Autonomía en actividades profesionales confiables luego de la pandemia por COVID-19: perspectivas de residentes y docentes / Autonomy in entrustable professional activities after the COVID-19 pandemic: the perspectives of residents and teachers

Introducción. Las actividades profesionales confiables (APROC) son 13 actividades que los médicos recién graduados deberían poder realizar sin supervisión directa. Nuestro objetivo fue evaluar la percepción de residentes y docentes acerca de la autonomía para realizar las APROC, luego de 2 años del inicio de la pandemia. Materiales y métodos. Estudio de corte transversal, que incluyó residentes de primer año de especialidades clínicas y quirúrgicas, y sus docentes. Se enviaron cuestionarios electrónicos y anónimos. Resultados. Se incluyeron 31 residentes y 20 docentes. La mayoría de los residentes creía que podía realizar en forma autónoma 8 de las 13 APROC. Para la mayoría de los docentes, los residentes requerían supervisión directa para 11 de las 13 actividades. Se observaron diferencias significativas entre la percepción de residentes y docentes en 8 de las 13 APROC. Conclusión. La percepción de autonomía para realizar las APROC al inicio de la residencia fue considerablemente mayor en residentes que en sus docentes.

Introduction. The entrustable professional activities (EPAs) are 13 activities that new medical graduates should be able to perform without direct supervision. Our objective was to assess the perceptions of residents and teachers regarding their autonomy to perform the EPAs 2 years after the onset of the COVID-19 pandemic. Materials and methods. Cross-sectional study of first-year residents of clinical and surgical specialties and their teachers. Electronic, anonymous questionnaires were used. Results. Subjects were 31 residents and 20 teachers. Most residents believed that they were able to perform 8 of the 13 EPAs independently. According to most teachers, residents required direct supervision to perform 11 of the 13 EPAs. Significant differences were observed between residents' and teachers' perceptions in 8 of the 13 EPAs. Conclusion. The perception of autonomy to perform the EPAs in the beginning of the residency program was considerably better among residents than their teachers.

Autonomy in entrustable professional activities after the COVID-19 pandemic: the perspectives of residents and teachers. / Autonomía en actividades profesionales confiables luego de la pandemia por COVID-19: perspectivas de residentes y docentes.

Introduction. The entrustable professional activities (EPAs) are 13 activities that new medical graduates should be able to perform without direct supervision. Our objective was to assess the perceptions of residents and teachers regarding their autonomy to perform the EPAs 2 years after the onset of the COVID-19 pandemic. Materials and methods. Cross-sectional study of first-year residents of clinical and surgical specialties and their teachers. Electronic, anonymous questionnaires were used. Results. Subjects were 31 residents and 20 teachers. Most residents believed that they were able to perform 8 of the 13 EPAs independently. According to most teachers, residents required direct supervision to perform 11 of the 13 EPAs. Significant differences were observed between residents' and teachers' perceptions in 8 of the 13 EPAs. Conclusion. The perception of autonomy to perform the EPAs in the beginning of the residency program was considerably better among residents than their teachers.

Introducción. Las actividades profesionales confiables (APROC) son 13 actividades que los médicos recién graduados deberían poder realizar sin supervisión directa. Nuestro objetivo fue evaluar la percepción de residentes y docentes acerca de la autonomía para realizar las APROC, luego de 2 años del inicio de la pandemia. Materiales y métodos. Estudio de corte transversal, que incluyó residentes de primer año de especialidades clínicas y quirúrgicas, y sus docentes. Se enviaron cuestionarios electrónicos y anónimos. Resultados. Se incluyeron 31 residentes y 20 docentes. La mayoría de los residentes creía que podía realizar en forma autónoma 8 de las 13 APROC. Para la mayoría de los docentes, los residentes requerían supervisión directa para 11 de las 13 actividades. Se observaron diferencias significativas entre la percepción de residentes y docentes en 8 de las 13 APROC. Conclusión. La percepción de autonomía para realizar las APROC al inicio de la residencia fue considerablemente mayor en residentes que en sus docentes.

A Fluid-Management Drape for Hysteroscopy: Innovation for Improved Patient Safety and Surgical Care.

