Análisis del programa de formación de Cirugía Plástica y Reparadora de la Universidad de Chile: encuesta a egresados 2011-2017 / Analysis of the training program of Plastic and Reconstructive Surgery of the University of Chile: survey of graduates 2011-2017

INTRODUCCIÓN: La formación de cirujanos plásticos de calidad exige una constante revisión y evaluación del programa aplicado. Han transcurrido 8 años desde que se evaluó la opinión de los egresados del Programa de Cirugía Plástica de la Universidad de Chile por primera vez. OBJETIVO: Recoger la opinión de los egresados del mismo programa entre los años 2011-2017, con el fin de cotejar los resultados con generaciones anteriores. MATERIALES Y MÉTODO: Se realizó una encuesta de 28 preguntas, las cuales evalúan aspectos generales de la residencia, rotaciones específicas del residente, actividades prácticas, actividades teóricas y aspectos económicos y de investigación. RESULTADOS: De un total de 21 egresados en el período comprendido 2011-2017 se obtuvo respuesta de la encuesta en 16 de ellos, el 100% de los encuestados aprueba el programa de formación, el 63% de los encuestados considera que la duración del programa es insuficiente. La rotación mejor evaluada del programa fue el Hospital Clínico de la Universidad de Chile según un 56% de los egresados. Las áreas de mejor percepción de formación fueron cirugía de contorno corporal y cirugía estética mamaria respectivamente. CONCLUSIÓN: La aprobación del programa de formación de la especialidad sigue siendo alta en los egresados, sin embargo, se mantiene la opinión de la necesidad de un programa más extenso. El análisis recogido de esta encuesta es una buena herramienta para identificar aspectos del programa que se pueden mejorar.

BACKGROUND: The adequate plastic surgeons training demand a constant review and assessment of the training programs of residents. It has been 8 years since the first survey made to Plastic Surgery graduates of the University of Chile about the program training. AIM: Collect the opinion of Plastic Surgery graduates of the University of Chile between the years 2011-2017, in order to compare the results with previous generations. MATERIAL AND METHOD: A survey of 28 questions was conducted which evaluated general aspects of the residence, specific rotations of the resident, practical activities, theoretical activities and economic and research aspects. RESULTS: There has been 21 graduates between 2011-2017, a survey response was obtained in 16 of them, 100% of the respondents approved the training program, 63% of respondents consider the duration of the program is insufficient. The best-evaluated rotation of the program was HCUCH according to 56% of graduates. The areas of best training perceived were body contour surgery and breast aesthetic surgery, respectively. CONCLUSION: Plastic surgery training program approval is still high in graduates; nevertheless the opinion about the needing for a more extensive program is kept. The analysis collected from this survey is an excellent tool to identify aspects of the training program can be improved.

Peso de nacimiento y posterior estado nutricional, desarrollo cognitivo y actividad ocupacional: una revisión crítica / Birth weight and later nutritional status, cognitive development and job status: a critical review

El impacto del estado nutricional prenatal, especialmente lo concerniente al peso de nacimiento (PN) y sus efectos tanto en el corto, mediano o largo plazo, sobre el estado nutricional y el desarrollo cognitivo del niño y, sobre la ocupación desempeñada en la vida adulta, ha sido una problemática de interés para diversos investigadores; al respecto, algunos autores encuentran una asociación positiva y significativa entre estas variables, mientras que otros no encuentran ninguna relación. Es así como se ha descrito que niños con PN insuficiente, bajo o, extremadamente bajo, además del deterioro temprano del estado nutricional, presentarían en el corto plazo, un mayor riesgo de daño en la maduración cerebral, retraso del desarrollo cognitivo y menores circunferencias craneanas, lo que implicaría menor volumen encefálico y bajo rendimiento intelectual. En el corto y mediano plazo, esta situación perjudicaría el proceso enseñanza-aprendizaje en la etapa escolar, mientras que en el largo plazo, esto condicionaría la ocupación a desempeñar en la vida adulta. Actualmente, el cuerpo de conocimientos pone de manifiesto que los hallazgos relativos a estas asociaciones no son concluyentes, existiendo gran controversia en estas materias. Este artículo de revisión tiene el propósito de analizar la evidencia existente hasta este momento, con el objeto de incentivar la investigación en estos aspectos que son de gran relevancia para el desarrollo del niño y su vida futura.

The impact of prenatal nutritional status, assessed through birth weight (BW) and their effects in the short, medium and long-term on nutritional status, cognitive development and job status in the adult life, has been a problem of interest for several researchers; as regards, some of these report a positive and significant association between these variables and others do not find any relation. Children with insufficient, low or very low BW despite the early more deteriorate nutritional status should present higher risk for brain maturation, failure cognitive development and lowered head circumference which implies both lowered brain volume and intellectual development. In the short and medium-term, this situation damages the learning process at school-age, while in the long-term this might condition the quality of jobs. At present, the body of knowledge pinpoints that findings related to these associations is not conclusive verifying a great controversy in these matters. This review article has the purpose of analyzing the current evidence, in order to stimulate research about to these aspects which are relevant for child development and their future life.

