Tasa de recurrencia e implicación del margen quirúrgico en la supervivencia del paciente con melanoma acral. ¿Es necesario un margen amplio? / Recurrence rate and survival implications of surgical margins in patients with acral melanoma. Is a wide margin necessary?

Resumen Introducción: La extensión apropiada de los márgenes de resección en el melanoma acral no está claramente establecida. Objetivo: Investigar si la escisión con margen estrecho es adecuada en el melanoma acral grueso. Métodos: Se estudiaron 306 pacientes con melanoma acral. Conforme a la extensión del margen quirúrgico (de 1 a 2 cm y > 2 cm), se analizaron los factores asociados a la recurrencia y la supervivencia. Resultados: De 306 pacientes, 183 fueron mujeres (59.8 %). La mediana del grosor de Breslow fue 6 mm; 224 casos (73.2 %) fueron de tipo ulcerados, 154 pacientes (50.3 %) tenían enfermedad en estadio clínico III, 137 en II (44.8 %) y 15 en IV (4.9 %). Todos los casos presentaron margen negativo, con una mediana de 31.5 mm. Un grosor de Breslow de 7 mm (p = 0.001) y la etapa clínica III (p = 0.031) se asociaron a recurrencia; los factores asociados a la supervivencia fueron el índice de Breslow (p = 0.047), la ulceración (p = 0.003), la etapa clínica avanzada (p < 0.001) y el uso de adyuvancia (p = 0.003). Conclusión: Un margen de resección de 1 a 2 cm no afectó la recurrencia tumoral ni la supervivencia en los pacientes con melanoma acral.

Abstract Introduction: Appropriate size of resection margins in acral melanoma is not clearly established. Objective: To investigate whether narrow-margin excision is appropriate for thick acral melanoma. Methods: Three-hundred and six patients with acral melanoma were examined. Factors associated with recurrence and survival were analyzed according to surgical margin size (1 to 2 cm and > 2 cm). Results: Out of 306 patients, 183 were women (59.8%). Median Breslow thickness was 6 mm; 224 cases (73.2%) were ulcerated, 154 patients (50.3%) had clinical stage III disease, while 137 were at stage II (44.8%) and 15 at stage IV (4.9%). All cases had negative margins, with a median of 31.5 mm. A Breslow thickness of 7 mm (p = 0.001) and clinical stage III (p = 0.031) were associated with recurrence; the factors associated with survival were Breslow index (p = 0.047), ulceration (p = 0.003), advanced clinical stage (p < 0.001), and use of adjuvant therapy (p = 0.003). Conclusion: A resection margin of 1 to 2 cm did not affect tumor recurrence or survival in patients with acral melanoma.

Asociación entre enfermedad por reflujo gastroesofágico e intensidad de la actividad física en una muestra de pobladores peruanos

Introducción: la nutrición adecuada, dejar de fumar y de beber alcohol son medidas preventivas y de tratamiento, ayudan a prevenir complicaciones de la enfermedad por reflujo gastroesofágico. Sin embargo, aún existen dudas sobre la intensidad de la actividad física y sus beneficios en el desarrollo de esta enfermedad. Objetivo: determinar la asociación entre la actividad física y la enfermedad por reflujo gastroesofágico en una muestra de peruanos. Metodología: estudio transversal analítico que utilizo una base de datos secundarias del estudio COHORT CRONICAS. La variable principal fue la presencia o no de enfermedad por reflujo gastroesofágico, lo cual se determinó a través de un autoinforme por diagnóstico médico. La variable independiente fue la actividad física, cuyos niveles fueron definidos de acuerdo con el protocolo del cuestionario internacional de actividad física, la que se dicotomizó en "bajo" y "medio/alto". Resultados: se trabajó con un total de 3211 sujetos. La prevalencia de reflujo gastroesofágico fue 4,48% y el 5,36% practicaba actividad física moderada/alta. En la regresión múltiple, se observó que los pacientes con actividad física baja tenían 391% mayor frecuencia de presentar reflujo gastroesofágico, respecto a quienes realizaban actividad física moderado/alta. Luego del ajuste de las covariables: sexo, edad, estatus socioeconómico, estado de fumador, bebedor de alcohol, actividad física e índice de masa corporal; se obtuvo un RP=4,91; IC95%: 1,19 - 20,23. Conclusiones: el estudio mostró que la actividad física de intensidad moderada/alta se asocia con una menor prevalencia de enfermedad por reflujo gastroesofágico. Si los resultados actuales se confirman en investigaciones futuras, los hallazgos de este estudio podrían ser importantes para la prevención y el tratamiento del reflujo gastroesofágico, a través de la intensidad de la actividad física.