BACKGROUND: Hysteroscopy requires accurate collection of unabsorbed distension media to measure patient fluid absorption. We assessed the effectiveness and usability of a novel total capture drape compared with a standard drape during hysteroscopy. METHOD: Simulation trials were followed by an early-phase study to compare fluid-capture efficiency and measures of drape usability during hysteroscopy randomizing the total capture drape compared with a standard drape. EXPERIENCE: Simulation trials indicated complete collection of unabsorbed fluid with the total capture drape and progressive loss of unabsorbed fluid with the standard drape. An early-phase study with 68 women found no statistical difference between groups for the hysteroscopic fluid deficit, but saw fewer cases with lost fluid in the total capture drape compared with the standard drape. Direct observation and focus group data indicated a trend for better capture of unabsorbed fluid with the total capture drape, along with increased usability once surgeons became familiar with correct placement. CONCLUSION: Simulation and early-phase study results are favorable for the total capture drape, demonstrating comparable fluid collection with the standard drape. With repeated use and in-service training, surgeons expressed greater confidence in the accuracy of the hysteroscopic fluid deficit with the total capture drape compared with the standard drape. Design modifications should improve overall usability and fluid-capture efficiency.

Comparative Pathogenesis of Generalist AcMNPV and Specific RanuNPV in Larvae of Rachiplusia nu (Lepidoptera: Noctuidae) Following Single and Mixed Inoculations.

The South American soybean pest, Rachiplusia nu (Guenée), is naturally infected by Autographa californica multiple nucleopolyhedrovirus (AcMNPV) and Rachiplusia nu nucleopolyhedrovirus (RanuNPV). We compared their pathogenicity to fourth-instar R. nu larvae, by evaluating time to death and virus spread throughout the tissues in single and mixed infections. Bioassays showed that generalist AcMNPV had a faster speed of kill than specific RanuNPV, while the mixed-virus treatment did not statistically differ from AcMNPV alone. Histopathology evidenced similar tissue tropism for both viruses, but co-inoculation resulted in mostly AcMNPV-infected cells. In sequential inoculations, however, the first virus administered predominated over the second one. Implications on baculovirus interactions and biocontrol potential are discussed.

In silico identification of immunotherapeutic and diagnostic targets in the glycosylphosphatidylinositol metabolism of the coccidian Sarcocystis aucheniae.

Meat of the South American camelids (SACs) llama and alpaca is an important source of animal protein and income for rural families in the Andes, and a product with significant growth potential for local and international markets. However, infestation with macroscopic cysts of the coccidian protozoon Sarcocystis aucheniae, a parasitosis known as SAC sarcocystosis, significantly hampers its commercialization. There are no validated methods to diagnose the presence of S. aucheniae cysts other than carcass examination. Moreover, there are no available drugs or vaccines to cure or prevent SAC sarcocystosis. Identification of relevant molecules that act at the host-pathogen interface can significantly contribute to the control of this disease. It has been shown for other pathogenic protozoa that glycosylphosphatidylinositol (GPI) is a critical molecule implicated in parasite survival and pathogenicity. This study focused on the identification of the enzymes that participate in the S. aucheniae GPI biosynthetic pathway and the repertoire of the parasite GPI-anchored proteins (GPI-APs). To this aim, RNA was extracted from parasite cysts and the transcriptome was sequenced and translated into amino acid sequences. The generated database was mined using sequences of well-characterized GPI biosynthetic enzymes of Saccharomyces cerevisiae and Toxoplasma gondii. Eleven enzymes predicted to participate in the S. aucheniae GPI biosynthetic pathway were identified. On the other hand, the database was searched for proteins carrying an N-terminal signal peptide and a single C-terminal transmembrane region containing a GPI anchor signal. Twenty-four GPI-anchored peptides were identified, of which nine are likely S. aucheniae-specific, and 15 are homologous to membrane proteins of other coccidians. Among the latter, 13 belong to the SRS domain superfamily, an extensive group of coccidian GPI-anchored proteins that mediate parasite interaction with their host. Phylogenetic analysis showed a great degree of intra- and inter-specific divergence among SRS family proteins. In vitro and in vivo experiments are needed to validate S. aucheniae GPI biosynthetic enzymes and GPI-APs as drug targets and/or as vaccine or diagnostic antigens.

Detection of Sarcocystis aucheniae in blood of llama using a duplex semi-nested PCR assay and its association with cyst infestation.

