Evaluación del formato remoto en tiempos de pandemia

En el contexto de la pandemia de COVID 19 durante el año 2020 y hasta la fecha se diseñó un formato de evaluación para nuestros alumnos de pre y posgrado bajo el alero de los exámenes clínicos objetivos estructurados (ECOE) en un formato remoto. Se revisó la literatura al respecto y se diseñó un instrumento que diera cuenta en forma oportuna y estandarizada del desempeño de nuestros alumnos y residentes. Estas experiencias están siendo evaluadas en estudios con metodología mixta. Sin embargo, decidimos compartir esta experiencia, por su impacto en el desarrollo docente de las ciencias de la salud.

In the context of the COVID-19 pandemic during 2020 and to date, an evaluation format has been designed for our undergraduate and graduate students under the design of the objective structured clinical examinations (OSCE) in a remote format. The literature was reviewed, and an instrument was designed to account for the performance of our students and residents in a timely and standardized manner. These experiences are being evaluated in studies with mixed methodology. However, we wanted to convey this experience due to its impact on the educational development of health sciences.

Percepción de los padres sobre la vacunación infantil / Parents' perception of child vaccination

La percepción de padres ante los programas de vacunación de los niños para la prevención de enfermedades, así como las campañas de información y conocimiento sobre las vacunas, motiva el interés científico por conocer y evaluar los factores relacionados al grado de conocimiento, aptitudes y fuentes de información de la población sobre las vacunas, siendo la inmunización un método que permite adquirir inmunidad contra las enfermedades comunes y mortales y reduce gastos por tratamientos para la mejoría de la salud. Objetivo: Describir la percepción de los padres sobre la vacunación infantil. Metodología: Investigación cualitativa, a través del estudio de revisión de contenido relacionado con el descriptor vacunación, donde se recopila la información de interés según su aparición en la búsqueda. El estudio está basado en el paradigma positivista con observación y registro de información relevante con el tema. Resultados: La falta de información sobre los riesgos y beneficios de la vacunación es un factor que induce a la desconfianza e inseguridad respecto a las vacunas; gran parte de los padres considera útil la vacuna, necesaria y beneficiosa pero prevalece la idea que la inmunización puede ser algo peligroso y con efectos indeseables y secuelas graves por información mediática no bién conducida. Conclusiones: Diversos estudios señalan factores que impiden que los padres de los niños cumplan con los esquemas de vacunación, entre estos la falta de información y conocimiento sobre las vacunas, que evitan las enfermedades en los menores reforzando el sistema inmunológico, así como, otra de las razones es la falta de vacunas en los centros asistenciales, que genera desinterés y dificulta el cumplimiento de los programas de vacunación, además, servicios lentos y poca empatía del personal que presta atención en los centros de salud aumentan la percepción negativa sobre la vacunación(AU)

The perception of parents regarding the vaccination programs for children for the prevention of diseases, as well as the information and knowledge campaigns about vaccines, motivates the scientific interest in knowing and evaluating the factors related to the degree of knowledge, aptitudes and sources of information for the population about vaccines, immunization being a method that allows acquiring immunity against common and deadly diseases and reduces expenses for treatments to improve health. Objective: To describe the perception of parents about childhood vaccination. Materials and Methods Qualitative research, through a content review study related to the vaccination descriptor, where the information of interest is compiled according to its appearance in the search. The study is based on the positivist paradigm with observation and recording of information relevant to the subject. Results: The lack of information about the risks and benefits of vaccination is a factor that induces mistrust and insecurity regarding vaccines; A large part of the parents considers the vaccine useful, necessary and beneficial, but the idea prevails that immunization can be something dangerous and with undesirable effects and serious sequelae due to misguided media information. Conclusnios: Various studies point to factors that prevent parents of children from complying with vaccination schedules, including lack of information and knowledge about vaccines, which prevent diseases in minors by strengthening the immune system, as well as another of The reasons are the lack of vaccines in health centers, which generates disinterest and makes it difficult to comply with vaccination programs, in addition, slow services and little empathy of the personnel who provide care in health centers increase the negative perception about vaccination(AU)

Estrategias para fomentar la higiene de manos en la atención ambulatoria / Interventions aimed to improve clinical handwashing in an outpatient setting

