Endometrial cancer: predictors and oncological safety of tumor tissue manipulation.

PURPOSE: The main goal of this study is to assess the impact of tumor manipulation on the presence of lympho-vascular space invasion and its influence on oncological results. METHODS: We performed a retrospective multi-centric study amongst patients who had received primary surgical treatment for apparently early-stage endometrial cancer. A multivariate statistical analysis model was designed to assess the impact that tumor manipulation (with the use of uterine manipulator or preoperative hysteroscopy) has on lympho-vascular development (LVSI) in the final surgical specimen. RESULTS: A total of 2852 women from 15 centers were included and divided into two groups based on the lympho-vascular status in the final surgical specimen: 2265 (79.4%) had no LVSI and 587 (20.6%) presented LVSI. The use of uterine manipulator was associated with higher chances of lympho-vascular involvement regardless of the type used: Balloon manipulator (HR: 95% CI 4.64 (2.99-7.33); p < 0.001) and No-Balloon manipulator ([HR]: 95% CI 2.54 (1.66-3.96); p < 0.001). There is no evidence of an association between the use of preoperative hysteroscopy and higher chances of lympho-vascular involvement (HR: 95% CI 0.90 (0.68-1.19); p = 0.479). CONCLUSION: Whilst performing common gynecological procedures, iatrogenic distention and manipulation of the uterine cavity are produced. Our study suggests that the use of uterine manipulator increases the rate of LVSI and, therefore, leads to poorer oncological results. Conversely, preoperative hysteroscopy does not show higher rates of LVSI involvement in the final surgical specimen and can be safely used.

Violencia intrafamiliar en familias con niños en edad prescolar de un consultorio médico / Intrafamily Violence in Families with Children at Preschool Aged from a Family Medical Office

Introducción: La violencia intrafamiliar ocurre en el interior de la familia y, por lo general, la ejercen uno o varios miembros contra otros; casi siempre las víctimas son mujeres, ancianos y niños. Objetivo: Caracterizar el estado actual de la violencia intrafamiliar en familias con niños en edad prescolar. Métodos: Se realizó un estudio descriptivo transversal en el Consultorio Médico de Familia No. 1, poblado de Cuatro Caminos perteneciente al Policlínico Docente Mártires del 10 de abril, Corralillo, Villa Clara, de enero del 2020 a junio del 2021. La población estuvo constituida por 66 familias y la muestra por 64, según muestreo no probabilístico por criterio. Para la recogida de la información se utilizaron cuestionario y observación a las familias en estudio. Resultados: Presencia de violencia intrafamiliar (32,8 por ciento), familias extensas (70,3 por ciento), hacinamiento (14,1 por ciento), malas relaciones entre los adultos (66,6 %), maltrato en la niñez (66,6 por ciento) manifestaciones psicológicas: padres ausentes físicamente (57,1 por ciento), violencia psicológica (100 por ciento), violencia física (66,6 por ciento) y violencia sexual (42,9 por ciento). Conclusiones: Las malas relaciones entre los adultos, el maltrato en la niñez y los padres ausentes físicamente son asociados a la violencia intrafamiliar. La violencia psicológica estuvo presente en la totalidad de las familias. Las mayores cifras de tipos de violencia fueron en la familia extensa(AU)

Introduction: Intrafamily violence occurs within the family and is generally exercised by one or several members against others; almost always, the victims are women, the elderly or children. Objective: To characterize the current state of domestic violence in families with preschool children. Methods: A cross-sectional and descriptive study was carried out in the family medical office 1, in the neighborhood of Cuatro Caminos, belonging to the Policlínico Docente Mártires del 10 de Abril, in Corralillo Municipality, Villa Clara Province, from January 2020 to June 2021. The population consisted of 66 families and the sample was made up of 64, according to nonprobabilistic sampling by criteria. For the collection of information, a questionnaire and the observation method were used with the families under study. Results: There was presence of intrafamily violence (32.8percent) extended families (70.3percent), overcrowding (14.1percent), poor relationships between adults (66.6percent) and child abuse (66.6percent). The psychological manifestations were related to physically absent parents (57.1percent), psychological violence (100%), physical violence (66.6percent) and sexual violence (42.9percent). Conclusions: Poor relationships between adults, childhood abuse and physically absent parents are associated with intrafamily violence. Psychological violence was present in all families. The highest numbers of types of violence occurred in the extended family(AU)

Anthropogenic Contamination in the Free Aquifer of the San Luis Potosí Valley.