The protozoon Sarcocystis aucheniae is the causative agent of South American camelid (SAC) sarcocystosis. Infections are characterized by the presence of cysts in muscles which are in size and appearance similar to rice grains. As consumption of insufficiently cooked infected meat produces gastroenteritis, cyst-containing SAC meat is confiscated by sanitary authorities or depreciated with serious economic consequences for SAC breeders. In this work, a duplex semi-nested PCR was designed to simultaneously detect parasite and llama DNA in host blood samples. Species-specific regions of S. aucheniae 18S rRNA gene and Lama glama 16S mitochondrial gene were amplified, yielding bands of 583 and 257 bp, respectively, and separated by gel electrophoresis. The method proved to be highly sensitive, with a detection limit lower than one parasite per milliliter blood, and the inclusion of primers to detect llama-specific DNA resulted useful as a methodological control. Blood samples collected from llamas of Argentina and Bolivia (n = 225) were analyzed using this method, and 18.7 % resulted positive for S. aucheniae. No correlation was found between PCR results and llama age, sex or the finding of macroscopic cysts in meat after slaughter. Lack of molecular detection in the blood of some llamas harboring macrocysts suggests that parasite circulation in the bloodstream after encystment is under the detection threshold of the test or even absent, while PCR positive results in cyst-infested animals suggests that prior exposure to the parasite does not impede subsequent infections. The described method can be useful to detect active foci of infection, to assess the effectiveness of parasiticide treatments, and for the surveillance and tracing of definitive hosts.

Seropositivity to Sarcocystis infection of llamas correlates with breeding practices.

Production of llama (Lama glama) meat in rural communities of the Andean regions is largely affected by Sarcocystis spp. infection. Macroscopic cysts develop in muscles as a consequence of S. aucheniae parasitism, often resulting in meat downgrade or condemnation. Llama meat production is informal in Argentina but has broad perspectives for improvement, and would significantly benefit from the development of standardized control methodologies. This work analyzes whether the presence of anti-Sarcocystis spp. antibodies in llamas is influenced by factors such as geographic region and/or herd management practices. To this aim, an indirect ELISA was set up based on a ~23kDa soluble immunogenic protein fraction (Sa23), isolated from S. aucheniae macrocysts (Sa23-iELISA). Serum samples (n=507) were collected from llamas bred under three different conditions: (i) with no sanitation controls and in the presence of pastoral dogs by small producers of different localities of the Argentine Puna (Group I, n=237); (ii) with sanitation controls and no pastoral dogs, in fenced fields of an experimental agricultural station in the Argentine Puna (Group II, n=167); and (iii) with sanitation controls and no pastoral dogs in fenced fields of farms of the humid Pampas (Group III, n=103). Results of the Sa23-iELISA were expressed as percentages of positivity with respect to a reference Sarcocystis-positive serum. Notably, the percentage of sera that fell above the cut-off (31.5% positivity) in group (i) was significantly higher (p<0.001) than those of groups (ii) and (iii) (50% vs 23% and 26%, respectively). These results indicate that herd management practices constitute a critical risk factor for sarcocystiosis in llamas. Differences in these practices include feeding of dogs with raw Sarcocystis-infected llama meat, with the consequent maintenance of the parasite life cycle by the contamination of pastures and water with fecal-derived infective oocysts/sporocysts. Additionally, the itinerancy of llama herds in search for pastures and water sources possibly exposes animals to a higher number of infective foci. On the other hand, percentages of seropositive llamas kept under controlled conditions in the Puna or the humid Pampas were not significantly different, suggesting that climate, altitude, and/or pasture characteristics do not influence Sarcocystis-infection. Male gender and older age of llamas were found to be propensity factors for sarcocystiosis in llamas bred in La Puna under controlled conditions. Availability of diagnostic tools, as well as increased knowledge on the parasite and its epidemiology, will allow the design of control strategies for SAC sarcocystiosis.

Molecular detection of Sarcocystis aucheniae in the blood of llamas from Argentina.

