Patrón de lectura radiológica digital para la clasificación de imágenes compatibles con silicosis / Digital reading radiation pattern for classification of image about silicosis (P0140-2013)

La silicosis es una enfermedad sin tratamiento. El programa de vigilancia de trabajadores expuestos a sílice está diseñado para detectarla lo más precozmente posible mediante una radiografía de tórax. A pesar de su rol fundamental, esta adolece de una gran variabilidad técnica y de interpretación. Para disminuir estos fenómenos, la OIT creó un sistema de clasificación ampliamente usado en Chile y el mundo. Este se basó en la radiografía análoga, la que ha sido reemplazada por el mismo set análogo, digitalizado. Si bien la OIT permite el uso de este nuevo tipo de imagen, indica que el patrón de comparación debe seguir siendo el análogo. Muchos estudios han demostrado que es mejor utilizar patrones de comparación digitales. El objetivo de este trabajo fue generar un set de radiografías digitales que representen las profusiones centrales de opacidades redondas del sistema de clasificación OIT. De un universo de 32.826 radiografías de pacientes expuestos a sílice, se obtuvo 252 radiografías, de las cuales 54 fueron informadas por 3 lectores acreditados, seleccionándose 8 casos que contaban con opacidades redondas puras de diferentes profusiones, las que se proponen como patrón digital para Chile.

Silicosis is a disease without treatment. The surveillance program for workers exposed to silica is designed to detect as early as possible by a chest radiograph. Despite its fundamental role, it suffers from a great technique and interpretation variability. To reduce these phenomena, the ILO created a classification system widely used in Chile and the world. This was based on analog radiography, which has been replaced by the same analog set, digitized. While the ILO permits the use of this new type of image it indicates that the pattern comparison must remain analog. Many studies have shown that it is best to use digital comparison patterns. The objective of this work was to generate a set of digital x-rays representing the central profusion of round opacities of ILO classification system. From a universe of 32,826 x-rays of patients exposed to silica, 252 films, of which 54 were reported for 3 accredited readers, selected 8 cases that had pure round opacities of different profusions was obtained, which are proposed as digital pattern for Chile.

Aspergilosis traqueobronquial necrotizante en paciente crítico / Necrotizing tracheobronchial aspergillosis in an immunosuppressed patient. Report of one case

Necrotizing tracheobronchitis due to Aspergillus spp is a rare form of invasive aspergillosis. This infection is limited to or predominant in the bronchial tree. The clinical evolution is gradual: from mild non-specific manifestations of acute tracheobronchitis to severe acute respiratory insufficiency determined by a bronchial obstruction syndrome. We report a 38 years old female with systemic lupus erythematosus treated with methylprednisolone and cyclophosphamide. She developed an invasive aspergillosis, severe respiratory failure with predominant tracheobronchial damage and upper respiratory complications.

Un curso de docencia clínica para residentes mejora la autopercepción de preparación para enseñar / A clinical teaching course for residents improves self-perception about preparation to teach

Background: Medical doctors need to be competent to teach patients, their families, students, and the health care team. In a previous study we determined that although the residents attach great importance to have teaching skills, they do not feel prepared to meet this role. Aim: To assess self-perception of learning in a formal course of training how to teach for residents. Material and Methods: In 2004 we implemented the course "Residents as Clinical Teachers", based on the Stanford Faculty Development Center for Medical Teachers Model (SFDC), for residents of a Medical School. Residents of all the post graduate programs were invited to take the course as an elective during the period 2004-2011. At the end of the course each resident completed the pre/post Seminar Series Housestaff/student Questionnaire; assessing perceptions of learning, expressed in a Likert scale from 1-5. Results: The implementation of the course in 111 residents significantly improved self-perception of general preparation for teaching and improved self-perception of preparedness in each educational category. The personal goals most commonly established by participants were on feedback (52,2%), control of session (44%) and communication of goals (40%). Barriers for teaching most frequently identified were lack of time to do clinical teaching (51,3%) and environmental limitations (16,2%). The main impact of the course reported by residents were acquisition of teaching skills or tools for teaching (39,6%), enhancing of motivation (14%), and a richer understanding of teaching principles (14%). Conclusions: A clinical teaching course for residents improves their self-perception of preparation to teach and enhances motivation for clinical teaching.

¿Están preparados los residentes e internos para enseñar?: Percepción de estudiantes de medicina de pre y postgrado / Are residents and interns prepared for teaching?: Perceptions of undergraduate and graduate medical students

Background: Every doctor is expected to be competent in teaching. There are few initiatives to prepare medical students for this role. Aim: To explore residents (graduate students) and interns (final year undergraduate students) perceptions of the importance of acquiring teaching skills and how prepared they feel to meet this role. To determine the importance that undergraduate students give to such teaching. Material and Methods: Residents and interns participated in focus groups, and completed the Medical Education Readiness Questionnaire (METRQ), 5th year medical students were also invited to complete it. Results: Three hundred and seventy seven subjects answered the questionnaire. The perceived importance of having teaching skills was 6.1 ±1.2 among residents and 5.7 ± 1.6 among interns, in a scale 1 to 7. Their perception of their own preparation for teaching was 4.3 ± 1.6 for both groups in the same scale. Students evaluated the preparation of the residents for teaching as 5.2 ± 1.6 and that of the interns as 4.4 ±1.7. Seventy-eight percent of 5th year medical students reported to learn more than two. 5 hours a week from residents. Fifty-nine percent of residents and 66 percent of interns reported to teach up to 2.5 hours per week to the same students. Focus groups participants agreed that teaching is an important role for a physician, and that to do it properly requires personal characteristics, along with teaching skills. They also found that the best opportunities to learn how to teach are during practical training. Conclusions. Our study contributes to the recognition of the teaching role of physicians and the need for teaching training among medical students.