Introducción: se realizó un análisis de la evidencia disponible sobre intervenciones orientadas a mejorar la adherencia al lavado de manos, para generar recomendaciones para los centros de atención en salud ambulatoria.Materiales y métodos: se realizó una búsqueda en Pubmed, Embase y Epistemonikos, y en las referencias de guías sobre el tema, seleccionando aquellos estudios no observacionales en que se realizaran intervenciones para aumentar la adherencia al lavado de manos en atención en salud. Se clasificaron las estrategias descritas según tipo de intervención, y se evaluaron según su efectividad en mejorar la adherencia al lavado de manos y el seguimiento en el tiempo.Resultados: se seleccionaron 34 estudios experimentales prospectivos, que se clasificaron en 10 grupos según el tipo de intervención realizada, y se evaluaron según efectividad y seguimiento en una escala del I al VII. 24 de 34 estudios mostraron un aumento estadísticamente significativo de la adherencia al lavado de manos mayor al 15% desde el basal o en comparación al grupo control, correspondiendo en su mayoría a estrategias multimodales y de feedback. Discusión: las intervenciones más efectivas para mejorar la adherencia al lavado de manos fueron las que incluían abordajes multimodales y las que incluían feedback. Se hace urgente generar mayor evidencia sobre esta temática en el contexto de atención ambulatoria.

Introduction: To analyze the available evidence on interventions aimed at improving adherence to handwashing, to generate re-commendations for outpatient health care centers. Methods: A search was made in Pubmed, Embase and Epistemonikos, and in the references of guides on the subject, selecting those non-observational studies in which interventions were carried out to increase adherence to handwashing in health care. The strategies described were classified according to the type of intervention, and evaluated according to their effectiveness in improving adherence to handwashing, and its follow-up time afterward. Results: 34 prospective experimental studies were selected, which were classified into 10 groups according to the type of intervention performed, and were evaluated according to effectiveness and follow-up on a scale from I to VII. 24 of 34 studies showed a statistically significant increase in handwashing adherence greater than 15% from baseline or compared to the control group, corresponding mostly to multimodal and feedback strategies. Discussion: The most effective interventions to improve adherence to handwashing were those that included multimodal approaches and the ones that included feedback. It is urgent to generate more evidence on the subject in the context of ambulatory care.

Práticas de atenção ao parto na experiência de puérperas: análise à luz da humanização / Prácticas de atención de parto en la experiencia de las mujeres puerperales: análisis a la luz de la humanización / Delivery care practices in the experience of puerperal women: analysis in the light of humanization

Objetivo: analisar as experiências de puérperas acerca das práticas profissionais desenvolvidas na atenção ao parto à luz do aporte teórico da humanização. Método: pesquisa qualitativa, com a participação de dez puérperas que vivenciaram parto vaginal, por meio de entrevista semiestruturada, desenvolvida entre setembro e novembro de 2019. Adotou-se a análise temática. Resultados: predominaram práticas que se distanciaram da humanização, como enema, restrição hídrica e alimentar, exames vaginais frequentes, episiotomia, manobras de Valsalva e de Kristeller. As práticas que se aproximaram da humanização foram a presença do acompanhante, utilização de métodos de alívio da dor no parto e contato cutâneo precoce entre mãe e bebê. Conclusão: as experiências das puérperas foram marcadas, principalmente, por condutas profissionais prejudiciais ou ineficazes, realizadas de forma inadequada e com poucas evidências científicas sobre a sua eficácia. Espera-se subsidiar a reflexão quanto à necessidade de revisão e atualização quanto às boas práticas de atenção ao parto.

Objective: to analyze the experiences of puerperal women about the professional practices developed in delivery care in the light of the theoretical contribution of humanization. Method: qualitative research, with the participation of ten puerperal women who experienced vaginal delivery, through semi-structured interviews, developed between September and November 2019. Thematic analysis was adopted. Results: practices that distanced themselves from humanization, such as enema, water and food restriction, frequent vaginal examinations, episiotomy, Valsalva and Kristeller maneuvers, predominated. The practices that approached humanization were the presence of the companion, use of methods of pain relief in the delivery and early skin contact between mother and baby. Conclusion: the experiences of the puerperal women were mainly marked by harmful or ineffective professional behaviors, performed inappropriately and with little scientific evidence about their efficacy. It is expected to support the reflection on the need for review and updating regarding good practices of delivery care.

