Inteligencia emocional y su importancia en el proceso formativo de especialidades médico-quirúrgicas / Emotional Intelligence and its Importance on the Training Process as within Medical-Surgical Specialties

Introducción: La inteligencia emocional es una habilidad blanda, definida como la capacidad de reconocer las emociones propias y ajenas para gestionarlas frente a otros de manera adecuada. Este tipo de inteligencia se relaciona con competencias y aptitudes humanas en diferentes áreas sociales, académicas y de trabajo. Objetivo: Describir el papel de la inteligencia emocional en la práctica clínica de los residentes médicos, como marco de referencia para su aplicación en la educación teórico-práctica y la realización de futuras investigaciones. Métodos: Se realizó una revisión de la literatura en las bases de datos PubMed, LILACS y Google Scholar. Se emplearon operadores lógicos mediante distintas combinaciones: MeSH: Emotional Intelligence, Medical Residencies, Education, Medical, Education, Medical, Graduate; y DeCS: Inteligencia Emocional, Residencia Médica, Educación Médica, Educación de Postgrado en Medicina. La búsqueda se limitó por año, idioma y acceso libre, teniendo en cuenta criterios de inclusión y exclusión. Se obtuvieron 279 resultados, de los cuales fueron seleccionados 26 para ser incluidos en la revisión y síntesis de los resultados. Resultados: Los resultados se organizaron según su relación con la inteligencia emocional en: medición en residentes médico-quirúrgicos, niveles de estrés y burnout, empatía en la relación médico-paciente, desempeño académico, bienestar y satisfacción laboral. Conclusiones: La inteligencia emocional en los residentes médico-quirúrgicos se ha relacionado con menores niveles de estrés y burnout, comunicación asertiva, mayor empatía con los pacientes y calidad en la atención médica; además, con elevado rendimiento académico, mejores habilidades de enseñanza, liderazgo y motivación; y, finalmente, con mejor bienestar psicológico, satisfacción laboral y rendimiento clínico(AU)

Introduction: Emotional intelligence is a soft skill, defined as the ability to recognize one's own and others' emotions in view of managing them in front of others adequately. This type of intelligence is related to human competences and skills in different social, academic and occupational areas. Objective: To describe the role of emotional intelligence in the clinical practice of medical residents, as a frame of reference for its application in theoretical-practical education and the development of future research. Methods: A literature review was carried out in the PubMed, LILACS and Google Scholar databases. Logical operators were used by means of different combinations from the Medical Subject Headings: Emotional Intelligence, Medical Residencies, Education, Medical, Education, Medical, Graduate. The following combinations from the Health Sciences Descriptors were also used: "Inteligencia Emocional [emotional Intelligence], Residencia Médica [medical residence], Educación Médica [medical education], Educación de Postgrado en Medicina [postgraduate education in Medicine]. The search was limited by year, language and free access, taking into account inclusion and exclusion criteria. A total of 279 results were obtained, of which 26 were selected to be included in the review and synthesis. Results: The results were organized, according to their relationship with emotional intelligence, in measurement in medical-surgical residents, levels of stress and burnout, empathy in the doctor-patient relationship, academic performance, well-being, and job satisfaction. Conclusions: Emotional intelligence in medical-surgical residents has been related to lower levels of stress and burnout, assertive communication, greater empathy with patients, and quality in medical care; furthermore, with high academic performance, better skills for teaching, leadership and motivation; and, finally, with better psychological well-being, job satisfaction and clinical performance(AU)

Pruebas de Estado de Educación Superior y Educación Médica en Colombia / State Tests for Higher Education and Medical Education in Colombia

Introducción: En Colombia, las pruebas de Estado para la evaluación de la calidad de los programas de educación superior (Saber Pro) tienen por objeto evaluar los conocimientos y capacidades profesionales de todos los estudiantes que han cumplido la mayoría de los créditos en sus programas académicos. Adicionalmente, estas pruebas son un requisito complementario al internado rotatorio para graduarse como profesional en medicina. Sin embargo, existen cuestionamientos relacionados con su utilidad en el ejercicio laboral y la articulación de estas pruebas con la formación médica. Objetivo: Establecer la coherencia entre la prueba Saber Pro y la educación médica. Métodos: Se realizó una revisión narrativa, mediante la búsqueda en PubMed, Ovid, Elsevier, SciELO y la normativa del contexto colombiano. Resultados: De acuerdo con la búsqueda realizada, existe un número considerable de artículos que soportan la aplicación de esta prueba, fundamentados en resultados cualitativos que se relacionan con la adaptación de instrumentos de evaluación médica. Asimismo, algunas fuentes muestran la influencia que pueden tener las competencias evaluadas con indicadores de salud y otros aspectos del contexto nacional. Conclusiones: Pese al número limitado de estudios que permitan dar conclusiones de carácter cuantitativo, existe evidencia sobre la utilidad y coherencia de la Prueba de Estado en el contexto nacional, de igual forma, se establece que la prueba Saber Pro puede garantizar estándares de calidad en los programas de educación superior y, con el paso del tiempo, ha contribuido al desarrollo de recomendaciones para la transformación de la educación médica en Colombia(AU)

