Consenso Colombiano de Tratamiento del Espectro de Acretismo Placentario (EAP) / Colombian Consensus on the Treatment of Placenta Accreta Spectrum (PAS)

RESUMEN Introducción: el espectro de acretismo placentario (EAP) es una condición asociada a sangrado masivo posparto y mortalidad materna. Las guías de manejo publicadas en países de altos ingresos recomiendan la participación de grupos interdisciplinarios en hospitales con recursos suficientes para realizar procedimientos complejos. Sin embargo, algunas de las recomendaciones de estas guías resultan difíciles de aplicar en países de bajos y medianos ingresos. Objetivos: este consenso busca formular recomendaciones generales para el tratamiento del EAP en Colombia. Materiales y métodos: en el consenso participaron 23 panelistas, quienes respondieron 31 preguntas sobre el tratamiento de EAP. Los panelistas fueron seleccionados con base en la participación en dos encuestas realizadas para determinar la capacidad resolutiva de hospitales en el país y la región. Se utilizó la metodología Delphi modificada, incorporando dos rondas sucesivas de discusión. Para emitir las recomendaciones el grupo tomó en cuenta la opinión de los participantes, que lograron un consenso mayor al 80 %, así como las barreras y los facilitadores para su implementación. Resultados: el consenso formuló cinco recomendaciones integrando las respuestas de los panelistas. Recomendación 1. Las instituciones de atención primaria deben realizar búsqueda activa de EAP en pacientes con factores de riesgo: placenta previa e historia de miomectomía o cesárea en embarazo previo. En caso de haber signos sugestivos de EAP por ecografía, las pacientes deben ser remitidas de manera inmediata, sin tener una edad gestacional mínima, a hospitales reconocidos como centros de referencia. Las modalidades virtuales de comunicación y atención en salud pueden facilitar la interacción entre las instituciones de atención primaria y los centros de referencia para EAP. Se debe evaluar el beneficio y riesgo de las modalidades de telemedicina. Recomendación 2. Es necesario que se definan hospitales de referencia para EAP en cada región de Colombia, asegurando el cubrimiento de la totalidad del territorio nacional. Es aconsejable concentrar el flujo de pacientes afectadas por esta condición en unos pocos hospitales, donde haya equipos de cirujanos con entrenamiento específico en EAP, disponibilidad de recursos especializados y un esfuerzo institucional por mejorar la calidad de atención, en busca de tener mejores resultados en la salud de las gestantes con esta condición. Para lograr ese objetivo los participantes recomiendan que los entes reguladores de la prestación de servicios de salud a nivel nacional, regional o local vigilen el proceso de remisión de estas pacientes, facilitando rutas administrativas en caso de que no exista contrato previo entre el asegurador y el hospital o la clínica seleccionada (IPS). Recomendación 3. En los centros de referencia para pacientes con EAP se invita a la creación de equipos que incorporen un grupo fijo de especialistas (obstetras, urólogos, cirujanos generales, radiólogos intervencionistas) encargados de atender todos los casos de EAP. Es recomendable que esos grupos interdisciplinarios utilicen el modelo de "paquete de intervención" como guía para la preparación de los centros de referencia para EAP. Este modelo consta de las siguientes actividades: preparación de los servicios, prevención e identificación de la enfermedad, respuesta ante la presentación de la enfermedad, aprendizaje luego de cada evento. La telemedicina facilita el tratamiento de EAP y debe ser tenida en cuenta por los grupos interdisciplinarios que atienden esta enfermedad. Recomendación 4. Los residentes de Obstetricia deben recibir instrucción en maniobras útiles para la prevención y el tratamiento del sangrado intraoperatorio masivo por placenta previa y EAP, tales como: la compresión manual de la aorta, el torniquete uterino, el empaquetamiento pélvico, el bypass retrovesical y la maniobra de Ward. Los conceptos básicos de diagnóstico y tratamiento de EAP deben incluirse en los programas de especialización en Ginecología y Obstetricia en Colombia. En los centros de referencia del EAP se deben ofrecer programas de entrenamiento a los profesionales interesados en mejorar sus competencias en EAP de manera presencial y virtual. Además, deben ofrecer soporte asistencial remoto (telemedicina) permanente a los demás hospitales en su región, en relación con pacientes con esa enfermedad. Recomendación 5. La finalización de la gestación en pacientes con sospecha de EAP y placenta previa, por imágenes diagnósticas, sin evidencia de sangrado vaginal activo, debe llevarse a cabo entre las semanas 34 y 36 6/7. El tratamiento quirúrgico debe incluir intervenciones secuenciales que pueden variar según las características de la lesión, la situación clínica de la paciente y los recursos disponibles. Las opciones quirúrgicas (histerectomía total y subtotal, manejo quirúrgico conservador en un paso y manejo expectante) deben incluirse en un protocolo conocido por todo el equipo interdisciplinario. En escenarios sin diagnóstico anteparto, es decir, ante un hallazgo intraoperatorio de EAP (evidencia de abultamiento violáceo o neovascularización de la cara anterior del útero), y con participación de personal no entrenado, se plantean tres situaciones: Primera opción: en ausencia de indicación de nacimiento inmediato o sangrado vaginal, se recomienda diferir la cesárea (cerrar la laparotomía antes de incidir el útero) hasta asegurar la disponibilidad de los recursos recomendados para llevar a cabo una cirugía segura. Segunda opción: ante indicación de nacimiento inmediato (por ejemplo, estado fetal no tranquilizador), pero sin sangrado vaginal o indicación de manejo inmediato de EAP, se sugiere realizar manejo en dos tiempos: se realiza la cesárea evitando incidir la placenta, seguida de histerorrafia y cierre de abdomen, hasta asegurar la disponibilidad de los recursos recomendados para llevar a cabo una cirugía segura. Tercera opción: en presencia de sangrado vaginal que hace imposible diferir el manejo definitivo de EAP, es necesario extraer el feto por el fondo del útero, realizar la histerorrafia y reevaluar. En ocasiones, el nacimiento del feto disminuye el flujo placentario y el sangrado vaginal se reduce o desaparece, lo que hace posible diferir el manejo definitivo de EAP. Si el sangrado significativo persiste, es necesario continuar con la histerectomía haciendo uso de los recursos disponibles: compresión manual de la aorta, llamado inmediato a los cirujanos con mejor entrenamiento disponible, soporte de grupos expertos de otros hospitales a través de telemedicina. Si una paciente con factores de riesgo para EAP (por ejemplo, miomectomía o cesárea previa) presenta retención de placenta posterior al parto vaginal, es recomendable confirmar la posibilidad de dicho diagnóstico (por ejemplo, realizando una ecografía) antes de intentar la extracción manual de la placenta. Conclusiones: esperamos que este primer consenso colombiano de EAP sirva como base para discusiones adicionales y trabajos colaborativos que mejoren los resultados clínicos de las mujeres afectadas por esta enfermedad. Evaluar la aplicabilidad y efectividad de las recomendaciones emitidas requerirá investigaciones adicionales.

