Importancia de la acreditación internacional de facultades de medicina

A partir de 2024, egresados de facultades de medicina que deseen hacer estudios de postgrado en los EE.UU o el Canadá, deberán graduarse en escuelas de medicina con programas educativos de calidad avalados por agencias reconocidas capaces de otorgar una acreditación internacional. La World Federation for Medical Education (WFME) es una de estas agencias. La WFME aceptó la nueva política de acreditación del Educational Committee for Foreign Medical Education (ECFMG) por la que médicos que postulen para la certificación del ECFMG del 2024 en adelante, tendrán que haberse graduado en un centro universitario de medicina acreditado por una agencia de aseguramiento de calidad que se encuentre reconocida por la WFME. El COMAEM (Consejo Mexicano para la Acreditación de la Educación Médica) está avalado por la WFME y otros organismos internacionales que aseguran la calidad de la educación superior. La acreditación que concede el COMAEM es un reconocimiento que el programa de medicina cumple con los criterios, indicadores y parámetros de calidad establecidos por este organismo. A partir de 2024, los egresados de un programa acreditado podrán postular para la certificación del ECFMG a través del examen de licencia médica de los Estados Unidos o USMLE (United States Medical Licensing Examination) y así poder hacer una residencia de especialización o trabajar en EE. UU. En el Perú, solo la Facultad de Medicina Alberto Hurtado de la Universidad Peruana Cayetano Heredia ha completado el proceso de acreditación internacional a través de COMAEM y ha recibido dicha acreditación.

As of 2024, medical school graduates who wish to pursue graduate studies in the U.S. or in Canada, they must have graduated from medical schools with quality educational programs endorsed by recognized agencies, capable of granting international accreditation. The World Federation for Medical Education (WFME) is one of these agencies. The WFME accepted the new accreditation policy of the Educational Committee for Foreign Medical Education (ECFMG) whereby physicians applying for ECFMG certification from 2024 onwards, must have graduated from a university medical center accredited by a quality assurance agency that is recognized by the WFME. The COMAEM (Mexican Council for the Accreditation of Medical Education) is endorsed by the WFME and other international organizations that ensure the quality of higher education. The accreditation granted by COMAEM is a recognition that the medical program meets the criteria, indicators and quality parameters established by this organization. Starting in 2024, graduates of an accredited program will be able to apply for ECFMG certification through the United States Medical Licensing Examination (USMLE) and thus be able to do a specialty residency or work in the U.S. In Peru, only the Alberto Hurtado School of Medicine of the Cayetano Heredia Peruvian University has completed the international accreditation process through COMAEM and has received such accreditation.

Predictores de la identificación de las mujeres con el feminismo en Chile / Predictors of identification of women with feminism in Chile

Resumen El feminismo es un movimiento que busca transformar el orden social imperante, establecido a partir de la jerarquización de la diferencia surgida de una concepción binaria sexo-génerica, y que ha situado a las mujeres en una situación histórica de opresión y explotación. A pesar de la vigencia del feminismo y el aporte de este en las democracias actuales, no todas las personas y, en particular, las mujeres, se identifican con este movimiento social. El objetivo principal de este estudio es identificar los predictores de la identificación feminista en mujeres en Chile. Con base en los resultados de un cuestionario online respondido por 389 mujeres, se realizó un análisis de regresión lineal múltiple (R. = .53, F (3,385) = 107.1, p < .001) en el que se utilizó como variable dependiente la identificación feminista. Las variables con mayor poder predictivo fueron: la predisposición a la participación feminista (. = .54); el sexismo hostil (. = -.20), y la orientación política (. = -.16). Lo anterior indicaría que aquellas mujeres dispuestas a participar en actividades feministas, que rechazan las formas de sexismo hostil y que adhieren a posiciones políticas de izquierda, son quienes mayormente se identifican con el feminismo en Chile. Este modelo relacionaría procesos identitarios que involucran una toma de consciencia de la ilegitimidad que implica que un grupo domine a otro o se encuentre en una situación de privilegio injustificados respecto de otros, y el consecuente reconocimiento de la puesta en acción para la transformación social. Esta relación entre toma de conciencia y acción, a su vez, permitiría explicar la imbricación de las luchas sociales durante el estallido social de octubre 2019 y el movimiento feminista chileno. Finalmente, se discute sobre las limitaciones del presente estudio y lineamientos para futuros.

Abstract The data obtained were subjected to a descriptive analysis (mean and standard deviation) and test score reliability (Cronbach´s Alpha). Then, Pearson´s partial correlations were calculated in order to contrast with the dependent variable feminist identification. From the total sample, 74.8 % self-identified with feminism to various degrees (from a form of private acceptance, but not public; up to activism); while 6 % self-declared as not feminist, and 19 %, well in-line with the objectives, did not self-identify as feminist. Feminism is a movement that looks to transform the current social order, established from the hierarchization based on the difference suggested of a binary sex/gender conception. This order has historically situated women in a position of oppression and exploitation. In spite of the relevance and support for feminism in current democracies, not everyone, in particular women, identify with this social movement. Considering this, the main objective of this study is to identify the predictors of feminist identification in women in Chile. This study, of quantitative type, has a sample size made up of 389 women. The type of sample was not probabilistic, rather self-selected. The participants answered an online survey that explored the variables: feminist identification, political orientation (left-right), support of the movement and feminist objectives, predisposition to feminist action, ambivalent sexism (hostile and benevolent sexism) (Glick & Fiske, 1996), social orientation domination SDO (Prato et al., 1994), right wing authoritarianism RWA (Altemeyer, 1996), and socio-demographic variables as well. Also, the participants signed an informed consent form, endorsed by the corresponding ethics committee. The ages of the participants fluctuated between 18 and 72 (M = 27.4; DT = 11.52). The data obtained were subjected to a descriptive analysis (mean and standard deviation) and test score reliability (Cronbach´s Alpha). Then, Pearson´s partial correlations were calculated in order to contrast with the dependent variable feminist identification. From the total sample, 74.8 % self-identified with feminism to various degrees (from a form of private acceptance, but not public; up to activism); while 6 % self-declared as not feminist, and 19 %, well in-line with the objectives, did not self-identify as feminist. Later on, the variables that showed a significant relationship with the dependent variable were subjected to a multiple linear regression analysis (R2 = .53, F (3,385) = 107.1 p < .001). The variables with the highest predictive power were predisposition to feminist participation (β = .54), hostile sexism (β = -.20), and political orientation (β = -.16). This would indicate that those women willing to participate in feminist activities, who reject hostile forms of sexism and adhere to leftist political positions are those who mostly identify with feminism in Chile. This model would relate identarian processes that involve an awareness of the legitimacy that implies that one group dominates another or finds itself in a position of unjustified privilege with respect to others, and the acknowledgement of the need for transformational social action. This relationship between awareness and action, likewise, would explain the overlapping social struggles during the social outbreak of October 2019 and the feminist movement in Chile. Finally, limitations of the present study are discussed with respect to the difficulty to generalize the results due to the type of sample (self-selected); and the characteristics of the sample, referring to the difficult access to women older than 50. These women presented difficulty in forms of access and in completing the survey online. Furthermore, it is considered that due to the bias of explicit attitude studies with regards to social desirability at the moment of response, it would be of great importance to complete this work with implicit attitude measures. Also, the study proposes that as future line of research a study that investigates what do women themselves understand about feminism in order to make realizations of the plurality of this social movement.