Introduction: In Colombia, the state tests for evaluating the quality of higher education programs (Saber Pro) are intended to evaluate the professional knowledge and skills of all students who have completed the majority of credits in their academic programs. Additionally, these tests are a complementary requirement before the rotation internship for graduating as a medical professional. However, there are questions related to their usefulness in the occupational practice and the articulation of these tests with the medical training. Objective: To establish the coherence between the Saber Pro tests and medical education. Methods: A narrative review was carried out by means of a search in PubMed, Ovid, Elsevier, SciELO and the regulations of the Colombian context. Results: According to the search carried out, there is a considerable number of articles that support the application of this test, based on qualitative results related to the adaptation of medical evaluation instruments. Likewise, some sources show the influence that the assessed competences may have, by means of health indicators and other aspects of the national context. Conclusions: Despite the limited number of studies that allow provide quantitative conclusions, there is evidence on the usefulness and coherence of the state test in the national context; likewise, the Saber Pro test is concluded to be able to guarantee quality standards in higher education programs and, with the passage of time, has contributed to the development of recommendations for the transformation of medical education in Colombia(AU)

Reintegration of returning migrant healthcare workers into the Philippine workforce: A qualitative case study

AIM@#This study aims to explore the reintegration experiences of returning migrant healthcare workers in the Philippines.@*BACKGROUND@#Return migration and reintegration of healthcare labor force is a relevant part of the migration process valuable in the improvement of human capital in source countries through transfer of knowledge and skills. However, this research field has received little attention in terms of policy, program, and research development. Hence, there is a paucity of information in the Philippines describing the reintegration experiences of returning migrant healthcare workers despite its maturity in health worker migration.@*METHODS@# A qualitative case study approach was utilized in this study. Initially, an online literature review of electronic databases and grey literature regarding reintegration of migrant workers in the Philippines was performed. This was followed by online in- depth interviews among purposively selected potential, current, or returning nurses, rehabilitation therapists, and caregiver health worker migrants through Zoom web conferencing platform. Government, private, and non-government institutions involved in the migration of health workers were also invited to participate in online focus group discussions and key informant interviews. An inductive content analysis using matrices was utilized to determine relevant descriptive codes, categories, and themes.@*RESULTS@#Return migration and reintegration is perceived as an uncommon phenomenon among healthcare worker migrants. Nonetheless, motivations and grounds of opting to return and reintegrate in the Philippines can mostly be due to personal reasons or entrepreneurial aspirations. Upon return, they successfully held teaching and training positions, engaged in business through specialized clinics, or established professional associations. There was largely a perceived lack of awareness of government efforts on reintegration as it was felt that services and assistance were limited. Further observed restraints to return migration include lower wages in the Philippines, lack of knowledge on financial management, paucity of skills and qualifications recognition acquired overseas in their home country, and absence of professional network support. The COVID-19 pandemic also positively or negatively influenced healthcare worker migration.@*CONCLUSION@#This study highlighted the motivations and restraints of health worker migrants in returning to reintegrate in the Philippines. The availability and deficiency in policies, programs, and services for returning migrant workers were also emphasized. In addition, the aspects and prospects of return migration and reintegration, as well as the challenges posed by the COVID-19 pandemic on healthcare worker reintegration was identified. The Philippine government and other concerned agencies need to ensure a supportive environment that will foster a positively conducive reintegration experience for returning healthcare worker migrants.

A comparative study on health risks, lifestyle behaviors, health perceptions, and health seeking patterns between older and younger Filipinos in the rural areas

BACKGROUND@#Worldwide trends in health risks, lifestyle behaviors, health perceptions, and health-seeking patterns suggest alarming disparities among individuals from low- and middle-income countries. Such international comparisons are particularly troubling for older individuals (≥60 years).@*OBJECTIVES@#This study aims to compare health risks, lifestyle behaviors, health perceptions, and health-seeking patterns between younger (<60) and older (≥60) Filipinos from rural communities in the Philippines.@*METHODS@# A comparative cross-sectional study was employed with 863 younger and 427 older Filipinos. Data were analyzed using frequencies, chi-squares, and T-tests.@*RESULTS@#Older participants were more likely to be single/widowed, ≤ high school education and had higher rates of hypertension, high cholesterol, diabetes, and depression. They reported poorer health status and went to the village health center when sick. Furthermore, they were less likely to drink alcohol and see a physician.@*CONCLUSION@#There were significant differences in modifiable health risks and lifestyle behaviors and differences in health perceptions between younger and older cohorts of Filipinos living in rural areas in the Philippines. Our findings suggest the need to design separate health promotion interventions that target older and younger Filipinos' unique needs from rural communities.