Sarcocystis aucheniae are apicomplexan protozoa that infect South American camelids (SACs), giving rise to macroscopic cysts similar to rice grains in skeletal muscles. Visual detection of macrocysts in slaughtered animals hampers commercialization of SAC meat, a highly relevant economic exploitation for Andean rural families. Importantly, the consumption of undercooked S. aucheniae-infested meat causes gastroenteritis. A carnivore definitive host, possibly the dog, acquires the parasite when feeding on infected SAC meat, and later eliminates infective oocysts in its feces. The parasite cycle is completed when SACs ingest contaminated water or pastures. We hypothesized that parasite DNA can be detected in SAC blood using molecular methods. In order to test this hypothesis, a seminested PCR format was specifically designed to target the hypervariable 18S rRNA gene region of S. aucheniae. PCR conditions were optimized using genomic DNA extracted from macrocyst bradyzoites. A detection limit of up to 1 parasite in 10µl of llama blood was established based on DNA samples extracted from aliquots of S. aucheniae bradyzoite-spiked non-infected llama blood. The seminested PCR allowed to detect natural infections of S. aucheniae in llama blood samples originating in the Andean flatlands of Argentina. Specific amplification of S. aucheniae DNA was corroborated by amplicon sequencing. This is the first report of S. aucheniae detection in llama blood, which provides a valuable diagnostic tool for epidemiological studies and for the evaluation of the efficacy of control measures for this parasitosis.

Detección molecular de Sarcocystis aucheniae en sangre de llamas de Argentina / Molecular detection of Sarcocystis aucheniae in the blood of llamas from Argentina

Sarcocystis aucheniae are apicomplexan protozoa that infect South American camelids (SACs), giving rise to macroscopic cysts similar to rice grains in skeletal muscles. Visual detection of macrocysts in slaughtered animals hampers commercialization of SAC meat, a highly relevant economic exploitation for Andean rural families. Importantly, the consumption of undercooked S. aucheniae-infested meat causes gastroenteritis. A carnivore definitive host, possibly the dog, acquires the parasite when feeding on infected SAC meat, and later eliminates infective oocysts in its feces. The parasite cycle is completed when SACs ingest contaminated water or pastures. We hypothesized that parasite DNA can be detected in SAC blood using molecular methods. In order to test this hypothesis, a seminested PCR format was specifically designed to target the hypervariable 18S rRNA gene region of S. aucheniae. PCR conditions were optimized using genomic DNA extracted from macrocyst bradyzoites. A detection limit of up to 1 parasite in 10 μl of llama blood was established based on DNA samples extracted from aliquots of S. aucheniae bradyzoite-spiked non-infected llama blood. The seminested PCR allowed to detect natural infections of S. aucheniae in llama blood samples originating in the Andean flatlands of Argentina. Specific amplification of S. aucheniae DNA was corroborated by amplicon sequencing. This is the first report of S. aucheniae detection in llama blood, which provides a valuable diagnostic tool for epidemiological studies and for the evaluation of the efficacy of control measures for this parasitosis.

Sarcocystis aucheniae es un protozoo apicomplexa que infecta a camélidos sudamericanos (CS), dando lugar a la formación de quistes macroscópicos similares a granos de arroz en los músculos esqueléticos. La detección visual de macroquistes en animales faenados dificulta la comercialización de la carne de CS, una explotación de gran relevancia para la economía de las familias rurales andinas. Es importante destacar que el consumo de carne infectada con S. aucheniae no suficientemente cocida causa gastroenteritis. Un hospedador definitivo carnívoro, posiblemente el perro, adquiere el parásito cuando se alimenta de carne de CS infectada y luego elimina ooquistes infectivos en las heces. El ciclo del parásito se completa cuando un CS ingiere agua o pasturas contaminadas. Hemos hipotetizado que es posible detectar ADN del parásito en la sangre de CS usando métodos moleculares. Para poner a prueba esta hipótesis, se diseñó una PCR semianidada que utiliza como blanco una región del gen 18S ARNr específica para S. aucheniae. Se optimizaron las condiciones de la PCR usando ADN genómico extraído de bradizoítos presentes en macroquistes. Se estableció un límite de detección de un parásito en 10 μl de sangre de llama, basado en muestras de ADN extraído de alícuotas de sangre de llama no infectada a las que se agregaron cantidades conocidas de bradizoítos de S. aucheniae. Más aún, la PCR semianidada permitió la detección de infecciones naturales por este parásito en muestras de sangre de llama de la Puna argentina. La amplificación específica de ADN de S. aucheniae fue corroborada por secuenciación de los productos de amplificación. Este es el primer reporte de la detección de S. aucheniae en sangre de llama. Además, este estudio contribuye una herramienta diagnóstica valiosa para estudios epidemiológicos y para la evaluación de la efectividad de medidas de control para esta parasitosis.