Resultados a largo plazo de la cirugía de revascularización coronaria según la presencia o no de enfermedad del tronco de la arteria coronaria izquierda / Long-term Outcomes of Coronary Artery Bypass Surgery According to the Presence or Absence of Left Main Coronary Artery Disease

RESUMEN Introducción: La cirugía de revascularización miocárdica (CRM) ha modificado la evolución natural de los pacientes con enfermedad de tronco de la arteria coronaria izquierda (TCI). En nuestro medio es escasa la información relacionada con el seguimiento a mediano y largo plazo de los pacientes intervenidos. Objetivo: Evaluar la implicancia de la enfermedad del TCI en la evolución alejada de los pacientes intervenidos con CRM, y conocer la mortalidad e incidencia de infarto de miocardio (IAM) y/o accidente cerebrovascular (ACV). Resultados: El seguimiento se completó en 438 pacientes (95,6%) con una mediana de 58 meses [Rango intercuartilo (RIC) 35-88 meses]. La sobrevida actuarial fue a 10 años del 91,8% para toda la población, sin diferencias significativas entre el grupo TCI (91,57%) vs. el grupo no TCI (91,86%), HR 1,008, IC95% 0,38-2,65, p=0,98. En el análisis multivariado se encontraron como predictores de mortalidad alejada la fracción de eyección ventricular izquierda preoperatoria (HR 0,95, IC 95% 0,93-0,97, p<0,001), la edad (HR 1,1, IC 95% 1,04-1,13, p< 0,001) y la prioridad no electiva de la cirugía (HR = 3,71; IC 95%: 1,3-10,35; p = 0,01). La sobrevida libre de IAM fue del 96,8% (TCI 94% vs. no TCI 97,4%, p= 0,8) y la libertad de ACV fue del 98% (TCI 97,8% vs. no TCI 98,1%, p= 0,8). Conclusión: En los pacientes sometidos a CRM, la presencia de enfermedad del TCI no incrementó la tasa de eventos duros (muerte, IAM y ACV) en el seguimiento alejado. Los resultados obtenidos en esta serie de pacientes son similares a los publicados en la bibliografía internacional utilizada para desarrollar las guías de revascularización miocárdica.

ABSTRACT Background: Coronary artery bypass grafting (CABG) has modified the natural evolution of patients with left main coronary artery (LMCA) disease. There is little information in our setting regarding the mid- and long-term follow-up of operated patients. Objective: The aim of this study was to evaluate the implication of LMCA disease in the long-term evolution of patients operated on with CABG, and to assess the mortality and incidence of myocardial infarction (AMI) and/or stroke. Results: Follow-up was completed in 438 patients (95.6%) with a median of 58 months [interquartile range (IQR) 35-88 months]. Actuarial survival at 10 years was 91.8% for the entire population, with no significant differences between the LMCA group (91.57%) vs. the non-LMCA group (91.86%), HR 1,008 95% CI 0.38-2.65, p=0.98. In multivariate analysis, preoperative left ventricular ejection fraction (HR = 0.95; 95% CI 0.93-0.97; p < 0.001), age (HR 1.1, 95% CI 1.04-1.13, p<0.001) and non-elective priority of surgery (HR=3.71; 95% CI 1.3-10.35; p=0.01) were independent predictors of long-term mortality. AMI-free survival was 96.8% (LMCA 94% vs. non-LMCA 97.4%, p=0.8) and freedom from stroke was 98% (LMCA 97.8% vs. non-LMCA 98.1 %, p=0.8). Conclusion: In patients undergoing CABG, the presence of LMCA disease did not increase the rate of hard events (death, AMI, and stroke) at the long-term follow-up. The results obtained in this series of patients are similar to those published in the international literature used to develop myocardial revascularization guidelines.

La edad avanzada en forma aislada no constituye una limitación para el reemplazo valvular aórtico quirúrgico / Old Age Alone is not a Limitation for Surgical Aortic Valve Replacement

RESUMEN Introducción: El reemplazo quirúrgico de la válvula aórtica (REEAO) en pacientes con valvulopatía aórtica grave sintomática, es el tratamiento definido como el de referencia. Sin embargo, el implante valvular aórtico transcatéter (TAVI) se posiciona actualmente como una alternativa en pacientes de diferentes riesgos según los scores internacionales. Algunas guías consideran al TAVI como el procedimiento preferible en los pacientes añosos. Objetivos: Conocer el riesgo y resultados de morbimortalidad del REEAO en pacientes adultos clasificados según la edad en mayores de 75 años, o de 75 años o menos. Material y métodos: Estudio retrospectivo sobre 228 pacientes consecutivos intervenidos mediante REEAO entre el 1 de enero de 2011 y el 31 de diciembre de 2020 por valvulopatía aórtica grave sintomática. Del total de pacientes operados, 46 (16%) eran mayores de 75 años (Grupo 1, G1) y 182 pacientes (84%) tenían 75 años o menos (Grupo 2, G2). Se excluyeron pacientes con enfermedad coronaria concomitante, endocarditis bacteriana u otras valvulopatías asociadas. Resultados: Los pacientes del G1 tenían mayor riesgo de morbimortalidad quirúrgica analizado por scores de riesgo validados: ArgenSCORE de 1,55 (RIC 0,99-3,33) vs 1,08 (RIC 0,68-2,23), p = 0,02 y STS score de 2,33 (RIC 1,57-3,23) vs. 0,94 (RIC 0,721,44), p = 0,0001, con respecto al G2; no se encontraron en cambio diferencias significativas en el EuroSCORE II : 2,37 (RIC 1,19-3,61) vs. 1,83 (RIC 1,16-3,04), p = 0,2. La mortalidad registrada global fue del 1,7% (G1: 2,1% vs. G2: 1,6% , p NS); no se observaron accidente cerebrovascular (ACV) ni infarto agudo de miocardio (IAM) perioperatorios. Conclusiones: La escasa presentación de muerte, ACV e IAM sugiere que el tratamiento seleccionado para estos pacientes fue adecuado, con excelentes resultados sin diferencias entre los dos grupos etarios.