Characteristics of dietary intakes including NOVA foods among pre-adolescents living in urban Kuala Lumpur – Findings from the PREBONE-Kids study

@#Introduction: Evidence showed considerable variability of health risk factors within different socioeconomic groups. This study aimed to characterise dietary intakes by total household income among a sample of Malaysian pre-adolescents in urban Kuala Lumpur. Methods: Baseline data of 243 healthy, pre-adolescent children between 9 and 11 years old including socio-demographic background (gender, ethnicity, and total household monthly income), anthropometry (body weight and height), and 7-day diet histories were collected. Secondary analysis was performed on dietary intakes to quantify food groups based on the Malaysian Dietary Guidelines and NOVA classification systems besides nutrients. Differences and associations between total monthly household income categories with anthropometry and dietary intakes were tested using independent t-test/Mann-Whitney U (depending on normality) and chi-square tests, respectively. Results: Most children in this study population had dietary intakes below the recommended serving sizes for five food groups, except meat/poultry (195.2±107.2%) and fish (110.1±106.3%) and consumed about 32% of energy from ultra-processed foods (NOVA food group 4). While there was no difference in dietary intake between the bottom 40% with the middle 40% and high 20% household income groups, the percentage of energy contributed by NOVA food group 4 (processed fats/oils, condiments, and sauces) was higher in the bottom 40% households (p=0.024). Conclusion: Most pre-adolescent children in this study, regardless of household income, did not meet dietary recommendations and ate diets comprised of less nutritious foods. Comprehensive approaches that aim to improve dietary patterns and reduce the risk of diet-related chronic diseases are warranted.

Emerging utility of endovascular thrombectomy in the Philippines: A single-center clinical experience

Background and Objective@#Stroke has remained one of the primary causes of significant morbidity and mortality. Among the therapeutic options for acute stroke management, endovascular thrombectomy is intended to remove the thrombi within the intracerebral vasculature and restore adequate perfusion to the surrounding penumbra. It is recommended up to 24 hours from onset of neurologic symptom. In the Philippines, only a few tertiary healthcare institutions are able to offer and perform endovascular thrombectomies. The aim was to describe the profile and discharge outcomes of endovascular thrombectomy for acute ischemic stroke at a tertiary hospital in our country. @*Methods@#We conducted a retrospective records review among 924 patients admitted for acute ischemic stroke from October 2018 to August 2021 who underwent mechanical thrombectomy. Clinical and functional outcomes were measured using the National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Score (mRS). @*Results@#Among 31 patients included in the study, 29 subjects (93.5%) had moderate to severe disability (mRS 3–5), and 25 (80.6%) had moderate stroke (NIHSS 6–21) on admission. The identified site of the cerebrovascular thrombi was within the M1 segment of the middle cerebral artery (41.9%, n=13). The stent retriever approach was performed in 19 participants (61.2%). Upon discharge, only 7 (22.6%) had favorable functional outcomes (MRS 0–2), and 9 (29.0%) resulted in mortality. Successful reperfusion was achieved in 92.3% of the patients.@*Conclusion@#Overall, endovascular thrombectomy is a possible treatment option for large vessel acute ischemic stroke in developing countries.

Duchenne muscular dystrophy in a Filipino boy reaching adulthood, and nine years into oral corticosteroids: A case report

Rationale@#Duchenne muscular dystrophy (DMD) is a disease that primarily manifests in the early stages of life and progressively affects muscle strength resulting in quadriparesis and ultimately resulting in premature death secondary to cardiac or respiratory failure. DMD is the most common x-linked genetic disorder in children that is because of an alteration of a protein called “dystrophin” which is responsible for strengthening muscle fibers and protecting them from injury as muscles contract and relax. @*Objective@#To highlight the case of a 19-year-old male who was diagnosed with DMD at 8 years of age and treated with oral corticosteroid and rehabilitation. @*Case@#We present the case of a 19-year-old male who developed difficulty climbing stairs and was diagnosed with DMD at 8 years old with the use of clinical exome sequencing. Corticosteroid therapy was initiated and rehabilitation perpetuated which dramatically improved his life expectancy. @*Discussion and Summary@#Clinical exome sequencing was employed on our patient to confirm the diagnosis of DMD from other neuromuscular and neurodegenerative diseases. Most cases of DMD succumb to cardiopulmonary arrest before reaching adulthood; however, this case exemplifies DMD from other cases since our patient was able to prolong his life with continuation of oral corticosteroid and rehabilitation and in the absence of extensive life support.

