Is my life going to change?-a review of quality of life after rectal resection.

Rectal resection is a common practice for colorectal surgeons. The causes of this procedure are varied. The most frequent is cancer, but also inflammatory bowel disease, endometriosis, and rectovaginal or rectourethral fistulas. The loss of the normal rectal reservoir function, urinary problems, sexual dysfunction or pelvic pain are frequently reported in patients after rectal surgery and these disorders markedly affect the overall quality of life (QoL). In the last decades, rectal surgery has radically changed, with the development of surgical techniques, and it has progressed from abdominoperineal resection (APR) with a permanent colostomy to sphincter-saving procedures. Nowadays, the use of sphincter-preserving surgery has increased, but all these surgical techniques can have important sequels that modify the QoL of the patients. Historically, surgical outcomes, such as complications, survival and recurrences, have been widely studied by surgeons. In the present day, surgical outcomes have improved, rectal cancer recurrence rate has decreased and survival has increased. For these reasons, it has begun to gain importance in aspects of the QoL of patients, such as body image, fecal continence and sexuality or urinary function. Therefore, physicians should know the influence of different techniques and approaches on functional outcomes and QoL, to be able to inform patients of the treatment benefits and risk of postoperative dysfunctions. The aim of our study is to review the current literature to determine to what degree the QoL of patients who underwent a rectal resection decreases, which domains are the most affected and, in addition, to establish the influence of different surgical techniques and approaches on functional outcomes.

Analysis of some immunogenic properties of the recombinant Sporothrix schenckii Gp70 expressed in Escherichia coli.

AIM: Sporothrix schenckii is the causative agent of sporotrichosis. A 70-kDa glycoprotein, Gp70, is a candidate for the development of prophylactic alternatives to control the disease, and its gene (GP70) is predicted to encode for a protein of 43 kDa, contrasting with the molecular weight of the native protein. MATERIALS & METHODS: The GP70 was expressed in bacteria, the recombinant protein purified, used in immunoassays and injected to Galleria mellonella. RESULTS & CONCLUSION: The recombinant protein was detected by anti-Gp70 antibodies, confirming that the Gp70 backbone is a 43-kDa peptide. This protein showed enzyme activity of cyclase and was recognized by sera of patients with sporotrichosis. Although it was not useful for serodiagnosis of sporotrichosis, it conferred protection to animals against experimental sporotrichosis.

Rectal linitis: A very unusual cause of stenosis / Linitis rectal: una causa muy inusual de estenosis

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Páncreas ectópico: una masa intestinal muy infrecuente / Ectopic pancreas: a very unusual intestinal mass

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Ectopic pancreas: a very unusual intestinal mass.

The ectopic pancreas is a rare entity, characterized by the presence of pancreatic islets in different locations of the gastrointestinal tract. Its clinical manifestations are nonspecific and it is often diagnosed incidentally in imaging tests or intraoperatively. Its management is controversial, since its malignancy is infrequent; however, its resection is recommended in the case of a casual intraoperative finding to establish the definitive histological diagnosis. Therefore, the ectopic pancreas should be included in the differential diagnosis of intestinal masses.

[Chilean health reform ten years since its implementation]. / La reforma de salud chilena a diez años de su implementación.

OBJECTIVE:: To analyze the process of design and implementation of AUGE. MATERIALS AND METHODS:: Literature review of pre-reform background, architecture design and implementation process of reform AUGE and complementary interviews to eight informants involved in its development. RESULTS:: The assessment of health equity was a key element in pre-reform, there are four fundamental dimensions in the design, and the implementation has nine phases. CONCLUSION:: The results show AUGE strengthening public health by investing in equipment for cost-effective treatments, and also through clinical guidelines that standardize and guide the management of health professionals with patients.

