Ránula cervical gigante: a propósito de un caso / Huge plunging ranula: about a case

La ránula es una lesión pseudoquística causada por la retención de contenido salival de la glándula sublingual en el tejido conjuntivo subyacente, siendo la patología más frecuente de esta glándula. Su localización es a nivel del suelo de la boca, pudiendo en ocasiones extenderse a través del músculo milohioideo hacia la región submaxilar o cervical (ránula plunging o cervical), presentándose clínicamente como una tumoración laterocervical de crecimiento lento. El apoyo de imágenes mediante ecografía, tomografía computarizada, o RM (resonancia magnética) es fundamental para un correcto diagnóstico. Respecto al tratamiento, el procedimiento más aceptado y con menos tasas de recurrencia es la escisión de la ránula cervical por abordaje laterocervical, asociada a la extirpación de la glándula sublingual implicada vía transoral. Aquí presentamos el caso clínico de un varón de 25 años quien presenta una masa laterocervical derecha de seis meses de evolución de crecimiento progresivo e indoloro. La ecografía y RM confirman una ránula cervical gigante de 62x45x101 mm, que se localiza en espacio submandibular derecho, alcanzando el espacio parafaríngeo en su vertiente más craneal. Debido a las características de la lesión y su anatomía se decide tratamiento quirúrgico.

The ranula is a pseudocystic lesion caused by the retention of salivary content of the sublingual gland in the underlying connective tissue, being the most frequent pathology of this gland. Its location is at the level of the floor of the mouth and can sometimes extend through the mylohyoid muscle towards the submaxillary or cervical region (plunging or cervical ranula), clinically presenting as a slow-growing laterocervical tumor. The support of images by ultrasound, computed tTomography or MRI (magnetic resonance imaging) is essential for a correct diagnosis. Regarding treatment, the most accepted procedure, and with the lowest recurrence rates is excision of the cervical ranula by the laterocervical approach, associated with the transoral removal of the involved sublingual gland. Here, we present the clinical case of a 25-year-old man who presented a six-month-old right laterocervical mass of progressive and painless growth. Ultrasound and MRI confirmed a giant cervical ranula measuring approximately 62x45x101 mm, located in the right submandibular space, reaching the parapharyngeal space in its most cranial aspect. Due to the characteristics of the injury and its anatomy, surgical treatment was decided.

Determinación de pensamiento creativo en estudiantes de medicina de una universidad chilena / Assessment of creative thinking among medical students

Background: Creativity is a highly valued quality in different fields. Despite this, it is rarely included in the curricula of medical careers. Aim: To assess creative thinking among undergraduate medical students. Material and Methods: Sixty-seven students aged 18 to 31 years (45% women) from the first (16), third (26) and seventh year (25) of medical school answered a sociodemographic questionnaire and the Torrance Test of Creative Thinking (TTCT). Results: Median creativity index according to age was in percentile 52 (range 2-99). Percentiles for fluency, originality, elaboration, abstraction of titles and resistance for premature closure were 31, 32, 79, 53 and 17 respectively. There were no significant differences between students of different levels (p = 0.73). Conclusions: In this group of students, there is a high performance in elaboration and a low score in Resistance to premature closure.

Satisfacción de estudiantes de enfermería con su formación teórico-práctica. Universidad de Panamá, Sede Azuero / Satisfaction of nursing students regarding their theoretical-practical formation. University of Panama, Sede Azuero / Satisfação de estudantes de enfermagem com sua formação teórico-prática. Universidad de Panamá, Sede Azuero

La universidad contemporánea tiene como misión formar profesionales competentes, que les permitan contribuir al desarrollo de la sociedad, por lo que se hace indispensable evaluar continuamente la calidad del proceso docente educativo y la eficiencia de los programas académicos vigentes, donde el estudiante es un factor clave. Objetivo Analizar el grado de satisfacción de los graduandos con la formación teórico-práctica recibida en la Facultad de Enfermería en el Centro Regional Universitario de Azuero. Material y Métodos Se realizó un estudio descriptivo de corte transversal, en el que se evaluó la satisfacción de los graduandos en relación a dos componentes: la formación teórico-práctica durante la carrera y la práctica profesional como opción para obtención del grado de Licenciados en Enfermería. Resultados Los estudiantes están satisfechos con la formación teórico-práctica y tienen una percepción del docente entre excelente y buena en un 87% al 95%. Los criterios con puntuaciones regulares 10% fueron obtenidos por: el horario de atención, la capacidad de interacción virtual del docente y el apoyo en la formulación y análisis de problemas. Las competencias adquiridas durante la práctica profesional como opción de grado fueron ponderadas con valores positivos en un 98% al 100%. Conclusiones Los estudiantes graduandos tienen un alto grado de satisfacción con la formación teórico-práctica y destacan la práctica profesional como una buena experiencia en el fortalecimiento de competencias profesionales.