ABSTRACT Introduction: Placenta accreta spectrum (PAS) is a condition associated with massive postpartum bleeding and maternal mortality. Management guidelines published in high income countries recommend the participation of interdisciplinary teams in hospitals with sufficient resources for performing complex procedures. However, some of the recommendations contained in those guidelines are difficult to implement in low and medium income countries. Objectives: The aim of this consensus is to draft general recommendations for the treatment of PAS in Colombia Materials and Methods: Twenty-three panelists took part in the consensus with their answers to 31 questions related to the treatment of PAS. The panelists were selected based on participation in two surveys designed to determine the resolution capabilities of national and regional hospitals. The modified Delphi methodology was used, introducing two successive discussion rounds. The opinions of the participants, with a consensus of more than 80 %, as well as implementation barriers and facilitators, were taken into consideration in order to issue the recommendations. Results: The consensus drafted five recommendations, integrating the answers of the panelists. Recommendation 1. Primary care institutions must undertake active search of PAS in patients with risk factors: placenta praevia and history of myomectomy or previous cesarean section. In case of ultrasound signs suggesting PAS, patients must be immediately referred, without a minimum gestational age, to hospitals recognized as referral centers. Online communication and care modalities may facilitate the interaction between primary care institutions and referral centers for PAS. The risks and benefits of telemedicine modalities must be weighed. Recommendation 2. Referral hospitals for PAS need to be defined in each region of Colombia, ensuring coverage throughout the national territory. It is advisable to concentrate the flow of patients affected by this condition in a few hospitals with surgical teams specifically trained in PAS, availability of specialized resources, and institutional efforts at improving quality of care with the aim of achieving better health outcomes in pregnant women with this condition. To achieve this goal, participants recommend that healthcare regulatory agencies at a national and regional level should oversee the process of referral for these patients, expediting administrative pathways in those cases in which there is no prior agreement between the insurer and the selected hospital or clinic. Recommendation 3. Referral centers for patients with PAS are urged to build teams consisting of a fixed group of specialists (obstetricians, urologists, general surgeons, interventional radiologists) entrusted with the care of all PAS cases. It is advisable for these interdisciplinary teams to use the "intervention bundle" model as a guidance for building PAS referral centers. This model comprises the following activities: service preparedness, disease prevention and identification, response to the occurrence of the disease, and debriefing after every event. Telemedicine facilitates PAS treatment and should be taken into consideration by interdisciplinary teams caring for this disease. Recommendation 4. Obstetrics residents must be instructed in the performance of maneuvers that are useful for the prevention and treatment of massive intraoperative bleeding due to placenta praevia and PAS, including manual aortic compression, uterine tourniquet, pelvic packing, retrovesical bypass, and Ward maneuver. Specialization Obstetrics and Gynecology programs in Colombia must include the basic concepts of the diagnosis and treatment of PAS. Referral centers for PAS must offer online and in-person training programs for professionals interested in improving their competencies in PAS. Moreover, they must offer permanent remote support (telemedicine) to other hospitals in their region for patients with this condition. Recommendation 5. Patients suspected of having PAS and placenta praevia based on imaging, with no evidence of active vaginal bleeding, must be delivered between weeks 34 and 36 6/7. Surgical treatment must include sequential interventions that may vary depending on the characteristics of the lesion, the clinical condition of the patient and the availability of resources. The surgical options (total and subtotal hysterectomy, one-stage conservative surgical management and watchful waiting) must be included in a protocol known by the entire interdisciplinary team. In situations in which an antepartum diagnosis is lacking, that is to say, in the face of intraoperative finding of PAS (evidence of purple bulging or neovascularization of the anterior aspect of the uterus), and the participation of untrained personnel, three options are considered: Option 1: In the absence of indication of immediate delivery or of vaginal delivery, the recommendation is to postpone the cesarean section (close the laparotomy before incising the uterus) until the recommended resources for safe surgery are secured. Option 2: If there is an indication for immediate delivery (e.g., non-reassuring fetal status) but there is absence of vaginal bleeding or indication for immediate PAS management, a two-stage management is suggested: cesarean section avoiding placental incision, followed by uterine repair and abdominal closure, until the availability of the recommended resources for safe surgery is ascertained. Option 3: In the event of vaginal bleeding that prevents definitive PAS management, the fetus must be delivered through the uterine fundus, followed by uterine repair and reassessment of the situation. Sometimes, fetal delivery diminishes placental flow and vaginal bleeding is reduced or disappears, enabling the possibility to postpone definitive management of PAS. In case of persistent significant bleeding, hysterectomy should be performed, using all available resources: manual aortic compression, immediate call to the surgeons with the best available training, telemedicine support from expert teams in other hospitals. If a patient with risk factors for PAS (e.g., myomectomy or previous cesarean section) has a retained placenta after vaginal delivery, it is advisable to confirm the possibility of such diagnosis (by means of ultrasound, for example) before proceeding to manual extraction of the placenta. Conclusions: It is our hope that this first Colombian consensus on PAS will serve as a basis for additional discussions and collaborations that can result in improved clinical outcomes for women affected by this condition. Additional research will be required in order to evaluate the applicability and effectiveness of these recommendations.

Safety & effectiveness of COVID-19 vaccines: A narrative review

There are currently eight vaccines against SARS-CoV-2 that have received Emergency Use Authorization by the WHO that can offer some protection to the world’s population during the COVID-19 pandemic. Though research is being published all over the world, public health officials, policymakers and governments are collecting evidence-based information to establish the public health policies. Unfortunately, continued international travel, violations of lockdowns and social distancing, the lack of mask use, the emergence of mutant strains of the virus and lower adherence by a sector of the global population that remains sceptical of the protection offered by vaccines, or about any risks associated with vaccines, hamper these efforts. Here we examine the literature on the efficacy, effectiveness and safety of COVID-19 vaccines, with an emphasis on select categories of individuals and against new SARS-CoV-2 strains. The literature shows that these eight vaccines are highly effective in protecting the population from severe disease and death, but there are some issues concerning safety and adverse effects. Further, booster shots and variant-specific vaccines would also be required.