La reforma de salud chilena a diez años de su implementación / Chilean health reform ten years since its implementation

Resumen: Objetivo: Analizar el proceso de diseño e implementación del Acceso Universal con Garantías Explícitas (AUGE). Material y métodos: Revisión de bibliografía sobre antecedentes prerreforma, arquitectura de diseño y proceso de implementación de la reforma AUGE y, complementariamente, entrevistas a ocho informantes involucrados en su desarrollo. Resultados: La valoración de la equidad en la salud fue un elemento clave prerreforma; existen cuatro dimensiones fundamentales en el diseño y nueve fases en la implementación. Conclusión: Los resultados del AUGE muestran un fortalecimiento en la salud pública por la inversión en equipamiento para tratamientos costo-efectivos; también por las guías clínicas que estandarizan y orientan la gestión de los profesionales de la salud con los pacientes.

Abstract: Objective: To analyze the process of design and implementation of AUGE. Materials and methods: Literature review of pre-reform background, architecture design and implementation process of reform AUGE and complementary interviews to eight informants involved in its development. Results: The assessment of health equity was a key element in pre-reform, there are four fundamental dimensions in the design, and the implementation has nine phases. Conclusion: The results show AUGE strengthening public health by investing in equipment for cost-effective treatments, and also through clinical guidelines that standardize and guide the management of health professionals with patients.

Heterogeneidad en los resultados de gestión de Centros de Salud Familiar de la Región Metropolitana mediante un método multicriterio / Heterogeneity in management results of primary care centers of the Metropolitan Region using a multi -criteria method

INTRODUCCIÓN: En Chile, la mayoría de los establecimientos de atención primaria dependen de los municipios, que cuentan con capacidades muy heterogéneas, lo cual se reproduce en la gestión de salud municipal. El objetivo del trabajo es presentar un índice de resultados de gestión de Centros de Salud Familiar (CESFAM), con el que se estudiará la heterogeneidad en la Región Metropolitana. METODOLOGÍA: Siguiendo la metodología multicriterio y el proceso de análisis jerárquico, se define junto a un equipo de expertos una estructura jerárquica para evaluar los resultados de gestión de los CESFAM. Se determinan tres criterios estratégicos (gestión clínica, gestión administrativa y trabajo intersectorial), que por medio de comparaciones a pares obtienen ponderadores de 53,7%, 34,3% y 12,0%, respectivamente. El índice es evaluado a través de 25 indicadores, utilizando información ya recopilada por los CESFAM. RESULTADOS: Se calculó el índice para 90 CESFAM, con datos del año 2013 disponibles en DEIS. Los CESFAM estudiados obtuvieron puntajes entre 0,26 y 0,81 (media 0,56, desviación estándar 0,12). Al realizar una categorización y una georreferenciación de los establecimientos se observa heterogeneidad en los resultados, la cual se manifiesta a nivel de red asistencial y comunal. DISCUSIÓN: Existen grandes diferencias en los resultados de gestión de los CESFAM, incluso entre establecimientos cercanos. Llama la atención la variabilidad al interior de algunas comunas, que no puede ser explicada por diferencias de recursos. Se identifica así un espacio importante de mejora, que puede ser abordado a través de actividades de colaboración entre establecimientos

INTRODUCTION: In Chile, most primary care centers are managed by municipalities, which have different capabilities. The aim of this work is to present an index to measure management results in primary care centers. This tool will be used to evaluate differences between primary care centers in the Metropolitan Region of Chile. METHOD: Using a multi-criteria method and the Analytical Hierarchy Process, a hierarchical structure was defined by a group of experts, to measure management results in primary care centers. Three strategic criteria were obtained and then prioritized through pairwise comparisons, resulting in: Clinical management (53.7%), Administrative management (34.3%) and Intersectoral work (12.0%). The index was built with 25 indicators that use information gathered by health centers for other purposes. RESULTS: Results were obtained for 90 primary care centers using data from 2013. Scores ranged between 0.26 and 0.81 (mean 0.56, standard deviation: 0.12). Through categorization and georeferential analysis, heterogeneity was observed, even at a neighborhood level. DISCUSSION: There are big differences in management results between primary care centers, even among nearby facilities. One issue that stands out is the heterogeneity found in centers managed by the same municipality, which cannot be explained by differences in budget. This is an opportunity for improvement that could be approached through collaborative work between facilities.

