Simulación en urología / Simulation in urology

Resumen El entrenamiento quirúrgico basado en simulación, es un método complementario de enseñanza cada vez más utilizado. Permite acortar las curvas de aprendizaje, desarrollar las habilidades técnicas y no técnicas, de la misma forma agilizar las competencias, en un entorno que no comprometa la seguridad del paciente, con la finalidad de transferir las destrezas aprendidas a la sala de operaciones. Dentro de la urología, la mayoría de los simuladores desarrollados son en el campo de endourología. Para la cirugía laparoscópica y robótica existe un número limitado de modelos específicos de procedimiento, destacando los modelos de realidad virtual. La incorporación de estos en una malla curricular, debe estar fundada y apoyada en el estado de validez de cada uno de los simuladores. El objetivo de esta revisión es entregar información acerca de los modelos de simulación, de mayor relevancia en las diferentes áreas de la urología, como también la validez objetiva y subjetiva de cada uno de estos.(AU)

Abstract Surgical training based on simulation, is a complementary method of teaching increasingly used. It allows to shorten the learning curves, to develop technical and non-technical skills, in the same way to speed up the competences, in an environment that does not compromise the safety of the patient, with the purpose of transferring the skills learned to the operating room. Within urology, most of the simulators developed are in the field of endourology. For laparoscopic and robotic surgery there is a limited number of specific models of procedure, highlighting the models of virtual reality. The incorporation of these in a curricular subject, must be founded and supported in the validity status of each of the simulators. The objective of this review is to provide information about simulation models, of greater relevance in different areas of urology, as well as the objective and subjective validity of each of these.(AU)

Suicidio en el mundo: ¿puede un enfoque evolutivo explicar la relación entre tasas de suicidio y variables asociadas a calidad de vida? / Suicide worldwide: can the evolutionary perspective explain the relationship between suicide rates and quality of life variables?

Introduction: Suicide is a complex phenomenon and seems to be paradoxical from an evolutionary standpoint, considering the multiple associated risk factors and the differences in suicide rates among countries. Suicide risks are usually attributed to economic hardship and low quality of life. However, some studies have shown an inverse relationship. Objective: To compare suicide rates reported for different countries to date with economic and quality of life indicators. Method: Suicide rates reported for 82 countries by the World Health Organization (WHO) were correlated with 2008 purchasing power parities (PPPs) and human development indexes (HDIs) published by the World Bank and the United Nations, respectively. Results: A positive correlation was observed between suicide rates, PPPs and HDIs (r = 0.3601 and r = 0.366, respectively p < 0.01). Conclusions: The positive correlation observed (i.e., suicide rates increased with economic and quality of life indicators) seem to be contradictory on the surface. We propose that interpreting these data from an evolutionary perspective could contribute to a deeper understanding of this phenomenon. Nevertheless, there are a myriad of factors that could be contributing to these results, thus further research is needed to understand suicide at a global scale.

Introducción: El suicidio es un fenómeno complejo y evolucionariamente en apariencia paradojal, siendo conocidos los múltiples factores de riesgo asociados y las diferencias de tasas existentes entre los países. Comúnmente se atribuye mayor riesgo a dificultades económicas y peor calidad de vida, sin embargo, algunos estudios mostrarían una tendencia inversa. Objetivo: Comparar las tasas de suicidio de distintos países publicadas hasta la fecha, con algunos indicadores económicos y de calidad de vida objetivos. Métodos: Se correlacionaron las tasas de suicidio de 82 países publicados por la Organización Mundial de la Salud, con la paridad de poder de compra (PPP) e índice de desarrollo humano (HDI) del año 2008 publicados por el Banco Mundial y las Naciones Unidas respectivamente. Resultados: Se obtuvo una correlación positiva entre tasas de suicidio con PPP e HDI (r = 0,3601 y r = 0,366 respectivamente, p < 0,01). Conclusión: La correlación positiva observada, es decir, mientras mejores indicadores económicos y de calidad de vida, habría mayores tasas de suicidio, son en apariencia contradictorios. Proponemos que la comprensión de estos datos desde una perspectiva evolucionaria podría contribuir a un mejor entendimiento de éstos. Sin embargo, son múltiples los factores que podrían estar involucrados en este resultado, por lo que es necesaria mayor investigación para poder entender de mejor manera el fenómeno del suicidio a nivel mundial.

Intoxicación familiar por mercurio elemental: caso clínico / Family poisoned by elemental mercury: a case report

Introduction: mercury is a heavy metal widely dispersed in nature, occurring in three chemical forms. Exposure to mercury at work sites and even at home may be clinically significant. Objective: to update the knowledge about the risks of this toxic element. Case report: the case of a teenager and his family poisoned by elemental mercury is reported. The diagnostic process was difficult, mainly due to an initial presumption of probable infectious etiology, unavailability of key anamnestic data and unusual clinical behavior, with signs and symptoms of multisystem compromise (neurological, hepatic, renal and dermatological compromise). Discussion: the study was based on literature review of various clinical presentations regarding this poisoning and its management, emphasizing the need for dimercaptosuccinic acid chelator. As a major public health problem, the importance of education and implementation of public policies to have a mercury-free environment is discussed.