Telemedicina en pediatría para el manejo de enfermedades crónicas y de grupos vulnerables / Telemedicine in Pediatrics for Managing Chronic Diseases and Vulnerable Groups

Introducción: La telemedicina es una herramienta para los servicios de atención en pediatría, ya que permite el seguimiento de los pacientes pediátricos en el manejo de enfermedades crónicas y de grupos vulnerables; disminuye los costos y mejora el acceso a los servicios de salud. Objetivo: Explorar, por medio de una revisión sistemática de la literatura, la efectividad de la teleconsulta en el manejo de enfermedades crónicas y grupos vulnerables en la población pediátrica. Métodos: Se realizó una revisión sistemática de la literatura, utilizando los términos MESH pediatrics AND telehealth AND primary care AND control care en las bases Medline PubMed, EMBASE, Scopus, Web of Science, Cochrane, Science Direct. Se incluyeron metaanálisis, revisiones sistemáticas, experimentos clínicos controlados, estudios de cohortes, casos y controles, realizados desde 1998 hasta julio de 2021. Se obtuvieron 54 estudios para la revisión final. Resultados: Los principales resultados de la búsqueda arrojaron beneficios a nivel del control de enfermedades crónicas, control posterior al egreso de la unidad de cuidado intensivo, poscirugía pediátrica, cuidado paliativo, enfermedades mentales, acceso a los servicios de salud de población proveniente de regiones apartadas. Se encontró un beneficio para prevenir las visitas al servicio de urgencias. Conclusiones: La telemedicina tiene una diversidad de utilidades e intervenciones como herramienta de la salud. Se ha encontrado evidencia científica robusta para la atención de enfermedades crónicas y/o seguimiento en pediatría. Asimismo, la prestación de servicios en la modalidad de telemedicina en pediatría debe incluirse en los procesos de atención y guías de práctica clínica de la especialidad(AU)

Introduction: Telemedicine is a tool for pediatric care services, since it allows monitoring of pediatric patients in the management of chronic diseases and vulnerable groups; lowers costs and improves access to health services. Objective: To explore, through a systematic review of the literature, the effectiveness of teleconsultation in the management of chronic diseases and vulnerable groups in the pediatric population. Methods: A systematic review of the literature was carried out, using the MESH terms pediatrics AND telehealth AND primary care AND control care in Medline PubMed, EMBASE, Scopus, Web of Science, Cochrane, Science Direct databases. Meta-analyses, systematic reviews, controlled clinical trials, cohort, case-control studies, conducted from 1998 to July 2021, were included. Fifty-four studies were obtained for the final review. Results: The main results of the search showed benefits at the level of chronic disease control, control after discharge from the intensive care unit, pediatric post-surgery, palliative care, mental illness, access to health services for populations from remote regions. A benefit was found in preventing visits to the Emergency Department. Conclusions: Telemedicine has a diversity of utilities and interventions as a health tool. Robust scientific evidence has been found for the care of chronic diseases and/or follow-up in pediatrics. Likewise, the provision of services in the telemedicine modality in pediatrics should be included in the care processes and clinical practice guidelines of the specialty(AU)

El rol predictivo de la red neuronal por defecto sobre la atención sostenida en edades escolares: una revisión sistemática

El rol de la Red Neuronal por Defecto en la aparición del trastorno de déficit atencional ha recibido evidencia científica creciente en los últimos 20 años. Este artículo tuvo por objetivo sistematizar la evidencia empírica y cuantitativa disponible en investigaciones sobre el rol de la Red Neuronal por Defecto en la atención sostenida y déficits atencionales en niños y adolescentes de etapa escolar; se usó la metodología de revisión sistemática de la literatura científica disponible entre 2010 y 2020. Se seleccionó una muestra de 13 estudios. Los resultados evidenciaron que la atención sostenida es rítmica y fluctúa junto a la memoria de trabajo. En cuanto a los niños con déficit atencional, se reportan anomalías en la disponibilidad de dopamina, adelgazamientos de las aéreas de la corteza cerebral interconectadas con la Red Neuronal por Defecto, así como hipo e híper conectividad de los tractos de materia blanca asociados a esta red. Estos hallazgos interpretados en su conjunto aportan evidencia valiosa acerca del rol emergente de la Red Neuronal por Defecto en los procesos subyacentes de la atención sostenida y la aparición de déficits atencionales. Estos hallazgos sistematizados pueden tener implicancias profundas en la didáctica y el diseño instruccional debido a que se cuenta con evidencia suficiente y validada como para adaptar las tareas de aprendizaje a los ritmos de atención y descanso puesto que estos obedecen a limitaciones biológicas y no a prescripciones administrativas.