Coerción en las hospitalizaciones psiquiátricas en Chile: El sufrimiento de la locura en el siglo XXI / Coercion in psychiatric hospitalizations in Chile: madness and suffering in the 21st century

RESUMEN Este artículo aborda el problema de la coerción en las hospitalizaciones psiquiátricas chilenas desde la perspectiva de personas usuarias que participan en un tratamiento en salud mental en la red pública de atención. Entre 2019 y 2020 se realizó un estudio cualitativo con enfoque epistémico hermenéutico, en el que se entrevistaron 25 personas de ambos sexos (15 hombres y 10 mujeres) con diagnóstico psiquiátrico, con el fin de analizar sus relatos y repensar críticamente las prácticas de intervención que se desarrollan al interior de las hospitalizaciones psiquiátricas en Chile, las cuales se constituyen como un espacio de importancia para la salud pública chilena y los derechos de las personas con problemas de salud mental. Uno de los principales hallazgos es que, en desmedro de la recuperación de las personas usuarias, las prácticas coercitivas siguen manteniéndose en Chile, lo que implica un impacto negativo en la calidad de vida y en la libertad ciudadana de las personas con problemas de salud mental.

ABSTRACT This article reflects on the problem of coercion in Chilean psychiatric hospitalizations from the perspective of users who participate in mental health treatment programs in the public healthcare system. Qualitative research from a hermeneutical epistemic approach was carried out between 2019 and 2020, which included 25 interviews with individuals of both sexes (15 men and 10 women) who had a psychiatric diagnosis. The purpose of this research was to analyze their narratives and critically reframe intervention practices implemented in psychiatric hospitalizations in Chile, which constitute an important space for public health in the country as well as the rights of people with mental health problems. One of the principal findings of the study was that coercive practices still persist in Chile, despite being detrimental to the recovery of mental health care users, representing a negative impact on the quality of life and citizen freedoms of individuals with mental health problems.

High volume online post-dilution hemodiafiltration: how relevant is it in chronic kidney disease? / Hemodiafiltração on-line pós-dilucional de alto volume: qual sua real importância na doença renal crônica?

ABSTRACT Online hemodiafiltration is potentially a superior mode of dialysis compared to conventional hemodialysis. However, prospective randomized controlled trials have failed to demonstrate such superiority. Post-hoc analyses of these trials have indicated that high volume post-dilution hemodiafiltration is associated with lower death rates than conventional dialysis. This study discusses whether the lower death rates ascribed to high volume hemodiafiltration are linked to convection volume or the time on dialysis needed to achieve high convection volumes.

RESUMO A hemodiafiltração on-line é uma modalidade de diálise com potencial de superioridade sobre a hemodiálise convencional. Entretanto, estudos prospectivos, randomizados e controlados falharam em demonstrar a superioridade da hemodiafiltração. Análises post hoc desses estudos sugerem que a hemodiafiltração pós-dilucional de alto volume apresenta taxa de mortalidade inferior à hemodiálise convencional. Neste estudo, discutimos se a menor taxa de mortalidade da hemodiafiltração de alto volume está associada ao volume de convecção ou ao tempo de diálise necessário para atingir um alto volume de convecção.

Violencia obstétrica en Chile: percepción de las mujeres y diferencias entre centros de salud / Obstetric violence in Chile: women's perceptions and differences among health centers / Violência obstétrica no Chile: percepção das mulheres e diferenças entre os serviços de saúde

RESUMEN Objetivo. El objetivo del presente artículo es reportar los resultados de la primera encuesta sobre violencia obstétrica en Chile, de modo de hacer visible una realidad más frecuente de lo que creemos y comparar su ocurrencia según tipo de servicio (público o privado) en que se ha atendido el parto. Métodos. Se trata de un estudio descriptivo y de tipo transversal conducido entre los meses de diciembre de 2019 y mayo de 2020. La muestra quedó compuesta por 2105 mujeres de todas las regiones de Chile. Resultados. Los análisis de los datos indican que un 79,3% de las mujeres cree haber experimentado alguna forma de violencia obstétrica. A pesar de la gran cantidad de informes de violencia en centros de salud públicos y privados, se detectan diferencias estadísticas significativas entre ambos, y son más frecuentes en los centros públicos. Del mismo modo, se detectan más informes de violencia obstétrica en mujeres jóvenes (18-29 años), en quienes se identifican con pueblos originarios y entre quienes tienen una orientación sexual no heterosexual. Conclusiones. La violencia obstétrica es parte del continuo de violencia hacia las mujeres e informada de modo sistemático por quienes atienden sus partos tanto en servicios públicos como privados de salud. Es una forma de violencia tiene graves consecuencias en las mujeres debido tanto a la posición del equipo médico y a la relevancia del evento de parto en la vida de cualquier mujer.

ABSTRACT Objective. The objective of this article is to report the results of the first survey on obstetric violence in Chile, to bring to light a reality more common than we think, and to compare its occurrence by the type of service (public or private) where the birth was attended. Methods. This is a descriptive and cross-sectional study conducted from December 2019 to May 2020. The sample was composed of 2 105 women from all regions of Chile. Results. Data analyses indicate that 79.3% of women believe they have experienced some form of obstetric violence. Despite the many reports of violence in public and private health centers, significant statistical differences were detected between the two, with higher numbers of reports for public centers. Similarly, more reports of obstetric violence were detected in young women (aged 18-29 years), in those who identify as indigenous, and among those with a non-heterosexual sexual orientation. Conclusions. Obstetric violence is part of the continuum of violence against women and is systematically reported by those who give birth in both public and private health services. This form of violence has serious consequences for women, due to both their difference in position with respect to the medical team and the importance of the birthing event in the life of any woman.

RESUMO Objetivo. Informar os resultados obtidos na primeira pesquisa sobre violência obstétrica realizada no Chile, com o propósito de dar visibilidade a uma realidade mais comum do que se acredita e comparar sua ocorrência por categoria de serviço de assistência ao parto (rede pública ou privada). Métodos. Estudo descritivo transversal realizado entre dezembro de 2019 e maio de 2020. A amostra incluiu 2 105 mulheres provenientes de todas as regiões do país. Resultados. Os dados analisados indicam que 79,3% das mulheres entrevistadas acreditam ter sofrido alguma forma de violência obstétrica. Apesar do alto índice de relatos de violência tanto em serviços públicos quanto privados, observam-se diferenças estatísticas significativas entre eles, com maior ocorrência na rede pública. A violência obstétrica foi relatada com mais frequência entre as jovens (18 a 29 anos), as que se identificam com os povos nativos e as que são de orientação sexual não heterossexual. Conclusões. A violência obstétrica faz parte do ciclo de violência contra a mulher e é sistematicamente relatada pelo pessoal que presta assistência ao parto em serviços públicos e particulares. Trata-se de uma forma de violência com consequências sérias devido à posição ocupada pela equipe médica e à importância do parto na vida da mulher.

