánicas (CM) en unidades de cuidados críticos (UCC) en términos de frecuencia y calidad de aplicación y analizar su relación con la monitorización del dolor/agitación-sedación/delirio, la ratio enfermera:paciente y la implicación institucional. Método: Estudio observacional multicéntrico realizado en 17 UCC entre febrero y mayo del año 2016. El tiempo de observación por UCC fue de 96h. Las principales variables fueron la prevalencia de contenciones, el grado de adherencia a las recomendaciones de uso de CM, la monitorización del dolor/agitación-sedación/delirio y la implicación institucional (protocolos y formación de los profesionales). Resultados: Se incluyeron 1.070 pacientes. La prevalencia general de contenciones fue del 19,11%, en pacientes con tubo endotraqueal (TET) del 42,10% y en pacientes sin TET ni vía aérea artificial del 13,92%. Se obtuvieron valores de adherencia entre el 0 y el 40% para las recomendaciones relacionadas con manejo no farmacológico y entre el 0 y el 100% para las relacionadas con la vigilancia de aspectos ético-legales. La menor prevalencia de contenciones se correlacionó con una adecuada monitorización del dolor en pacientes no comunicativos (p<0,001) y con la impartición de formación a los profesionales (p=0,020). Se halló correlación inversa entre la calidad de aplicación de CM y su prevalencia, tanto en el grupo general de pacientes ingresados en las UCC (r=−0,431) como en el subgrupo de pacientes con TET (r=−0,521). Conclusiones: Las contenciones son especialmente frecuentes en pacientes con TET/vía aérea artificial, pero también están presentes en otros pacientes que a priori no responden al perfil de uso atribuido. Las alternativas no farmacológicas al uso de CM, la vigilancia de aspectos éticos y legales y la implicación institucional presentan un amplio margen de mejora.(AU)

Objectives: To describe and characterise the use of mechanical restraint (MR) in critical care units (CCU) in terms of frequency and quality of application and to study its relationship with pain/agitation-sedation/delirium, nurse:patient ratio and institutional involvement. Method: Multicentre observational study conducted in 17 CCUs between February and May 2016. The observation time per CCU was 96h. The main variables were the prevalence of restraint, the degree of adherence to MR recommendations, pain/agitation-sedation/delirium monitoring and institutional involvement (protocols and training of professionals). Results: A total of 1070 patients were included. The overall prevalence of restraint was 19.11%, in patients with endotracheal tube (ETT) 42.10% and in patients without ETT or artificial airway it was 13.92%. Adherence rates between 0% and 40% were obtained for recommendations related to non-pharmacological management and between 0% and 100% for those related to monitoring of ethical-legal aspects. The lower prevalence of restraint was correlated with adequate pain monitoring in non-communicative patients (P<.001) and with the provision of training for professionals (P=.020). An inverse correlation was found between the quality of the use of MR and its prevalence, both in the general group of patients admitted to CCU (r=−.431) and in the subgroup of patients with ETT (r=−.521). Conclusions: Restraint is especially frequently used in patients with ETT/artificial airway, but is also used in other patients who may not meet the use profile. There is wide room for improvement in non-pharmacological alternatives to the use of MC, ethical and legal vigilance, and institutional involvement. Better interpretation of patient behaviour with validated tools may help limit use of MR.(AU)

Efecto de una intervención educativa sobre la agencia de autocuidado en estudiantes de Enfermería / Impact of an educational intervention on the self-care agency among Nursing students

mediante el Aprendizaje Basado en Problemas (ABP) y basada en la Teoría de Autocuidado de Orem sobre la agencia de autocuidado en estudiantes de Enfermería de dos universidades colombianas. Método: estudio cuasiexperimental antes/después multicéntrico realizado en 2019. La población fueron los 56 estudiantes del primer semestre de Enfermería de dos universidades colombianas. Se realizó la intervención “Hacia el cuidado de la vida” con 12 sesiones de dos horas durante 13 semanas sobre autocuidado mental y espiritual, estilos de vida saludable, autocuidado corporal y autocuidado social mediante ABP. Se midieron variables sociodemográficas, académicas y de hábitos de consumo. La agencia de autocuidado se midió basal (B) y en la última sesión (P) mediante la escala ASA-B (muy baja: 1-24, baja: 25-48, buena: 49-72 o muy buena: 73-96 puntos). Se efectuó estadística descriptiva y bivariante. Resultados: completaron el estudio 40 personas. El 82,1% era mujer, con una edad mediana de 18. La puntuación global de la escala ASA-B se incrementó de manera estadísticamente significativa de manera global [B: X= 71,1 (DE= 0,73) y P: X= 75,6 (DE= 1,07); p< 0,001] y en las mujeres, de 18 a 20 años, solteras, con puntuación en Prueba Saber 11 en cuartil 1 o 2, antecedentes de ingesta de alcohol o de bebidas energizantes (p< 0,05). No varió la puntuación en función de la pertenencia a equipos deportivos, federaciones estudiantiles o grupos religiosos. Conclusión: la intervención educativa basada en la Teoría de Autocuidado y ABP aplicada a estudiantes de primer semestre de Enfermería mejoró su agencia de autocuidado.(AU)