Introduction: Adequate nutrition, smoking cessation and alcohol cessation are preventive and treatment measures, help prevent complications of gastroesophageal reflux disease. However, there are still doubts about the intensity of physical activity and its benefits in the development of the disease. Objective: To determine the association between physical activity and gastroesophageal reflux disease in a sample of Peruvian population. Methods: Analytical cross-sectional study with the use of secondary databases from the COHORT CRÓNICAS study. The main variable was the presence or absence of gastroesophageal reflux disease, which was determined through a self-report by medical diagnosis. The independent variable was physical activity, whose levels were defined according to the protocol of the international physical activity questionnaire. This variable was dichotomized into "low" and "medium / high". Results: A total of 3211 subjects were worked on. The prevalence of gastroesophageal reflux was 4.48% and 5.36% practiced moderate / severe physical activity. In the multiple regression, it was observed that patients with low physical activity had 391% greater frequency of presenting gastroesophageal reflux, compared to those who carried out moderate / high physical activity; After adjustment for the covariates: sex, age, socioeconomic status, smoking status, alcohol drinker, physical activity and body mass index; a PR=4.91; 95%CI: 1.19 - 20.23 was obtained. Conclusions: The study showed that moderate / high intensity physical activity is associated with a lower prevalence of gastroesophageal reflux disease. If the current results are confirmed in future research, the findings of this study could be important for the prevention and treatment of gastroesophageal reflux disease, through the intensity of physical activity.

Tricobezoar gástrico: reporte de un caso y revisión de la literatura

El bezoar gástrico es una tumoración por cuerpo extraño que resulta de la acumulación de material no digerible en el estómago. El tricobezoar es uno de ellos y frecuentemente se presenta en la población femenina joven que padece trastornos psiquiátricos. La presentación del bezoar gástrico es insidiosa e inespecífica, teniendo un curso inicialmente asintomático por años, hasta que alcanza un tamaño que evidencia síntomas. El método diagnóstico de elección es la endoscopía, ya que permite visualizar el bezoar y plantear el tratamiento. El abordaje terapéutico estará determinado por el tipo, tamaño y consistencia de este; sin embargo, la resolución quirúrgica es la de elección, la cual siempre debe estar asociada a tratamiento psiquiátrico para prevenir la recurrencia del cuadro. Se presenta el caso de una paciente de 19 años con el diagnóstico de tricobezoar gástrico, asociado a tricotilomanía y tricofagia como patologías de fondo, y se realiza una revisión de la literatura.

A gastric bezoar is a foreign body tumor that results from the accumulation of indigestible material in the stomach. The trichobezoar is one of them and frequently occurs in the young female population suffering from psychiatric disorders. The presentation of the gastric bezoar is insidious and nonspecific, having an initially asymptomatic course for years, until it reaches a size that shows symptoms. The diagnostic method of choice is endoscopy since it allows the bezoar to be visualized and propose the treatment. The therapeutic approach will be determined by its type, size, and consistency; however, surgical resolution is the one of choice, which must always be associated with psychiatric treatment to prevent recurrence of the condition. The case of a 19-year-old patient with a diagnosis of gastric trichobezoar, associated with trichotillomania and trichophagia as underlying pathologies is presented, and a literature review is carried out.

Tuberculosis abdominal que mimetiza cáncer de ovario. Reporte de una serie de casos / Abdominal tuberculosis mimicking ovarian cancer. A case series report

Resumen Introducción: La tuberculosis peritoneal (tuberculosis abdominal) puede ser confundida con una neoplasia maligna. Objetivo: Describir características clínicas y demográficas de pacientes con tuberculosis abdominal que semeja cáncer de ovario avanzado, diagnosticados en un centro oncológico de referencia nacional. Métodos: Se describen las características clínicas y patológicas de nueve pacientes con tuberculosis abdominal que clínicamente semejaba cáncer de ovario avanzado Resultados: La mediana de edad fue de 47 años, el estrato socioeconómico más común fue bajo (44 %). El dolor abdominal y la pérdida ponderal se presentaron en 77.7 %, ascitis en 55.5 %, prueba COMBE positiva en 22.2 % y ausencia de antecedente de tuberculosis pulmonar en 100 %. La elevación de CA-125 se reportó en 77.7 %, con > 500 U/mL en 57.1 %. La tomografía indicó carcinomatosis en 50 % y tumor pélvico y ascitis en 37.5 %. Todas las pacientes fueron sometidas a cirugía; 62.5 % fueron diagnosticadas mediante estudio patológico transoperatorio como enfermedad neoplásica Conclusión: La tuberculosis es considerada como la gran imitadora, por ello se debe tener en mente el diagnóstico de tuberculosis abdominal ante un caso sospechoso, aun cuando la presentación clínica, estudios de imagen e, incluso, el examen transoperatorio sugieran cáncer de ovario.

Abstract Introduction: Peritoneal tuberculosis (abdominal tuberculosis) can be confused with a malignant neoplasm. Objective: To describe clinical and demographic characteristics of patients with abdominal tuberculosis mimicking advanced ovarian cancer, diagnosed in a national reference cancer center. Methods: Clinical and pathological characteristics of nine patients with abdominal tuberculosis that clinically resembled advanced ovarian cancer are described. Results: Median age was 47 years; the most common socioeconomic status was low (44%). Abdominal pain and weight loss occurred in 77.7%; ascites, in 55.5%; 22.2% had a positive COMBE test, and 100% had no history of pulmonary tuberculosis. CA-125 elevation was reported in 77.7%, with levels > 500 U/mL in 57.1%. Tomography reported carcinomatosis in 50% and pelvic tumor and ascites in 37.5%. All patients underwent surgery, where 62.5% were diagnosed by intraoperative pathology study as neoplastic disease. Conclusion: Tuberculosis is considered the great imitator, which is why abdominal tuberculosis diagnosis should be borne in mind when faced with a suspicious case, even when clinical presentation, imaging studies, and even intraoperative examination suggest ovarian cancer.