ABSTRACT Background: Surgical aortic valve replacement (SAVR) is the reference treatment in patients with symptomatic severe aortic valve disease. However, according to international scores, transcatheter aortic valve implantation (TAVI) is currently an alternative in different risk patients, and some guidelines consider TAVI as a preferable procedure in elderly patients. Objectives: The aim of this study was to assess SAVR morbidity and mortality risk and results in adult patients, classified according to age as >75 years or ≤75 years. Methods: A retrospective study was performed on 228 consecutive patients undergoing SAVR between January 1, 2011 and December 31, 2020 for symptomatic severe aortic valve disease. Among the total number of patients operated on, 46 (16%) were >75 years (Group 1, G1) and 182 (84%) were ≤75 years (Group 2, G2). Patients with concomitant coronary heart disease, bacterial endocarditis or other associated valve diseases were excluded from the analysis. Results: Group 1 patients had greater risk of surgical morbidity and mortality analyzed by validated risk scores: ArgenSCORE 1.55 (IQR 0.99-3.33) vs 1.08 (IQR 0.68-2.23), p = 0.02 and STS score 2.33 (IQR 1.57-3.23) vs. 0.94 (IQR 0.72-1.44), p = 0.0001, with respect to G2, while no significant differences were found for EuroSCORE II: 2.37 (IQR 1.19-3.61) vs. 1.83 (IQR 1.163.04), p = 0.2. Overall mortality was 1.7% (G1: 2.1% vs. G2: 1.6%, p=NS), with no perioperative stroke or acute myocardial infarction (AMI). Conclusions: The low number of deaths, stroke and AMI observed suggests that the selected treatment for these patients was adequate, with excellent results and without significant differences between these two age groups.

Psychometry and estimation of cutoff points of Jefferson Scale of empathy in dental students.

OBJECTIVE: The objective of this study was to determine the psychometric properties of the 3-dimensional latent model of empathy on the Jefferson Scale of Physician Empathy instrument (version S), and to verify the existence of cutoff points capable of differentiating empathy measures classified as: "high," "medium," and "low" using data collected from observations of students from 11 dental faculties of 5 Central American and Caribbean countries (n = 3082) between 2015 and 2019. METHODS: This is an exploratory, "a posteriori," and non-experimental study. Factor structure and factor invariance by country and gender were analyzed. Hierarchical cluster analysis and bifactorial analysis were applied, and the data were normalized by cluster and by percentiles within them. RESULTS: Confirmatory factor analysis showed that the original model was replicable and fit the data, while multigroup analysis allowed assuming an invariant factor structure by country and by gender. There is reliability in the measurement made by the scale and its dimensions. CONCLUSIONS: The instrument has adequate psychometric properties, and cutoff values obtained allow people with lower or higher levels of empathy and its components to be classified. Therefore, these results solve the problem of comparing the scores and observed levels of empathy between dental schools within and between countries and between genders. Such comparisons were only possible since the original data of each study were made available for traditional statistical methods.

Implicancia de la enfermedad del tronco de coronaria izquierda en los resultados de la cirugía de revascularización miocárdica / Implication of Left Main Coronary Artery Disease on Coronary Artery Bypass Graft Surgery Results

RESUMEN Introducción: La cirugía de revascularización miocárdica (CRM) ha sido el abordaje indicado para el tratamiento de la lesión del tronco de la coronaria izquierda (TCI), siendo la angioplastia coronaria (ATC) un tratamiento alternativo en un grupo muy seleccionado de pacientes. Sin embargo, los criterios de no inferioridad de los resultados de la ATC en términos de mortalidad e infarto de miocardio (IAM) en el seguimiento a mediano plazo es tema de discusión actual. Objetivo: Evaluar las características clínicas, funcionales y angiográficas de los pacientes sometidos a CRM con y sin TCI, y las implicancias de morbimortalidad halladas. Material y métodos: Se sometió a 458 pacientes consecutivos a CRM; 187 (40.82%) presentaban TCI. El grupo con TCI tenía un perfil de riesgo mayor: ArgenScore: 2.78 (1.55-5.9) vs 2.78 (1.95-7) p=0.03, STS score: 0.85 (0.55-1.8) vs 0.77 (0.5-1.17) p=0.01 y EuroSCORE II: 2.2 (1.35-3.97) vs 1.75 (1.08-2.9) p=0.04 respecto al grupo sin TCI. Resultados: A pesar del mayor riesgo esperado no hubo diferencias estadísticamente significativas en mortalidad 3.2% vs 1.1%, IAM 2.6% vs 1.1% y ACV 1% vs 0.3% en los dos grupos. En el análisis multivariado el TCI no fue predictor de morbimortalidad (HR = 2.1; IC 95% 0.70-6.23; p = 0.18) e identifico positivamente a la fracción de eyección preoperatoria (HR = 0.96; IC 95%: 0.93-0.99; p = 0.040) y la cirugía no programada (HR = 3.44; IC 95%: 1.60-7.41; p = 0.002). Conclusiones: en nuestra experiencia los pacientes intervenidos con CRM el TCI no es predictor de muerte, IAM y/o ACV.