Ultrasound evaluation of schistosomiasis-related morbidity among the Xakriabá people in the state of Minas Gerais, Brazil / Avaliação ultrassonográfica da morbidade por esquistossomose mansoni na população indígena Xakriabá, Minas Gerais, Brasil

Abstract Objective: To use ultrasound to investigate the morbidity related to schistosomiasis in the Xakriabá indigenous population. Materials and Methods: This was a field-based census study conducted in the territory of the Xakriabá people. A total of 166 individuals were invited, and 148 (≤ 77 years of age) agreed to participate. Most participants underwent abdominal ultrasound, physical examination, and stool examination. Mann-Whitney U and chi-square tests were used for comparisons. We determined risk by calculating odds ratio (OR) and performed logistic regression analysis. Results: Schistosoma mansoni eggs were found in 31 (26.7%) of the 116 stool samples examined, 22 (70.9%) of the 31 being from individuals 4-16 years of age. The median count was 144 eggs/g of feces (interquartile range, 264). Of the 105 participants examined with ultrasound, 68 (64.8%) had hepatomegaly (left lobe), 6 (5.7%) had splenomegaly, and 4 (3.8%) had portal hypertension. Egg-positive stool samples were more common in those with an enlarged left lobe (OR = 3.4; 95% confidence interval (CI): 1.1-11.2; p = 0.043). Periportal fibrosis was found in 30 participants (28.6%), of whom 9 (30%) had pattern C, 10 (33.3%) had pattern D, and 11 (36.7%) had pattern Dc. Age was the only independent risk factor for fibrosis (p = 0.007). Fibrosis was up to nine-fold more common in alcohol drinkers than in nondrinkers (OR = 9.28; 95% CI: 2.60-33.06; p < 0.001). Among the 138 participants in whom the clinical form was classified, the chronic hepatic form was identified in 54 (39.1%), of whom 32 (59.2%) were under 30 years of age and one (1.8%) was hepatosplenic. Conclusion: Schistosomiasis in the Xakriabá population is characterized by a high frequency of egg-positive stool samples, predominantly in children/adolescents, and by chronic hepatic form in the young, especially among alcohol drinkers.

Resumo Objetivo: Investigar a morbidade por esquistossomose na população indígena Xakriabá usando a ultrassonografia. Materiais e Métodos: Estudo de campo censitário realizado na terra da população indígena Xakriabá (166 convidados; 148 participantes; idade de 0-77). Foram feitos ultrassonografia abdominal, exame físico e coproscopia (EPF). Os testes Mann-Whitney U e qui-quadrado foram usados para comparações. Foram realizadas análise de risco (odds ratio - OR) e regressão logística. Resultados: De 116 índios com resultado de EPF, 31 (26,7%) tiveram ovos de Schistosoma; 22/31 (70,9%) tinham idade entre 4-16 anos. A carga parasitaria mediana foi 144 ovos/g (intervalo interquartílico: 264). De 105 examinados por ultrassom, 68 (64,8%) tiveram lobo hepático esquerdo aumentado, 6 (5,7%) tiveram esplenomegalia e 4 (3,8%) tiveram hipertensão portal. EPF+ foi mais frequente nos indivíduos com lobo esquerdo aumentado (OR: 3,4; intervalo de confiança (IC) 95%: 1,1-11,2; p = 0,043). Fibrose periportal ocorreu em 30/105 (28,6%) examinados, e desses 30, 9 (30%) apresentavam padrão C, 10 (33,3%) apresentavam padrão D e 11 (36,7%) apresentavam padrão Dc. A idade foi o único fator de risco independente para fibrose (p = 0,007). A fibrose ocorreu até nove vezes mais em usuários de álcool que em não usuários (OR: 9,28; IC 95%: 2,60-33,06; p < 0,001). Formas crônicas ocorreram em 54/138 (39,1%) participantes, sendo 32 dos 54 (64,8%) em menores de 30 anos; um (1,8%) era hepatoesplênico. Conclusão: A esquistossomose na população Xakriabá caracteriza-se por alta positividade, predomínio em crianças e presença de formas hepáticas crônicas em jovens, especialmente entre usuários de álcool.

Relationship between skeletal Class II and Class III malocclusions with vertical skeletal pattern

ABSTRACT Objective: The purpose of this study was to establish the association between sagittal and vertical skeletal patterns and assess which cephalometric variables contribute to the possibility of developing skeletal Class II or Class III malocclusion. Methods: Cross-sectional study. The sample included pre-treatment lateral cephalogram radiographs from 548 subjects (325 female, 223 male) aged 18 to 66 years. Sagittal skeletal pattern was established by three different classification parameters (ANB angle, Wits and App-Bpp) and vertical skeletal pattern by SN-Mandibular plane angle. Cephalometric variables were measured using Dolphin software (Imaging and Management Solutions, Chatsworth, Calif, USA) by a previously calibrated operator. The statistical analysis was carried out with Chi-square test, ANOVA/Kruskal-Wallis test, and an ordinal multinomial regression model. Results: Evidence of association (p< 0.05) between sagittal and vertical skeletal patterns was found with a greater proportion of hyperdivergent skeletal pattern in Class II malocclusion using three parameters to assess the vertical pattern, and there was more prevalent hypodivergence in Class III malocclusion, considering ANB and App-Bpp measurements. Subjects with hyperdivergent skeletal pattern (odds ratio [OR]=1.85-3.65), maxillary prognathism (OR=2.67-24.88) and mandibular retrognathism (OR=2.57-22.65) had a significantly (p< 0.05) greater chance of developing skeletal Class II malocclusion. Meanwhile, subjects with maxillary retrognathism (OR=2.76-100.59) and mandibular prognathism (OR=5.92-21.50) had a significantly (p< 0.05) greater chance of developing skeletal Class III malocclusion. Conclusions: A relationship was found between Class II and Class III malocclusion with the vertical skeletal pattern. There is a tendency toward skeletal compensation with both vertical and sagittal malocclusions.