Rehabilitación estética con coronas de resina personalizadas utilizando encerado digital en paciente pediátrico: informe de caso / Aesthetic rehabilitation with customized resin crowns using digital wax-up in pediatric patient: a case report

Resumen Introducción: El presente informe de caso clínico se enfoca en el diagnóstico y tratamiento para la rehabilitación de la dentición temporal en el sector anterosuperior utilizando tecnología CAD-CAM. Objetivo: Proponer una alternativa para mitigar el margen de error y tiempo de trabajo en el paciente pediátrico, reintegrando la estética y funcionalidad en la cavidad oral. Métodos: Se describe el caso de un paciente de sexo masculino de 6 años que acudió a la clínica universitaria de la Universidad UTE con lesiones cariosas extensas en sus dientes anterosuperiores y su rehabilitación a través de la utilización de coronas personalizadas de resina mediante un encerado digital realizado en CAD-CAM. Resultados: El tratamiento efectuado en el niño fue satisfactorio, se evidenció una mejoría en la dimensión vertical e incremento en la estética dental y facial, mejorando su aspecto y autoestima después de la rehabilitación. Conclusión: La utilización del encerado digital en pacientes pediátricos podría ser una alternativa que permita reducir el tiempo de trabajo del tratamiento en una rehabilitación estética dental.

Abstract Introduction: This case report focuses on the diagnosis and treatment for the rehabilitation of the primary dentition in the anterosuperior sector using CADCAM technology. Objective: To propose an alternative to mitigate the margin of error and working time in pediatric patients, reintegrating esthetics, and functionality in the oral cavity. Methods: We describe the case of a 6-year-old male patient who came to the clinic of Universidad UTE with extensive carious lesions in his anterosuperior teeth and his rehabilitation using personalized resin crowns by means of a digital waxup performed in CAD-CAM. Results: The treatment performed on the child was satisfactory, there was an improvement in the vertical dimension and an increase in dental and facial esthetics, improving his appearance and self-esteem after the rehabilitation. Conclusión: The use of digital wax-up in pediatric patients could be an alternative that allows the treatment time to be reduced in esthetic dental rehabilitation.

Association of quality of life and disease control with cigarette smoking in patients with severe asthma

More information is needed on asthma control and health-related quality of life (HRQoL) in smokers with severe asthma. The main study objective was to characterize the association of HRQoL and disease control with cigarette smoking in individuals with severe asthma. A secondary objective was to analyze subject characteristics according to asthma onset: asthma that developed before smoking initiation versus asthma that developed after smoking initiation. This cross-sectional study included subjects with severe asthma aged 18-65 years. HRQoL was assessed using the Asthma Quality of Life Questionnaire (AQLQ) and asthma control was assessed using the Asthma Control Test (ACT) and Global Initiative for Asthma (GINA) criteria. Of the 87 patients studied, 58 (66.7%) were classified as asthmatics who had never smoked and 29 (33.3%) as asthmatics with smoking exposure. The proportion of subjects with uncontrolled asthma was higher in the asthma and smoking group (GINA criteria: P=0.032 and ACT criteria: P=0.003. There were no between-group differences in overall AQLQ score (P=0.475) or AQLQ domain scores (P>0.05). Fifty-eight subjects (66.7%) were nonsmokers, 20 (23%) had asthma onset before smoking, and 9 (10.3%) had asthma onset after smoking. Asthma onset before smoking was associated with uncontrolled asthma (P=0.013). In subjects with severe asthma, smoking was associated with a higher rate of uncontrolled disease but not with HRQoL scores.

Pulmonary involvement in patients with juvenile systemic sclerosis / Afección pulmonar en pacientes con esclerosis sistémica juvenil

Abstract Background: Pulmonary involvement in juvenile systemic sclerosis (JSSc) is rare in children and contributes to morbimortality. This study aimed to describe the pulmonary function and clinical, radiologic, and tomographic findings in JSSc. Methods: Patients with JSSc between 5-14 years of age were included. Clinical, functional, and imaging characteristics were assessed. Patients were excluded if they showed lung disease not associated with JSSc: mixed connective tissue disease, overlap syndrome, or acute cardiopulmonary failure at the time of the study. All patients underwent physical examination, electrocardiogram, spirometry, chest X-ray, high-resolution computed tomography (HRCT) of the chest, echocardiography, lung function tests, and the 6-minute walk test (6-MWT). Descriptive statistics were employed for data analysis. Results: We studied 15 patients with the following characteristics: median age, 11 years; median since symptoms onset, 6 years; median since JSSc diagnosis and the finding of pulmonary involvement, 2 years. Lung disease was detected in 73%, interstitial lung disease (ILD) the most common affection (67%); pulmonary hypertension was found in 6.6%. 6-MWT was positive in 26.6%, forced vital capacity (FVC) was abnormal in 26.6%. No pulmonary involvement was found in four patients. Conclusions: The most frequent pulmonary affection in JSSc was ILD. Thus, early JSSc detection and periodic lung monitoring are mandatory to avoid further complications once JSSc is diagnosed.