ABSTRACT Background: Coronary artery bypass graft surgery (CABG) has been the indicated approach for the treatment of left main coronary artery disease (LMCA), with percutaneous coronary intervention (PCI) as an alternative treatment in a highly selected group of patients. However, the non-inferiority criteria of PCI outcomes in terms of mortality and acute myocardial infarction (AMI) in the mid-term follow-up are currently subject of debate. Objective: The aim of this study was to evaluate the clinical, functional and angiographic characteristics of patients undergoing CABG with and without LMCA disease, and the implications of morbidity and mortality encountered. Methods: A total of 458 consecutive patients underwent CABG; 187 (40.82%) presented LMCA disease. This group had a higher risk profile compared with the group without LMCA disease: ArgenSCORE: 2.78 (1.55-5.9) vs. 2.78 (1.95-7); p=0.03, STS score: 0.85 (0.55-1.8) vs. 0.77 (0.5-1.17); p=0.01 and EuroSCORE II: 2.2 (1.35-3.97) vs. 1.75 (1.08-2.9); p=0.04. Results: Despite the higher expected risk, there were no statistically significant differences in mortality (3.2% vs. 1.1%), AMI (2.6% vs. 1.1%) and stroke (1% vs. 0.3%) in the two groups. In the multivariate analysis, LMCA disease was not a predictor of morbidity and mortality (HR=2.1; 95% CI 0.70-6.23; p=0.18) and positively identified the preoperative ejection fraction (HR=0.96; 95% CI 0.93-0.99; p=0.040) and non-programmed surgery (HR=3.44; 95% CI 1.60-7.41; p=0.002). Conclusions: In our experience, LMCA disease in patients undergoing CABG is not a predictor of death, AMI and/or stroke.

Consideraciones sobre la declinación empática en estudiantes de medicina en Latinoamérica / Considerations on Empathic Declination in Medical Students in Latin America / Considerações acerca da declinação empática em estudantes de medicina na Latino-América

Resumen Introducción: algunos autores plantean que la empatia en los estudiantes de medicina sufre un proceso de declinación a partir del tercer año de estudios, y otros han encontrado que ello no se da. El objetivo del presente estudio es verificar la coexistencia de varios modelos de comportamiento empático. Materiales y métodos: trabajo exploratorio y transversal. Se aplicó la escala de empatia para estudiantes de medicina (EEJM-S) en tres facultades de medicina de Colombia, El Salvador y Argentina, entre 2018 y 2019. Los valores de las medias de cada año de estudio se sometieron a pruebas de regresión con datos previamente estandarizados. Se realizaron un análisis de varianza (Anova), para comprobar si el coeficiente de la ecuación era diferente de cero, y un Anova secuencial, para determinar el tipo de curva. Resultados: la distribución de las medias, a través de los años de estudio, presentó diversos tipos de curvas de regresión entre las diferentes universidades en la empatia, asi como en cada uno de sus componentes. Conclusión: se comprobó la presencia de tipos diferentes de comportamiento empático (diferentes curvas de regresión) de las medias de los años de estudio entre las distintas facultades estudiadas, y la hipótesis de trabajo planteada resultó verdadera.

Abstract Introduction: Some authors argue that empathy in medical students undergoes a declining process from the third year of medical school. On the other hand, some authors have found that such a decline does not occur. A working hypothesis is proposed which consists of several coexisting empathic behavior models. Materials and methods: Exploratory and transversal work was included as part of this study. The Empathy scale for medical students (EEJM-S) was applied amongst medical students in three medical faculties of Colombia, El Salvador and Argentina between 2018-2019. The mean values of each year of study were subjected to regression tests with previously standardized data. An analysis of variance (Anova) was first performed to determine if the coefficient of the equation was different from zero and sequential Anova was performed to determine the type of curve and distribution of the data. Results: The distribution of the means, through the years of study, presented different types of regression curves between the different universities used in the study, as well as in each of its components for empathy. Conclusion: Differing types of empathic behaviour existed (different regression curves) in the means of the years of study between the different faculties and the working hypothesis proved to be true.

Resumo Introdução: alguns autores propõem que empatia nos estudantes de medicina sofre um processo de declinado a partir de terceiro ano. Por outro lado, outros autores têm encontrado que tal declinado não se produz. Se apresenta a hipótese de trabalho consistente na coexistência de vários modelos de comportamento empático. Materiais e métodos: trabalho exploratório e transversal. Se aplicou a escala de Empatia para estudantes de medicina (EEJM-S) em três faculdades de medicina da Colombia, El Salvador, e a Argentina entre os anos 2018-2019. Os valores das médias de cada ano de estudo foram submetidos a provas de regressão com dados previamente estandardizados. Se realizou primeiro uma análise de variância (Anova) para comprovar se o coeficiente da equação era diferente de cero e Anova sequencial para determinar o tipo de curva. Resultados: a distribuição das médias, através dos anos de estudo, apresentou diferentes tipos de curvas de regressão entre as diferentes universidades estudadas na empatia, assim como em cada um de seus componentes. Conclusao: comprova-se a presenta de tipos diferentes de comportamento empático (diferentes curvas de regressão) das médias dos anos de estudo entre as diferentes faculdades estudadas e a hipótese de trabalho apresentada resulta verdadeira.