Contemporary universities have the mission to form competent professionals who can contribute to the development of society. Because of this, it is necessary to continually assess the quality of the teaching process and the efficiency of the current academic programs. Objective To analyze the degree of satisfaction of graduate nursing students regarding their theoretical-practical formation at the Nursing Faculty of the Universitarian Regional Center in Azuero, Panama. Material and Methods This is a descriptive and transversal study assessing the satisfaction of graduates according to two components: the theoretical-practical formation during the education stage, and the professional practice as an option to obtain the title of Baccalaureate in Nursing. Results Students are satisfied with their theoretical-practical formation and they have an excellent-good impression of the teachers (87% to 95%). The low or regular scores were found in the areas of: attention schedule, virtual interaction capability, and support in elaborating and analyzing problems. Acquired competencies resulting from the professional practice as a graduating option turned out to be positive (98% to 100%). Conclusions Graduate students have a high level of satisfaction with their theoretical-practical formation, at the same time highlighting professional practice as a good experience for the strengthening of professional competencies.

A universidade contemporânea tem como missão formar professionais competentes, que lhes permitam contribuir ao desenvolvimento da sociedade, pelo que se faz indispensável avaliar continuamente a qualidade do processo docente educativo e a eficiência dos programas académicos vigentes, onde o estudante é um fator chave. Objetivo Analisar o grau de satisfação dos formandos com a formação teórico-prática recebida na Faculdade de Enfermagem no Centro Regional Universitário de Azuero. Material e Métodos Realizou-se um estudo descritivo de corte transversal, no que se avaliou a satisfação dos formandos em relação à dos componentes: a formação teórico-prática durante a carreira e a prática profissional como opção para obtenção do grau de Licenciados em Enfermagem. Resultados Os estudantes estão satisfeitos com a formação teórico-prática e têm uma percepção do docente entre excelente e boa em um 87% ao 95%. Os critérios com pontuações regulares de 10% foram obtidos pelo: horário de atenção, pela capacidade de interação virtual do docente e pelo apoio na formulação e análise de problemas. As competências adquiridas durante a prática profissional como opção de grau foram ponderadas com valores positivos em um 98% ao 100%. Conclusões Os estudantes graduandos têm um alto grau de satisfação com a formação teórico-prática e destacam a prática profissional como uma boa experiência no fortalecimento de competências profissionais.

Condiciones del contexto educativo para ejercer el rol docente en Ciencias de la Salud: un enfoque cualitativo / The educational context to train health care professionals: a qualitative approach

Background: There are differences in the educational context in Health Sciences, between clinical and non-clinical teachers. Therefore, the didactic and reflexive peculiarities of both educational scenarios should be analyzed. Aim: To describe the conditions of the educational context in Health Sciences for the practice of the teaching role in a Chilean university. Material and Methods: Qualitative study, performed according to Grounded Theory of Strauss and Corbin. Thirty one teachers from six health sciences programs were selected according to Patton's maximum variation criterion and contacted personally, after an informed consent process. Semi-structured interviews and focus group were performed, analyzed by open coding, using the constant comparison method, with the Atlas-ti 7.5.2 software. Results: Six conditions of the educational context that can support the teaching role in these careers emerged. Namely, a clinical field suited for patient attention and teaching, classrooms designed for the new educational models, number of students in the classrooms and clinical settings, insertion programs for teachers' training, teachers' coordination and economic resources of the program. Conclusions: Health Sciences programs are developed in a complex educational context, having to articulate diverse elements to train professionals. Therefore, it is fundamental to understand the conditions of the educational context that can favor the practice of the teaching role, thus generating improvements in teaching-learning process.