Resumen Introducción: La afección pulmonar en la esclerosis sistémica juvenil (ESJ) es rara en niños y contribuye a la morbimortalidad. El objetivo de este estudio fue describir los hallazgos de función pulmonar, clínicos, radiológicos y tomográficos en la ESJ. Métodos: Se incluyeron pacientes con ESJ de 5-14 años de edad. Se evaluaron las características clínicas, funcionales y de imagen. No se incluyeron pacientes con enfermedades pulmonares no asociadas con ESJ en el momento del estudio: enfermedad mixta del tejido conectivo, síndrome de superposición o insuficiencia cardiopulmonar aguda. Se realizaron exploración física, electrocardiograma, espirometría, radiografía de tórax, tomografía computarizada de alta resolución de tórax, ecocardiografía, pruebas de función pulmonar y prueba de caminata de 6 minutos (PC6M). Se utilizó estadística descriptiva para el análisis de los datos. Resultados: Se estudiaron 15 pacientes con las siguientes características: mediana de edad, 11 años; mediana desde el inicio de los síntomas, 6 años; y mediana desde el diagnóstico de ESJ y hallazgo de afección pulmonar, 2 años. Se detectó enfermedad pulmonar en el 73%. La enfermedad pulmonar intersticial (EPI) fue la afección más común (67%) y se encontró hipertensión pulmonar en el 6.6%. La PC6M fue positiva en el 26.6%, y la capacidad vital forzada resultó anormal en el 26.6%. Cuatro pacientes no presentaron afección pulmonar. Conclusiones: La afección pulmonar más frecuente en la ESJ fue la EPI. La detección temprana de ESJ y la monitorización pulmonar periódica son obligatorias para evitar más complicaciones una vez diagnosticada la ESJ.

Standardization of a rapid quadruplex PCR method for the simultaneous detection of bovine, buffalo, Salmonella spp, and Listeria monocytogenes DNA in milk / [Padronização de um método rápido de PCR quadriplex para a detecção simultânea de DNA de bovino, bubalino, Salmonella spp. e Listeria monocytogenes em leite]

The objective of the present study was to Standardize a Polymerase Chain Reaction (PCR) protocol for the authentication of bovine and buffalo milk, and to detect the presence of Salmonella spp. and Listeria monocytogenes. For this, the target DNA was extracted, mixed, and subjected to a PCR assay. Milk samples were defrauded and experimentally contaminated with microorganisms to assess the detection of target DNA at different times of cultivation, bacterial titers, and concentration of genetic material. In addition, the protocol was tested with DNA extracted directly from food, without a pre-enrichment step. The proposed quadruplex PCR showed good accuracy in identifying target DNA sequences. It was possible to simultaneously identify all DNA sequences at the time of inoculation (0h), when the samples were contaminated with 2 CFU/250mL and with 6h of culture when the initial inoculum was 1 CFU/250mL. It was also possible to directly detect DNA sequences from the food when it was inoculated with 3 CFU/mL bacteria. Thus, the proposed methodology showed satisfactory performance, optimization of the analysis time, and a potential for the detection of microorganisms at low titers, which can be used for the detection of fraud and contamination.

O objetivo do presente estudo foi padronizar um protocolo de reação em cadeia da polimerase (PCR) para a autenticação de leite bovino e bubalino e a detecção da presença de Salmonella spp. e Listeria monocytogenes. Para isso, o DNA-alvo foi extraído, misturado e submetido ao ensaio de PCR. Amostras de leite foram fraudadas e contaminadas experimentalmente com os micro-organismos, para se avaliar a detecção do DNA-alvo em diferentes tempos de cultivo, os títulos bacterianos e a concentração de material genético. Além disso, o protocolo foi testado com DNA extraído diretamente do alimento, sem a etapa de pré-enriquecimento. A PCR quadriplex proposta mostrou boa precisão na identificação de sequências de DNA-alvo. Foi possível identificar simultaneamente todas as sequências de DNA no momento da inoculação (0h), quando as amostras estavam contaminadas com 2 UFC/250mL, e com seis horas de cultura, quando o inóculo inicial foi de 1 UFC/250mL. Também foi possível detectar diretamente as sequências de DNA do alimento quando este foi inoculado com 3 UFC/mL de bactérias. Dessa forma, a metodologia proposta apresentou desempenho satisfatório, otimização do tempo de análise e potencial para detecção de micro-organismos em baixos títulos, podendo ser utilizada para detecção de fraude e contaminação.