[Birth weight and later nutritional status, cognitive development and job status: a critical revision]. / Peso de nacimiento y posterior estado nutricional, desarrollo cognitivo y actividad ocupacional: una revisión crítica.

The impact of prenatal nutritional status, assessed through birth weight (BW) and their effects in the short, medium and long-term on nutritional status, cognitive development and job status in the adult life, has been a problem of interest for several researchers; as regards, some of these report a positive and significant association between these variables and others do not find any relation. Children with insufficient, low or very low BW despite the early more deteriorate nutritional status should present higher risk for brain maturation, failure cognitive development and lowered head circumference which implies both lowered brain volume and intellectual development. In the short and medium-term, this situation damages the learning process at school-age, while in the long-term this might condition the quality of jobs. At present, the body of knowledge pinpoints that findings related to these associations is not conclusive verifying a great controversy in these matters. This review article has the purpose of analyzing the current evidence, in order to stimulate research about to these aspects which are relevant for child development and their future life.

Una experiencia de acompañamiento con doula a adolescentes en trabajo de parto / Doula support during labor: experience in a sample of pregnant teenagers

Objetivo: Comparar la percepción del dolor-temor durante el trabajo de parto y parto, y el grado de dificultad-satisfacción con la experiencia de parto, en un grupo de adolescentes acompañadas por doula y otro con atención habitual. Método: El grupo estudio comprendió 80 adolescentes del "Programa Emprende Mamá" que controlaron sus embarazos en centros de salud de la comuna de La Florida y con parto en el hospital Dr. Sótero del Río, acompañadas por una mujer familiar o amiga, elegida por la joven, con capacitación previa de 2 horas. El grupo control estuvo formado por 80 adolescentes no participantes del programa, que controlaron sus embarazos en los mismos centros de salud, con parto en el mismo período. Resultados: El grupo estudio refirió menor percepción de dolor durante el trabajo de parto y parto, menor temor durante el parto y lo percibió como más fácil. No se encontraron diferencias significativas en el nivel de satisfacción respecto de la experiencia total. Sin embargo, las adolescentes con doula señalaron estar satisfechas por aspectos positivos de la vivencia, mientras que el grupo control centra su satisfacción en la ausencia de expectativas negativas temidas. Conclusión: El acompañamiento por doula en el parto de la embarazada adolescente, es una intervención de bajo costo que permite mejorar cualitativamente su vivencia de parto.

Objective: To compare the effects of continuous doula support and standard hospital care on pain and fear perception, during labor and delivery, as well as perception of difficulty and satisfaction with the birth experience, in a sample of pregnant teenagers. Method: The study group was conformed by eighty pregnant teenagers participants in "Emprende Mama Program" attended in the outpatient clinics of La Florida county for their prenatal care and delivery at a public hospital. They received emotional support during labor by a 2 hour trained female relative or friend, previously chosen by them. The control group was conformed by eighty non participants teenagers attended at the same outpatient clinics and delivery in the same period. Results: Teenagers with doula support reported less pain and fear during labor and delivery and perceived their birth experience as less difficult. No significant differences were reported in relation to satisfaction with birth experience. Although teenagers with doula support reported satisfaction due to positive aspects with birth experience, meanwhile the control group felt mostly satisfied due the absence of negative feared expectations. Conclusion: Labor support given by doula, is a low cost intervention which improves quality perception of birth experience in the adolescent pregnant.

Carotid body chemosensory activity and ventilatory chemoreflexes in cats persist after combined cholinergic-purinergic block.

Acetylcholine (ACh) and ATP have been proposed as excitatory co-transmitters operating at synapses between glomus cells and sensory nerve endings of the carotid body (CB). To test such hypothesis, we performed experiments on cats under pentobarbitone anesthesia and breathing spontaneously. Cholinergic and purinergic agonists and antagonists were given into one common carotid artery. Chemoreflex ventilatory changes initiated from the ipsilateral CB or chemosensory activity from the ipsilateral carotid nerve were recorded. Agonists ACh, nicotine, epibatidine, ATP, betagamma-methylene-ATP and gammaS-ATP induced transient chemoreflex enhancements of ventilation or increased chemosensory activity. When given in combination, mecamylamine and suramin suppressed both nicotine- and ATP-induced ventilatory chemoreflexes or chemosensory responses. However, neither chemoreflex hyperventilation induced by brief hypoxic exposures or steady-state hypoxic levels, nor chemosensory excitation elicited by these maneuvers were eliminated. Asphyxia-induced chemosensory excitation was not reduced by combined blockade of ACh and ATP receptors. Furthermore, ventilatory or chemosensory depression evoked by 100% O2 tests was unmodified, thus evidencing that basal chemosensory drive in normoxia was not suppressed by combined cholinergic-purinergic blockade. Therefore, although ACh and ATP may participate in chemoexcitation of the CB, their involvement fails to explain the origin of chemosensory discharges from synaptic transmission between glomus cells and chemosensory nerve endings of the CB.

Effects of combined cholinergic-purinergic block upon cat carotid body chemoreceptors in vitro.