The San Luis Potosí valley is an endorheic basin that contains three aquifers: a shallow unconfined aquifer of alluvial material and two deep aquifers, free and confined. The groundwater contamination documented for the shallow aquifer generates contamination of the deep unconfined type aquifer, from which part of the population's drinking water needs are met. This study records incipient anthropogenic contamination of two types: biogenic and potentially toxic trace elements. The studied contaminants include fecal coliform bacteria, total coliform, nitrate, and potentially toxic elements such as: manganese (Mn), mercury (Hg), arsenic (As), and cadmium (Cd). This contamination in some locations exceeds the permissible limit for human consumption. Some major consequences to health, including severe illness, may be caused by the trace elements. The present results give a first signal about the contamination of the deep unconfined type aquifer due to anthropogenic activity in the valley. This is a priority issue because this aquifer supplies drinking water, and in the short or medium term it will have an effect on public health.

Lymphovascular Space Invasion in Early-Stage Endometrial Cancer (LySEC): Patterns of Recurrence and Predictors. A Multicentre Retrospective Cohort Study of the Spain Gynecologic Oncology Group.

The main aim is to compare oncological outcomes and patterns of recurrence of patients with early-stage endometrioid endometrial cancer according to lymphovascular space invasion (LVSI) status. The secondary objective is to determine preoperative predictors of LVSI. We performed a multicenter retrospective cohort study. A total of 3546 women diagnosed with postoperative early-stage (FIGO I-II, 2009) endometrioid endometrial cancer were included. Co-primary endpoints were disease-free survival (DFS), overall survival (OS), and pattern of recurrence. Cox proportional hazard models were used for time-to-event analysis. Univariate and multivariate logistical regression models were employed. Positive LVSI was identified in 528 patients (14.6%) and was an independent prognostic factor for DFS (HR 1.8), OS (HR 2.1) and distant recurrences (HR 2.37). Distant recurrences were more frequent in patients with positive LVSI (78.2% vs. 61.3%, p < 0.01). Deep myometrial invasion (OR 3.04), high-grade tumors (OR 2.54), cervical stroma invasion (OR 2.01), and tumor diameter ≥ 2 cm (OR 2.03) were independent predictors of LVSI. In conclusion, in these patients, LVSI is an independent risk factor for shorter DFS and OS, and distant recurrence, but not for local recurrence. Deep myometrial invasion, cervical stroma invasion, high-grade tumors, and a tumor diameter ≥ 2 cm are independent predictors of LVSI.

Competencias profesionales del Equipo Básico de Salud en prevención de violencia intrafamiliar / Professional competencies of the Basic Health Team in the prevention of intra-family violence

Fundamento: la violencia intrafamiliar representa un problema de salud y los profesionales de estas ciencias deben reconocer su existencia y estar debidamente preparados para prevenirla. Objetivo: identificar el nivel de competencia de los equipos básicos de salud en el manejo contra la violencia intrafamiliar en la edad pediátrica desde la atención primaria de salud. Métodos: se realizó un estudio descriptivo transversal en el Policlínico Universitario "Mártires del 10 de Abril", municipio Corralillo de enero a abril de 2021. Se utilizaron métodos teóricos y empíricos; para recogida de información se empleó el análisis de documentos y examen de competencia a profesionales de salud. Las variables en estudio fueron: categoría ocupacional, años de graduado, dimensiones cognitivas, procedimentales y actitudinales; y competencias profesionales en la prevención contra la violencia intrafamiliar. Resultados: El 52,94 % de los profesionales encuestados tenía más de 5 años de graduados, hubo predominio de residentes de MGI y licenciados en enfermería, respectivamente 44,12 % y 35,29 %. Las dimensiones de competencias en prevención contra la violencia intrafamiliar fueron evaluadas de medianamente adecuadas: la cognitiva en 18 (52,94 %), la procedimental en 21 (61,76 %) y la actitudinal en 24 (70,59 %). Conclusiones: el nivel de desarrollo de competencias profesionales resultó ser medianamente adecuado, como promedio. El diagnóstico realizado evidenció la necesidad de desarrollar competencias profesionales para la prevención contra la violencia intrafamiliar en edad pediátrica.