Variables pronósticas de pacientes con melanomas gruesos. Análisis de 362 casos / Prognostic variables in patients with thick melanomas. Analysis of 362 cases

Resumen Antecedentes: Los estudios sobre factores pronóstico de melanoma están basados en poblaciones caucásicas, con predominio de melanomas delgados (Breslow < 3 mm). Los pacientes mexicanos muestran predominio de melanomas gruesos (Breslow ≥ 3 mm). Objetivo: Identificar factores asociados al pronóstico de pacientes con melanomas gruesos. Material y métodos: Se analizó la influencia pronóstica de factores clinicopatológicos en 362 melanomas gruesos. Resultados: La mediana de Breslow fue de 7 mm, 271 (74.9 %) pacientes tuvieron melanoma acral y 49 (13.5 %) melanoma nodular. El 56.6 % de los pacientes se encontró en etapa clínica [EC] III), 269 (74.3 %) tenía ulceración y 15 (4.1 %) márgenes positivos. Las variables asociadas con menor supervivencia global [SG] fueron la EC (p < 0.001), Breslow (p = 0.044), ulceración (p = 0.004), mitosis (p < 0.001) y margen < 2 cm (p < 0.001) . En el análisis multivariante los factores que influyen en SG fueron la EC, mitosis y el margen quirúrgico. Conclusiones: En pacientes con melanomas gruesos la SG es influida por un margen positive, mitosis y EC.

Abstract Background: Studies on prognostic factors in melanoma are based on Caucasian populations, with a predominance of thin melanomas (Breslow <3 mm). Mexican patients show a predominance of thick melanomas (Breslow ≥ 3 mm). Objective: To identify factors associated with the prognosis of patients with thick melanomas. Material and methods: The prognostic influence of clinicopathological factors was analyzed in 362 thick melanomas. Results: The Breslow median was 7 mm, 271 (74.9 %) patients had acral melanoma and 49 (13.5 %) nodular melanoma. The 56.6 % of patients were found in clinical stage [CS] III), 269 (74.3 %) had ulceration, and 15 (4.1 %) had positive margins. The variables associated with lower overall survival [OS] were CS (p < 0.001), Breslow (p = 0.044), ulceration (p = 0.004), mitosis (p < 0.001) and margin < 2 cm (p < 0.001). In the multivariate analysis, the factors influencing OS were CD, mitosis, and the surgical margin. Conclusions: In patients with thick melanomas, OS is influenced by a positive margin, mitosis and CS.

Recomendaciones sobre el tratamiento farmacológico del cáncer de ovario epitelial en México / Recommendations on the pharmacological treatment of epithelial ovarian cancer in Mexico

Resumen El cáncer de ovario es la tercera neoplasia maligna ginecológica más frecuente globalmente y también en México, con una elevada tasa de mortalidad debido a que en muchos casos su diagnóstico se realiza en etapas avanzadas. Para establecer su pronóstico es importante la determinación del subtipo y del grado de evolución. En los últimos años, el manejo del cáncer de ovario ha sufrido una importante evolución con la incorporación de nuevas opciones terapéuticas, que a su vez representan un incremento en la supervivencia de estas pacientes. Se presentan las recomendaciones para el manejo del cáncer de ovario elaboradas por un panel de expertos mexicanos basadas en la evidencia disponible hasta el momento y en las características de la atención sanitaria del país.

Abstract Ovarian cancer is the third most frequent gynaecological malignancy worldwide and in Mexico, with a high mortality rate, due to that in many cases its diagnosis is made in advanced stages. Prognosis is important for determining the subtype and the degree of evolution. During lasts years, the management of ovarian cancer has undergone an important evolution with the incorporation of new therapeutic options, which in turn represent an increase in the survival of these patients. We present recommendations for the management of ovarian cancer developed by an expert panel Mexican based on available evidence so far and the characteristics of health care in the country.

Therapeutic use of human papillomavirus vaccines in cervical lesions

ABSTRACT Human papillomavirus (HPV) has been associated with the development of precancerous lesions of the cervix and cervical cancer (CC). Prophylactic HPV vaccination induces the development of a specific memory immune response that facilitates HPV elimination once the natural infection occurs. At present, in addition to the prophylactic vaccine, therapeutic vaccines are being developed and researched with the aim of inducing an immune response that allows the elimination of HPV-infected cells. The purpose of this study is to describe the current evidence on the use of therapeutic vaccines and their effect on cervical precancerous lesions, to establish recommendations on their clinical use. So far, the studies that have generated results have described a marginal beneficial effect of the prophylactic vaccine in the management of infection and pre-invasive lesions. Based on the evidence, continuing research on the efficacy and safety of therapeutic vaccines for the treatment of cervical intraepithelial lesions is recommended. The use of the HPV prophylactic vaccine as treatment for pre-existing lesions is not advised, but it is recommended to prevent new lesions.