Objective: to determine the impact of an educational intervention through Problem-Based Learning (PBL) and based on Orem’s Self-Care Theory on the self-care agency in Nursing students from two Colombian universities. Method: a multicentre quasi-experimental before-and-after study conducted on 2019. The population included the 56 students of the first Nursing semester from two Colombian universities. The “Hacia el cuidado de la vida” (“Towards Life Care”) intervention was conducted, with 12 two-hour sessions during 13 weeks on mental and spiritual self-care, healthy lifestyles, body self-care and social self-care through PBL. Sociodemographic and academic variables were measured, as well as consumer habits. The Self-Care Agency was measured at baseline (B) and at the last session (P) through the ASA-B scale (very low: 1-24, low: 25-48, good: 49-72 or very good: 73-96 scores). Descriptive and bivariate statistics were applied. Results: forty (40) persons completed the study; 82.1% were female, with 18 years as median age. The overall score in the ASA-B scale was increased overall in a statistically significant way [B: X= 71.1 (SD= 0.73) and P: X= 75.6 (SD= 1.07); p< 0.001] and in 18-to-20-year old single women, with a score of 11 in knowledge test in first or second quartile, past history of using alcohol or energy drinks (p< 0.05). There was no variation in score in terms of affiliation to sport teams, student federations or religious groups. Conclusion: the educational intervention based on the self-care theory and PBL applied to students in their first Nursing semester improved their self-care agency.(AU)

Reintervenciones tras apendicectomía en niños. Estudio multicéntrico / Re-interventions following appendectomy in children: a multicenter study

Introducción: La apendicitis aguda es la causa más frecuente deabdomen agudo en niños. El objetivo de este trabajo es estudiar lascausas, abordaje y resultados de las complicaciones que requieren in-tervención quirúrgica después de la apendicectomía.Material y métodos: Estudio retrospectivo de las apendicectomíasrealizadas en 3 centros de tercer nivel entre 2015-2019. Se recogieronlas complicaciones, causas y número de reintervenciones, intervalo entreambas cirugías, técnica empleada, hallazgos operatorios según la Clasi-ficación de la American Association for the Surgery of Trauma (AAST)en la apendicectomía inicial y tiempo de ingreso.Resultados: Se intervinieron 3.698 apendicitis, un 76,7% por víalaparoscópica, encontrando un 37,2% evolucionadas (grado II-V de laclasificación AAST). El tiempo medio quirúrgico fue de 50,4 minutos(laparoscopia 49,8 ± 20,1 vs. laparotomía 49,9 ± 20,1, p > 0,05), superioren aquellos pacientes que requirieron reintervención (68,6 ± 27,2 vs.49,1 ± 19,3, p < 0,001).Se realizaron 76 reintervenciones (2,05%). Las causas fueron: infec-ción postoperatoria (n = 46), obstrucción intestinal (n = 20), dehiscencia(n = 4) y otras (n = 6). El abordaje inicial no influyó en el riesgo dereintervención (laparotomía o laparoscopia, OR 1,044, IC 95% 0,57-1,9),pero sí el grado de evolución de la apendicitis (7,8% evolucionadas vs.0,7% incipientes, OR 12,52, IC 95% 6,18-25,3).Hubo una tendencia a reintervenir por el mismo abordaje que laapendicectomía, esto ocurrió en un 72,2% de las apendicectomías lapa-roscópicas y en un 67,7% de las apendicectomías abiertas. El abordajemínimamente invasivo (50/76) fue más frecuente que la laparotomía(27 laparoscopias y 23 drenajes ecoguiados frente a 26 laparotomías)(p < 0,05). El 55% de los pacientes obstruidos se reintervinieron porvía abierta (p > 0,05).