Enfermedad de cambios mínimos como glomerulopatía paraneoplásica en un paciente con tumor sólido / Minimal Change Disease as a paraneoplastic glomerulopathy in a patient with solid tumor

Resumen La enfermedad de cambios mínimos (ECM) es la principal causa de síndrome nefrótico en niños y una causa poco común en adultos, asociada usualmente a causas secundarias, predominantemente de origen hematológico. Es poco frecuente que este tipo de glomerulopatía se diagnostique de manera sincrónica en pacientes con tumores sólidos. Presentamos el caso de un paciente de 35 años con diagnostico reciente de cáncer de recto quien ingresa con un cuadro compatible con síndrome nefrótico, a quien se le diagnostica, mediante una biopsia renal, una enfermedad de cambios mínimos, con mejoría parcial del cuadro posterior al manejo quirúrgico de la patología neoplásica. Consideramos que este caso puede ser útil en el enfoque diagnóstico y el manejo de pacientes que presenten tumores sólidos de origen gastrointestinal con síndrome nefrótico concomitante.

Abstract Minimal change disease is the main cause of nephrotic syndrome in children and a rare cause in adults, usually associated with secondary causes, predominantly hematological. This type of glomerulopathy is rarely diagnosed synchronously in patients with solid tumors. We present the case of a 35-year-old patient with a recent diagnosis of rectal cancer who is admitted with a condition compatible with nephrotic syndrome, diagnosed with minimal change disease in the renal biopsy, and with partial improvement in the condition after surgical management of neoplastic pathology. We consider that this case may be useful in the diagnostic approach and the management of patients with solid tumors of gastrointestinal origin with concomitant nephrotic syndrome.

Antibacterial Activity of Zinc Oxide Nanoparticles in Self- Curing Acrylic Resin Against Streptococcus mutans

ABSTRACT: Antibacterial activity of zinc oxide nanoparticles in self-curing acrylic resin against Streptococcus mutans. The main objective of this study was to investigate whether nanoparticles of zinc oxide (ZnO) in self-curing acrylic resin, hav e antimicrobial properties against Streptococcus mutans, one of the microorganisms involved in the development of caries. Self- cured acrylic resin samples were prepared by incorporating ZnO nanoparticles at different concentrations based on the minimum inhibitory concentration (MIC) for Streptococcus mutans ATCC 25175. Antibacterial activity against a biofilm was evaluated in samples that were aged in artificial saliva for different times using spectral confocal laser microscopy and scanning electron microscopy. Kruskal-Wallis test using IBM SPSS Statistics version 23.0 software (SPSS Inc. ®, Chicago, IL, United States) were used, establishing the value of p <0.05 for statistical significance. The volume of the total biomass that formed in the samples aged for one day was significantly lower than the volume of the total biomass that was formed in those aged for additional days (p <0.001). Electron microscopy analysis revealed high porosity surfaces in all samples. Bacterial clusters wer e located next to large pores and irregular surfaces, while smooth surfaces had defined and linear organization cocci or simple chains. Considering the limitations of this study, the results suggest that the antibacterial activity of ZnO nanoparticles add ed to self-curing acrylic (ALIKE) is effective, mainly in fresh 1-day samples, independent of their concentration, and in samples with 16 MIC aged for 14 days, indicating it does not lose its antibacterial activity despite setting for more days. In addition, the ZnO nanoparticles added to ALIKE have the ability to inhibit the formation of biofilms, although they do not minimize the number of viable bacteria.

RESUMEN: El objetivo principal de este estudio fue investigar si nanopartículas de óxido de zinc (ZnO), incorporadas a acrílico acrilico de autocurado, tienen propiedades antimicrobianas contra Streptococcus mutans, uno de los microorganismos implicados en el desarrollo de caries. Se prepararon muestras de resina acrílica autopolimerizada mediante la incorporación de nanopartículas de ZnO a diferentes concentraciones basadas en la concentración mínima inhibitoria (MIC) para Streptococcus mutans ATCC 25175. Se evaluó la actividad antibacteriana contra una biopelícula en muestras envejecidas en saliva artificial para diferentes tiempos utilizando espectros microscopía láser confocal y microscopía electrónica de barrido. Se utilizó la prueba de Kruskal-Wallis utilizando el software IBM SPSS Statistics versión 23.0 (SPSS Inc. ®, Chicago, IL, Estados Unidos), estableciendo el valor de p <0,05 para la significancia estadística. El volumen de la biomasa total que se formó en las muestras envejecidas durante un día fue significativamente menor que el volumen de la biomasa total que se formó en las envejecidas durante días adicionales (p <0,001). El análisis de microscopía electrónica reveló superficies de alta porosidad en todas las muestras. Los cúmulos bacterianos se ubicaron junto a poros grandes y superficies irregulares, mientras que las superficies lisas tenían cocos o cadenas simples de organización lineal y definida. Considerando las limitaciones de este estudio, los resultados sugieren que la actividad antibacteriana de las nanopartículas de ZnO agregadas al acrílico autopolimerizable (ALIKE) es efectiva, principalmente en muestras frescas de 1 día, independientemente de su concentración, y en muestras con 16 MIC envejecidas para 14 días, lo que indica que no pierde su actividad antibacteriana a pesar de estar fraguada durante más días. Además, las nanopartículas de ZnO añadidas a ALIKE tienen la capacidad de inhibir la formación de biopelículas, aunque no minimizan el número de bacterias viables.

Validación de la escala de violencia obstétrica y pruebas de la invarianza factorial en una muestra de mujeres chilenas / Validation and factorial invariance test of obstetric violence scale in women from Chile

Resumen La violencia obstétrica (VO) es un problema de enorme relevancia social en nuestro contexto, ya que puede afectar psíquica y físicamente a las mujeres, al mismo tiempo que puede socavar la confianza en el sistema de salud y limitar el acceso oportuno a este por parte de las mujeres. La violencia obstétrica se ha definido como la apropiación del cuerpo de la mujer por parte del personal de salud a través de prácticas que redundan en la medicalización y patologización de sus procesos reproductivos. Esta violencia puede ser psicológica (p. e., regaños, negativa a responder a preguntas o realizar un plan de parto ajustado a sus expectativas), física (p. e., uso innecesario de la fuerza o querer causar dolor intencionalmente) y/o sexual (p. e. comentarios de naturaleza sexual referidos a su cuerpo o genitales, etc.). También se puede verificar mediante la realización de prácticas que están desaconsejadas o estrictamente prohibidas (p. e., monitorización fetal continua, uso de oxitocina sintética para agilizar el procedimiento, negación de la libertad de movimiento, maniobra de Kristeller, episiotomía de rutina, entre otros). No existen a la fecha escalas validadas que permitan detectar violencia obstétrica en la atención de salud. Método: Se analiza la fiabilidad (alfa y omega) y se aportan pruebas de la validez (análisis factorial confirmatorio) de la escala de VO. Las participantes de la muestra fueron 367 mujeres, mayores de edad, de la región de Valparaíso (Chile), que habían tenido alguna vez un parto. Los resultados apoyan la validez de la escala de VO y la estructura unifactorial propuesta muestra un buen ajuste (CFI = .94, NFI = .91, IFI = .94 y RSMEA = .067); también apoyan la idea de invarianza a través de diferentes muestras (ΔCFI < .01 y ΔRSMEA < .01), toda vez que la escala de VO demuestra ser un instrumento confiable (α = .83 y ω = .88). Por lo tanto se concluye que la escala de VO es un instrumento fiable y válido para la detección de este tipo específico de violencia contra las mujeres.