Magnesium versus poly-L-lactic acid bioresorbable scaffolds: in vivo optical coherence tomography comparison of mechanical performance / Andamiajes bioresorbibles de magnesio versus poliméricos: comparación in vivo de su comportamiento mecánico por OCT

Abstract Background: Different mechanical properties have been suggested for metallic bioresorbable vascular scaffolds (BVS) in comparison to polymeric BVS. We aim to evaluate the acute mechanical performance of Magmaris® scaffold in comparison to Absorb®. Materials and Methods: Two groups of 10 coronary lesions treated with Magmaris® and Absorb® 1.1 (20584 vs. 21016 struts) were compared. In all cases, optical coherence tomographic (OCT) images were acquired after scaffold deployment. Baseline clinical, angiographic, and procedural characteristics were compared, including OCT evaluations. Results: No baseline clinical or angiographic significant differences were found between groups. The most common indication for revascularization was effort angina (60% vs. 70% p = 0.45) with no ST-elevation myocardial infarction (MI) cases. Main target artery was left anterior descending, with a mean vessel diameter of 3.46 ± 0.23 in Absorb® and 3.52 ± 0.19mm in Magmaris® groups (p = 0.56). All cases underwent pre- and post-dilatation with a procedural success rate of 100%. OCT analyses showed larger scaffold and vessel diameters in Magmaris® group: 3.11 ± 0.38 mm versus 3.07 ± 0.36 mm, p = 0.03 and 4.12 ± 0.51 mm versus 4.04 ± 0.46 mm, p = 0.04. Despite the application of slightly higher postdilatation pressures to Magmaris® devices (18.01 ± 2.15 vs. 17.20 ± 3.80 atm, p = 0.05), significantly lower percentages of disrupted and malapposed struts were identified within Magmaris® scaffolds (0.15% vs. 0.27%, p = 0.03 and 1.06% vs. 1.46% p = 0.01). No cardiac death, target vessel-related MI, or clinically driven target lesion revascularization was reported in a 30-day follow-up. Conclusion: Mechanical properties of Magmaris® scaffold allow achieving larger vessel and scaffold diameters in a safe manner, with lower rates of malapposition and scaffold disruption.

Resumen Introducción: Se ha sugerido la presencia de un distinto comportamiento mecánico entre los dos grupos principales de dispositivos bioresorbibles: metálicos y poliméricos. En este estudio evaluamos el comportamiento mecánico agudo del andamiaje bioresorbible metálico Magmaris® frente al del polimérico Absorb®. Métodos: Se compararon dos grupos de 10 lesiones coronarias tratadas con Magmaris® y Absorb® 1.1 (20584 vs. 21016 struts). En todos los casos se realizó estudio postimplante del dispositivo mediante tomografia de coherencia óptica (OCT). Se compararon las características basales clínicas y angiográficas, así como aspectos del procedimiento (incluídos los estudios de OCT) entre ambos grupos. Resultados: No se encontraron diferencias clínicas o angiográficas estadísticamente significativas entre ambos grupos. La indicación más frecuente de revascularización coronaria fué la presencia de angina de esfuerzo (60% vs. 70% p = 0.45), sin incluirse casos de IAMCEST. La arteria descendente anterior fué el principal vaso diana, con un diámetro medio de 3.46 ± 0.23 mm en el grupo de Absorb® y de 3.52 ± 0.19mm en el grupo de Magmaris® (p = 0.56). En todos los casos se realizó pre y postdilatación, con una tasa de éxito del procedimiento del 100%. Los estudios mediante OCT demostraron un mayor diámetro de stent y del vaso en el grupo de Magmaris®: 3.11 ± 0.38mm versus 3.07 ± 0.36 mm, p = 0.03 y 4.12 ± 0.51mm versus 4.04 ± 0.46mm, p = 0.04. A pesar de someter a los dispositivos Magmaris® a presiones de postdilatación ligeramente superiores (18.01 ± 2.15 vs. 17.20 ± 3.80 atm, p = 0.05), se identificó un menor porcentaje estadísticamente significativo de struts rotos o malapuestos en dicho grupo (0.15% vs. 0.27 %, p = 0.03 y 1.06 % vs. 1.46% p = 0.01). En un seguimiento a 30 días no se registraron eventos mayores: muerte cardíaca, IM relacionado con vaso diana o TLR. Conclusión: Las propiedades mecánicas del scaffold metálico bioresorbible Magmaris® permiten alcanzar mayores diámetros de stent y vaso de forma segura tras su implante, con una baja tasa de malaposición y disrupción.

Distance learning and patient safety: Report and evaluation of an online patient safety course / Educación a distancia y seguridad del paciente: informe y evaluación de un curso en línea sobre seguridad del paciente / Aprendizagem à distância e segurança do paciente: descrição e avaliação de um curso online sobre segurança do paciente