Introduction: Acute appendicitis is the most frequent cause ofacute abdomen in children. The objective of this study was to analyzethe causes, approach, and results of complications requiring surgeryfollowing appendectomy.Materials and methods: A retrospective study of the appendecto-mies conducted in three third-level institutions from 2015 to 2019 wascarried out. Complications, causes, and number of re-interventions, timefrom one surgery to another, surgical technique used, operative findingsat baseline appendectomy according to the American Association forthe Surgery of Trauma (AAST) classification, and hospital stay werecollected.Results: 3,698 appendicitis cases underwent surgery, 76.7%of which laparoscopically, with 37.2% being advanced (grades II-Vof the AAST classification). Mean operating time was 50.4 min-utes (49.8 ± 20.1 for laparoscopy vs. 49.9 ± 20.1 for open surgery,p > 0.05), and longer in patients requiring re-intervention (68.6 ± 27.2vs. 49.1 ± 19.3, p < 0.001).76 re-interventions (2.05%) were carried out. The causes includedpostoperative infection (n = 46), intestinal obstruction (n = 20), dehis-cence (n = 4), and others (n = 6). Re-intervention risk was not impactedby the baseline approach used (open surgery or laparoscopy, OR: 1.044,95% CI: 0.57-1.9), but it was by appendicitis progression (7.8% ad-vanced vs. 0.7% incipient, OR: 12.52, 95% CI: 6.18-25.3).There was a tendency to use the same approach both at baseline ap-pendectomy and re-intervention. This occurred in 72.2% of laparoscopicappendectomies, and in 67.7% of open appendectomies. The minimallyinvasive approach (50/76) was more frequent than the open one (27laparoscopies and 23 ultrasound-guided drainages vs. 26 open surger-ies) (p < 0.05). 55% of obstruction patients underwent re-interventionthrough open surgery (p > 0.05).

Características laborales y académicas de los recursos humanos del sistema de salud en ocho países de Latinoamérica / Labor characteristics and postgraduate studies of human resources in health in eight Latin American countries

RESUMEN Introducción: la mayoría de las investigaciones muestran la situación de los recursos humanos del sistema de salud en países primermundistas, por lo que es necesario caracterizar nuestra realidad latinoamericana en este aspecto. Objetivo: caracterizar el tipo de trabajo y la formación de posgrado de los recursos humanos del área de salud en ocho países de Latinoamérica. Métodos: se realizó un estudio descriptivo a través de encuestas autoaplicadas sobre las características de los centros de labores y capacitaciones de posgrado que se han tenido. Resultados: de las 1.283 personas que respondieron la encuesta, el 87,1 % laboraba en un hospital (salario promedio mensual: 840 dólares), el 23,3 % también lo hacía en una clínica (salario promedio mensual: 1.200 dólares). Además, solo el 20,5 % trabajaba en un establecimiento del primer nivel de atención (salario promedio mensual: 420 dólares). El 31,2 % había realizado un curso de posgrado, el 23,2 % un diplomado, el 17,8 % una maestría y, el 5,1 %, un doctorado. Conclusiones: los recursos humanos en salud trabajan principalmente en hospitales con sueldos diferentes según el lugar donde laboran. Los médicos son los que tienen mayor remuneración, pero en el sector privado las diferencias son menos marcadas. Menos de la tercera parte han hecho cursos u otras actividades académicas culminadas hace ya varios años. Esto sirve para la mejora de las características laborales y de capacitación.

SUMMARY Introduction: Most research shows the situation of first world countries regarding human resources of health; therefore, it is necessary to characterize our Latin American reality. Objective: To characterize the type of work and postgraduate training of health human resources in eight Latin American countries. Methods: A descriptive study was carried out, through self-applied surveys on the characteristics of its work center, and post-graduate training that them has had. Results: Of the 1283 people who responded to the survey, 87.1% worked in a hospital (average monthly salary: 840 dollars), 23.3% also worked in a clinic (average monthly salary: 1200 dollars). In addition, only 20.5% worked in an establishment of the first level of care (average monthly salary: 420 dollars). 31.2% had completed a post-graduate course, 23.2% had a diploma, 17.8% had a master's degree and 5.1% had a doctoral degree. Conclusions: The human resources in health work mainly in hospitals and the salaries are different according to the place where they work. The physicians are those who have higher remuneration, but in the private sector the salaries are more similar than in the other sectors. Less than a third have taken courses or other academic activities, having been completed several years ago. This serves to improve the work and training characteristics.