Background: intra-family violence represents a health problem and professionals in these sciences must recognize its existence and be properly prepared to prevent it. Objective: to identify the level of competence of the basic health team in the management of intra-family violence in the pediatric age. Methods: a cross-sectional descriptive study was carried out at the "Mártires del 10 de Abril" University Polyclinic, Corralillo municipality from January to April 2021. Theoretical and empirical methods were used; For the collection of information, the analysis of documents and the examination of the competence of health professionals were used. The variables under study were: occupational category, years of graduation, cognitive, procedural and attitudinal dimensions; and professional skills in the prevention of intra-family violence. Results: 52.94% of the surveyed professionals had more than 5 years working experience, there was a predominance of comprehensive General Medicine residents and nursing graduates, respectively 44.12% and 35.29%. The dimensions of competencies in intra-family violence prevention were evaluated as moderately adequate: cognitive in 18 (52.94%), procedural in 21 (61.76%), and attitudinal in 24 (70.59%). Conclusions: the level of development of professional skills turned out to be moderately adequate, on average. The diagnosis made showed the need to develop professional skills for the prevention of intra-family violence in children.

Nuevos antecedentes de la docencia médica superior en Santa Clara, Villa Clara, Cuba / New background of higher medical teaching in Santa Clara, Villa Clara, Cuba

Fundamento: estudiar la carrera de Medicina en Cuba antes de 1959 se limitaba a la Facultad de Medicina de la Universidad de la Habana. Sin embargo, en Villa Clara se encontraron algunos indicios que llaman la atención sobre este tema. Objetivo: identificar hechos que demuestren la existencia de antecedentes para la creación de una Facultad de Medicina en Santa Clara antes de 1959. Métodos: se realizó una investigación documental de corte histórico durante los años 2019 y 2020. Se emplearon métodos teóricos que permitieron el análisis del objeto de estudio, sustentado en la interacción de lo histórico y lo lógico, y desde las dimensiones temporal y espacial; y empíricos: análisis documental y entrevistas a informantes clave; se efectuó triangulación metodológica para arribar a consideraciones integradoras. Resultados: los hechos identificados, entre ellos: el desarrollo de la vida científica regida por el Cuerpo Médico Farmacéutico y Dental y la Sociedad de Medicina y Cirugía, así como el crecimiento de la red de instituciones salubristas en la provincia Las Villas, impulsaron la idea de incorporar los estudios de Medicina en la recién inaugurada Universidad Central "Marta Abreu" de Las Villas, entre algunos miembros del Consejo Universitario; pero esa intención no encontró apoyo nacional por los gobernantes de la época, fundamentalmente por la falta de interés en incrementar la formación médica en Cuba, entre 1953-1956. Conclusiones: existieron ideas y hechos en la sociedad villaclareña de la década de 1950 que constituyeron un precedente importante para la creación de la Escuela de Medicina de Santa Clara en 1966.

Background: studying Medicine in Cuba before 1959 was limited to the Faculty of Medicine of Havana University. However, in Villa Clara some hints were found that draw attention to this issue. Objective: to identify facts that demonstrate the existence of antecedents for the creation of a School of Medicine in Santa Clara before 1959. Methods: a historical documentary research was carried out during the years 2019 and 2020. Theoretical methods were used that allowed the analysis of the object of study, based on the interaction of the historical and the logical, and from the temporal and spatial dimensions; and empirical ones: documentary analysis and interviews to key informants; and comparison of sources was carried out to arrive at integrating considerations. Results: the facts identified, among them: the development of scientific life governed by the Pharmaceutical and Dental Medical Corps and the Society of Medicine and Surgery, as well as the growth of the network of health institutions in Las Villas province, promoted the idea to incorporate the studies of Medicine in the recently inaugurated "Marta Abreu" Central University of Las Villas, among some members of the University Council; but this intention did not find national support, fundamentally due to the lack of interest in increasing medical training in Cuba, from 1953 to 1956. Conclusions: there were ideas and facts in the Villa Clara society of the 1950s that constituted an important precedent for the creation of Santa Clara School of Medicine in 1966.