Validation of a cross-NTD toolkit for assessment of NTD-related morbidity and disability. A cross-cultural qualitative validation of study instruments in Colombia.

BACKGROUND: Many neglected tropical diseases (NTDs) are not fatal, but they are disabling, disfiguring and stigmatizing. More accurate data on these aspects would benefit planning, monitoring and evaluation of interventions, as well as provision of appropriate services for the often life-long consequences. In 2015, a cross-NTD toolkit was developed, consisting of a variety of existing questionnaires to measure morbidity, disability and health-related quality of life. The toolkit covers the domains of the International Classification of Functioning, Disability and Health (ICF) framework. These tools have been developed in a source country, however, it was intended for the cross-NTD toolkit to be applicable across NTDs in many countries with different cultures and languages in order to generate universally comparative data. Therefore; the present study aimed to validate several tools of the toolkit among people affected by leprosy or leishmaniasis in the cultural settings of Cartagena and Cúcuta, Colombia. METHODOLOGY: This study aimed to validate the following tools among 55 participants between 18-85 years old, affected by leprosy and leishmaniasis: (I) Clinical Profile, (II) Self-Reporting Questionnaire (SRQ), (III) WHO Quality of Life assessment-abbreviated version (WHOQOL-BREF), and (IV) WHO Quality of Life assessment-Disability (WHOQOL-DIS). The tools were administered during face-to-face interviews and were followed by open questions about the respondents' thoughts on format of the tool and the understanding, relevance and acceptability of the items. The tools were validated using a qualitative method approach based on the framework for cultural equivalence, measured by the cultural, item, semantic and operational equivalences. RESULTS: The Clinical Profile was seen as acceptable and relevant, only the semantic equivalence was not as satisfying and needs a few adaptations. The SRQ was very well understood and shows to reach the equivalences for the population of Colombia without any additional changes. Several items of the WHOQOL-BREF and the WHOQOL-DIS were not well understood and changes are recommended due to semantic difficulties. Operational equivalence of both questionnaires was not as desired in relation to the used response scales. The participants shared that the tools are relevant and important for their particular situation. CONCLUSIONS/SIGNIFICANCE: The SRQ is found to be a valid tool for Colombia and can be included in the cross-NTD toolkit. The Clinical Profile, WHOQOL-BREF & WHOQOL-DIS need changes and retesting among Colombian people affected by an NTD. The toolkit as a whole is seen as useful to show the effects leprosy and leishmaniasis have on the participants. This cultural validation will contribute to a universally applicable cross-NTD toolkit.

Factors associated with the delay of diagnosis of leprosy in north-eastern Colombia: a quantitative analysis.

OBJECTIVES: To determine the average time in months between the beginning of symptoms and the diagnostic confirmation of leprosy by the health system and to investigate factors associated with diagnostic delay. METHODS: A total of 249 patients older than 15 years diagnosed with leprosy between 2011 and 2015, in 20 endemic municipalities of north-eastern Colombia, provided informed consent and were interviewed face-to-face. Clinical histories from health centres or hospitals where study participants were treated for leprosy were also reviewed. RESULTS: The mean delay in diagnosis of leprosy was 33.5 months. About 14.9% of patients showed a visible deformity or damage (disability grade 2, DG2) at the time of diagnosis. In multivariable regression analysis, five or more consultancies required to confirm the diagnosis and not seeking care immediately after noticing first symptoms were associated with longer diagnostic delay. CONCLUSIONS: Our study found a significant delay in diagnosis of leprosy in north-eastern Colombia, which might explain the continuously high rate of DG2 among new cases being notified in the country. Both patient- and health system-related factors were associated with longer diagnostic delay. Interventions to increase awareness of disease among the general population and timely referral to a specialised health professional are urgently needed in our study setting.

Reconsidering the 'Decline' of Dental Student Empathy within the Course in Latin America.

INTRODUCTION: The controversy over the presence of empathic decline within the course in students of medicine, dentistry and health sciences in general, has not fully been studied. This controversy could be partially solved if massive studies of empathy levels are made in similar cultural, social and economic contexts. MATERIAL AND METHODS: Empathy levels within the course were studied in eighteen dental schools from six countries in Latin America (2013). The mean of the empathy levels were used to study the behavior between first and fifth academic years. The values of empathy levels within the course were observed by applying the Jefferson Scale of Physician Empathy, the Spanish version. All these studies were cross-sectional. The value of means observed, were subjected to regression studies and further adjustment curves were obtained and the coefficient of determination were calculated. RESULTS: Six different models of behavior were observed, which found that five of them suffer empathic decline within the course, but with different final results: in some the decline persists until the fifth academic year and in others, this decline 'recovers' persistently until the fifth academic year. The sixth model is characterized by a constant and persistent increase of levels of empathy within the course until the last academic year. DISCUSSION: There are six different models for the behavior of means of levels of empathy within the course evaluated by a common methodology in eighteen dental schools from six countries of Latin America. These findings support the existence of variability of empathic response and a comprehensive approach is needed to find the causes that give rise to this variability. CONCLUSION: In dental students of Latin America, there is variability in the behavior of the distribution in means between the academic years of the dentistry schools examined in this study.