Características nutricionales de los escolares afrodescendientes de la costa pacífica Colombiana / Nutritional characteristics of afro-descendant schoolchildren of Colombian pacific southwest coast

This paper provides a current diagnosis on the nutritional status of schoolchildren of pacific coast of Cauca in Colombia. A secondary analysis of publicly available anthropometric data was performed. BMI/Age and H/Age indices, nutritional classification and their association with gender, ethnicity, age and geographical area of 6793 students aged 5 to 18 years of the municipalities of Guapi, Lopez de Micay and Timbiquí were determined. Normality was the prevalent nutritional status in the three municipalities for schoolchildren of all ages according to BMI and height (65.7% and 59.3 %, respectively); Guapi was found to be the main contributor. There was no significant differences of BMI and region among males and females. Adolescents between 12 and 14 years old had percentages of stunting significantly higher than other age ranges. Results highlight the need to identify, measure and monitor indicators of health, food habits and sociodemographic aspects of schoolchildren in this region to strictly explore whether Colombian black children fit WHO patterns and to provide specific information for successful national nutrition policy planning for this population.

El presente artículo proporciona un diagnóstico sobre el estado nutricional de los escolares de la costa pacífica del Cauca en Colombia. Se realizó un análisis secundario de datos antropométricos públicos que están disponibles. Se determinaron los índices IMC/edad y talla/edad, la clasificación nutricional y su asociación con el género, etnia, edad y área geográfica de 6793 estudiantes de 5 a 18 años de los municipios de Guapi, López de Micay y Timbiquí. La normalidad fue el estado nutricional prevalente en los tres municipios para escolares de todas las edades de acuerdo al BMI y la talla (65.7% y 59.3 %, respectivamente); Guapi resultó ser el principal contribuyente. No hubo diferencias significativas de IMC y región entre hombres y mujeres. Los adolescentes entre 12 y 14 años tuvieron porcentajes de retraso en el crecimiento significativamente más elevados que los de otros rangos de edad. Los resultados destacan la necesidad de identificar, medir y monitorear los indicadores de salud, hábitos alimentarios y aspectos sociodemográficos de los escolares en esta región para explorar si los niños afrodescendientes se ajustan a los patrones de la OMS y para proveer información específica para un exitoso planeamiento de una política de nutrición nacional para esta población.

Aspectos motivacionales involucrados en el aprendizaje autodirigido en estudiantes de medicina. un enfoque cualitativo / Motivation and self-directed learning among medical students

Background: Motivation is an essential aspect in the training process of medical students. The association that motivation can have with learning self-regulation is of utmost importance for the design of curriculum, teaching methods and evaluation. Aim: To describe the motivational aspects of self-directed learning among medical students from a traditional Chilean University. Material and Methods: A qualitative, descriptive study based on grounded theory of Strauss and Corbin. Twenty 4th and 5th year medical students were selected using a maximum variation sampling technique. After obtaining an informed consent, semi-structured interviews and field notes were carried out. Data were analyzed to the level of open coding through Atlas-ti 7.5.2. Results: From the student point of view, personal motivational aspects are linked to the search for information, constant updating, the perception of the physician-patient relationship and interest in subject matters. From the scope of teachers, a main issue is related to their ability to motivate students to develop independent study skills. Conclusions: Personal motivational aspects facilitate the development of independent study skills, specifically in the search of information. The role of teachers is crucial in promoting these skills and the perception of medical students from their learning process.

Estructura factorial de la escala DREEM en estudiantes de medicina chilenos

Background: The entry to a University requires an adaptation process that not all students solve with the same kind of success. Even though students social adaptation and emotional skills are essential, the educational environmental that they perceive has a significant influence in their academic life. Aim: To describe the changes in the perception about academic environment that medical students experience during the first three years of undergraduate career. Material and Methods: The Dundee Ready Education Environment Measure (DREEM) scale was applied to 525 first to third year medical students and an exploratory factorial analysis was made. Results: Four factors were identified: Academic Perception: academic quality that students attribute to the process in which they take part, as well as to the assessment that they do of their learning outcomes (coefficient ± = 0.85); Academic Experience: refers to positive emotions that students experience during the career such as confidence, pleasure and energy (coefficient ± = 0.76); Atmosphere Perception, comfort and calm that students experiment during their academic activities (coefficient ± = 0.79); Teachers Perception: the perception that students have of teachers about their interest and disposition towards students (coefficient ± = 0.50). Conclusions: The assessment of academic environment quality is inversely associated with the lapse that the students have spent in their undergraduate careers.