Objetivo: analizar las experiencias de las mujeres puerperales sobre las prácticas profesionales desarrolladas en la atención del parto a la luz de la contribución teórica de la humanización. Método: investigación cualitativa, con la participación de diez mujeres puerperales que experimentaron el parto vaginal, a través de entrevistas semiestructuradas, desarrolladas entre septiembre y noviembre de 2019. Se adoptó un análisis temático. Resultados: predominaron las prácticas que se distanciaron de la humanización, como el enema, la restricción del agua y los alimentos, los exámenes vaginales frecuentes, la episiotomía, las maniobras de Valsalva y Kristeller. Las prácticas que se acercaron a la humanización fueron la presencia del compañero, el uso de métodos de alivio del dolor en el parto y el contacto temprano de la piel entre la madre y el bebé. Conclusión: las experiencias de las mujeres puerperales estuvieron marcadas principalmente por conductas profesionales dañinas o ineficaces, realizadas de manera inapropiada y con poca evidencia científica sobre su eficacia. Se espera que apoye la reflexión sobre la necesidad de revisar y actualizar las buenas prácticas de la atención al parto.

Correspondencia entre el índice de placa y el recuento de Streptococcus mutans y Lactobacillus sp. en una población infantil: Un estudio transversal / Correspondence between plaque index and Streptococcus mutans and Lactabacillus spp. counts in a child population: A cross-sectional study

Antecedentes: La identificación de microorganismos como Streptococcus mutans(SM) y Lactobacillus sp. (LB) es un predictor del desarrollo de caries, sin embargo los métodos de identificación son de acceso limitado por su alto costo. Objetivo:determinar la correlación entre la biopelícula dental medida por el índice de placa bacteriana de (IPB) Silness y Löe modificado y el recuento de SM y LB en niños colombianos en edad preescolar. Este es un estudio descriptivo de corte transversal y correlacional. Materiales y métodos: Se tomaron 202 muestras de niños entre los 3 y 4 años de edad de tres jardines Infantiles de Cali, Colombia, pertenecientes al estrato socioeconómico 1 y 2, evaluados en cuatro tiempos (0, 3, 6 y 9 meses). Resultados: Hubo una correlación entre el IPB más alto y el mayor recuento de unidades formadoras de colonia de SMsólo a los 3 meses (p = 0,003*). Los recuentos de LB fueron homogéneos en todos los niños y no presentaron correlación con el IPB. Conclusión: Se observaron resultados mixtos sobre la relación entre IPB y los recuentos de SM presentes en la saliva, por lo cual se requiere un análisis de múltiples factores.

Background:The identification of microorganisms such as Streptococcus mutans(SM) and Lactobacillusspp. (LB) is a predictor of the development of caries, however the identification methods are of limited access due to their high cost. Aim:To determine the correlation between the dental biofilm measured by the modified Silness and Löe dental plaque index (DPI)) and the SM and LB count, in preschool children from Colombia. Materials and methods: This is a descriptive cross-sectional and correlational study. We took202 samples from children between 3 and 4 years of age from three kindergartens in Cali, Colombia, belonging to socioeconomic stratum 1 and 2, evaluated at four times (0, 3, 6 and 9 months). Results: We found a correlation between the highest IPB and thehighest count of SM colony forming units only at 3 months (p = 0.003*). LB counts were homogeneous in all children and there was no correlation with IPB. Conclusion: We observed mixed results on the relationship between IPB and the counts of SM present in the saliva, therefore an analysis of multiple factors is required.KEY WORDSDental plaque;Streptococcus mutans;Lactobacillus spp;dental caries.1

Factores histológicos relacionados con resultados discordantes entre la biopsia y la prueba de ADN, en el diagnóstico del virus papiloma humano (VPH) / Histological factors associated with discordant results between biopsy and DNA testing in the diagnosis of human papillomavirus (HPV)