Combined radical prostatectomy and abdominoperineal resection for locally invasive rectal cancer.

INTRODUCTION: An infiltration of urological organs is found in 5-10% of patients with colorectal carcinoma. Total pelvic exenteration is the standard procedure for locally advanced rectal cancer. In selected patients with rectal cancer involving the prostate or seminal vesicles, the bladder can be preserved and en bloc radical prostatectomy with abdominoperineal rectal resection can be performed. We report two patients who treated with this combined approach. PRESENTATION OF CASE: Two patients with symptoms of rectal bleeding and pelvic pain were investigated. Colonoscopy demonstrated a tumor in the lower rectum. Biopsies revealed adenocarcinoma. Both pelvic MRI and endorectal ultrasound showed tumors that invaded the prostate and the seminal vesicles directly but without invasion of the bladder. After neoadjuvant chemoradiation, combined radical prostatectomy and abdominoperineal amputation was performed. None has developed local recurrence, but one of them was operated on for a single lung metastasis. After a follow-up of 28 and 20 months, respectively, the patients are alive without evidence of local recurrence or distant disease. DISCUSSION: This procedure obviates the need for urinary diversion without compromising the local tumor control. Intraoperative and postoperative diagnostic difficulties, and clinical aspects in relation to postoperative anastomotic leak and survival of patients are discussed. CONCLUSION: En bloc radical prostatectomy and proctosigmoidectomy is feasible in selected patients with rectal cancer and invasion limited to the prostate or seminal vesicles because it provides good local tumor control and significantly improves the patient's quality of life in comparison to total pelvic exenteration.

Experiencia y dilemas en la focalización del Programa de Alimentación Escolar / Experience and dilemmas in the targeting of the School Feeding Program

El Programa de Alimentación Escolar PAE, es un importante programa nutricional de apoyo a la educación y su objetivo principal es, constituir un incentivo para que los escolares de extrema pobreza asistan a la escuela, evitando el ausentismo, repitencia y deserción escolar. El programa consiste en la entrega gratuita de raciones alimenticias de desayuno y almuerzos/onces a los niños, las que se distribuyen en las escuelas municipales y particulares subvencionadas por el Estado. En 1991 se repartieron alrededor de 570.000 raciones completas a escuelas de enseñanza básica y el costo anual del programa fue cercano a los 65 millones de dólares. Este trabajo analiza la evolución histórica del programa identificando los principales cambios ocurridos en una organización institucional y en los mecanismos de focalización. Estos mecanismos han ido cambiando a través del tiempo y esta evolución ha tenido una incidencia directa en mejorar el impacto en la población objetivo. Luego se analiza la incorporación del sector privado en la provisión directa del servicio y el efecto que este cambio ha tenido en incrementar la eficiencia del programa a través de reducir los costos de administración y como consecuencia los costos de las raciones, y diversificar y mejorar la calidad de las raciones servidas

Contribución de modelos estadísticos a la equidad en la asignación del programa de alimentación escolar: PAE, 1991 / Contribution to statistic models in the distribution of school feeding programme

Se presenta un modelo estadístico que se denomina "porcentaje", (PAJE) con el propósito de determinar la asignación de los beneficios del PAE. Este fue calculado con datos de las encuestas ad-hoc realizadas al inicio del año académico de 1990 en todos los primeros y cuartos cursos del país. (Incluye a medio millón de alumnos en casi 8.000 escuelas con información, de las 10.000 que funcionan en el país). PAJE se calcula con base a las tasas de cada una de las variables por escuela, las que fueron procesadas según al procedimiento computacional LOGIT (regresión logística), a diferencia del índice utilizado hasta el año pasado "percentil" (PTIL) que se fundamentaba en los valores promedios de dos de sus cuatro variables y se elaboró según el procedimiento denominado de los "Componentes Principales"