Predictores afectivos y académicos del aprendizaje autodirigido en estudiantes de medicina / Factors associated with self-directed learning among medical students

Background: Self-directed learning is a skill that must be taught and evaluated in future physicians. Aim: To analyze the association between self-directed learning, self-esteem, self-efficacy, time management and academic commitment among medical students. Material and methods: The self-directed learning, Rosemberg self-esteem, general self- efficacy, time management and Utrecht work engagement scales were applied to 297 first year medical students. Results: A multiple regression analysis showed a significant association between self-efficacy, time management and academic commitment with self-directed learning. Self-esteem and satisfaction with studies did not enter in the model. Conclusions: self-esteem, academic commitment and a good time management were associated with self-directed learning in these students.

Aprendizaje autodirigido y su relación con estilos y estrategias de aprendizaje en estudiantes de medicina / Relationship between self-directed learning with learning styles and strategies in medical students

Background: Self-directed learning (SDL) skills are particularly important in medical education, considering that physicians should be able to regulate their own learning experiences. Aim: To evaluate the relationship between learning styles and strategies and self-directed learning in medical students. Material and Methods: One hundred ninety nine first year medical students (120 males) participated in the study. Preparation for Independent Learning (EPAI) scale was used to assess self-direction. Schmeck learning strategies scale and Honey and Alonso (CHAEA) scales were used to evaluate learning styles and strategies. Results: Theoretical learning style and deep processing learning strategy had positive correlations with self-direct learning. Conclusions: Medical students with theoretical styles and low retention of facts are those with greater ability to self-direct their learning. Further studies are required to determine the relationship between learning styles and strategies with SDL in medical students. The acquired knowledge will allow the adjustment of teaching strategies to encourage SDL.

Evaluación de componentes del currículum oculto en estudiantes de medicina / Assessment of hidden curriculum components by medical students

Background: Hidden curriculum refers to the unwritten, unofficial, and often unintended lessons, values, and perspectives that students learn at the university, which influences the acquisition of professional skills. Aim: To analyze the perception about the influence of the hidden curriculum in the education of medical students at the Universidad de Concepción, Chile. Material and Methods: Qualitative investigation with case study approach. Seventeen graduated medical students were selected by probability sampling. A semi-structured interview was used to collect the information and a content analysis was applied. Results: Forty seven percent of participants recognized having fulfilled their academic expectations. As favorable factors for academic achievement the students underlined clinical practice, access to patients and to clinical fields. As negative factors, they identified the lack of commitment, educational support and over-specialization of their mentors. Conclusions: The results show the strengths and weaknesses of the educational environment of undergraduated medical students. This information should be used to modify teaching environments.

Implantación de catéteres translumbares: experiencia de seis años en el Hospital Universitario San Ignacio / Translumbar Catheter Placement. Six Years' Experience at Hospital Universitario San Ignacio

Introducción: La implantación de catéteres translumbares es un tipo de abordaje venoso que constituye una de las últimas opciones en pacientes sin disponibilidad de accesos venosos centrales convencionales. Objetivos: Revisar la literatura, describir la técnica y comunicar la experiencia de seis años en la realización de este procedimiento. Métodos: Se realizó una búsqueda de la literatura disponible sobre la implantación de catéteres translumbares en MedLine, Ovid y Liliacs; asimismo, se obtuvo una base de datos sobre los pacientes en quienes se implantó un catéter translumbar en el Hospital Universitario San Ignacio en el periodo entre 2008 y 2013. Finalmente, se ejecutó un estudio retrospectivo descriptivo. Resultados: Se realizaron 98 procedimientos en 66 pacientes (41 hombres y 25 mujeres). Se observó la incidencia de complicaciones hasta 72 horas posprocedimiento y se identificaron solo tres complicaciones (4,6 %) Conclusiones: El implante de catéteres translumbares constituye una alternativa eficaz y segura en pacientes que necesitan hemodiálisis y han agotado otros accesos venosos convencionales. Los resultados se hallan dentro de los indicadores publicados en la literatura.