El diagnóstico de la infección cervical ocasionada por el virus del papiloma humano (VPH), se realiza básicamente a través de la biopsia y/o de métodos moleculares como la reacción en cadena de la polimerasa (PCR). Los resultados de estos estudios en ocasiones no coinciden. En este estudio se evalúa la posible influencia de diferentes factores asociados a resultados falsos positivos y a falsos negativos de ambas pruebas. Se analizaron 271 muestras de cuello uterino de pacientes que acudieron a la consulta ginecológica durante el período 1999-2009, a las cuales se les tomó biopsia por presentar hallazgos colposcópicos y/o citológicos sospechosos de infección por VPH. Tomando en consideración al resultado de PCR como prueba estándar de oro, la biopsia presentó 14% de falsos positivos y 16,6% de falsos negativos, el diagnóstico de VPH en biopsia y PCR presentó mayor concordancia cuando las muestras abarcan la zona de transformación endo-exocervical, así como la presencia de metaplasia escamosa en la muestra y el tamaño del fragmento mayor (>0,5 cm); mientras que el tiempo de fijación, el tipo e intensidad de la inflamación, la hemorragia y la erosión del epitelio no fueron significativos. En conclusión, a fin de disminuir la discrepancia de los resultados entre la biopsia y prueba de ADN, sería importante que la muestra de biopsia incluya la zona de transformación del cuello uterino y al menos un fragmento mayor de 0,5 cm.

The diagnosis of cervical infection caused by human papilloma virus (HPV) is made basically through the biopsy and/or molecular methods such as polymerase chain reaction (PCR). The results of these studies sometimes do not match. In this work is evaluated the possible influence of different factors associated with results false positive and false negative of both tests. Were analyzed 271 samples from uterin cervix of patients presenting to the gynecologist during the period 1999-2009, to which were taken biopsies due present findings colposcopics and/or cytological suspicious of HPV infection. Considering the result of PCR as gold standard test, biopsy showed 14% false positive and false negative 16.6%, the diagnostic of VPH in biopsy and PCR showed greater concordance when samples include endo-exocervical transformation zone, and the presence of squamous metaplasia in the sample and size of the largest fragment (>0.5 cm); while the fixation time, the type and intensity of inflammation, bleeding and erosion of the epithelium were not significant. In conclusion, in order to reduce the discrepancy between the results of the biopsy and test DNA, it is important that the biopsy sample includes the transformation zone of the uterin cervix and at least one fragment greater than 0.5 cm.

Violencia intrafamiliar y abuso sexual: ¿Cómo integrarlos al círculo de pregrado de medicina? / Domestic violence and sexual abuse: How to integrate them into undergraduate circle of medicine?

: Las cifras chilenas sobre abuso sexual (AS) y violencia al interior de las familias (VIF) son altísimas y transversales a todo estrato social. Un 25,9 por ciento de los niños ha sido víctima de violencia grave en sus hogares (patadas, puñetazos, mordeduras, quemaduras, agresiones con armas) y un 8,7 por ciento refiere haber experimentado AS. Un tercio de las chilenas ha sufrido VIF, cifra que se tradujo en 45 mujeres fallecidas el año 2015. Los médicos están en una posición única para identificar víctimas y romper el ciclo de violencia, sin embargo su formación al respecto es mínima. El Instituto de Medicina de Estados Unidos plantea que el medio más eficaz para mejorar la respuesta a VIF es la educación de los médicos, y ha llamado a que las facultades entreguen las competencias necesarias a sus estudiantes. Distintas Escuelas de Medicina de EEUU y Canadá ya lo están haciendo; en Chile esto aún no ocurre. Entre 2013 y 2014, mediante un Proyecto FONDEDOC revisamos la formación actual de los estudiantes de medicina en pesquisa y abordaje inicial de pacientes víctimas de VIFAS, y generamos una propuesta para fortalecer el desarrollo de competencias afines en el currículo de pregrado. Este artículo presenta los productos finales de ese proyecto. Se discute sobre la discordancia entre la magnitud del problema en Chile y la formación actual de nuestros médicos, se entrega un listado de competencias básicas para pesquisar y brindar una primera respuesta, y se ofrece una propuesta para fortalecer el currículo de pregrado en esta área. (AU)