RESUMO Objetivo: o objetivo do presente estudo foi estabelecer a relação entre os padrões esqueléticos sagitais e verticais, e avaliar quais variáveis esqueléticas podem influenciar na chance de desenvolver uma má oclusão de Classe II ou de Classe III esquelética. Métodos: foi feito um estudo transversal, cuja amostra incluiu radiografias cefalométricas laterais pré-tratamento de 548 pacientes (325 mulheres, 223 homens), com idades entre 18 e 66 anos. O padrão esquelético sagital foi estabelecido por meio de três parâmetros distintos de classificação (ângulo ANB, Wits, App-Bpp); e o padrão esquelético vertical, por meio do ângulo SN.Plano Mandibular. As variáveis cefalométricas foram aferidas utilizando-se o software Dolphin (Imaging and Management Solutions, Chatsworth, Calif, EUA) por um avaliador previamente calibrado. A análise estatística foi realizada por meio do teste qui-quadrado, teste ANOVA/Kruskal-Wallis e modelo de regressão multinomial ordinal. Resultados: foram encontradas evidências de associação significativa (p< 0,05) entre os padrões esqueléticos sagitais e verticais, com maior proporção do padrão esquelético hiperdivergente nas más oclusões de Classe II, segundo os três parâmetros utilizados. Na Classe III, houve maior proporção do padrão esquelético hipodivergente, considerando-se os parâmetros ANB e App-Bpp. Pacientes com padrões esqueléticos hiperdivergentes (odds ratio [OR] = 1,85 - 3,65), prognatismo maxilar (OR=2,67 - 24,88) e retrognatismo mandibular (OR=2,57 - 22,65) apresentaram chance significativamente maior (p< 0,05) de desenvolver má oclusão esquelética de Classe II. Por outro lado, pacientes com retrognatismo maxilar (OR=2,76 - 100,59) e prognatismo mandibular (OR=5,92 - 21,50) apresentaram uma chance significativamente maior (p< 0,05) de desenvolver má oclusão esquelética de Classe III. Conclusões: Foi encontrada uma associação entre as más oclusões de Classe II e Classe III e o padrão esquelético vertical. Há uma tendência à compensação esquelética tanto nas más oclusões verticais quanto nas sagitais.

Estudio de casos de Leishmaniasis cutánea registrados en un hospital público en Portoviejo, Ecuador / Case studies of cutaneous Leishmaniasis registered at a public hospital in Portoviejo City, Ecuador

Laleishmaniasis cutánea (LC) es una zoonosis endémica y un problema de salud pública en el Ecuador. En los últimos años, Manabí, es la provincia más incidente de Leishmania como consecuencia de los desastres naturales ocurridos y la migración de locales a las áreas rurales.El objetivo del estudio es determinarlos aspectos clínicos yepidemiológicosde la Leishmania.El estudio de casos de datos secundarios, reclutó 4 pacientes registrados en el hospital regional de Portoviejo en Manabí, en el 2017. La determinación clínica (características de las lesiones) y epidemiológica de la leishmaniasis, así como el diagnóstico complementario de las muestras (polo benigno) con frotis directo fueron evaluados. La determinación taxonómica de Leishmaniano se prescribe en entidades públicas gubernamentales.El análisis descriptivo se realizó en M. Excel, determinándose la LC en el 100% (N=4) de las mujeres, de entre 1 a 43 años, 3 (75%) de ellas <16 años. Solo 1 (25%) paciente acudió a la consulta hospitalaria por las lesiones dérmicas mientras que el resto [n=3 (75%)], fueron determinadas como un hallazgo fortuito durante la hospitalización por otras entidades clínicas emergentes. El 25% (n=1) de ellas, recibió tratamiento hospitalario con glucantime, mientras que el 75% (n=3) de ellas fueron derivados a hospitales de segundo nivel. La necesidad urgente de capitación del equipo médico de la atención primaria es inherente para la identificación oportuna de Leishmaniasis comunitaria para mejorar la supervisión epidemiológica de la zoonosis. Aún existen reportes clínicos diagnósticos erróneos sobre las lesiones dérmicas, sin considerar los aspectos epidemiológicos y de laboratorio que pueden ayudar a determinarLC.

The cutaneous leishmaniasis (CL) is an endemic zoonosis and a public health problem in Ecuador. In recent years, Manabí is the most incident province with Leishmania as a result of recent natural disasters and the migration of locals to rural areas. The Aim of this study is to determine the clinical and epidemiological aspects of Leishmania. The case study used secondary data cases and recruited 4 patients, registered at a tertiary hospital in Portoviejo, Manabí, in 2017. The clinical (characteristics of the lesions) and epidemiological determination of CL, as well as the complementary diagnosis of skin samples (benign pole) with direct smear were evaluated. The taxonomic determination of Leishmania is not prescribed in public health institutions. The descriptive analysis was performed in M. Excel. The CL was determined in 100% (N=4) of women between 1 to 43 years, 3 (75%) of them <16 years. Only 1 (25%) patient attended the hospital checking out for skin lesions while the rest [n=3 (75%)] were determined as a fortuitous finding during hospitalization by other emerging clinical entities. Only 25% (n=1) of them received treatment with glucantime at hospital, while 75% (n=3) of them were referred to second level hospitals. The urgent need for training of health workers at primary care level is inherent to the timely identification of community leishmaniasis, to improve epidemiological surveillance upon the zoonoses. Some mistakes in diagnosis of skin lesions, without considering the epidemiological and laboratory aspects, in order to determine cutaneous leishmaniasis, have been reported.

Inflammatory response in pregnant women with high risk of preterm delivery and its relationship with periodontal disease: a pilot study / Respuesta inflamatoria en pacientes embarazadas con alto riesgo de parto pretérmino y su relación con la enfermedad periodontal. Estudio piloto

Periodontal disease and its inflammatory response have been related to adverse outcomes in pregnancy such as preterm birth, preeclampsia and low birth weight. This study analyzed systemic inflammatory response in patients with high risk of preterm delivery and its relationship to periodontal disease. A pilot study was conducted for a case and control study, on 23 patients at risk of preterm delivery and 23 patients without risk of preterm delivery as controls. Exclusion criteria were patients who had received periodontal treatment, antibiotic or antimicrobial agents within the past three months, or with infections or baseline diseases such as diabetes or hypercholesterolemia. All patients underwent periodontal assessment, laboratory tests (complete blood count, lipid profile, baseline glycemia) and quantification of cytokines (IL2, IL4, IL6, IL10, TNFα and INFγ). Higher levels of proinflammatory cytokines (IL2, IL4, IL6, IL10, TNFα and INFγ) were found in patients with chronic periodontitis than in patients with gingivitis or periodontal health. These cytokines, in particular IL2, IL10 and TNFα, were higher in patients at high risk of preterm delivery. Patients with high risk of preterm delivery had higher severity of periodontal disease as well as higher levels of the proinflammatory markers IL2, IL4, IL6, IL10, TNFα and INFγ (AU)