La madre acompañante en los servicios pediátricos, ejemplo del pensamiento humanista de Fidel / The Accompanying Mother in Pediatric Services, An Example of Fidel's Humanist Thought

Introducción: El desarrollo de la pediatría en Villa Clara tiene una rica historia e importantes contribuciones de grandes personalidades. Una de ellas, fue la incorporación de la madre acompañante en los servicios pediátricos, controversial decisión inicialmente no bien comprendida, que se desarrolló en la provincia en 1968. Objetivo: Explicar el surgimiento de la madre acompañante en los servicios pediátricos de Villa Clara. Métodos: Para analizar el objeto de estudio se realizó una investigación histórica durante el año 2019 mediante el método teórico, que se sustenta en la interacción de lo histórico y lo lógico desde las dimensiones temporal y espacial; y el empírico, consistente en la revisión de fuentes primarias (análisis documental) y secundarias (incluido entrevistas con informantes clave), seguidos por la triangulación metodológica para arribar a consideraciones integradoras. Resultados: Se identificaron destacadas figuras de la especialidad de Pediatría en Villa Clara, y su contribución a la incorporación de la madre acompañante en los hospitales pediátricos. Conclusiones: Los servicios pediátricos de Villa Clara fueron pioneros en la incorporación del modelo de la madre acompañante y su generalización contó con el apoyo del líder histórico de la Revolución, Fidel Castro Ruz(AU)

Introduction: The development of pediatrics in Villa Clara has a rich history and important contributions from great personalities. One of them was the incorporation of the accompanying mother in the pediatric services, a controversial decision initially not well understood, which was developed in the province in 1968. Objective: To explain the emergence of the accompanying mother modality in the pediatric services of Villa Clara. Methods: To analyze the object of study, a historical research was carried out during 2019 using the theoretical method, which is based on the interaction of the historical and the logical from the temporal and spatial dimensions; and the empirical one, consisting in the review of primary sources (documentary analysis) and secondary sources (including interviews with key informants), followed by methodological triangulation to arrive at integrative considerations. Results: Outstanding figures of the specialty of Pediatrics in Villa Clara were identified, and their contribution to the incorporation of the accompanying mother modality in pediatric hospitals. Conclusions: The pediatric services of Villa Clara were pioneers in the incorporation of the accompanying mother model and its generalization had the support of the historical leader of the Revolution, Fidel Castro Ruz(AU)

Preoperative sampling in endometrial cancer: evaluation of the histopathological agreement with definitive surgical specimen.

PURPOSE: The main goal of this study is to assess the diagnostic agreement between preoperative biopsy and definitive histology of the surgical specimen to determine which sampling method is most suitable for diagnosis of early-stage endometrial cancer. METHODS: We performed a retrospective multicentric study to assess the correlation between three endometrial sampling methods (hysteroscopy, pipelle and D&C) in patients who had undergone preoperative endometrial biopsy and received primary surgical treatment for endometrial cancer. The primary objective was the agreement rate between hysteroscopy (HSC), endometrial biopsy (pipelle) and dilatation and curettage (D&C). RESULTS: A total of 1833 women who underwent preoperative sampling at 15 centers were included: 1042 biopsies were performed by HSC, 703 by pipelle and 88 by D&C. All three methods presented a moderate diagnostic concordance (κ = 0.40-0.61) with the definitive specimen's histology: HSC (κ = 0.47), pipelle sampling (κ = 0.48) and D&C (κ = 0.48). Likewise, a subgroup analysis was performed by histological subtype comparing HSC and endometrial biopsy, showing that neither is superior as a diagnostic method. CONCLUSIONS: According to this study, the use of pipelle sampling could become an adequate diagnostic method in endometrial cancer due to its similar agreement to HSC, ease of use and affordability.