The figures on sexual abuse and domestic violence are very high in Chile and they cut across the whole span of socioeconomic classes. 25.9 percent of children have suffered severe violence at home (kicks, punches, bites, burns, weapon agressions) and 8.7 percent refer having experimented sexual abuse. One third of Chilean women have suffered domestic violence, which translates in 45 women dying for this cause during 2015. Doctors are in a unique positoin to identify victims and to cut the violence cycle, however their training on this regard is scarce. The Institute of Medicine of the USA postulates the most effective way of improving the response to domestic violence is educating doctors, and has made a call to faculties to provide the competencies needed to their students. Several medical schools in USA and Canada are already doing so; in Chile this is not happening yet. Between 2013 and 2014 through a FONDEDOC project we reviewed the existing curriculum of Medical School in relation to identifying and to initially approach patients suffering domestic violence-sexual abuse, and we generated a proposal to strengthen the development of pertinent competencies in undergraduate curriculum. This article exposes the product of this project. The discrepancy between the magnitude of the problem in Chile and the current training of our doctors is discussed. A list of basic competencies to identify and deliver the first response is presented, and a proposal to strengthen undergraduate curriculum in this area is offered.(AU)

A snapshot of cancer in Chile: analytical frameworks for developing a cancer policy

INTRODUCTION: The South American country Chile now boasts a life expectancy of over 80 years. As a consequence, Chile now faces the increasing social and economic burden of cancer and must implement political policy to deliver equitable cancer care. Hindering the development of a national cancer policy is the lack of comprehensive analysis of cancer infrastructure and economic impact. OBJECTIVES: Evaluate existing cancer policy, the extent of national investigation and the socio-economic impact of cancer to deliver guidelines for the framing of an equitable national cancer policy. METHODS: Burden, research and care-policy systems were assessed by triangulating objective system metrics -epidemiological, economic, etc. - with political and policy analysis. Analysis of the literature and governmental databases was performed. The oncology community was interviewed and surveyed. RESULTS: Chile utilizes 1% of its gross domestic product on cancer care and treatment. We estimate that the economic impact as measured in Disability Adjusted Life Years to be US$ 3.5 billion. Persistent inequalities still occur in cancer distribution and treatment. A high quality cancer research community is expanding, however, insufficient funding is directed towards disproportionally prevalent stomach, lung and gallbladder cancers. CONCLUSIONS: Chile has a rapidly ageing population wherein 40% smoke, 67% are overweight and 18% abuse alcohol, and thus the corresponding burden of cancer will have a negative impact on an affordable health care system. We conclude that the Chilean government must develop a national cancer strategy, which the authors outline herein and believe is essential to permit equitable cancer care for the country.

Potencial herramienta en la personalización del tratamiento oncológico: Casos clínicos / In vitro cell response to chemotherapeutic agents, to personalize ovarian cancer treatment: Report of two cases

Our laboratory has implemented an in vitro assay to estimate the response to chemotherapy in ovarian cancer cells pertaining to individual patients. In two selected patients, we determined the correlation between an in vitro assay of cells from suspected ovarian cancer ascites, with the clinical chemotherapy response. Cancer cells isolated from peritoneal fluid with suspected ovarian cancer were tested for cytotoxicity with corresponding chemotherapy regimens. Circulating Cal25 levels and attending physician consultation determined clinical course and response to chemotherapy. The in vitro assay result correlated with Cal25 levels, progression free survival and attending physician evaluation. The assay predicted correctly the failure of two successive chemotherapy regimes in the first patient, while predicting a favorable clinical response in the second subject.

Ethanol effect on the chick embryo ossification: a macroscopic and microscopic study

This study attempts to analyze anomalies in avian embryos induced macroscopically and microscopically when exposed to ethanol (EtOH) during the first stages of development. Fertilized chicken eggs were employed in this study. The eggs were incubated at 37.8§C. Some of the eggs were treated on day O with EtOH (20 per cent, 40 per cent and 60 per cent) by instillation in the air sac. The control group was instilled with 0.1 ml of NaCl at 0.9 per cent. Other eggs were treated on the 4th post-incubation day, employing the same methodology. The embryos in both groups were removed from eggs on the 11th incubation day and examined using a dissecting binocular micrsocope. After macroscopic analysis, the samples obtained were fixed in 10per cent formol, photographed and processed according to common histological techniques and the Picrosirius method. Embryos treated with EtOH demonstrated a significant weight decrease. Microscopic analysis by means of the Picrosirius method revealed that the intra-membranous ossification process presents less development, and therefore there wass less type I collagen in trabecular bone in the embryos post-exposure to EtOH with respect to the control.