Introduction: In recent years the Hospital Universitario San Ignacio has become a local and national reference center for translumbar catheter placement. This procedure is one of the last options to achieve effective central venous access in patients without other possible alternatives. Objectives: To review the literature, describe the technique and report the experience of six years in the making of this procedure. Methods: Search of the available literature about translumbar catheter placement was performed in MEDLINE, OVID and LILIACS. Additionally, it was obtained a database on patients with translumbar catheter placement at Hospital Universitario San Ignacio in the 2008-2013 period. Finally a retrospective study was made. Results: 98 Procedures were performed in 66 patients (41 men and 25 women). The incidence of complications up to 72 hours post-procedure was observed, identifying only 3 complications (4.6%) Conclusions: Translumbar catheter placement is an effective and safe alternative in patients requiring hemodialysis and have exhausted other conventional venous accesses. Our results are according to those reported in the available literature.

Aprendizaje autodirigido en estudiantes de primer año de medicina de la Universidad de Concepción y su relación con el perfil sociodemográfico y académico / Association between self-directed learning behaviors, socio-demographic and academic variables among medical students

Medical education must encourage autonomous learning behaviors among students. However the great income profile disparity among university students may influence their capacity to acquire such skills. Aim: To assess the association between self-directed learning, socio-demographic and academic variables. Material and Methods: The self-directed learning readiness scale was applied to 202 medical students aged between 17 and 25 years (64% males). Simultaneously information about each surveyed participant was obtained from the databases of the medical school. Results: There is an association between socio-demographic and academic variables with the general scale of self-directed learning and the subscales learning planning and willingness to learn. Participants coming from municipal schools have a greater willingness to learn than their counterparts coming from subsidized and private schools. High school grades are related to self-directed learning and the subscales learning planning and self-assessment. Conclusions: Among the surveyed medical students, there is a relationship between self-directed learning behaviors, the type of school where they come from and the grades that they obtained during high school.

Percepción de académicos de carreras de la salud de Chile sobre el perfeccionamiento docente / Perceptions about continuous training of Chilean health care teachers

Background: Continuous training of teachers, in discipline ana pedagogical topics, is a key step to improve the quality of educational processes. Aim: To report the perception of Chilean teachers of undergraduate health care programs, about continuous training activities. Material and Methods: Twenty teachers working at different undergraduate health care programs in Chile were interviewed. Maximum variation and theoretical sampling methods were used to select the sample. Data was analyzed by open coding, according to the Grounded Theory guidelines. Results: Nine categories emerged from data analysis: Access to continuous training, meaning of training in discipline, activities of continuous training in discipline, meaning of continuous training in pedagogy, kinds of continuous training in pedagogy, quality of continuous training in pedagogy, ideal of continuous training in pedagogy, outcomes of continuous training in pedagogy and needs for continuous training in pedagogy. Conclusions: Teachers of health care programs prefer to participate in contextualized training activities. Also, they emphasize their need of training in evaluation and teaching strategies.

Morfometría tomográfica del foramen magno y su relación con el sexo y la etnia mapuche / Tomographic morphometry of the foramen magnum and its relation to sex and Mapuche ethnicity

Introducción: El foramen magno es una estructura anatomoquirúrgica importante en síndromes compresivos del sistema nervioso central, en que se ven comprometidas la función neuronal y circulatoria. Objetivo: Determinar los valores morfométricos del foramen magno en tomografías computarizadas y su relación con el sexo y la etnia mapuche. Material y Método: Estudio descriptivo tipo corte transversal realizando muestreo no probabilístico por conveniencia de 100 tomografías computarizadas cerebrales (TC), realizadas en el Hospital Hernán Henríquez Aravena en 2010 e informadas como “normal” por médico especialista. Fueron seleccionados 50 hombres y 50 mujeres, integrándose dentro de cada grupo 25 TC de sujetos que presentaran apellidos de la etnia mapuche. Se midió diámetro transverso, diámetro anteroposterior y área, además de determinar la forma. Análisis estadístico con Stata 10,1, estudiándose diferencias con t de Student y considerándose un p<0,05 como significativo estadísticamente. Todos los sujetos permanecieron bajo anonimato en las bases de datos construidas. Resultados: Entre hombres y mujeres existen diferencias estadísticamente significativas en todas las mediciones, siendo mayores en el sexo masculino. Existen además diferencias estadísticamente significativas en la medición del área entre sujetos mapuches y no mapuches, siendo menores en los primeros. La forma predominante fue la oval. Discusión: Las diferentes mediciones entre sexos son concordantes con la literatura. Existen diferencias en las medidas de forámenes magnos de sujetos mapuches y no mapuches, pudiendo servir estos datos para nuevos estudios en el área.