Introdução: A controvérsia sobre o declínio da empatia relativamente ao curso em estudantes de Medicina, Odontologia e Ciências da Saúde em geral ainda não foi completamente elucidada. Esta controvérsia poderia ser parcialmente solucionada se fossem realizados estudos significativos sobre os níveis de empatia em contextos culturais, sociais e económicos similares. Material e Métodos: Foram estudados os níveis de empatia com o curso em dezoito escolas de Odontologia de seis países na América Latina (2013). As médias dos níveis de empatia foram usadas para estudar o comportamento entre académicos do primeiro e quinto anos. Os valores de níveis de empatia para com o curso foram observados aplicando a versão em espanhol da escala Jefferson de Empatia Médica. Todos estes estudos foram transversais. O valor das médias observadas sujeito a tratamento estatístico de regressão, obtendo-se as subsequentes curvas de ajustes e calculado o coeficiente de determinação. Resultados: Foram observados seis diferentes modelos de comportamento, sendo que em cinco deles se verificou declínio da empatia, com diferentes resultados finais: em alguns, o declínio persistiu até o quinto ano académico e, em outros, o declínio 'recuperou-se' persistentemente até ao quinto ano académico. O sexto modelo caracterizou-se por um constante e persistente aumento nos níveis de empatia com o curso até o último ano académico. Discussão: Existem seis modelos diferentes para o comportamento das médias dos níveis de empatia para com o curso, avaliados por uma metodologia comum em dezoito escolas de Odontologia de seis países na América Latina. Estes resultados suportam a existência de variabilidade de resposta empática, sendo necessária uma abordagem compreensiva para encontrar as suas causas. Conclusão: Em estudantes de Odontologia da América Latina verifica-se variabilidade no comportamento da distribuição de meios entre os anos acadêmicos das escolas de odontologia examinadas neste trabalho.

Sensibilidad y especificidad de la endosonografía en diagnóstico de cáncer de cabeza de páncreas. clínica general del Norte, periodo 2013-2014 / Sensitivity and specificity of endosonography in diagnosis of pancreatic head cancer. Clinica General del Norte, period 2013-2014

Objetivo: Determinar la sensibilidad y especificidad de la endosonografía en el diagnóstico de cáncer de cabeza de páncreas en pacientes con sospecha clínica de cáncer de páncreas atendidos en la Clínica General del Norte, enero de 2013-diciembre de 2014. Materiales y Métodos: Estudio evaluativo mediante el uso de una prueba ta-miz, se realizaron un total de 457 procedimientos endosonográficos; la muestra es por conveniencia en aquellos pacientes que se indicó la endosonografía por sospecha clínica de cáncer de páncreas y cumplieron los criterios de inclusión, para un total de 46 pacientes. Resultados: El sexo femenino mostró la mayor prevalencia en la mues-tra estudiada con un 54,3 %, la edad media 63,5 ± 3,0 años; de los 40 casos de hallazgos sugestivos de patología maligna en endosonografía, se correlacionó con la histopatología en 37, y de los 6 casos de hallazgos sugestivos de patología benigna se correlacionó en 1 caso. Conclusiones: Los hallazgos endosonográficos imagenológicos, en el diagnóstico de cáncer de cabeza de páncreas, muestra una sensibilidad del 97,3 %, con una especificidad del62,5 %, basados en el reporte anatomopatológico-histológico del tejido pancreático (gold estándar).

Objective: To determine the sensitivity and specificity of endosonography in diagnosis of pancreatic head cancer in patients with clinical suspicion of pancreatic cancer served in the Clinica General del Norte, January 2013-De-cember 2014. Materials and methods: Evaluation study using a screening test, Endosonographic a total of 457 procedures were performed; the sample is for convenience in patients endosonography was indicated by clinical suspicion of pancreatic cancer and met the inclusion criteria for a total of 46 patients. Results: Females showed the highest prevalence in the studied sample with 54.3 %, mean age 63.5 ± 3.0 years, 40 cases suggestive of ma-lignancy in endosonography, was correlated with histopathological at 37, and 6 cases of benign pathology findings suggestive of correlated in 1 case. Conclusions: Endosonographic the imaging findings in the diagnosis of pancre-atic head cancer, shows a sensitivity of 97.3 %, with a specificity of 62.5 %, based on the pathological-histological report pancreatic tissue (gold standard).