Oncological safety of hysteroscopy in endometrial cancer.

OBJECTIVE: It has been suggested that the manipulation of neoplastic tissue during hysteroscopy may lead to dissemination of tumor cells into the peritoneal cavity and worsen prognosis and overall survival. The goal of this study was to assess the oncological safety comparing hysteroscopy to Pipelle blind biopsy in the presurgical diagnosis of patients with endometrial cancer. METHODS: We performed a retrospective multicentric study among patients who had received primary surgical treatment for endometrial cancer. A multivariate statistical analysis model was used to compare relapse and survival rates in patients who had been evaluated preoperatively either by hysteroscopy or Pipelle biopsy. The relapse rate, disease-free survival, and overall survival were assessed as the main outcomes. The histological type, tumor size, myometrial invasion, International Federation of Gynecology and Obstetrics (FIGO) stage, surgical approach, use of a uterine manipulator, and adjuvant treatment were also included in the analysis. RESULTS: A total of 1731 women from 15 centers were included: 1044 in the hysteroscopy group and 687 in the Pipelle sampling group. 225 patients relapsed during the 10 year follow-up period: 139 (13.3%) in the hysteroscopy group and 86 (12.4%) in the Pipelle sampling group. There is no evidence of an association between the use of hysteroscopy as a diagnostic method and relapse rate (HR 1.24, 95% CI 0.92 to 1.66; p=0.16), lower disease-free survival (HR 1.23, 95% CI 0.92 to 1.66; p=0.15), or overall survival (HR 0.95, 95% CI 0.70 to 1.29; p=0.76). CONCLUSION: Hysteroscopy is a safe diagnostic method for patients with endometrial cancer with no impact on oncological outcomes when compared with sampling by Pipelle.

Villaclareños de la salud en el Primer Congreso Médico Regional de la Isla de Cuba / Health representatives from Villaclara in the First Regional Medical Congress of the Island of Cuba

RESUMEN Fundamento: la salud pública villaclareña tiene una rica historia que permite conocer destacados profesionales en las diferentes ramas de las ciencias médicas. La existencia de esas figuras durante el período colonial sentó las bases de un desarrollo científico en el territorio. Objetivo: reseñar las historias de vidas de las principales figuras de la medicina villaclareña que participaron en el Primer Congreso Médico Regional de la Isla de Cuba de 1890 y sus aportes a la salud pública del territorio. Métodos: se realizó una investigación documental de corte histórico durante el año 2019, se emplearon métodos teóricos, sustentados en la interacción de lo histórico y lo lógico y desde las dimensiones temporal y espacial; y empíricos: el análisis documental y entrevistas a informantes clave; se efectuó triangulación metodológica para arribar a consideraciones integradoras. Resultados: se identificaron importantes figuras de la medicina en Villa Clara que participaron en el Primer Congreso Médico Regional de la Isla de Cuba: Joaquín Albarrán Domínguez, Enrique López Veitía, Pedro Albarrán Domínguez, Agustín Wenceslao Reyes Zamora y Francisco Rodríguez Hernández, Fernando Plazaola, Agustín Abril y Letamendis, Domingo Lagomasino Álvarez y López Silvero. Se confeccionaron sus historias de vida identificando sus principales aportes a la salud pública cubana, y su influencia en la sociedad villaclareña del siglo XIX. Conclusiones: Villa Clara tuvo una importante participación en el Primer Congreso Médico Regional de la Isla de Cuba en 1890. Los médicos que asistieron a ese evento dejaron un importante legado que debe ser conocido por las nuevas generaciones.