La enfermedad periodontal y su repuesta inflamatoria ha sido relacionada con desenlaces adversos del embarazo como el parto pretérmino, preeclampsia y bajo peso al nacer. La presente investigación analizó la respuesta inflamatoria sistémica en pacientes embarazadas con alto riesgo de parto pretérmino y su relación con la enfermedad periodontal. Se realizó un estudio piloto de casos y controles, en el cual se contó con 23 pacientes que presentaban riesgo de parto pretérmino como casos y 23 pacientes sin riesgo de parto pretérmino como controles. Fueron excluidas las pacientes que hubieran recibido tratamiento periodontal, antibióticos o antimicrobianos en los últimos tres meses, que tuvieran infecciones, o enfermedades de base como diabetes o hipercolesterolemia. A todas las pacientes se les hicieron valoración periodontal, exámenes de laboratorio (cuadro hemático, perfil lipídico, glucemia basal) y cuanti ficación de citocinas (IL2, IL4, IL6, IL10, TNFα e INFγ). En las pacientes con periodontitis crónica se encontraron niveles más elevados en las citocinas proinflamatorias (IL2, IL4, IL6, IL10, TNFα e INFγ) en comparación con las pacientes con gingivitis o sanas periodontales. Estas citocinas se encontraron más elevadas en las pacientes con alto riesgo de parto pretérmino, en especial la IL2, IL10 y TNFα. Las pacientes con alto riesgo de parto pretérmino presentaron mayor severidad de la enfermedad periodontal y adicional mente niveles aumentados de los marcadores pro inflamatorios IL2, IL4, IL6, IL10, TNFα e INFγ (AU)

Ivan oransky: the 2004-2006 digital undertaker for Elsevier's the lancet

Dr. Ivan Oransky is a self-proclaimed science watchdog who, together with Adam Marcus, have taken on the world of science in a blaze of public shaming – disguised as science journalism – that has already caused irreparable damage to science, despite the informative nature of those reports. Their portal for launching attacks on the publishing establishment and on scientists is Retraction Watch, a blog that sees monthly traffic in the hundreds of thousands of hits. One of the loudly claimed key tenants of Retraction Watch is to hold science and scientists accountable, and to thus be open and transparent. What is not very known, because Oransky fails to provide a full listing of his own publications, i.e., he does not show equivalent transparency that he expects or demands from others, is that he held a very important role at Elsevier's The Lancet, a premier medical journal that he now aggressively critiques, almost without impunity. That role at The Lancet was primarily to record the death of medical scientists. In the real world, taking care of the dead and the deceased lies in the hands of an undertaker. It is thus very apt that the role of digital undertaker for The Lancet established the necessary credentials that Oransky required to overlook the cadaver he and Marcus wish to create of science, and of scientists’ and publishers’ reputations.

On the abuse of online submission systems, fake peer reviews and editor-created accounts / Sobre el abuso de sistemas de presentación en línea, falsos comentarios de pares y cuentas creadas por el editor / Sobre abuso de sistemas de apresentação on-line, falsos comentários de pares e contas criadas pelo editor

ABSTRACT Many journals and publishers employ online submission systems (OSSs) to process manuscripts. In some cases, one "template" format exists, but it is then molded slightly to suit the specific needs of each journal, a decision made by the editor-in-chief or editors. In the past few years, there has been an increase in the number of cases in which OSSs have been abused, mostly by the authorship, either through the creation of fake identities or the use of false e-mail accounts. Although the abusive or fraudulent authors are at fault in such cases, the fact that such cases remained undetected for so long is of concern. Moreover, the current OSSs are imperfect, have security issues and may not be able to detect false information, except through post-submission verification. Sting operations, which involve the submission of false manuscripts with false identities and false affiliations, are no less unethical, and those who abuse the publishing protocol deserve to be as reprimanded as those who abuse OSSs. Finally, I question the ethics of editors or publishers creating OSS accounts on behalf of reviewers prior to obtaining their explicit permission.

RESÚMEN Muchas revistas y editores emplean sistemas de envío en línea (OSS, por su sigla en inglés) para el procesamiento de manuscritos. En algunos casos, existe un formato único de "plantilla", que luego se moldea ligeramente para adaptarse a las necesidades específicas de cada revista, según la decisión tomada por el editor en jefe o los editores. En los últimos años ha habido un aumento en el número de casos en que los OSS han sido abusados, principalmente por la autoría, ya sea mediante la creación de falsas identidades o el uso de cuentas de correo electrónico falsas. Aunque los autores abusivos o fraudulentos son culpables en tales casos, el hecho de que estos no hayan sido detectados durante tanto tiempo es motivo de preocupación. Además, los OSS actuales son imperfectos, tienen problemas de seguridad y pueden no ser capaces de detectar información falsa, excepto a través de la verificación posterior a la presentación del manuscrito. Las operaciones de relámpago, que implican la presentación de manuscritos falsos con falsas identidades y falsas afiliaciones, no son menos éticas, y quienes abusan del protocolo de publicación merecen ser tan amonestados como aquellos que abusan de los OSS. Finalmente, el autor del artículo cuestiona la ética de los editores o editores que crean cuentas OSS en nombre de los revisores, antes de obtener su permiso explícito.

RESUMO Muitas revistas e editores empregam sistemas de envio on-line (OSS, por sua sigla em inglês) para o processamento de manuscritos. Em alguns casos, há um formulário único de "modelo", que logo é adaptado superficialmente para as necessidades de cada revista, segundo a decisão tomada pelo editor-chefe ou pelos editores. Nos últimos anos, tem ocorrido um aumento no número de casos em que se tem abusado dos OSS, principalmente pela autoria, seja mediante a criação de falsas identidades, seja pelo uso de contas de e-mail falsas. Embora os autores abusadores ou fraudulentos sejam culpados nesses casos, o fato de que isso não tenha sido detectado durante tanto tempo é motivo de preocupação. Além disso, os OSS atuais são imperfeitos, têm problemas de segurança e podem não ser capazes de detectar informação falsa, exceto por meio da conferência posterior à apresentação do manuscrito. As operações relâmpago, que implicam a apresentação de textos falsos com falsas identidades e afiliações não são menos éticas, e os que abusam do protocolo de publicação merecem ser tão punidos quanto aqueles que abusam dos OSS. Finalmente, o autor deste artigo questiona a ética dos editores ou dos editores que criam contas OSS em nome dos pares avaliadores antes de obter sua autorização explícita.

Pay Walled Retraction Notices.