The role of the Default Neural Network in the emergence of attention deficit disorder has received increasing scientific evidence in the last 20 years. This article aimed to systematize the empirical and quantitative evidence available in research on the role of the Default Neural Network in sustained attention and attention deficits in school children and adolescents; The methodology of systematic review of the scientific literature available between 2010 and 2020 was used. A sample of 13 studies was selected. The results showed that sustained attention is rhythmic and fluctuates along with working memory. Regarding children with attention deficit, anomalies in the availability of dopamine, thinning of the areas of the cerebral cortex interconnected with the Neural Network by Default, as well as hypo and hyper connectivity of the white matter tracts associated with this network are reported. These findings, interpreted as a whole, provide valuable evidence about the emerging role of the Default Neural Network in the underlying processes of sustained attention and the appearance of attentional deficits. These systematized findings can have profound implications in didactics and instructional design, due to the fact that there is sufficient and validated evidence to adapt the learning tasks to the rhythms of attention and rest since these processes obbey biological limitations and not to administrative requirements.

The Phenomenon of the ‘Starry Sky’ on Blood:Lesson Learned From Severe Malaria Falciparum

Severe malaria occurs when previously uncomplicated malaria infections are then turn to be full blown and tangled by serious, single or multi-organ failures or abnormalities in the patient's blood or metabolism. Clinical deterioration can happen abruptly and unnoticed, due to the masking of other prominent clinical condition like hyperthermia. Making the correct diagnosis as soon as possible is pivotal before administering antimalarial therapy. Diagnosis is made by examining the thick and thin blood films in an attempt to find malaria parasites in the blood sample.The “Starry Sky” appearance is a microscopic feature of severe malaria infection and its exclusively found only in thick blood film. The aim of this minireview is to discuss about theclinical background of“Starry Sky”appearance found in thick blood smear of severe malaria and its brief review combined with our experience in the Deptartment of Parasitology, Faculty of Medicine Universitas Kristen Indonesia, Jakarta-Indonesia, inhandled blood test from a vulnerable patient with severe malaria and how we pass on the lessons from that story to our students as part of health communication in community based Parasitology. By inserting this story to our lesson materials, we hope can build awareness among our students as future health practitioners and also to the publicthey serveas well as all stake holders; this snow ball action are currently and continously requiredto be done

Granulomatosis with polyangiitis: A case report of early systemic fulminant presentation

Granulomatosis with polyangiitis is a systemic vasculitis that affects medium and small vessels, with high expression of anti-neutrophil cytoplasmic autoantibody. A case is pre sented on a patient with an initial compromise of the lower airway, who did not respond to management, required intensive care unit management, and died due to severe diffuse alveolar hemorrhage. His definitive diagnosis was established with a clinical autopsy. Gran-ulomatosis with polyangiitis is a disease with different ways of presentation, and can have fatal outcomes if it is not diagnosed early.

La granulomatosis con poliangeítis es un tipo de vasculitis que afecta a vasos de mediano y pequeño calibre de manera sistémica, con una alta expresión de anticuerpos contra el citoplasma del neutrófilo. Se presenta el caso de un paciente con un compromiso inicial de la vía área inferior, que no respondió al tratamiento y requirió manejo en unidad de cuidados intensivos. Finalmente, falleció por una hemorragia alveolar difusa severa. Su diagnóstico definitivo se estableció con una autopsia clínica. La granulomatosis con poliangeítis tiene diferentes formas de presentación y puede tener desenlaces fatales si no se diagnostica a tiempo.

Study the Impact of Cramming in Medical Students

Aim:To reveal pre-exam cramming among pre-clinical medical students, what drives this practice, failure due to cramming and the problems and difficulties related to the act of cramming.Discussion:Cramming is common practice among struggling medical students. The prevalence of cramming is like an iceberg phenomenon. The act of stacking too many information just the night before an exam probably authorize the perpetrator to remember some information in the short term period and enable them to take in enough information for the exam. Along with this practice also comes sleep deprivation, mental and emotional disturbances and even substance abuse in order to achieve good marks and passing the exam. Unfortunately for some experts, cramming is not considered as learning. Procrastination and some other reason are believed to be the reason the culprit commits cramming. Conclusion:Cramming not only changes the behavior of the perpetrator, but also has an impact on his family, classmates, environment and future.

Cardioneuroablación como tratamiento del síncope reflejo: reporte de un caso

Resumen: El síncope mediado neuralmente es un trastorno causado por un reflejo autónomo anormalmente amplificado que involucra componentes tanto simpáticos como parasimpáticos. Es la causa más frecuente de síncope en personas jóvenes y su tratamiento sigue siendo un desafío, ya que no se ha demostrado que alguna terapia farmacológica prevenga por completo su recurrencia. En los últimos años ha surgido una técnica denominada cardioneuroablación, que consiste en la ablación por radiofrecuencia de los plexos ganglionares (PG) parasimpáticos, con buenos resultados a corto y largo plazo en la prevención de síncope recurrente, según los diferentes grupos de investigación. Presentamos el primer caso en Chile de un hombre joven con síncopes mediados neuralmente recurrentes que fue tratado con esta técnica en el Hospital Regional de Concepción.