Abstract Obstetric violence is a long-standing problem of great social relevance in our context, since it can affect women psychically and physically. Similarly, obstetric violence can strongly undermine confidence in the health system and limit timely access to it by women (who could avoid conducting routine examinations associated with their pregnancy and which would explain the growing proportion women who wish to deliver at home and outside the medical system). Obstetric violence (also commonly referred to as "disrespect and abuse" during childbirth and "mistreatment" during childbirth care) has been defined as the appropriation of women's bodies by health personnel through practices that become the medicalization and pathologization of their reproductive processes. This violence can be psychological (e.g. abuse, scolding, refusal to answer your questions or carry out a birth plan adjusted to your expectations), physical (e.g. use of force or intentionally wanting to cause pain) and / or sexual (e.g. tacts of a sexual nature, comments of a sexual nature referring to your body or genitals, etc.), which can also be verified in the performance of a series of practices that are discouraged or strictly prohibited (for example, continuous fetal monitoring, use of synthetic oxytocin to speed up the procedure, impaired free movement, Kristeller's maneuver, routine episiotomy, among others). To date, there are no validated scales in our context that allow detecting obstetric violence (OV) in health care. These forms of violence can be a traumatic experience for many women. The scale has been created having as its main reference the so-called "obstetric violence test" prepared by the association El parto es nuestro, which includes the most recurrent situations of lack of respect and abuse in obstetric care. Reliability (alpha and omega) is analyzed and validity tests (confirmatory factor analysis) of the VO scale are provided. The invariance tests aim to ensure that the construct being evaluated (in this case obstetric violence) has the same meaning for women who provide care in the private and public health systems. The participants in the sample were 367 women, all of legal age, from the Valparaíso region (Chile) and who had had a child birth at some point in their lives. These women had their deliveries in both the public and private health systems. Of the total number of women who participated in the study, 58.9% declared having experienced some situation of violence during their delivery. The results support the validity of the VO scale, the proposed unifactorial structure shows a good fit (CFI = .94, NFI = .91, IFI = .94 and RSMEA = .067). The results support the idea of ​​invariance through the samples of women who attended their delivery in the private and public health system (ΔCFI < .01 and ΔRSMEA < .01), since the VO scale proves to be a reliable instrument (α = .83 and ω = .88) and with high levels of internal consistency (either based on total item correlations or factor loadings, which would be the most appropriate method for scales that use ordinal level of measurement). In conclusions, the VO scale is a reliable and valid instrument for the detection of this specific type of violence against women that can contribute to studies that detect abusive practices within the health system. Many of the women who do not report having experienced obstetric violence, do report the presence of some practices that are discouraged or prohibited: genital shaving (66.2 %), enema (45.5 %), prohibition of consuming food or water (51.7 %), indication of lying down during labor (24.5 %), induction of labor using medication (36.1 %), repeated vaginal examinations (24.3 %), compression of the abdomen (34.5 %), episiotomy (33.6 %), cesarean section (54.1 %) ) and uterine scraping without anesthesia (2 %). The previous results indicate the normalization of violent practices and their routine performance in the framework of delivery care in public and private health services, which could make us underestimate their prevalence.

Recomendaciones para la investigación psicológica con personas transgénero: Una aproximación desde una experiencia en Chile / Recommendations for psychological research with transgender people: an approach from an experience in Chile

Resumen El presente trabajo expone y fundamenta recomendaciones basadas en la experiencia de investigación en personas transgénero, con la intención de que puedan ser útiles a quienes realicen estudios con dicha población. Estas recomendaciones incluyen orientaciones conceptuales, metodológicas y éticas, aplicables a lo largo del proceso de investigación. En particular, las orientaciones cubren los siguientes temas: definir con precisión el colectivo con el que se trabaja, registrar la variedad de identificaciones de género posibles al interior del mismo, utilizar métodos de muestreo aptos para poblaciones de difícil acceso, retribuir la participación, incluir líderes e investigadores transgéneros como expertos, pilotar los instrumentos en la población que será investigada, optar por modalidades de recolección grupal de datos, ofrecer asistencia individualizada durante la recolección, utilizar un lenguaje no estigmatizante e inclusivo, convocar la participación en conjunto con organizaciones transgénero, atender a la movilidad geográfica de la población, realizar una escucha comprometida y contemplar protocolos de derivación, considerar las diferentes trayectorias de transición, realizar sesiones de interanálisis y, finalmente, difundir apropiadamente los hallazgos al interior de la población transgénero. Se discuten estas proposiciones en términos de sus efectos en las comunidades trans, su utilidad y alcances éticos, su articulación con exigencias generales de toda investigación y sus implicaciones para el activismo.

Abstract Prejudice and discrimination have important effects on the well-being and quality of life of trans people. Hence, investigating with said population implies, in addition to actions to obtain relevant and truthful information, having the necessary actions to attend to their needs and peculiarities. These are populations that are difficult to access (hard-to-reach), stigmatized, in which there is no defined sampling frame, that have physical and mental health indicators lower than those of any other group with which we have worked and that, therefore, it is necessary to take extreme the precautions not to reproduce types of relationships that may be harmful or offensive. The purpose of the present article was to systematize part of our field experience with transgender people, so that it can be useful for those who study with this population. These recommendations aim to provide some conceptual, methodological and ethical guidelines, useful throughout the research process. In particular, we made a series of recommendations that cover from the moment of taking conceptual decisions about the design of the study, through contact with the organizations, until the completion of the field work and subsequent stage of dissemination of results. In particular, a series of recommendations are made regarding: specifying the definition of the group with which one works, recording the variety of gender identifications as people present them, using to sampling methods for hard-to-reach populations or hidden populations, deliver a retribution for the participation (consider participants as experts to be compensated for their work), including activists as experts in every stage of the study (study design, field work, data analysis and dissemination of results), piloting the instruments in specific population, preferably opt for group applications modality and continue with a debriefing, have specific assistance for participants during the application (special needs derived from their age, educational level, reduced mobility, among others), use non-stigmatizing and inclusive language, call together with trans organizations (in order to establish greater trust in the population), attend to a mobility of the population (so as not to replicate the sample in different places), carry out a committed listening and contemplate referral protocols (if necessary given the type of situations described by the participants and their current degree of elaboration), consider different trajectories of transition, conduct inter-analysis sessions and disseminate appropriately within the transgender population. These propositions are discussed in terms of their effects on trans communities, their usefulness and ethical scope, their articulation with the general requirements of all research, and their implications for activism. On the other hand, these recommendations can serve as criteria for evaluating the ethical dimension of research projects with trans people. It may therefore be important to project reviewers, editors, and reviewers of manuscripts submitted for publication. The perspective that we assume in this work is aligned with those called "evidence-based activism", which implies articulating a variety of knowledge, scientifically accredited and of an "experiential" type, in order to explore situations in which the team members Research staff are part of networks that involve them personally in their study topics. It is precisely the relationship with groups that work for the rights of minorities, activists and members of these groups is essential, since they have knowledge acquired through their experience as part of discriminated groups and they can contribute to the mobilization of knowledge in the governance of health issues.