Abstract: A retraction of a scientific paper is made, most often due to errors or lack of publishing ethics on the part of authors, or, on occasion, duplicate publication by a publisher in error. The retraction notice that accompanies the retraction is an extremely important document, because it is the only information that provides a background to the public regarding the reason why the manuscript was retracted. In most cases, if the retraction notice is truly transparent, it will contain a few sentences that indicate the reason, and possibly also the authors’ responsible, among other facts. According to the Committee on Publication Ethics (COPE), retraction notices should be free to view, i.e. open access. This opinion piece exposes how several publishers are selling access to retraction notices, including COPE members, despite, in some cases, being paying COPE members. The business and academic ethics of such an action is thus called into question.

Evaluación del cuestionario SF-12: verificación de la utilidad de la escala salud mental / Evaluation of the SF-12: Usefulness of the mental health scale

Background: The SF-12 is one of the most used questionnaires to evaluate the multidimensional health related quality of life, worldwide. However, the factor structure does not match the structure of the original instrument. Besides, most studies centered in the physical dimension paying less attention to mental health related quality of life. Aim: To evaluate the psychometric properties of the SF-12 and to validate the mental health dimension of this questionnaire. Material and Methods: Two studies were conducted, the first consisting of 840 people aged between 18 and 60 years, who answered the SF-12. In the second study, 970 people aged between 18 and 60 years answered the SF-12 questionnaire, the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). Reliability (internal consistency and temporal stability) was analyzed, along with construct and criterion validity for the mental health dimension. Results: The reliability estimate using Cronbach’s alpha in both studies was higher than 0.74 in both dimensions (physical and psychological). Construct validity analysis yielded a three factor complex solution. Finally the criterion validity analysis showed appropriate and significant correlations with depression and anxiety. Conclusions: The SF-12 and its mental health scale are suitable for epidemiological characterization studies.

Efectos de las experiencias adversas temprana y tardía en las características morfométricas y estereológicas de la glándula suprarrenal de ratas Sprague Dawley sometidas a estrés durante su vida adulta / Effects of early and late adverse experiences in morphometric and stereological characteristics of the adrenal gland of Sprague Dawley rats subjected to stress during adulthood

La ruptura temprana del vínculo materno y el aislamiento social son variables que están involucradas con los comportamientos social y emocional y también con el aumento de la ansiedad, especialmente en situaciones estresantes. Sin embargo, no se dispone de investigaciones que expliquen los cambios morfológicos de la glándula suprarrenal (GSR). Por lo anterior, el objetivo de este trabajo fue conocer experimentalmente, a través del modelo de alteración del vínculo social temprano madre-cría y alteración del vínculo social tardío por aislamiento, el efecto sobre las características morfométricas y estereológicas de la GSR, en ratas de la cepa Sprague Dawley sometidas a estrés crónico intermitente en la vida adulta. Utilizamos 35 ratas hembras recién nacidas, distribuidas en grupos de 7, en condiciones de lactancia y alimentación estandarizadas. Los grupos experimentales fueron expuestos a experiencias adversas temprana (E1), tardía (E2), temprana-tardía (E3) y posteriormente, sometidas a estrés crónico intermitente en la adultez. Se aisló la GSR izquierda de cada animal determinando características morfométricas y parámetros estereológicos. El peso absoluto fue mayor en los grupos control C2 y grupo experimental (E1). El número de células por mm3, el porcentaje de tejido glandular y la densidad de superficie en la zona fascicular de la GSR fue menor en el grupo E3. Las características estereológicas de la GRS en ratas, no sólo pueden ser afectadas por la exposición al estrés en la adultez, sino que también las experiencias adversas temprana y/o tardía juegan un rol importante en los cambios de los parámetros morfológicos cuantitativos observados en esta glándula.

The early break in maternal bonding and social isolation are variables involved with social and emotional behaviors and also with increased anxiety, especially in stressful situations. However, there is no research to explain the morphological changes of the adrenal gland (GSR). Therefore, our objective was to experimentally study through alteration model of social ties and early mother-cub bond alteration belated social isolation, the effect on the morphometric and stereological characteristics of the GSR in rats of the Sprague Dawley subjected to intermittent chronic stress in adulthood. We used 35 newborn female rats, divided into groups of 7 under lactating and standardized feeding conditions. The experimental groups were exposed to adverse experiences early (E1), late (E2), and early/late (E3) and subsequently, subject to intermittent chronic stress in adulthood. Left GSR was isolated from each animal determining morphometric characteristics and stereological parameters. The absolute weight was higher in control group C2 and the experimental group E1. In the group E3 number of cells per mm3, the percentage of glandular tissue and density of the surface in the fascicular area of the GSR was lower. Stereological characteristics of the GRS in rats, not only can be affected by exposure to stress in adulthood, but also early and / or late adverse experiences play an important role in the changes of quantitative morphological parameters observed in this gland.

Escala de bienestar de Ryff: análisis comparativo de los modelos teóricos en distintos grupos de edad / Ryff scale of well-being: factorial structure of theoretical models in different age groups

La escala de bienestar psicológico surge a partir del modelo multidimensional propuesto por Ryff (1989). Pese a su amplia utilización, su estructura teórica inicial no ha sido confirmada completamente, debido a que se han encontrado otro tipo de soluciones factoriales distintas a las 6 dimensiones propuestas por la autora. Estas divergencias podrían estar relacionadas al tipo de muestras y poblaciones utilizadas. Ante esto, la siguiente investigación compara el ajuste factorial de los modelos tradicionalmente aplicados de corrección en distintos grupos en edad adulta. Se describen las propiedades psicométricas de la adaptación al español realizada por Díaz et al. (2006), analizando los niveles de confiabilidad (consistencia interna y estabilidad temporal) y estructura factorial confirmatoria, en datos de 1646 personas entre 18 y 90 años de edad. Se encuentran diferencias en los indicadores de confiabilidad para la escala total y las dimensiones, así como en los indicadores de bondad de ajuste dependiendo del grupo de edad. El modelo que presenta mejores indicadores de ajuste en la mayoría de los rangos etarios evaluados fue el de seis factores de primer orden.

The scale of psychological well-being arises from the multidimensional model proposed by Ryff (1989). Despite its wide use, its initial theoretical structure has not been completely confirmed because other factorial solutions which are different from those 6 dimensions proposed by the author have been found. These differences may be related to the type of sample and population used. Given this fact, the current study compares the adjustment factor of correction models traditionally used in different groups of adults. We describe the psychometric properties of the Spanish adaptation done by Díaz et al. (2006) and analyze the levels of reliability (internal consistency and temporal stability) and confirmatory factorial structure with data from 1,646 people aged from 18 to 90 years old. Differences are found in the indicators of reliability for the total scale and its dimensions as well as in the indicators of goodness of fit depending on the age group. The model that presents the best indicators of adjustment for most age ranges evaluated was the one of six first-order factors.