ABSTRACT Patient safety is a critical topic in health care globally, with implications for nurses, physicians, administrators, and most importantly, patients and their well-being. Online distance learning (ODL) is widely accepted among most disciplines in higher education and has been used to promote patient safety knowledge among health care students and professionals in diverse contexts. This article reports on an online Nursing and Patient Safety course developed in 2012 by the University of Miami School of Nursing and Health Studies in conjunction with the Pan American Health Organization and the International Network for Nursing and Patient Safety. The study's objectives are to describe the implementation of an international ODL program to enhance patient safety knowledge in nurses and nursing students, and to examine the participants' assessments of this online approach as an effective learning tool. Most participants who completed the Nursing and Patient Safety ODL course reported being satisfied with the course content and experience, and demonstrated increased knowledge on patient safety, as measured by post-module quizzes and self-report. Limitations of the study include the lack of a comparison group, disparity in the number of participants across the course's language formats (English, Portuguese, Spanish), and the large number of participants who registered for but did not complete the course. Future research should identify obstacles to course completion, explore participants' awareness of patient safety issues and perceived need for more instruction, and look at ways to disseminate the course to the broadest international population of nurses and nursing students.(AU)

RESUMEN La seguridad del paciente es un tema fundamental en la atención de la salud a nivel mundial, con repercusiones para los enfermeros, médicos, administradores y, lo que es más importante, para los pacientes y su bienestar. La educación a distancia en línea está ampliamente aceptada en la mayoría de las disciplinas de enseñanza superior y se ha empleado para difundir los conocimientos en materia de seguridad del paciente a los estudiantes de atención de salud y los profesionales en diversos contextos. En este artículo se informa sobre el curso en línea de enfermería y seguridad del paciente creado en el 2012 por la facultad de enfermería y estudios de salud de la Universidad de Miami, conjuntamente con la Organización Panamericana de la Salud y la Red Internacional de Enfermería y Seguridad del Paciente. Los objetivos del estudio son describir la ejecución de un programa internacional de educación a distancia en línea para mejorar el conocimiento sobre la seguridad del paciente de los enfermeros y los estudiantes de enfermería, y examinar las evaluaciones de los participantes sobre este enfoque en línea como herramienta eficaz de aprendizaje. La mayoría de los participantes en este curso afirmó sentirse satisfecho con su contenido y experiencia, y demostró un mayor conocimiento sobre la seguridad del paciente, de acuerdo con las mediciones de las encuestas posteriores al módulo y la autoevaluación. Entre las limitaciones del estudio se aprecia la falta de un grupo de comparación, una disparidad en el número de participantes entre las diferentes versiones lingüísticas del curso (español, inglés y portugués) y el gran número de participantes que se inscribieron sin llegar a finalizar el curso. Las futuras investigaciones deberán indicar cuáles son los obstáculos para la finalización del curso, explorar la concienciación de los participantes en temas relativos a la seguridad del paciente y las necesidades que perciben de una instrucción más profunda, así como considerar modos de mayor difusión del curso en la comunidad internacional de enfermeros y estudiantes de enfermería.(AU)

RESUMO A segurança do paciente é um tema fundamental para a assistência de saúde em todo o mundo, com implicações para enfermeiros, médicos, administradores e, mais importante ainda, para os pacientes e o seu bem-estar. A educação à distância online (EDO) conta com grande aceitação na maioria das disciplinas do ensino superior e tem sido utilizada para transmitir conhecimentos sobre segurança do paciente a estudantes e profissionais da saúde em diversos contextos. Este artigo descreve um curso online de Enfermagem e Segurança do Paciente desenvolvido em 2012 pela Faculdade de Enfermagem e Estudos da Saúde da Universidade de Miami, em conjunto com a Organização Pan-Americana da Saúde e a Rede Internacional de Enfermagem e Segurança do Paciente. Os objetivos do estudo são descrever a implementação de um programa internacional de EDO para melhorar os conhecimentos de enfermeiros e estudantes de enfermagem sobre segurança do paciente e examinar a forma como os participantes avaliaram a eficácia desta abordagem online como uma ferramenta de aprendizagem. Em sua maioria, os participantes que completaram o curso online de Enfermagem e Segurança do Paciente afirmaram ter tido uma boa experiência com o curso e estar satisfeitos com o seu conteúdo; além disso, demonstraram maiores conhecimentos sobre segurança do paciente, medidos por questionários aplicados após os módulos e pela autoavaliação. As limitações deste estudo incluem a falta de um grupo de comparação, a disparidade no número de participantes nos diferentes formatos do curso (inglês, português, espanhol) e o grande número de participantes que se inscreveram mas não completaram o curso. A pesquisa futura deve identificar os obstáculos à conclusão do curso, explorar a conscientização dos participantes sobre questões de segurança do paciente e a necessidade de mais instrução e procurar formas de divulgar o curso para uma população internacional mais ampla de enfermeiros e estudantes de enfermagem.(AU)

Evacuación aeromédica de pacientes COVID-19. Reporte de casos / Case reports: Aeromedical evacuation of patients COVID-19

BACKGROUND: The aeromedical evacuation in the Chilean Air Force has had an important development in the last 15 years. The coronavirus disease declared as a global pandemic by the WHO has generated the challenge of transferring highly infectious patients to centers of greater complexity. The objective of this article is to report our experience in the transfer of COVID ­ 19 patients in constant attention and medical monitoring. CLINICAL CASE REPORTS: The aeromedical evacuation of 2 COVID-19 patients was performed from the Hanga Roa Hospital, Rapa Nui, to the National Thorax Institute, Metropolitan Region, in a Lockheed Hercules C-130, which corresponds to a pressurized fixed-wing airplane. The transfer was carried out with the corresponding personal protection elements and in individual isolation capsules with advanced negative pressure life support (ISO ­ POD), in order to reduce the level of contagion to the aero sanitary crew and minimize the impact on the flight material used. DISCUSSION: The transfer was carried out achieving all the objectives set out under a strict security protocol and the two COVID-19 patients were transferred successfully. The negative pressure isolation capsule system was safe and reliable, since no crew member presented symptoms or was infected by COVID -19, and also allowed the transfer of highly contagious patients during an 8-hour flight operation.