Prevalencia de la enfermedad periodontal en pacientes con antecedente de síndrome coronario agudo en un programa de rehabilitación cardiaca / Prevalence of periodontal disease in patients with a history of acute coronary syndrome in a cardiac rehabilitation programme

Resumen Objetivo: establecer la prevalencia y la gravedad de la enfermedad periodontal en pacientes con síndrome coronario agudo sin comorbilidades, que ingresan al programa de rehabilitación cardíaca en la Fundación Clínica Shaio. Métodos: se examinaron 83 pacientes con diagnóstico de síndrome coronario agudo sin comorbilidades y los siguientes diagnósticos: angina inestable (n = 27), infarto de miocardio con elevación del segmento ST (STEMI) (n = 34) e infarto de miocardio sin elevación del segmento ST (NSTEMI) (n = 22). La prevalencia y la gravedad de la enfermedad periodontal fueron evaluadas con el índice periodontal de los Centros para el Control y la Prevención de Enfermedades (CDC). Se compararon entre los grupos índice clínico, placa, cálculo, hemorragia gingival, profundidad de sondaje y nivel de inserción clínica. Resultados: la prevalencia de enfermedad periodontal fue del 97,6% y se observó periodontitis avanzada en el 38,3%. Los pacientes con STEMI mostraron la mayor gravedad de la periodontitis. Los índices clínicos inflamatorios de la enfermedad periodontal se elevaron en todos los grupos sin diferencias significativas. El nivel de inserción clínica no mostró diferencias significativas entre las condiciones cardíacas. Sin embargo, se observó mayor porcentaje de sitios con pérdida de inserción clínica (PIC) ≥ 6 mm, y sitios con una profundidad de bolsas > 6 mm, en pacientes con STEMI. Conclusión: los pacientes con síndrome coronario agudo sin comorbilidades, que ingresaron al programa de rehabilitación cardíaca para completar su tratamiento, tuvieron alta prevalencia y gravedad de la enfermedad periodontal. Es necesario hacer énfasis en el control de la enfermedad periodontal en pacientes con enfermedad coronaria.

Abstract Objective: To determine the prevalence and severity of periodontal disease in patients with acute coronary syndrome with no comorbidities admitted to a cardiac rehabilitation programme in the Clínica Shaio Foundation, Colombia. Methods: The study included a total of 83 patients diagnosed with acute coronary syndrome with no comorbidities and the following diagnoses: unstable angina (n = 27), ST-segment elevation myocardial infarction (STEMI) (n = 34), and non-ST-elevation myocardial infarction (NSTEMI) (n = 22). The prevalence and severity of periodontal disease were evaluated using the Periodontal Index of the Centres for the Control and Prevention of Diseases. A between-group comparison was made of the clinical index, plaque, calculi, gingival bleeding, probing depth, and level of clinical attachment. Results: The prevalence of periodontal disease was 97.6%, and advance periodontitis was observed in 38.3% of subjects. The patients with a STEMI showed more severe periodontitis. The inflammatory clinical indices of periodontal disease were increased in all groups, with no significant differences being observed. There were no significant differences between clinical attachment and heart conditions. However, it was observed that there was a higher percentage of locations with a loss of clinical attachment ≥ 6 mm, and locations with bag depths > 6 mm in patients with a STEMI. Conclusión: The patients with acute coronary syndrome with no comorbidities, and who entered the cardiac rehabilitation programme to complete their treatment, had a high prevalence and severity of periodontal disease. The control of periodontal disease should be emphasised in patients with coronary disease..

Conocimientos sobre Fitoterapia en estudiantes de 5to.año de la carrera de Medicina. Bayamo. 2019 / Knowledge of Phytotherapy in 5th year students of the Medical degree. Bayamo. 2019 / Conhecimentos de Fitoterapia em estudantes do 5º ano do curso de Medicina. Bayamo. 2019

RESUMEN Introducción: las plantas medicinales son unas de las alternativas más utilizadas por la humanidad a lo largo del periodo evolutivo, por sus propiedades preventivas y curativas contra enfermedades. En el año 2010 se rediseñó la estrategia curricular de MNT en la carrera de medicina, con la que se espera consolidar y sistematizar el trabajo de una forma interdisciplinaria. Objetivo: identificar el nivel de conocimiento que poseen los estudiantes de 5to año de la carrera de medicina sobre la Fitoterapia. Métodos: para la recolección y obtención de información una encuesta en la cual se recogen aspectos encaminados a identificar aspectos relacionados con el conocimiento y uso de las plantas medicinales en los estudiantes de la Facultad de Ciencias Médicas (FCMB) Granma, así como sexo con mayor conocimiento de la Fitoterapia, vía por la cual han obtenido información, nivel de efectividad y plantas medicinales con frecuente uso. Resultados: se encontró que las mujeres tienen conocimiento más sólido sobre las plantas medicinales, predomino la edad de 22 años de la muestra, el 61% de los estudiantes adquirieron conocimientos durante la carrera, considerando menos eficaz la MNT el 65%, las plantas con frecuente uso son manzanilla, guayaba, ajo y orégano. Conclusiones: los resultados demuestran que existe conocimiento de la Medicina herbolaria, pero aún queda mucho por hacer en este campo para incrementar cada vez más el arsenal medico terapéutico y continuar la capacitación de los estudiantes en el uso de estas técnicas, por las bondades que ofrecen las mismas en el tratamiento a los pacientes, a la par de lograr que cada vez sean más aceptadas por la población.

ABSTRACT Introduction: Medicinal plants are one of the most widely used alternatives by humanity throughout the evolutionary period, for their preventive and curative properties against diseases. In 2010, MNT's curriculum strategy was redesigned in the medical career, which is expected to consolidate and systematize work in an interdisciplinary way. Objective: to identify the level of knowledge that students in 5th year of the medical degree on Phytotherapy have. Methods: for the collection and obtaining of information a survey in which aspects are collected aimed at identifying aspects related to the knowledge and use of medicinal plants in students of the Faculty of Medical Sciences (FCMB) Granma, as well as sex with greater knowledge of Phytotherapy, through which they have obtained information, level of effectiveness and medicinal plants with frequent use. Results: women were found to have more solid knowledge about medicinal plants, predominate the age of 22 years of the sample, 61% of students acquired knowledge during the career, considering less effective MNT 65%, the plants with frequent use are chamomile, guava, garlic and oregano. Conclusions: the results show that there is knowledge of herbal medicine, but much remains to be done in this field to increase the therapeutic medical arsenal and continue the training of students in the use of these techniques, for the benefits they offer in the treatment of patients, while making them increasingly accepted by the population.