Abstract: Cardioneuroablation is a novel method that can be used to treat reflex syncope. Although the experience with this technique is relatively limited it provides a more physiological way to treat this condition. The first case in Chile is herein reported along with a discussion of the subject.

Lesiones de vía biliar poscolecistectomía: conducta terapéutica actual / Post Cholecystectomy Bile Duct Injuries: Current Therapeutic Option

Resumen La colecistolitiasis es una condición común en Chile. La complicación más frecuente de esta condición es la colecistitis aguda. Aproximadamente 60.000 colecistectomías son realizadas anualmente en nuestro país, convirtiéndola en una de las patologías digestivas más frecuentes. El tratamiento de la colelitiasis ha evolucionado las últimas dos décadas. Con el desarrollo de la laparoscopía a final de 1980, la colecistectomía abierta fue definitivamente sustituida en los 90 por la vía laparoscópica. Desafortunadamente, la generalización de este procedimiento produjo un aumento en la incidencia de lesiones de vía biliar, aumentando desde una 0,1-0,2% hasta un 0,5-0,7%. Si bien, con el progresivo entrenamiento de los cirujanos en la cirugía mínimamente invasiva esta cifra ha disminuido nuevamente, la LVB aún constituye una de las complicaciones más graves en cirugía, generando gran impacto en la calidad de vida del paciente, e incluso costos en salud que pueden llegar a ser devastadores. El manejo de una lesión de vía biliar es, para muchos cirujanos, un desafío quirúrgico, que para su resolución requiere de las habilidades y experiencia de un cirujano hepatobiliar y derivación a centros de salud especializados. Sin duda, la acción más importante es extremar de manera rutinaria las medidas de prevención. Sin embargo, una vez que la lesión se ha producido, el futuro del paciente depende, directamente, del buen criterio del cirujano, tanto para realizar un diagnóstico temprano, como del enfrentamiento terapéutico que realice. El objetivo de este trabajo es dar a conocer diferentes conductas preventivas y terapéuticas cuando esta complicación se presenta.

Calculous biliary disease is a common condition in Chile. Over 60.000 cholecystectomies are performed annually, making gallstone disease one of the most common digestive health problems. The treatment of calculous biliary disease has evolved over the last 2 decades. With the development of laparoscopic technology in the late 1980s, new techniques for cholecystectomy were introduced. By the early 1990s, laparoscopic cholecystectomy had replaced open cholecystectomy in the operative management of gallbladder stone disease. Unfortunately, the widespread application of laparoscopic cholecystectomy has led to a concurrent rise in the incidence of major bile duct injuries. Reports have estimated the incidence has risen from 0.1-0.2 to 0.5-0.7%. Although, exponential training of surgeons in minimally invasive surgery has led to decrease this numbers again, bile duct injuries still constitute one of the most serious complications in surgery, generating a great impact on the patient's quality of life, and even health costs that can be devastating. The management of patients following major bile duct injurie is a surgical challenge, often requiring the skills of experienced hepatobiliary surgeons at tertiary referral centers. In this setting, the most important action is to routinely maximize prevention measures. However, once injury has occurred, patient's future depends directly on the correct judgment of the surgeon, both to make an early diagnosis and to choose the best therapeutic confrontation. The objective of this article is to present the different preventive and therapeutic options available when this complication occurs.

Factores influyentes en el desarrollo de competencias en Ortopedia y Traumatología durante el internado médico / Influential Factors in The Development of Competencies in Orthopedics and Traumatology During the Medical Internship

RESUMEN Introducción: Actualmente la salud es concebida como un derecho fundamental y para garantizarlo se debe propender por una adecuada formación de los profesionales de la salud. El internado rotatorio es la última etapa y la más importante del pregrado en Medicina. Objetivo: Explorar los factores desde la perspectiva de estudiantes y docentes, que influyen en el desarrollo de competencias en la rotación de Ortopedia y Traumatología durante el internado médico. Métodos: Estudio cualitativo con enfoque en teoría fundamentada. Para la recolección de datos se realizó un cuestionario semiestructurado a una muestra aleatoria de 14 participantes, 7 estudiantes y 7 docentes, que cumplían los criterios de inclusión. El análisis se basó en la codificación y categorización de los datos que posteriormente fueron sometidos a un proceso de triangulación para lograr la teorización final. Resultados: Los factores que favorecen el desarrollo de competencias están relacionados con la motivación intrínseca del estudiante, la flexibilidad y disponibilidad de recursos académicos, las características del programa de la rotación y el ambiente de práctica. Se identificaron como factores limitantes aquellos asociados a una formación deficiente en ciencias básicas médicas, la priorización del componente asistencial sobre el académico, la disponibilidad limitada de espacios y recursos de aprendizaje y los métodos de enseñanza tradicionales. Conclusiones: Es de vital importancia la identificación de los factores que favorecen y limitan el desarrollo de las competencias de los estudiantes de medicina en su última etapa de formación en ortopedia.