Orientación empática en estudiantes de medicina de las Universidades Libre y San Martín, Barranquilla, Colombia / Empathic guidance in medical students of the Universidad Libre and San Martin, Barranquilla, Colombia

Antecedentes. La empatía es un importante atributo que los estudiantes de medicina deben tener y ha sido poco estudiado en América Latina. Objetivo. Determinar el nivel de orientación empática de los estudiantes de medicina de las universidades Libre, seccional Barranquilla, y San Martín, sede Puerto Colombia, Barranquilla. Materiales y métodos. La orientación empática de los estudiantes se midió mediante la aplicación de la Escala de Empatía Médica de Jefferson en español, diseñada para estudiantes -versión S-, validada en otros países de Latinoamérica y adaptada culturalmente a Colombia. La comparación de los datos se realizó mediante análisis de varianza bifactorial -Modelo III-. Resultados. El nivel de orientación empática de los estudiantes tiene valores bajos, ubicados por encima del valor central del rango de la escala, 20 a140. Las diferencias entre las puntuaciones, según cursos y género, no fueron estadísticamente significativas al comparar los promedios de las sumatorias del puntaje de los estudiantes; sin embargo, se observó, un comportamiento diferente según el género entre las universidades: el femenino tuvo valores de orientación empática mejores que el masculino en la Universidad San Martín, mientras que en la Universidad Libre sucedió, relativamente, lo contrario. La comparación de las respuestas permitió observar que existen diferencias entre ellas. Conclusiones. Los resultados de este estudio no explican la contradicción encontrada en relación a las diferencias de género y cursos entre universidades; sin embargo, estos resultados son consistentes con otros trabajos, especialmente realizados en Latinoamérica, que muestran variabilidad de la respuesta empática en estudiantes de medicina. Las diferencias entre las universidades no pueden atribuirse a causas psicológicas solamente, sino a la presencia de otros factores que también influyen en la respuesta empática.

Background. Empathy is an important characteristic that medical students must have and which has not been a central subject of study in Latinamerica. Objective. To determine the level of empathic orientation of medicine students from San Martin University, Puerto Colombia campus, and Libre University, Barranquilla campus, both located in Barranquilla, Colombia. Materials and methods. The empathic orientation in medical students was measured by the implementation of the Jefferson Physician Empathy Scale Spanish version for students (S version), validated in other countries of Latin America and culturally adapted to Colombia. Data comparison was carried out through bifactorial analysis of (Model III). Results. The level of empathetic guidance of students is low, with levels situated above the central value of the scale range, 20 to 140. There were no statistically significant differences in the score, in terms of courses and gender, to compare averages of the sums of scores of students. However, a different behavior between the two universities in terms of gender and courses was observed: women had better absolute values of the levels of empathy than men at University of San Martin, but not statistically; while at University Libre statistical differences in gender and the courses were observed. As a result, there are differences between both universities. Conclusions. The results of this study do not explain the contradiction that was found in relation to gender differences between universities and courses. However, these results are consistent with other works, in particular those carried out in Latin America, which show variability of the empathic response in medical students and health. Differences between both universities cannot only be attributed to "psychological reasons", but also to the presence of other factors influencing the empathic response.

Risk factors for ureteral occlusion during transvaginal uterosacral ligament suspension.

INTRODUCTION AND HYPOTHESIS: To determine any risk factors associated with ureteral occlusion during transvaginal uterosacral ligament suspension (USLS). METHODS: A retrospective query to identify patients that underwent transvaginal USLS at a teaching hospital from 2008 to 2013 was performed. Patients in which ureteral occlusion was identified by cystoscopy were identified (cases), and compared with those without occlusion (controls). Medical records were reviewed for data abstraction. Variables compared between cases and controls included demographics, medical history/examination, concomitant procedures, number of suspension sutures placed, estimated blood loss and length of hospital stay. Univariate analyses were performed to identify potential risk factors for ureteral occlusion, followed by multivariate regression analysis to estimate odds ratios for identified predictors. RESULTS: A total of 144 USLS procedures were performed. Thirteen cases of ureteral occlusion were identified (9%). Baseline prolapse stage, body mass index, parity, previous hysterectomy or pelvic surgery of the groups were similar (all P > 0.05). Univariate analysis identified age (P = 0.04), concomitant anterior colporrhaphy (P = 0.01), and use of a suture-capturing device for suture placement (P = 0.04) as significant factors. On multivariate logistic regression analysis, concomitant anterior colporrhaphy increased ureteral occlusion risk (OR 10.5, 95%CI 2.37-74.99, P = 0.001), while use of a suture-capturing device decreased it (OR 0.1, 95%CI 0-0.41, P = 0.01). The mean number of suspension sutures placed per side was similar in the two groups (2.6 [range 2-4] for cases and 2.4 [range 1-4] for controls, P = 0.15). CONCLUSIONS: During transvaginal USLS, performance of a concomitant anterior colporrhaphy increased the risk of ureteral occlusion, while the use of a suture-capturing device for suspension suture placement was associated with decreased risk.