RESUMO Introdução: as plantas medicinais são uma das alternativas mais utilizadas pela humanidade ao longo do período evolutivo, para suas propriedades preventivas e curativas contra doenças. Em 2010, a estratégia curricular do MNT foi redesenhada na carreira médica, que deverá consolidar e sistematizar o trabalho de forma interdisciplinar. Objetivo: identificar o nível de conhecimento que os alunos do 5º ano do curso de medicina em Fitoterapia possuem. Métodos: para a coleta e obtenção de informações, uma pesquisa em que são coletados aspectos que visam identificar aspectos relacionados ao conhecimento e uso de plantas medicinais em alunos da Faculdade de Ciências Médicas (FCMB) Granma, bem como sexo com maior conhecimento da Fitoterapia, através do qual obtiveram informações, nível de eficácia e plantas medicinais com uso frequente. Resultados: as mulheres apresentaram conhecimento mais sólido sobre plantas medicinais, predominam a idade de 22 anos da amostra, 61% dos alunos adquiriram conhecimento durante a carreira, considerando MNT 65% menos eficaz, as plantas com uso frequente são camomila, goiaba, alho e orégano. Conclusões: os resultados mostram que há conhecimento da medicina fitoterápica, mas ainda há muito a ser feito nesse campo para aumentar o arsenal médico terapêutico e continuar a formação dos alunos no uso dessas técnicas, pelos benefícios que oferecem no tratamento dos pacientes, ao mesmo tempo em que os fazem cada vez mais aceitos pela população.

Vascular access cannulation in hemodialysis patients: technical approach / Canulação do acesso vascular em pacientes em hemodiálise: abordagem técnica

ABSTRACT Introduction: The vascular access cannulation technique varies among clinics, and guidelines on vascular access give little importance to cannulation techniques. The objective of this study was to evaluate the cannulation technique and to determine which factors are associated with each detail of the technique. Material and methods: The vascular access cannulation was evaluated in 260 patients undergoing hemodialysis. The type and anatomical location of the vascular access, the cannulation technique, direction, gauge, and distance between needles, besides bevel direction and needle rotation were registered. Results: The arteriovenous fistula was the most frequent vascular access (88%), the most used cannulation technique was area (100%), the needle direction was anterograde in most cases (79.5%), and the mean distance between the tips of needles was 7.57±4.43 cm. For arteriovenous grafts, the proximal anatomical location (brachial artery) and cannulation with 16G needles in anterograde position were more predominant. For arteriovenous fistulas, the distal anatomical location (radial artery) and cannulation through 15G needles were more common. Cannulation of vascular access in retrograde direction was associated with a greater distance between needles (13.2 ± 4.4 vs 6.1 ± 3 cm, p < 0.001). Kt/V was higher when the distance between needles was higher than 5 cm (1.61 ± 0.3 vs. 1.47 ± 0.28, p < 0.01). Conclusions: The vascular access cannulation technique depends on the vascular access characteristics and expertise of cannulators. Clinical trials are required for the formulation of guidelines for vascular access cannulation.

RESUMO Introdução: A técnica de canulação do acesso vascular varia entre instituições de saúde, e as diretrizes sobre o acesso vascular dão pouca importância às técnicas de canulação. O objetivo deste estudo foi avaliar a técnica de canulação e determinar quais fatores estão associados a cada detalhe da técnica. Material e métodos: A canulação do acesso vascular foi avaliada em 260 pacientes em hemodiálise. Foram registrados o tipo e localização anatômica do acesso vascular, a técnica de canulação, a direção, a bitola e a distância entre as agulhas, além da direção do bisel e da rotação da agulha. Resultados: A fístula arteriovenosa foi o acesso vascular mais frequente (88%), a técnica de canulação mais utilizada foi a área (100%), a direção da agulha foi anterógrada na maioria dos casos (79,5%) e a distância média entre as pontas das agulhas foi de 7,57 ± 4,43 cm. Para enxertos arteriovenosos, a localização anatômica proximal (artéria braquial) e a canulação com agulhas 16G em posição anterógrada foram mais predominantes. Para as fístulas arteriovenosas, a localização anatômica distal (artéria radial) e a canulação através de agulhas 15G foram mais comuns. A canulação do acesso vascular na direção retrógrada foi associada a uma maior distância entre as agulhas (13,2 ± 4,4 v.s. 6,1 ± 3 cm, p < 0,001). O Kt / V foi maior quando a distância entre as agulhas foi superior a 5 cm (1,61 ± 0,3 vs. 1,47 ± 0,28, p < 0,01). Conclusões: A técnica de canulação do acesso vascular depende das características do acesso vascular e da experiência dos "canuladores". Ensaios clínicos são necessários para a formulação de diretrizes para a canulação do acesso vascular.

Differences in hospitalization due to infectious causes between patients with hemodialysis and those with peritoneal dialysis / Diferencias en la hospitalización por causas infecciosas entre pacientes con hemodiálisis y diálisis peritoneal

Abstract Introduction: approximately 50% of the annual health care expenditure of patients with chronic kidney disease on dialysis is related to hospitalizations. Infections represent the second reason for consultation, with a high morbidity and mortality. There are no studies comparing hospitalization time due to infectious causes between the different dialysis options. Objective: to determine the difference in hospitalization time for treatment of infectious diseases in patients with chronic kidney disease on dialysis, comparing patients on hemodialysis vs. peritoneal dialysis. Materials and methods: a retrospective, dynamic cohort study of patients on hemodialysis and peritoneal dialysis who were admitted to the emergency department at the Hospital Universitario Mayor due to infectious diseases. The study patients were included using nonprobabilistic methods. The sample size was calculated by comparison of means. A total of 172 hemodialysis patients and 85 peritoneal dialysis patients were included for statistical analysis. Results: hospitalization time is greater in patients on hemodialysis than in patients on peritoneal dialysis; 12 (IQR 8-21) vs. 10 (IQR 6.5-13) days, respectively, p= 0.004. Conclusions: hospitalization time due to infectious causes is greater in patients on hemodialysis than in patients on peritoneal dialysis. In addition, the incidence of treatment-related infections in our population is lower than the globally reported incidence.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1222).

Resumen Introducción: aproximadamente el 50% del gasto anual en salud de los pacientes con enfermedad renal crónica en diálisis está relacionada con hospitalizaciones; las causas infecciosas representan la segunda causa de consulta con una alta morbilidad y mortalidad. No existen estudios donde se compare el tiempo de hospitalización por causas infecciosas entre las diferentes opciones de diálisis. Objetivo: determinar las diferencias en tiempos de hospitalización que se deriva del manejo de patologías infecciosas en pacientes con enfermedad renal crónica en diálisis, comparando los pacientes que se encuentran en hemodiálisis vs diálisis peritoneal. Material y métodos: estudio de cohorte retrospectiva, dinámica, de pacientes en hemodiálisis y diálisis peritoneal que ingresan al servicio de urgencias del Hospital Universitario Mayor por patologías infecciosas. Los pacientes que ingresaron al estudio se incluyeron por métodos no probabilísticos. El cálculo de tamaño de muestra se realizó por comparación de medias. Para el análisis estadístico se incluyeron 172 pacientes en hemodiálisis y 85 en diálisis peritoneal. Resultados: el tiempo de hospitalización es mayor en pacientes con hemodiálisis en comparación con los pacientes en diálisis peritoneal, 12 (RIC 8-21) vs 10 (RIC 6.5-13) días respectivamente, p= 0.004. Conclusiones: el tiempo de hospitalización por causas infecciosas es mayor en los pacientes con hemodiálisis que los de diálisis peritoneal, adicionalmente la incidencia de infecciones asociadas a la terapia en nuestra población es menor que lo reportado a nivel mundial.(Acta Med Colomb 2020; 45. DOI:https://doi.org/10.36104/amc.2020.1222).