ABSTRACT Introduction: Few areas of orthopedic surgery have had such important technical changes in recent decades as in corrective spinal surgery. Fundamental changes have come with the new spinal instrumentation systems, which have been substantially modified and improved to facilitate three-dimensional correction of the deformity and provide secure spinal fixation, correction and stability. Objective: To evaluate the results achieved with the spinal instrumentation systems used in the correction of thoracolumbar kyphosis due to ankylosing spondylitis. Methods: A descriptive, retrospective and longitudinal study was carried out on 16 patients with thoracolumbar kyphosis due to ankylosing spondylitis operated on with the pedicle subtraction osteotomy technique and instrumented with Luque-type pedicle and sublaminar systems, in the Orthopedics service at Hermanos Ameijeiras Surgical Clinical Hospital, from March 2001 to March 2021. Results: All the patients were male, white skin color and average age of 39 years. More than 80% correction was achieved in the sagittal profile and an average of 34.3° per osteotomy, without major neurological complications. Good functional results were obtained, with high degree of patient satisfaction and improvement in their quality of life. Conclusions: The use of both spinal instrumentation systems is effective in maintaining the correction of thoracolumbar kyphosis due to ankylosing spondylitis.

Prevención y detección precoz del cáncer de mama en atención primaria / Prevention and early detection of breast cancer in primary care

El cáncer de mama es el tipo de cáncer más común, no restrictivo por edad, condición social, sexo, que afecta la condición de salud de alrededor de 2,3 millones de mujeres con resultados desfavorables. Este tipo de enfermedad afecta gravemente a la población y se estima que a nivel mundial la pérdida de la funcionalidad supera a las de otros tipos de cánceres. La información pertinente al tema se pudiera considerar como aporte en el nivel de conocimientos, estrategias válidas para la prevención y el despistaje oportuno de esta patología clínica Objetivo: Describir las estrategias de prevención y detección precoz del cáncer de mamá en atención primaria. Materiales y Métodos: Esta investigación es del tipo descriptiva, observacional y transversal. Se aplica una técnica de abordaje al tema con la extracción de datos bibliográficos y la intervención de la misma mediante el análisis sistemático, donde se emplea el método y diseño descriptivo. Resultados: El tipo de estudio busca la correlación estilo de vida saludable y no prevalencia de cáncer mediante una actuación temprana y oportuna como una conducta saludable. Conclusiones: La inspección y la técnica de palpación son de gran importancia para evaluar la aparición de un bulto y su reconocimiento por parte médica especializada. Cabe resaltar que no todo bulto en las mamas se considera cáncer, sin embargo, el diagnóstico médico oportuno y las pruebas diagnóstico especializadas para la detección son claves en la detección precoz y prevención(AU)

Breast cancer is the most common type of cancer, not restricted by age, social condition, sex, which affects the health condition of around 2.3 million women with unfavorable results. This type of disease seriously affects the population and it is estimated that worldwide the loss of functionality exceeds that of other types of cancers. The information pertinent to the topic could be considered as contribution in the level of knowledge, valid strategies for prevention and screening of this clinical pathology. Objective: To describe the strategies of prevention and Early detection of breast cancer in primary care. Materials and methods: This The research is descriptive, observational and cross-sectional. A technique is applied approach to the subject with the extraction of bibliographic data and the intervention of the same through systematic analysis, where the method and descriptive design are used. Results: The type of study seeks the correlation of healthy lifestyle and not prevalence of cancer through early and timely action as a behavior healthy. Conclusions: Inspection and palpation technique are of great importance to evaluate the appearance of a lump and its recognition by a specialized medical part. It should be noted that not every lump in the breast is considered cancer, however, the Timely medical diagnosis and specialized diagnostic tests for screening are keys to early detection and prevention(AU)

La telesalud como estrategia de atención primaria en la diabetes mellitus tipo 2 en Colombia / Telehealth as a primary care strategy in type 2 Diabetes Mellitus in Colombia