Estudio de viabilidad de escólices de quistes hidatídicos hepáticos humanos / Viability study of scolices of human hydatid liver cysts

El adecuado control de la hidatidosis en general, requiere conocer algunos aspectos relacionados con la supervivencia de los agentes infectantes, especialmente de los escólices. El objetivo de este trabajo, es evaluar la viabilidad de los escólices de quistes hidatídicos humanos de localización hepática. Estudiar la asociación entre las características clínicas al momento de la cirugía y el porcentaje de viabilidad de los escólices. Los criterios de viabilidad utilizados fueron: forma ovoide, invaginados, ganchos rostrales y corpúsculos calcáreos intactos, movimientos vibratorios presentes y ausencia de tinción con colorantes vitales. Los criterios para certificar mortalidad de los escólices fueron dos o más de los siguientes hechos: inmovilidad, alteración de los ganchos rostrales y de los corpúsculos calcáreos, rotura de membrana y pérdida de la forma ovoide y fácil tinción con el colorante vital (azul de tripan al 1,5 por ciento). Se estudiaron de esta forma 16 quistes, con un diámetro promedio de 16,2 cm. Siete lesiones (44 por ciento) de tipo univesicular, 5 (31 por ciento) multivesiculares y 4 (25 por ciento) quistes abscedados. En 7 oportunidades (44 por ciento), se evidenció comunicación a la vía biliar; y se constató viabilidad en 9 de los 16 quistes (56 por ciento). Las muestras con mayor porcentaje de escólices viables fueron los quistes multivesiculares, principalmente a expensas de las vesículas hijas. Se constató que los quistes multivesiculares eran viables en el 100 por ciento de los casos, a diferencia de los univesiculares con un 57 pir ciento y los abscedados con 0 por ciento (p= 0,01)

Epidemiología de la hidatidosis humana en la IX Región de La Araucanía Chile: 1991-1998 / Epidemiology of human hydatidosis in the IX Región of La Araucanía Chile: 1991-1998

In the region of la Araucania, locate in the south of Chile (37º24ï-39º34ï South lat.), the economy is based in cattle raising and agriculture. The case of human hydatidosis, mortality and notification registered in la Araucania 1991-1998 are reviewed. The rate for hydatid disease is 38.5 per 100,000 population. Liver (47.1 percent) and lung (40.7 percent) were the most affected viscera. Days in hospital, 11-20 the 56.1 percent. Disease in female is 51.1 percent. The mortality rate is 0.8 per 100,000, the most frecuently affected county is Imperial. The age 15-44 years is the most affected. The notification rate is 8.74 per 100,000 population. The rate for hydatid disease is higher than the rate of notification, then necessarily there exist a subnotification. We think that it is necessary to investigate the serological prevalence of hydatidosis in the population of the IX Región Araucania

Alternativas quirúrgicas en el tratamiento de la hidatidosis hepática / Surgical alternatives in the treatment of hepatic hydatidosis

Echinococcosis is an endemic zoonosis in the south of Chile, so we have the opportunity to treat many patients especially the liver location which is the most common situation of this disease. Hepatic hydatid cyst presents its own morbidity and mortality due its complications and associated with surgical procedures. Morbidity has rates between 11 and 86 percent and is related with previous surgical interventions, cysts complications, the necessity of perfom additional procedures during surgery and the tratment of other disease locations. Mortality by otherwise has rates below 5 percent. But both, Morbidity and mortality persist high in spite of technological advances and therapeutical improvement. The surgical tretment of hepatic hydatidosis can be divided in four phases: surgical area isolation, cysts evacuation, tratment of cyst complications (biliary tract rupture, hepatothoracic transit, etc.), and residual cavity treatment. For each one exist different alternatives. On the other hand, hydatid cyst surgery can be classified in conservative and resective procedures. In the first group we consider marsupialization, cystostomy, knowsly or Posadas operation and cystojejunostomy. In the resective group we include pericystectomy, partial or subtotal cystectomy and the different types of hepatectomies. Finally, some other surgical procedures are under evaluation. These include the laparoscopic approach of liver echinoccosis with few studies in the field, but with hopeful results

Hidatidosis: un problema y desafío regional / Hydatidosis: a regional problem and challenger

La infección por el echinococcus granulosus es la principal zoonosis parasitaria que afecta a la IX Región de Chile, con tasas de incidencia en humanos entre 18,2 y 48 X 100.000, dependiendo de la zona estudiada y el método empleado para su cálculo. A nivel animal la incidencia es de 40 por ciento en bovinos, 39,5 en ovinos y 14,8 en porcinos sacrificados en la Plata Faenadora de Carnes de la ciudad de Temuco. Se estima e infiere que la zoonosis significa en la Región un gasto aproximado de U$A 300.000 anuales por recuperación en humanos y decomiso de vísceras, aceptando que existe subnotificación, que se desconoce la magnitud animal real en zonas rurales en que se sacrifican animales para el consumo doméstico sin revisión veterinaria y que el rendimiento en carne, lana, leche, etc. del animal parasitado es menor. A pesar de la magnitud del impacto no existe aún un Programa de Control Regional por lo que estamos organizando la II Jornada Nacional de Hidatidología con ese fín