Efectos del prejuicio sexual en la salud mental de personas transgénero chilenas desde el Modelo de Estrés de las Minorías: Una aproximación cualitativa / Sexual prejudice effects on Chilean transgender individuals' mental health from Minority Stress Model: A qualitative approach

Resumen El Modelo de Estrés de las Minorías (Meyer, 2003) ha permitido explicar de qué forma el prejuicio sexual produce efectos negativos en la salud y bienestar de personas pertenecientes a las minorías sexuales, a través de la identificación de estresores de tipo distales y proximales. Este estudio buscó indagar los efectos del prejuicio sexual en la salud mental de personas transgénero en Chile desde un enfoque cualitativo. Se realizaron entrevistas semi-estructuradas a 17 personas transgénero femeninas y masculinas en cuatro ciudades del país. Los resultados nos permite identificar la presencia de factores distales asociados a discriminación manifiesta y factores proximales asociados a la vivencia del estigma y su relación con el autoconcepto. Finalmente, se describen efectos en la salud mental, entre los que destacan la presencia de sintomatología ansioso-depresiva, ideación e intentos suicidas, conductas autolesivas y consumo de alcohol y otras sustancias.

Abstract The Minority Stress Model (Meyer, 2003) has made it possible to explain how sexual prejudice produces negative effects on the health and wellbeing of people belonging to sexual minorities, through distal and proximal stressors. A qualitative study was conducted to investigate the effects of sexual prejudice on the mental health of transgender adults in Chile. Semi-structured interviews were conducted with 17 transgender people, both male and female, in four cities of the country. The results allow us to identify the presence of distal factors associated with overt discrimination, as well as, proximal factors associated with the experience of stigma and its effects on self-concept. Finally, effects on mental health are described, among which the presence of anxious-depressive symptomatology, suicidal ideation and attempts, self-injurious behavior and consumption of alcohol and other substances.

Conservative management for patients with chronic kidney disease refusing dialysis / Tratamento conservador de paciente com doença renal crônica que renuncia à diálise

ABSTRACT Estimates suggest that 20-30% of the deaths of patients with chronic kidney disease with indication to undergo dialysis occur after refusal to continue dialysis, discontinuation of dialysis or inability to offer dialysis on account of local conditions. Contributing factors include aging, increased comorbidity associated with chronic kidney disease, and socioeconomic status. In several occasions nephrologists will intervene, but at times general practitioners or family physicians are on their own. Knowledge of the main etiologies of chronic kidney disease and the metabolic alterations and symptoms associated to end-stage renal disease is an important element in providing patients with good palliative care. This review aimed to familiarize members of multidisciplinary care teams with the metabolic alterations and symptoms arising from chronic kidney disease treated clinically without the aid of dialysis.

RESUMO Estimativas sugerem que em torno de 20% a 30% dos óbitos de pacientes com doença renal crônica em estágio dialítico decorrem de renúncia à diálise, da interrupção do tratamento dialítico ou da incapacidade de oferecer tratamento dialítico em função das condições locais. O envelhecimento populacional, o aumento das comorbidades associadas à doença renal crônica e o nível socioeconômico do país contribuem para esse cenário. Em diversas ocasiões o nefrologista estará presente para intervir ativamente, mas em outras o médico generalista ou o médico de família estarão sós. O conhecimento das principais etiologias da doença renal crônica e das alterações metabólicas e dos sintomas associados à fase terminal da doença renal são condições importantes para a evolução do paciente sem sofrimento para uma boa morte. O objetivo desta revisão é familiarizar os membros da equipe multiprofissional para o reconhecimento e conduta quanto às alterações metabólicas e aos sintomas decorrentes da doença renal crônica tratada clinicamente sem suporte dialítico.

¿Afecta el apoyo temprano la estabilidad de la rodilla en cirugía reconstructiva de esquinas? Estudio clinico comparativo aleatorizado / Does the early support affect knee stability in corner reconstructive surgery?

Introducción: El objetivo de este estudio fue comparar en un grupo de pacientes sometidos a cirugía reconstructiva de las esquinas postero medial (EPM), y posterolateral de la rodilla (EPL), el efecto en la estabilidad medio-lateral con dos métodos de rehabilitación diferentes, en el que a un grupo de pacientes se les asigno aleatoriamente el apoyo temprano (grupo A) y a otros el apoyo tardío a partir de la 6 semana (Grupo B) de la extremidad intervenida. Métodos: Estudio prospectivo donde se incluyeron a todos los pacientes tratados con cirugía reparativa/reconstructiva de la EPM y EPL de la rodilla, en el periodo comprendido entre enero del 2016 a Septiembre del 2017. El procedimiento quirúrgico utilizado en la EPM fue la plicatura del ligamento colateral medial/profundo y Ligamento Oblicuo Posterior (LOP), y en la EPL, la reconstrucción ligamentaria utilizando las técnicas de Arciero (no anatómica) y LaPrade (anatómica) según el caso. Todos los pacientes tuvieron asociado una reconstrucción del ligamento cruzado anterior y/o posterior. Resultados: De un total de 104 pacientes intervenidos por cirugía ligamentaria de rodilla, 31 pacientes cumplían con los criterios de inclusión, solo 20 pacientes completaron la evaluación y seguimiento en un periodo no menor a 6 meses del post operatorio. Diez pacientes conformaron el Grupo A o de apoyo temprano inmediato y 10 del Grupo B o de apoyo tardío. De los cuales 10 fueron del género masculino y 10 del género femenino con una edad que oscilo entre los 20 y 50 años con promedio de 35 años. Se evaluó a los 6 meses la estabilidad medio/lateral medida con las pruebas del bostezo lateral/medial en extensión y flexión de 30 grados, el dial test a 30 grados para la esquina posterolateral, el cajón Postero lateral y el dial test reverso para la esquina posteromedial. El estudio mostró que los pacientes que recibieron apoyo temprano tienen un riesgo mayor de afectarse la estabilidad lateral de la rodilla comparado con los que apoyaron después de la 6 semana. El estudio mostro que los pacientes a los que se les practico reconstrucción medial el apoyo no afecto su estabilidad a los 6 meses. Conclusiones: Este estudio soporta la hipótesis que el apoyo temprano de la extremidad intervenida en cirugía de esquinas posterolateral de la rodilla tiene un efecto negativo en la estabilidad articular lateral. Tipo de estudio: Serie de casos. Nivel de Evidencia: III