Resumen Introducción: la monitorización de pacientes con diabetes mellitus tipo 2 es una estrategia costo-efectiva, la cual, con un abordaje integral, disminuye los gastos derivados de la atención. La telesalud es una herramienta enfocada en este propósito. El objetivo de este trabajo consistió en describir el uso de la telesalud para el monitoreo de la diabetes mellitus tipo 2 en Colombia, bajo el marco de la atención primaria. Métodos: se realizó una revisión narrativa mediante la búsqueda en bases de datos (PubMed, Google Scholar, ScienceDirect, Cochrane y EMBASE) y documentos oficiales. Se reunieron 154 documentos y con un análisis de contenido, se seleccionaron 45 artículos y documentos. Resultados: la telesalud es una herramienta útil en el control de pacientes con diabetes. En los estudios revisados se evidencia el potencial de la telesalud en la reducción de los costos y el adecuado control glucémico de esta población. Las herramientas de la tecnología y la comunicación junto con la telesalud, en pacientes diabéticos, podrían favorecer su adecuado autocontrol, beneficiando la disminución de los gastos al sistema de seguridad social. Conclusiones: el uso de la telesalud se presenta como una alternativa para el control glucémico de los pacientes y debe considerarse por parte de los médicos de atención primaria, pues son la puerta de entrada al sistema de salud. Sin embargo, se necesitan más estudios sobre el tema para determinar su beneficio exacto como herramienta para el control de la diabetes mellitus tipo 2 en Colombia, bajo el marco de la atención primaria en salud.

Summary Introduction: Monitoring in patients with type 2 diabetes mellitus is a cost-effective strategy, which with a comprehensive approach, reduces the costs of care. Telehealth is an adequate tool focused on this purpose. Objective: To describe the use of telehealth for monitoring type 2 diabetes mellitus in Colombia under the primary care framework. Methods: A narrative review was carried out by searching databases (PubMed, Google Scholar ScienceDirect, Cochrane, and EMBASE) and official documents. In total, 154 documents were collected; subsequently, a content analysis was carried out and 45 articles and documents were selected. Results: Telehealth is a useful tool in the control of patients with diabetes. In the reviewed studies, the potential of telehealth in reducing costs and adequate glycemic control in this population is evidenced. The tools of technology and communication, together with telehealth in diabetic patients, could favor their adequate self-control, reduction the costs to the social security system. Conclusions: The use of telehealth is presented as an alternative for patients with diabetes, which should be considered by primary care physicians who are the gateway to the health system. However, more studies are needed on the subject, to determine accurately the benefit of telehealth as a tool for control of type 2 diabetes mellitus in Colombia, under the framework of primary health care.

Modelo de impresión 3D para planificación quirúrgica en trasplante hepático con donante vivo adulto-adulto

Gracias a los grandes avances de la tecnología, los últimos diez años, la impresión en tres dimensiones (3D) se ha convertido en una herramienta accesible, útil e innovadora para distintas áreas de la medicina. Entre ellas planificación quirúrgica, creación de implantes y prótesis, educación médica e incluso comunicación médico-paciente. Con respecto a planificación quirúrgica, la impresión 3D cobra especial relevancia en cirugías de alta complejidad. En el caso del trasplante hepático con donante vivo, donde es prioritario garantizar la máxima seguridad para el donante, al mismo tiempo que la mejor calidad del injerto para el receptor, la planificación quirúrgica es mandatoria. En este aspecto, la impresión 3D de un modelo de hígado, anatómicamente comparable al del donante, entrega al cirujano la posibilidad de obtener una imagen más clara, directa y tangible, desde cualquier ángulo del órgano, que una imagen virtual tradicional. De esta forma, el cirujano tiene a su alcance una herramienta adicional para plantear el mejor abordaje quirúrgico, anticipar variaciones anatómicas e incluso, cuando el material de impresión lo permite, practicar el procedimiento. En Clínica Las Condes, el centro de trasplante junto al Centro de Innovación, trabajaron en conjunto en la impresión 3D de dos modelos de hígado, utilizados para la planificación quirúrgica de los primeros dos trasplantes hepáticos con donante vivo adulto-adulto realizados en Latinoamérica, donde la hepatectomía del donante se realizó de manera totalmente laparoscópica. El objetivo de este trabajo es describir el proceso de impresión 3D y analizar las dificultades y beneficios del proceso y sus resultados.

The last ten years, thanks to the great advances in technology, three-dimensional (3D) printing has become an accessible, useful, and innovative tool for different areas of medicine. These include surgical planning, implant and prosthetic creation, medical education, and even doctor-patient communication. Regarding surgical planning, 3D printing takes on special relevance in highly complex surgeries. In the case of living donor liver transplantation where it is a priority to guarantee maximum safety for the donor, as well as the best quality of the graft for the recipient, surgical planning is mandatory. Regarding this, 3D printing of an anatomically comparable liver model of the donor, gives the surgeon the possibility of obtaining a clearer, more direct, and tangible image, from any angle of the organ, than a traditional virtual image. In this manner, the surgeon has an additional tool to plan the best surgical approach, anticipate anatomical variations and even, when the impression material allows it, to practice the procedure. Transplant center of Clinica las Condes, together with Innovation laboratory worked together on the 3D printing process liver models used for surgical planning of the first two liver transplants with an adult-adult laparoscopic living donor. The objective of this work is to describe the 3D printing process and analyze the difficulties and benefits of the process and its results.