Calidad de atención del infarto agudo de miocardio en la Argentina: Observaciones del Registro SCAR (Síndromes Coronarios Agudos en Argentina) / Quality of Care for Acute Myocardial Infarction in Argentina: Observations from the SCAR (Acute Coronary Syndromes in Argentina) Registry

Introducción: Las mediciones de calidad ayudan a cuantificar la distancia entre la atención en salud que se brinda y la que se debería brindar. Existen mediciones específicas sobre la calidad de la atención del infarto de miocardio que permiten uniformar los datos de calidad que toda institución debería medir para autoevaluarse y compararse con otras. Objetivo: Analizar los datos de calidad de la atención del infarto en nuestro país utilizando los datos del Registro Multicéntrico SCAR (Síndromes Coronarios Agudos en Argentina). Material y métodos: Se analizaron los datos de calidad de atención del infarto de miocardio de los pacientes de la base de datos del Registro Multicéntrico SCAR utilizando definiciones del documento "ACC/AHA 2008 performance measures for adults with ST-elevation and non-ST-elevation myocardial infarction". Resultados: Se analizaron 751 casos de infarto de miocardio con datos completos sobre indicadores de calidad. El uso de aspirina, betabloqueantes, estatinas y antagonistas de la angiotensina fue cercano al 90%. La excepción fue el uso de clopidogrel, que fue del 72,5% en quienes no recibieron reperfusión mecánica. Se relevó la función ventricular durante la internación en el 90,2% de los casos. Recibieron alguna estrategia de reperfusión el 90,1% de los infartos con elevación del segmento ST y menos de 12 horas de evolución. El tiempo puerta-balón fue < 90 minutos en el 50,8% de los casos, mientras que el tiempo puerta-aguja fue < 30 minutos en el 40,5%. Conclusiones: Globalmente se observaron valores altos de cumplimiento en los tratamientos farmacológicos y de reperfusión, excepto en el uso de clopidogrel sin revascularización mecánica. Se observó un cumplimiento bajo en los tiempos apropiados de los tratamientos de reperfusión.

Introduction: Quality assessments help to quantify the gap between healthcare provision and what should be awarded. There are specific measurements on quality of medical care for myocardial infarction which standardize the quality information that every institution should determine for self-assessment and for comparison with others. Objective: The aim of this study was to analyze quality of care for myocardial infarction data in our country using the SCAR (Acute Coronary Syndromes in Argentina) Multicenter Registry. Methods: Quality of care data for myocardial infarction was analyzed in patients included in the database of the SCAR Multicenter Registry using definitions of the "ACC/AHA 2008 performance measures for adults with ST-elevation and non-ST-elevation myocardial infarction" document. Results: The study analyzed 751 myocardial infarction cases with complete data on quality indicators. Aspirin, betablockers, statins and angiotensin antagonists were used in nearly 90% of patients. The exception was clopidogrel which was used in 72.5% of patients not receiving mechanical reperfusion. Ventricular function was assessed during hospitalization in 90.2% of cases. A reperfusion strategy was used in 90.1% of ST-segment-elevation infarctions and less than 12-hour evolution. Door-to-balloon time was < 90 minutes in 50.8% of cases, while door-to-needle time was < 40.5%. Conclusions: Overall, there was high compliance to pharmacological and reperfusion treatments except in the use of clopidogrel without mechanical revascularization, and low compliance to the appropriate times of reperfusion therapy.

Calidad de atención del infarto agudo de miocardio en la Argentina: Observaciones del Registro SCAR (Síndromes Coronarios Agudos en Argentina) / Quality of Care for Acute Myocardial Infarction in Argentina: Observations from the SCAR (Acute Coronary Syndromes in Argentina) Registry

Introducción: Las mediciones de calidad ayudan a cuantificar la distancia entre la atención en salud que se brinda y la que se debería brindar. Existen mediciones específicas sobre la calidad de la atención del infarto de miocardio que permiten uniformar los datos de calidad que toda institución debería medir para autoevaluarse y compararse con otras. Objetivo: Analizar los datos de calidad de la atención del infarto en nuestro país utilizando los datos del Registro Multicéntrico SCAR (Síndromes Coronarios Agudos en Argentina). Material y métodos: Se analizaron los datos de calidad de atención del infarto de miocardio de los pacientes de la base de datos del Registro Multicéntrico SCAR utilizando definiciones del documento "ACC/AHA 2008 performance measures for adults with ST-elevation and non-ST-elevation myocardial infarction". Resultados: Se analizaron 751 casos de infarto de miocardio con datos completos sobre indicadores de calidad. El uso de aspirina, betabloqueantes, estatinas y antagonistas de la angiotensina fue cercano al 90%. La excepción fue el uso de clopidogrel, que fue del 72,5% en quienes no recibieron reperfusión mecánica. Se relevó la función ventricular durante la internación en el 90,2% de los casos. Recibieron alguna estrategia de reperfusión el 90,1% de los infartos con elevación del segmento ST y menos de 12 horas de evolución. El tiempo puerta-balón fue < 90 minutos en el 50,8% de los casos, mientras que el tiempo puerta-aguja fue < 30 minutos en el 40,5%. Conclusiones: Globalmente se observaron valores altos de cumplimiento en los tratamientos farmacológicos y de reperfusión, excepto en el uso de clopidogrel sin revascularización mecánica. Se observó un cumplimiento bajo en los tiempos apropiados de los tratamientos de reperfusión.(AU)

