ABSTRACT
Resumen La pandemia por el virus SARS-CoV-2 ha afectado fuertemente los programas de educación quirúrgica. El Capítulo Chileno del American College of Surgeons realizó un webinar para evaluar y discutir los efectos de la pandemia en la educación quirúrgica. Este evento contó con la asistencia de 450 personas de 17 países, incluyendo la participación de destacados docentes del área quirúrgica. Las principales conclusiones de este webinar fueron que la pandemia alteró considerablemente los programas de educación quirúrgica. Un 26% de los residentes se contagiaron, pero la mayoría no precisó cuidados especiales. Las intervenciones quirúrgicas disminuyeron hasta en un 90% en algunos programas. Los residentes debieron asumir el cuidado de pacientes COVID-19. Se han implementado sistemas de enseñanza virtual, como seminarios en línea o webinars, discusión de casos clínicos, videos y simulación. Dichas actividades teóricas, al igual que la simulación quirúrgica fueron evaluadas, mayoritariamente, vía web. Las sociedades científicas han tenido un importante rol en estas actividades. En el futuro, los programas universitarios enfrentarán escenarios con menos pacientes y una reducción de las oportunidades de enseñanza para residentes. Las actividades en línea y simulación adquirirán mayor relevancia. Es posible superar esta crisis como lo han hecho los países desarrollados, comparados con ellos, carecemos de un plan nacional de emergencia en salud, en el que los estudiantes y personal sanitario tengan un rol definido en áreas específicas, con metas concretas. El retorno a la "nueva normalidad" estará lleno de desafíos.
The SARS-CoV-2 pandemic has had an impact in surgical residency programs. The Chilean chapter of the American College of Surgeons organized a webinar to discuss and address the effects of this pandemic on surgical education. This meeting had a virtual attendance of 450 people from 17 countries, including the participation of surgical educators. Conclusions of this webinar were that COVID-19 has strongly affected surgical education programs. Twenty six per cent of residents were infected. Most of them did not need special care. Surgical opportunities have decreased up to 90% in some programs. Residents have had to be involved in managing COVID-19 patients. Changes in surgical education, led to a virtual instruction which includes seminars, webinars, case discussion, videos and simulation. Assessment has been performed of theoretical activities, via web. Simulation tasks also have been evaluated. Scientific societies had a very important role in these activities. In the near future, university programs will face different scenarios in hospitals and clinical centers, with fewer patients and reduced clinical instruction for residents. Online activities and simulation will increase in relevance in years to come. It is possible to overcome this crisis, as some developed countries have already done, compared to them, we lack a national emergency health plan in which medical students, residents, doctors, and all health care providers have a designated role in specific areas with clear goals. The return to "the new normal" will be filled with challenges.
Subject(s)
Humans , Pandemics , Surgeons/education , Internship and Residency , Chile , Education, Medical, Graduate , COVID-19ABSTRACT
Background and aim: Abnormal liver function tests (LFTs) and gastrointestinal (GI) symptoms have been reported up to 50% in patients with COVID-19, and in 5% they can precede respiratory symptoms. The objective of this work is to describe the LFTs and GI symptoms of patients with COVID-19 and their association with admission to the intensive care unit (ICU) and mortality. Material and Methods. We conducted a retrospective, cross sectional, descriptive study, using files from patients with a positive Gen Finder COVID-19 test, admitted to Medica Sur Clinic and Foundation between March 13th through May 14th, 2020. We performed descriptive analysis of data and its association with clinical outcomes. Results: A total of 108 patients with COVID-19 were identified;68.5% (n = 74) were men, the mean age was 53 ± 14 years and the body mass index was 28.6 ± 5.8 kg/m2. The most frequent comorbidity was hypertension with 24% (n = 26). The presence of comorbidities was associated with risk of ICU admission (OR 3.9 [95% CI 1.6-9.9], p = 0.002). The most frequent symptoms were cough (72.2%, n = 78), fever (69.4%, n = 75) and dyspnea (48.1%, n = 52). At least one abnormal LFT was present in 94% (n = 103) of patients at admission, the most frequent was LDH (88.9%, n = 96), AST and GGT (63%, n = 65), which are summarized in Table 1. Patients presented abnormal LFTs and respiratory symptoms in 48.1% (n = 52), while 16.6% (n = 18) presented abnormal LFTs without respiratory symptoms. Among GI symptoms, 37% (n = 4) reported at least one, including diarrhea (28.7%, n = 31), hyporexia (9.3%, n = 10), nausea (8.3%, n = 9) or vomiting (4.6%, n = 5). Of patients admitted to the ICU (n = 39), 27.5% (n = 10) presented at least one GI symptom. Mortality was 7.4% (n = 8). No associations were found between abnormal LFTs, GI symptoms, and outcomes of mortality and ICU admission. Conclusions: In patients with COVID 19, the presence of metabolic comorbidities confers a higher risk of ICU admission, in contrast to abnormal LFTs and GI symptoms that were not associated with clinical outcomes. Conflicts of interest: The authors have no conflicts of interest to declare.