Introduction: The foramen magnum is an important surgical anatomical structure in the compression syndromes of the central nervous system, which are compromised neuronal function and circulation. Objective: To determine the morphometric values of the foramen magnum on CT and its relation to sex and Mapuche ethnicity. Material and Method: Descriptive cross-sectional type made by non-probabilistic convenience sampling of 100 brain CT scans (CT) performed at the Hospital Hernán Henríquez Aravena in 2010 reported as"normal" for radiologists. Were selected 50 men and 50 women, integrating within each group 25 TC of subjects with surnames belonging to the Mapuche ethnicity. We measured the transverse diameter, anteroposterior diameter and area, in addition to determining the shape. The data was analyzed using Stata 10.1, comparing different variables with t-test, considering statistically significant a p value < 0.05. All subjects remained under anonymity in the built databases. Results: We found statistically significant differences in all measurements between men and women, being higher in males. There are also significant differences in the measurement of the area between Mapuche and non Mapuche patients, being lower in the first ones. The oval shape was predominant. Discussion: The different measurements between sexes are consistent with the literature. There are differences in measures of foramen magnum of Mapuche and non Mapuche patients and can serve as data for further studies in the area.

Phylogeny and evolution of the aspartyl protease family from clinically relevant Candida species

Aspartyl proteases are a class of enzymes that include the yeast aspartyl proteases and secreted aspartyl protease (Sap) superfamilies. Several Sap superfamily members have been demonstrated or suggested as virulence factors in opportunistic pathogens of the genus Candida. Candida albicans, Candida tropicalis, Candida dubliniensis and Candida parapsilosis harbour 10, four, eight and three SAP genes, respectively. In this work, genome mining and phylogenetic analyses revealed the presence of new members of the Sap superfamily in C. tropicalis (8), Candida guilliermondii (8), C. parapsilosis(11) and Candida lusitaniae (3). A total of 12 Sap families, containing proteins with at least 50 percent similarity, were discovered in opportunistic, pathogenic Candida spp. In several Sap families, at least two subfamilies or orthologous groups were identified, each defined by > 90 percent sequence similitude, functional similarity and synteny among its members. No new members of previously described Sap families were found in a Candida spp. clinical strain collection; however, the universality of SAPT gene distribution among C. tropicalis strains was demonstrated. In addition, several features of opportunistic pathogenic Candida species, such as gene duplications and inversions, similitude, synteny, putative transcription factor binding sites and genome traits of SAP gene superfamily were described in a molecular evolutionary context.

Metodología para evaluación del ruido ambiental urbano en la ciudad de Medellín / Assessment methodology of urban environmental noise in the city of Medellín

Objetivo: desarrollar una metodología que permita determinar el grado de exposición al ruido ambiental urbano de los habitantes de la ciudad de Medellín y verificar el cumplimiento de la legislación colombiana al respecto. Materiales y métodos: se hizo un estudio descriptivo de corte transversal bietápico en cuya primera fase se recogió información, mediante una encuesta, acerca de la percepción que se tiene sobre la presencia del ruido urbano; en la segunda fase se midieron los niveles de presión sonora y se compararon con los límites permisibles. Resultados: la metodología desarrollada fue probada con una prueba piloto en la comuna La Candelaria, donde 67 por ciento de esa población reportó molestia ocasionada por el ruido urbano, el 81 por ciento en horario diurno, y que en general destacó como principal fuente emisora el tráfico vehicular. Las mediciones de ruido se realizaron en 16 puntos del barrio Prado, y se encontró que 94 por ciento de los puntos evaluados superan los límites permisibles establecidos en la legislación colombiana; además, se detectó que en el interior de este barrio, considerado como residencial, existe un sector significativo con connotación de zona de tranquilidad. Conclusiones:esta metodología permite determinar si una comunidad está expuesta o no a niveles de ruido superiores a los establecidos en las normas colombianas, así como también identificar las fuentes emisoras y validar la conformación de zonas urbanas.