ABSTRACT Background: Villa Clara's public health has a rich history that allows us to meet prominent professionals in the different branches of medical sciences. The existence of these figures during the colonial period laid the foundations for scientific development in the territory. Objective: to review the life stories of the main figures of Villa Clara medicine who participated in the First Regional Medical Congress of the Island of Cuba in 1890 and their contributions to the public health of the territory. Methods: a historical documentary research was carried out during 2019; theoretical methods were used, supported by the interaction of the historical and the logical and from the temporal and spatial dimensions; and empirical ones: documentary analysis and interviews with key informants; information was methodologically contrasted to arrive at integrative considerations. Results: important figures of medicine were identified in Villa Clara who participated in the First Regional Medical Congress of the Island of Cuba: Joaquín Albarrán Domínguez, Enrique López Veitía, Pedro Albarrán Domínguez, Agustín Wenceslao Reyes Zamora and Francisco Rodríguez Hernández, Fernando Plazaola, Agustín Abril and Letamendis, Domingo Lagomasino Álvarez and López Silvero. Their life histories were compiled identifying their main contributions to Cuban public health, and their influence on Villa Clara society in the 19th century. Conclusions: Villa Clara had an important participation in the First Regional Medical Congress of the Island of Cuba in 1890. The doctors who attended this event left an important legacy that should be known by the new generations.

Impact of uterine manipulator on oncological outcome in endometrial cancer surgery.

BACKGROUND: There are limited data available to indicate whether oncological outcomes might be influenced by the uterine manipulator, which is used at the time of hysterectomy for minimally invasive surgery in patients with endometrial cancer. The current evidence derives from retrospective studies with limited sample sizes. Without substantial evidence to support its use, surgeons are required to make decisions about its use based only on their personal choice and surgical experience. OBJECTIVE: To evaluate the use of the uterine manipulator on oncological outcomes after minimally invasive surgery, for apparent early-stage endometrial cancer. STUDY DESIGN: We performed a retrospective multicentric study to assess the oncological safety of uterine manipulator use in patients with apparent early-stage endometrial cancer, treated with minimally invasive surgery. The type of manipulator, surgical staging, histology, lymphovascular space invasion, International Federation of Gynecology and Obstetrics stage, adjuvant treatment, recurrence, and pattern of recurrence were evaluated. The primary objective was to determine the relapse rate. The secondary objective was to determine recurrence-free survival, overall survival, and the pattern of recurrence. RESULTS: A total of 2661 women from 15 centers were included; 1756 patients underwent hysterectomy with a uterine manipulator and 905 without it. Both groups were balanced with respect to histology, tumor grade, myometrial invasion, International Federation of Gynecology and Obstetrics stage, and adjuvant therapy. The rate of recurrence was 11.69% in the uterine manipulator group and 7.4% in the no-manipulator group (P<.001). The use of the uterine manipulator was associated with a higher risk of recurrence (hazard ratio, 2.31; 95% confidence interval, 1.27-4.20; P=.006). The use of uterine manipulator in uterus-confined endometrial cancer (International Federation of Gynecology and Obstetrics [FIGO] I-II) was associated with lower disease-free survival (hazard ratio, 1.74; 95% confidence interval, 0.57-0.97; P=.027) and higher risk of death (hazard ratio, 1.74; 95% confidence interval, 1.07-2.83; P=.026). No differences were found regarding the pattern of recurrence between both groups (chi-square statistic, 1.74; P=.63). CONCLUSION: In this study, the use of a uterine manipulator was associated with a worse oncological outcome in patients with uterus-confined endometrial cancer (International Federation of Gynecology and Obstetrics I-II) who underwent minimally invasive surgery. Prospective trials are essential to confirm these results.

Valoración del documento: "Recomendaciones generales relacionadas con las decisiones éticas difíciles y la adecuación de la intensidad asistencial/ingreso en las Unidades de Cuidados Intensivos en situaciones excepcionales de crisis" por parte del Consejo Asesor Regional de Ética Asistencial –Dr. D. Juan Gómez Rubí– (carea) / Evaluation of the document: "General recommendations related to difficult ethical decisions and the adequacy of the health care/admission in the Intensive Care Units in exceptional crisis situations" by the Regional Advisory Council of Health Care Ethics. –D. Juan Gómez Rubí- (carea)

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