Introduction: The purpose of this study was to compare in a group of patients undergoing reconstructive postero- lateral and postero-medial knee corners, the effect of the medio-lateral stability with two different methods of rehabilitation in which a group of patients were assigned randomly early weight bearing and ( group A) and late weight bearing after 6 weeks (group B). Methods: The study included all patients treated with postero-lateral and postero-medial knee corner reconstruction between January 2016 and September 2017. Surgical technique in the postero-medial side consisted in a plication of the deep and superficial Medial Collateral Ligament (MCL) and Posterior oblique ligament (POL), and on the postero-lateral side using the Arciero or LaPrade technique according to the case. All patients had an anterior cruciate ligament (ACL) and/or Posterior Cruciate Ligament reconstruction. Results: 103 patients were operated for reconstructive knee ligament surgery in that period, 31 patients met the inclusion criteria and 20 patients completed the evaluation and follow up of 6 months post operatory. 10 patients formed the group A or early weight bearing and 10 patients group B or late weight bearing, 10 Men and 10 Women, in ages between 20-50, average 35. All patients were evaluated 6 months after the surgery with the standard test for postero-lateral and postero-medial instability; For the lateral side we used the opening test in flexion of 30 grades and in full extension, postero-lateral drawer test and dial test in 30 and 90 degrees and for the medial side we used the medial opening test in 30 degrees of flexion and full extension and the reverse Dial test. The study showed that patients undergoing postero-lateral corner reconstruction and early weight bearing have a higher risk of presenting residual lateral instability measure 6 months post op compared with the patients who their weight bearing was late. Conclusions: This study support the hypothesis of early weight bearing will produce a negative effect of the Lateral Stability in patients undergoing postero-lateral but no in patients undergoing to postero-medial plication. Type of study: Case series. Level of evidence: III

Reflections on end-of-life dialysis / Reflexões sobre a diálise no fim da vida

ABSTRACT The world population is aging and diseases such as diabetes mellitus and systemic arterial hypertension are increasing the risk of patients developing chronic kidney disease, leading to an increase in the prevalence of patients on dialysis. The expansion of health services has made it possible to offer dialysis treatment to an increasing number of patients. At the same time, dialysis survival has increased considerably in the last two decades. Thus, patients on dialysis are becoming more numerous, older and with greater number of comorbidities. Although dialysis maintains hydroelectrolytic and metabolic balance, in several patients this is not associated with an improvement in quality of life. Therefore, despite the high social and financial cost of dialysis, patient recovery may be only partial. In these conditions, it is necessary to evaluate the patient individually in relation to the dialysis treatment. This implies reflections on initiating, maintaining or discontinuing treatment. The multidisciplinary team involved in the care of these patients should be familiar with these aspects in order to approach the patient and his/her relatives in an ethical and humanitarian way. In this study, we discuss dialysis in the final phase of life and present a systematic way to address this dilemma.

RESUMO A população mundial está envelhecendo, e doenças como diabetes mellitus e hipertensão arterial sistêmica estão aumentando o risco de doença renal crônica, com consequente elevação na prevalência de pacientes em diálise. A expansão dos serviços de saúde permitiu oferecer tratamento dialítico para um número cada vez maior de pacientes. Paralelamente, a sobrevida em diálise aumentou consideravelmente nas últimas duas décadas. Dessa maneira, os pacientes em diálise são cada vez mais numerosos, mais idosos e com maior número de comorbidades. Embora a diálise mantenha o equilíbrio hidroeletrolítico e metabólico, em diversos pacientes isso não está associado à melhora da qualidade de vida. Então, apesar do elevado custo social e financeiro da diálise, a recuperação do paciente pode ser apenas parcial. Nessas condições, é necessário avaliar individualmente o paciente em relação ao tratamento dialítico, o que implica reflexões sobre iniciar, manter ou suspender o tratamento. A equipe multidisciplinar envolvida no cuidado desses pacientes deve estar familiarizada com esses aspectos para abordar o paciente e seus familiares de forma ética e humanitária. Neste estudo, foi discutido o tratamento dialítico na fase final da vida e apresentada uma maneira sistemática para enfrentar esse dilema.

La Desaparición Forzada de Personas a Cuarenta Años del Golpe de Estado en Chile: un Acercamiento a la Dimensión Familiar / Forced Disappearance of Persons Forty Years after the Coup in Chile: an Approach to the Family Dimension / O Desaparecimento Forçado de Pessoas há Quarenta Anos do Golpe de Estado no Chile: uma Aproximação à Dimensão Familiar

Resumen Este artículo analiza las memorias sobre el familiar detenido y desaparecido de 19 mujeres de la Agrupación de Familiares de Detenidos Desaparecidos de Santiago de Chile. Se utilizó la entrevista reflexiva-grupal como estrategia de producción de testimonios, los cuales fueron analizados mediante el análisis de datos verbales. Los principales resultados señalan que las memorias familiares transmitidas intergeneracionalmente son de alta intensidad y afectividad, constituyendo una postmemoria (Hirsch, 1998). También se establece que los testimonios de las víctimas se configuran a manera de lucha contra la negación e impunidad de la desaparición del familiar detenido desaparecido. Este estudio aporta conocimiento útil para el desarrollo de políticas de memoria que permitan el reconocimiento social de la historia familiar de víctimas de terrorismo de Estado. Del mismo modo, se considera que tanto la propuesta teórico-metodológica como los resultados obtenidos en este estudio, aportan pistas para el desarrollo de nuevas líneas de investigación, orientadas a la comprensión de la transmisión transgeneracional de experiencias traumáticas.

Abstract This article analyzes the recollections of detained and disappeared relatives of 19 women from the Association for Relatives of the Detained-Disappeared. Testimony was collected using group reflective interviews, with an analysis of the verbal data. The main results indicate that the family memories transmitted trans-generationally are of high intensity and affectivity, constituting a post-memory (Hirsch, 1998). The recollections of the victim's relatives also work against negation and impunity of the disappearance of the detained relative. This study contributes to the development of policies for memory which permit the social recognition of the family history of the victims of State terrorism. Both the theoretical-methodological proposal and the results obtained in this study indicate pathways to new lines of research oriented to the understanding of inter-generational transmission of traumatic experiences.

Resumo Este artigo analisa as memórias sobre o familiar detido e desaparecido de 19 mulheres da Agrupação de Familiares de Detidos Desaparecidos de Santiago do Chile. Utilizou-se a entrevista reflexiva-grupal como estratégia de produção de depoimentos, os quais foram analisados mediante a análise de dados verbais. Os principais resultados indicam que as memórias familiares transmitidas intergeracionalmente são de alta intensidade e afetividade, constituindo uma pós-memória (Hirsch, 1998). Também se estabelece que o depoimento das vítimas se configura como forma de luta contra a negação e impunidade do desaparecimento do familiar detido. Este estudo contribui com conhecimento útil para o desenvolvimento de políticas de memória que permitam o reconhecimento social da história familiar de vítimas de terrorismo de Estado. Do mesmo modo, considera-se que tanto a proposta teórico-metodológica quanto os resultados obtidos neste estudo contribuem com orientações para o desenvolvimento de novas linhas de pesquisa, orientadas à compreensão da transmissão transgeracional de experiências traumáticas.