Introduction: Quality assessments help to quantify the gap between healthcare provision and what should be awarded. There are specific measurements on quality of medical care for myocardial infarction which standardize the quality information that every institution should determine for self-assessment and for comparison with others. Objective: The aim of this study was to analyze quality of care for myocardial infarction data in our country using the SCAR (Acute Coronary Syndromes in Argentina) Multicenter Registry. Methods: Quality of care data for myocardial infarction was analyzed in patients included in the database of the SCAR Multicenter Registry using definitions of the "ACC/AHA 2008 performance measures for adults with ST-elevation and non-ST-elevation myocardial infarction" document. Results: The study analyzed 751 myocardial infarction cases with complete data on quality indicators. Aspirin, betablockers, statins and angiotensin antagonists were used in nearly 90% of patients. The exception was clopidogrel which was used in 72.5% of patients not receiving mechanical reperfusion. Ventricular function was assessed during hospitalization in 90.2% of cases. A reperfusion strategy was used in 90.1% of ST-segment-elevation infarctions and less than 12-hour evolution. Door-to-balloon time was < 90 minutes in 50.8% of cases, while door-to-needle time was < 40.5%. Conclusions: Overall, there was high compliance to pharmacological and reperfusion treatments except in the use of clopidogrel without mechanical revascularization, and low compliance to the appropriate times of reperfusion therapy.(AU)

Hypertension, renal failure, and edema in a 38-year-old man: light chain deposition disease; a case report and review of the literature.

BACKGROUND: Monoclonal immunoglobulin deposition disease (MIDD) is a rare disease, usually manifesting between the 5(th) and 6(th) decades of life but can also occur earlier. Characteristic feature of MIDD is a non-fibrillar, Congo red negative deposition of monoclonal immunoglobulins in various organs, including the kidneys. Depending on the composition of the deposits, MIDD is classified into 3 types; light chain deposition disease (LCDD), which is the most common form, heavy chain deposition disease (HCDD) and light and heavy chain deposition disease (LHCDD). Kidney involvement is common in MIDD. Renal biopsy reveals nodular sclerosing glomerulopathy on light microscopy and diffuse linear staining of glomerular and tubular basement membranes on immunofluorescence (IF) microscopy. CASE PRESENTATION: A 38-year-old male patient recently diagnosed with hypertension presented with lower extremity edema, shortness of breath, and fatigue. The workup that was performed in a different hospital prior to this admission, demonstrated the presence of significant proteinuria and renal failure. He was intermittently dialyzed and a renal biopsy was obtained, which showed LCDD. Further laboratory workup revealed an increase of IgM, kappa chain and ß2 microglobulin chain, in addition to proteinuria and renal insufficiency. Bone marrow biopsy demonstrated an involvement of 30% with plasma cells. The flow cytometry test showed monotypic plasma cells expressing intracytoplasmic kappa light chain restriction with kappa to lambda ratio of 35/1. The diagnosis of LCDD was established. Treatment with steroids and bortezomib was initiated. CONCLUSIONS: MIDD is an unusual disease and LCDD is the most common form of MIDD. The peak incidence is around the 5(th) and 6(th) decade of life, however, LCDD can also be found in younger patients. Renal involvement, proteinuria, hematuria, and hypertension are markers of the initial clinical presentation. Nodular sclerosing glomerulopathy is found in about 60% of the affected patients. Early diagnosis and early treatment improve the prognostic course of LCDD.

Empathic orientation among medical students from three universities in Barranquilla, Colombia and one university in the Dominican Republic.

OBJECTIVE: To compare empathic orientation among medical students from three schools of medicine in Colombia and one in the Dominican Republic. MATERIAL AND METHODS: Empathic orientation of medical students was measured using the Jefferson Scale of Physician Empathy (JSPE), Spanish version for students (the "S" version) validated in Mexico and Chile, and culturally adapted to Colombia and the Dominican Republic. Data were compared using a three-factor analysis of variance (model III) and a discriminant analysis. RESULTS: No differences in empathic orientation were observed among courses and between sexes, but differences were found in schools of medicine considered as a unit in each studied country. CONCLUSIONS: Empathic orientation levels tend to reduce as courses advance. This was observed in both male and female students and in all schools analyzed.

Orientación empática de estudiantes de medicina en tres universidades de Barranquilla, Colombia y en una universidad de República Dominicana / Empathic orientation among medical students from three universities in Barranquilla, Colombia and one university in the Dominican Republic

Objetivo. Comparar la orientación empática entre estudiantes de Medicina de tres facultades de Medicina de Colombia y una de República Dominicana. Material y métodos. Se midió la orientación empática de los estudiantes de Medicina mediante la escala de empatía médica de Jefferson, en la versión en español para estudiantes (versión S) validada en México y Chile, y adaptada culturalmente a Colombia y República Dominicana. Los datos se compararon mediante un análisis de varianza trifactorial (modelo III) y por un análisis discriminante. Resultados. No se encontraron diferencias de orientación empática entre los cursos ni entre los sexos, pero sí entre las facultades de Medicina consideradas como una unidad en cada uno de los países estudiados. Conclusiones. Los niveles de orientación empática tienden a disminuir a medida que los cursos avanzan. Este hecho se produce en estudiantes de ambos sexos y en todas las facultades analizadas.

Objective. To compare empathic orientation among medical students from three schools of medicine in Colombia and one in the Dominican Republic. Material and Methods. Empathic orientation of medical students was measured using the Jefferson Scale of Physician Empathy (JSPE), Spanish version for students (the "S" version) validated in Mexico and Chile, and culturally adapted to Colombia and the Dominican Republic. Data were compared using a three-factor analysis of variance (model III) and a discriminant analysis. Results. No differences in empathic orientation were observed among courses and between sexes, but differences were found in schools of medicine considered as a unit in each studied country. Conclusions. Empathic orientation levels tend to reduce as courses advance. This was observed in both male and female students and in all schools analyzed.