INTRODUCCIÓN: La evacuación aeromédica en la Fuerza Aérea de Chile ha tenido un importante desarrollo en los últimos 15 años. La enfermedad por coronavirus declarada como pandemia mundial por la OMS ha generado el desafío de trasladar pacientes altamente infecciosos a centros de mayor complejidad. El objetivo de este artículo es reportar nuestra experiencia en el traslado de pacientes COVID ­ 19 en constante atención y monitorización médica. REPORTE DE CASOS CLÍNICOS: Se realizó la evacuación aeromédica de 2 pacientes COVID ­ 19 desde el Hospital de Hanga Roa, Rapa Nui, hacía el Instituto Nacional del Tórax, Región Metropolitana, en un Lockheed Hércules C-130, que corresponde a un avión de ala fija presurizado. El traslado se realizó con los elementos de protección personal correspondientes y en capsulas de aislamiento individual con soporte vital avanzado a presión negativa (ISO ­ POD), con la finalidad de reducir el nivel de contagio a la tripulación aero sanitaria y minimizar el impacto en el material de vuelo utilizado. DISCUSIÓN: El traslado se desarrolló logrando todos los objetivos planteados bajo un estricto protocolo de seguridad y los dos enfermos COVID-19 fueron trasladados de manera exitosa. El sistema de cápsulas de aislamiento a presión negativa fue seguro y confiable, ya que ningún miembro de la tripulación presento sintomatología o resultó contagiado por COVID -19, y además permitió trasladar pacientes altamente contagiosos durante una operación de vuelo de 8 horas.

Visual and automatic classification of the cyclic alternating pattern in electroencephalography during sleep

Cyclic alternating pattern (CAP) is a neurophysiological pattern that can be visually scored by international criteria. The aim of this study was to verify the feasibility of visual CAP scoring using only one channel of sleep electroencephalogram (EEG) to evaluate the inter-scorer agreement in a variety of recordings, and to compare agreement between visual scoring and automatic scoring systems. Sixteen hours of single-channel European data format recordings from four different sleep laboratories with either C4-A1 or C3-A2 channels and with different sampling frequencies were used in this study. Seven independent scorers applied visual scoring according to international criteria. Two automatic blind scorings were also evaluated. Event-based inter-scorer agreement analysis was performed. The pairwise inter-scorer agreement (PWISA) was between 55.5 and 84.3%. The average PWISA was above 60% for all scorers and the global average was 69.9%. Automatic scoring systems showed similar results to those of visual scoring. The study showed that CAP could be scored using only one EEG channel. Therefore, CAP scoring might also be integrated in sleep scoring features and automatic scoring systems having similar performances to visual sleep scoring systems.

Feasibility and safety of vitrectomy under topical anesthesia in an office-based setting

Purpose: The purpose of this study was to evaluate the feasibility and safety of office-based vitreoretinal procedures. Methods: Patients undergoing primary elective pars plana vitrectomy were elected for surgery in an office-based setting (performed in a minor procedure room under topical anesthesia [TA] and oral anxiolysis). Rates of surgical objective achievement, surgical timing, and comfort were recorded to evaluate feasibility. Intraoperative and postoperative adverse events were assessed to evaluate safety. Results: Office-based vitrectomy surgery was performed in 34 eyes of 30 patients. The mean surgical time was 12.351 � 8.21 min. Surgical objectives were achieved in 100% of cases. The mean best-corrected visual acuity improvement was 9.08 letters (P < 0.0001). During most parts of the procedure, no patient reported pain or discomfort. Neither intraoperative nor postoperative adverse events were reported until the final follow-up visit. Conclusion: Office-based vitreoretinal procedures under TA could be as feasible and as safe as vitreoretinal procedures under conventional anesthesia.

Can parenting practices predict externalizing behavior problems among children with hearing impairment?

Objective: To identify possible differences in the level of externalizing behavior problems among children with and without hearing impairment and determine whether any relationship exists between this type of problem and parenting practices. Methods: The Behavior Assessment System for Children was used to evaluate externalizing variables in a sample of 118 boys and girls divided into two matched groups: 59 with hearing disorders and 59 normal-hearing controls. Results: Significant between-group differences were found in hyperactivity, behavioral problems, and externalizing problems, but not in aggression. Significant differences were also found in various aspects of parenting styles. A model for predicting externalizing behavior problems was constructed, achieving a predicted explained variance of 50%. Conclusion: Significant differences do exist between adaptation levels in children with and without hearing impairment. Parenting style also plays an important role.