Introducción: el mercurio es un metal pesado ampliamente distribuido en el medio ambiente, en sus tres formas químicas. La exposición a dicho metal en recintos laborales e incluso en el hogar, puede llegar a ser clínicamente significativa. Objetivo: actualizar el conocimiento acerca de los riesgos de este tóxico. Caso clínico: se presenta el caso clínico de un adolescente y su familia intoxicados por mercurio elemental, cuyo proceso diagnóstico fue difícil, principalmente por la presunción inicial de una probable etiología infecciosa, falta de disponibilidad de datos anamnésticos claves y el inusual comportamiento clínico, con signos y síntomas de compromiso multisistémico (neurológico, hepático, renal y dermatológico). Discusión: se revisa la literatura en relación a las diversas formas de presentación clínica de esta intoxicación y su manejo, destacando la utilidad del quelante ácido dimercaptosuccínico. Por ser un importante problema de salud pública, se destaca la trascendencia de la educación e implementación de políticas públicas por un ambiente libre de mercurio.

Estrés postraumático en niños y adolescentes abusados sexualmente / Post-traumatic stress disorder among sexually abused children and adolescents

Introduction: The development of Post-Traumatic Stress Disorder (PTSD) is a frequently observed effect of sexual abuse among children and adolescents. Objectives: This study focused on the prevalence of PTSD among children and adolescents who were victims of sexual abuse. Method: A sample of 75 sexually abused children and adolescentes seeking outpatient care were evaluated utilizing a Children's Post Traumatic Stress Scale (CPSS). Results: 21.3 percent met the criteria for PTSD, an additional 16 percent met the criteria for a SubSyn-drome. Conclusíons: These data confirm the importance of focusing on post-traumatic symptomatology on sexually abused children and adolescents. Equally important is the finding that the majority of the children in the sample did not show symptomatology at the time of the study.

Introducción: El desarrollo de sintomatología postraumática es uno de los efectos del abuso sexual de niños y adolescentes que se observa con mayor frecuencia. Objetivos: En el presente estudio se evaluó la prevalencia de trastorno de estrés postraumático y del denominado subsíndrome de estrés postraumático en niños y adolescentes víctimas de abusos sexuales. Método: La muestra estuvo constituida por 75 niños y adolescentes sexualmente abusados consultantes de centros de atención quienes fueron evaluados con la Escala Infantil de Síntomas del Trastorno de Estrés Postraumático (CPSS). Resultados: Un 21,3 por ciento cumplió con los criterios para el diagnóstico de Trastorno de Estrés Postraumático, y un 16 por ciento adicional cumplió con los criterios de subsíndrome de Estrés Postraumático. Conclusiones: Estos datos confirman la importancia de considerar la sintomatología postraumática como un foco de evaluación y tratamiento en niños y adolescentes sexualmente abusados. Sin embargo, es de importancia destacar que la mayoría de los niños y adolescentes evaluados no informó presentar sintomatología postraumática acusada al momento del estudio.

Carcinoma espinocelular en hospitales públicos de la Región Metropolitana de Chile: análisis de la localización anatómica, género y edad / Spinocellular carcinoma in public hospitals metropolitan region, Chile: analysis of anatomic localization, genus and age

Cutaneous squamous cell carcinoma (SCC) is the second most common skin cancer; its incidence is increasing in the last decades worldwide. The purpose of this study was to analyze 1320SCC (716 males and 604 females) from five hospitals of Santiago. The tumours were studied by gender, anatomical localization and age of the patient. For this, 600.000 histopathological reports were reviewed (1992-2001). SCC was more frequent in males than females and also more frequent in older people. The average age was 72.1 +/-14.3 years old in females and 69.5+/-13.2 years old in males. The most frequent anatomical locations in females were the face (51.2 percent), lower extremities (13.9 per cent) and genitals (12.1 percent). The most frequent anatomical locations in males were the face (62.4 percent); genitals (9.8 percent) and lower extremities (8.1 percent ). More number of facial SCC was observed in males than in females; however; more SCC in lower extremities was observed in females than in males. In relation to age, CEC was more frequent in males in the 50-59 and 70-79 years old groups, however; CEC was more frequent in females older than 80 years old. The study of 1320 SCC tumours allows us to analyze risk groups in the Chilean population that help to direct future skin cancer prevention campaigns in Chile.

Efecto diferencial sobre el IGF-1 sérico de tibolona (5 mg/día) vs combinado continuo de estrógeno/progestina en mujeres postmenopáusicas / Differential effects on serum IGF-1 of tibolone (5 mg/day) vs combined continuous estrogen/progestagen in post menopausal women

BACKGROUND: Tibolone has estrogenic, androgenic and progestational effects and is used in post menopausal women. It apparently has weaker effects on endometrial proliferation and mammary stimulation than conventional hormone replacement therapy. AIM: To compare the metabolic effects of tibolone (5 mg/day) and continuous combined conjugated estrogens/medroxyprogesterone acetate in postmenopausal women. PATIENTS AND METHODS: Postmenopausal women, aged 45 to 60 years old, receiving estradiol valerate and medroxyprogesterone were included in the study. After a two months wash out period, in a double blind fashion, they were randomly assigned to oral tibolone 5 mg/day or equine conjugated estrogens 0.625 mg + medroxiprogesterone acetate 2.5 mg/day (ECE/MPA). At baseline, 30 and 45 days of treatment, fasting serum osteocalcin, somatomedin C (IGF-1, insulin-like growth factor 1), growth hormone (GH), and follicle stimulating hormone and first morning urine calcium and creatinine were measured. RESULTS: Thirty women were studied. There was more than 50 per cent fall in urine calcium with either tibolone or ECE/MPA, while fasting GH or osteocalcin did not show significant changes. Serum IGF-1 increased significantly with tibolone at basal, 30 (+109 per cent) and 45 days of treatment and did not change in the ECE/MPA group. CONCLUSIONS: Tibolone (5 mg/day) and ECE/MPA induced a similar reduction in urinary calcium. Tibolone increased serum IGF-1 levels. This may be due to undetected increment of overall GH secretion or to a specific action or IGF-1 generation from the liver and appears to be a novel differential effect of tibolone.