Estudio multicéntrico para la validación de la versión en español del Eating Disorder Diagnostic Scale / Validation of the Spanish version of the Eating Disorders Diagnostic Scale

Background: The Eating Disorders Diagnostic Scale (EDDS) is a self-administered low cost psychometric instrument with excellent levels of temporal reliability and validity. Aim: To adapt and validate the EDDS in Chile. Material and Methods: Thefactorial structure, internal consistency and test-retest reliability ofthe Spanish-language version of the EDDS was analyzed in a sample of1964 university and high school students. The concurrent validity was tested in a sample of 50 primary care patients with ED and 59 controls, comparing its results with those of a structured psychiatric interview (CIDI). Results: The EDDS showed a high internal consistency, moderate test-retest reliability, an appropriate factorial structure (in women) and an excellent convergent validity. Also, the diagnosis of ED obtained with the EDDS is moderately consistent with the structured psychiatric interview. Conclusions: The Spanish-language version of the EDDS showed a satisfactory psychometric behavior and a good capacity for detecting ED, according to the DSM criterion.

Evaluation of Subjective Well-being: Analysis of the Satisfaction With Life Scale in Chilean Population / Evaluación del Bienestar subjetivo: Análisis de la Escala de Satisfacción con la Vida en población chilena

The aim of this investigation is to evaluate the psychometric properties of the Satisfaction with Life Scale (SWLS), in the adult population from ages 18 to 65. In order to do this two studies were conducted. In the first one, we evaluated the internal consistency and construct validation of data from 330 people between 18 and 52 years of age; in the second study, we evaluated the confirmatory factor and validation of data indicators from 1157 people between 18 and 65 years of age. The results show suitable indicators of internal consistency (Cronbach's alpha = 0.82), the exploratory and confirmatory factor analysis finds a one factor's solution. The correlation between the SWLS, the WHOQOL-BREF Quality of Life Questionnaire, and the Difficulties in Emotion Regulation Scale (DERS), display significant, consistent correlations in the expected direction. We conclude that the SWLS is a reliable and valid instrument to use for evaluating the cognitive sphere of subjective well-being in Chile's adult population.

El objetivo de esta investigación fue evaluar las propiedades psicométricas del cuestionario de satisfacción con la vida (SWLS) en población adulta de 18 a 65 años. Para esto, se realizaron dos estudios. En el primero se evaluó la consistencia interna y la validez de constructo con datos de 330 personas entre 18 y 52 años. En el segundo estudio se evaluó la estructura factorial confirmatoria e indicadores de validez con datos de 1157 personas entre 18 y 65 años. Los resultados mostraron adecuados indicadores de consistencia interna (alfa de Cronbach = 0.82), en el análisis de estructura factorial exploratoria y confirmatoria se encontró una solución unifactorial. La correlación entre SWLS, Cuestionario de Calidad de Vida WHOQOL-BREF y Cuestionario de Dificultades en la Regulación Emocional, arrojó correlaciones significativas, congruentes y en la dirección esperada. Concluimos que el cuestionario SWLS es un instrumento confiable y válido para su utilización en la evaluación de la esfera cognitiva del bienestar subjetivo en población adulta en Chile.

El rol predisponente del optimismo: hacia un modelo etiológico del bienestar / The causal role of the optimism; towards an etiological model of well-being

En los últimos años, la investigación de los recursos psicológicos que favorecen la salud y el bienestar han experimentado un aumento considerable. Recientes datos muestran a partir de estudios altamente rigurosos y controlados, algunos de los beneficios que producen los estados y afectos positivos, como también del optimismo y el bienestar, entre otros estados positivos en la salud física y psicológica. A pesar de esta evidencia, existe aún poca información de los mecanismos y variables relacionadas en los procesos de bienestar, optimismo y afectos positivos. Así mismo existe escaso consenso acerca de los mecanismos psicológicos y/o neurofisiológicos que expliquen la relación con los estados positivos y su beneficio para la salud y principalmente acerca de las variables causales o etiológicas del bienestar. Se revisa la evidencia científica acerca de los beneficios de los estados positivos como el optimismo, felicidad y principalmente el bienestar. Se propone un modelo causal conceptual que plantea que el nivel de bienestar subjetivo y psicológico, está influenciado previamente por el nivel de optimismo. De esta forma y basada en la literatura y evidencia previa se plantea que el optimismo, al ser una condición aprendida desde la niñez, favorecería la mayor cantidad de experiencias positivas y emociones positivas. Estos estados afectivos positivos mediarían la relación entre el optimismo y el bienestar y sus consecuencias.

Research into the psychological resources that benefit health and well-being have increased dramatically in recent years. The latest data from highly rigorous and controlled studies show some of the benefits that produce positive states and affects, as well as optimism and well-being, among other positive states in physical and psychological health. In spite of this evidence, there is little information about the mechanisms and variables related to the processes of well-being, optimism and positive affects. In addition, there is no real consensus regarding the psychological and/or neurophysiological mechanisms that explain the relation to positive states and their benefit for health and mainly with respect to the causal or etiological variables of well-being. The scientific evidence about the benefits of positive states like optimism, happiness and mainly well-being is reviewed. A conceptual causal model is proposed which suggests that the level of subjective and psychological well-being is previously influenced by the level of optimism. This way, and based on the prior literature and evidence, it is proposed that optimism, being a condition learned from childhood, may stimulate the greatest number of positive experiences and positive emotions. These positive affect states would then mediate the relation between optimism and well-being and their consequences.

Descomponiendo el síndrome de déficit atencional en el adulto: hacia un entendimiento de su heterogeneidad pronóstica / Prognostic heterogeneity of attention deficit/hyperactivity disorder in adults

Attention Deficit/Hyperactivity Disorder (ADHD) is a clinical syndrome characterized by an onset in early life. More than 65% of patients persist with manifestations of ADHD in adulthood. These symptoms may interfere in activities of daily-living, interpersonal relationships and professional and academic achievement. Nevertheless, the observation of an important group of adults with ADHD who do not show significant difficulties in the areas mentioned before puts into evidence the prognostic heterogeneity of this disorder. One of the current, most accepted explanations is the Double-Pathway Model: two double-dissociated deficits (Executive Disorders and Delayed-Reward Processing impairments) are involved in the genesis of ADHD, which explains the existence of different behavioral phenotypes. Moreover, personality traits like tenacity or perseverance are associated with higher levels of achievement in adults. On these grounds, we propose the hypothesis that the neurobiological correlate of tenacity/perseverance is a preserved Delayed-Reward Processing capacity, although further studies are needed to verify this idea.

International affective picture system (IAPS) in Chile: a cross-cultural adaptation and validation study / El sistema internacional de imágenes afectivas (International Affective Picture System-IAPS) en Chile: estudio de adaptación y validación transcultural

The International Affective Picture System (IAPS) (Lang, Ohman, & Vaitl, 1988) is a standardized set of photographs to induce emotions in the context of experimental investigations. The aim of this study was determine the psychometric behavior of the IAPS for the preparation of standards in the Chilean population and the subsequent validation of the instrument for its use in Chile. 208 university students participated (40 percent men) and had an affective experience induced using the presentation of visual stimuli extracted from sets 7 and 14 of the IAPS. In order to evaluate valence, arousal and dominance, the self-assessment manikin (SAM) was used, made up of pictographic scales for each dimension and a scale of continuous variation of emotional reactions. The IAPS showed psychometric behavior comparable to the original, with the same boomerang-shaped distribution of scores being found in the valence/arousal relationship. The IAPS is a reliable tool for inducing emotions in studies related to affectivity.

El Sistema Internacional de Imágenes Afectivas (International Affective Picture System-IAPS) (Lang, Ohman, & Vaitl, 1988) es un conjunto estandarizado de fotografías para la inducción de emociones en el contexto de investigaciones experimentales. El objetivo de este estudio fue conocer el comportamiento psicométrico del IAPS para la confección de normas en la población chilena y la validación consiguiente del instrumento para su uso en Chile. Participaron 208 estudiantes universitarios (40 por ciento hombres) a quienes se les indujo una experiencia afectiva mediante la presentación de estímulos visuales extraídos del set 1 y 14 del IAPS. Para evaluar valencia, arousal y dominancia, se utilizo el maniquí de auto-evaluación o SAM (Self - Assessment Manikin), compuesto por escalas pictográficas para cada dimensión y una escala de variación continua de reacciones emocionales. El IAPS muestran un comportamiento psicométrico comparable al original, encontrándose la dispersión de puntajes de boomerang en la relación Valencia/Arousal. El IAPS es una herramienta confiable para la inducción de emociones en estudios ligados a la afectividad.

Asociación de polimorfismos de los genes CRF-BP, SLC6A4 y restricción alimentaria crónica: un estudio preliminar / CRF-BP and SLC6A4 gene polymorphisms among restrained eaters

Background: Restrained eaters (RE) are a group of individuals who constantly restrict their eating. However, they usually alternate restriction with periods of overeating. Aim: To evaluate the possible association of CRF-BP and SLC6A4 gene polymorphisms with chronic alimentary restriction. Material and Methods: The Spanish version of the Revised Restraint Scale was applied to 132 women aged 18 to 25 years. They were divided in a group classified as restrained eaters (RE) and a group of unrestrained eaters. The 5-HTTLPR and CRF-BPs11 polymorphisms of the SLC6A4 and CRF-BP genes were evaluated by polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism (RFLP), respectively. Results: There was a significant association between the s/s homozygous genotype for the 5-HTTLPR polymorphism of SLC6A4 gene and RE condition (p = 0.033). However, this association was not observed for the CRF-BPs11 polymorphism. Conclusions: The presence of s/s genotype is associated with the RE condition, being the presence of a s allele, a risk factor for this condition.

Controle da leishmaniose visceral no município de Porteirinha, estado de Minas Gerais, no período de 1998 a 2003 / Control of visceral leishmaniasis in the town of Porteirinha, state of Minas Gerais, Brazil, from 1998 to 2003

INTRODUÇÃO: No município de Porteirinha, Estado de Minas Gerais, foram registrados 23 casos humanos de leishmaniose visceral (LV) nos anos de 1998 e 1999. MÉTODOS: Foi realizado um estudo envolvendo a tríade de ações preconizadas no controle da LV. Pacientes com leishmaniose humana foram tratados e cães sorologicamente positivos foram eutanasiados, trimestralmente. O inseticida piretróide α-cipermetrina foi aplicado nos bairros onde casos humanos foram registrados. RESULTADOS: Houve uma redução da soroprevalência canina e de flebotomíneos capturados, após a implementação das medidas de controle, refletindo na diminuição de casos humanos de leishmaniose visceral. CONCLUSÕES: Os resultados mostraram a eficiência destas medidas quando empregadas em conjunto.

INTRODUCTION: In the town of Porteirinha, State of Minas Gerais, 23 human cases of visceral leishmaniasis (VL) in 1998 and 1999 were recorded. METHODS: A study was conducted involving the triad of action recommended for the control of VL. Patients were treated and serologically positive dogs were euthanized quarterly. The pyrethroid insecticide α-cypermethrin was applied in the neighborhoods where human cases were recorded. RESULTS: A reduction in canine seroprevalence and sand flies occurred following the implementation of control measures, reflecting in a reduction in human cases of VL. CONCLUSIONS: The results show the efficiency of such control measures when used in association.

Maestro de la psiquiatría chilena: entrevista con Fernando Oyarzún / Master of Chilean psychiatry: an interview with Fernando Oyarzún

El Dr. Fernando Oyarzún es Maestro de la Psiquiatría Chilena y ha dedicado su carrera académica al desarrollo de un enfoque clínico-antropológico en psiquiatría. Desde su perspectiva elaboró una "idea médica de la persona', la que promueve la personalización del acto médico en psiquiatría y medicina. Método: En una entrevista personal este trabajo describe los logros profesionales del Dr.Oyarzún y sus concepciones clínicas-antropológicas. Conclusión: El legado intelectual del Dr. Oyarzún va más allá del campo de la medicina, conformando una perspectiva original de las relaciones humanas.

Dr. Fernando Oyarzún is a Master of Chilean Psychiatry, who has devoted his academic career to the development of a clinical-anthropologic approach in psychiatry. From this perspective, he elaborated a "medical idea of the person", which promote the personalization of medical act in psychiatry and medicine. Method: In a personal interview, this paper describe Dr. Oyarzún s professional achievements and his clinical-anthropologic conceptions. Conclusion: Dr. Oyarzún’s intellectual legacy goes beyond the medicine field, conforming an original perspective of human relationships.