Since acetylcholine (ACh) and ATP have been proposed as excitatory co-transmitters at synapses between glomus cells and sensory nerve endings of the carotid body (CB), we tested such hypothesis by studying the effects of combined cholinergic-purinergic block on the chemosensory activity recorded from cat's carotid bodies perfused and/or superfused in vitro. The preparations were bathed with Tyrode's solution, either normoxic (PO2=98.5+/-13.5 Torr) or hypoxic (PO2=31.8+/-5.2 Torr), and the frequency of chemosensory impulses (fchi) was recorded from the carotid (sinus) nerve. Dose-response curves for fchi increases evoked by intra-stream boluses of acetylcholine, nicotine and ATP were studied. A combination of mecamylamine 2 microM and suramin 50 microM, applied through the perfusate or superfusate, suppressed nicotine- and ATP-induced increases in fchi, but the basal chemosensory activity in normoxia and the chemosensory excitation elicited by hypoxic superfusion were preserved, although variably reduced in most preparations. Thus, in spite of the excitatory effects provoked by applying ACh and ATP to the perfused/superfused CB in vitro, a co-release of these substances cannot account entirely for the chemosensory excitation induced by hypoxic stimulation of the CB.

Gallstones in spinal cord injury (SCI): a late medical complication?

STUDY DESIGN: Prospective controlled study. OBJECTIVES: To assess the prevalence of cholelithiasis among chronic spinal spinal cord injured (SCI) male patients of the ACHS (Asociación Chilena de Seguridad). To evaluate statistically the prevalence of cholelithiasis among SCI patients compared to a control group and to the general male Chilean population. To assess the correlation between cholelithiasis in chronic SCI patients and usual risk factors such as age, obesity and diabetes mellitus. To assess the association of cholelithiasis in chronic SCI patients and the duration of the spinal cord injury. SETTING: Rehabilitation Service at the Hospital del Trabajador, in Santiago, Chile. METHODS: One hundred SCI patients followed up at the Hospital del Trabajador on a regular basis were included in the study; one group consisted of 76 subjects rated ASIA A or B and the other group consisted of 24 subjects rated ASIA C and D. They were all male, older than 20 years old (average age: 41,9 and 42,6 respectively), and suffered from a spinal cord injury greater than one year of evolution. The control group (CG) consisted of 100 male volunteers, without both SCI and history of biliary disease, aged 40.3 years old in average. All three groups underwent ultrasonographic imaging evaluation of the gallbladder and the biliary tract between 1998 and 2000. RESULTS: The prevalence of cholelithiasis among the groups was the following: 25% in the SCI patients ASIA A and B (19/76), 25% in the SCI patients ASIA C and D (6/24) and 9% (1/100) in the CG. The statistical analysis showed a value of P=0.0037, thus establishing a significant association between cholelithiasis and SCI, both complete and incomplete. The difference was not statistically significant when correlating the presence of cholelithiasis with the neurological level of the injury--above and below T10 (24,1 and 25%, respectively)--with the duration of the SCI, with age, obesity and diabetes mellitus. CONCLUSIONS: SCI represents a major risk factor for the development of cholelithiasis, and it should be considered a late, secondary complication of a spinal cord injury. SPONSORSHIP: The present work is sponsored by the Fundación Científica y Tecnológica of the ACHS, grant No 2899.

Leucemia mieloide crónica en hemofilia B / Chronic myeloid leukemia in hemophilia B

A known hemophiliac B male (blood coagulation factor IX level of 15 per cent), HIV negative, in whom a Philadelphia chromosome positive chronic myeloid leukemia developed at the age of 29 years, is presented. The leukemia was diagnosed after an upper digestive tract bleeding, due to a duodenal ulcer. Two years elapsed between the diagnosis of leukemia and the start of busulfan therapy. During that period and after the start of treatment, the hemorrhagic tendency did not increase. The follow up of the patient was almost 8 years, with favorable clinical response to busulfan therapy. The patient survived more than twice the average survival of chronic myeloid leukemia patients treated with busulfan. A reciprocal influence between chronic myeloid leukemia and hemophilia appears illustrated by this case report.

[A tribute to Professor Mario Plaza de los Reyes, MD]. / Homenaje póstumo al Profesor Dr. Mario Plaza de los Reyes.

Revista Médica de Chile renders a tribute to Professor Mario T Plaza de los Reyes, one of the founders of Nephrology as a specialty in Chile, a brilliant teacher and scholar. As Member of the Sociedad Médica de Santiago (Chilean Society of Internal Medicine) and former President (1964-1965) he had an active role as contributor, reviewer and reader of our journal.

[Contribution of Professor Armando Roa to humanities and medical ethics at the University of Chile's School of Medicine]. / Contribución del Profesor Armando Roa al conocimiento de las humanidades y de la ética en la Facultad de Medicina de la Universidad de Chile.

Dr. Roa was the first professor of the Faculty of Medicine of the University of Chile to give an ethics course to medical students, even when the importance of formal teaching of medical ethics was not yet recognized internationally. His efforts contributed to the creation of the Center for Bioethical and Humanistic Studies in 1988 and to the creation of official ethics courses for first and sixth year medical students in 1993. During 20 years, be chaired the Ethics Committee of the Faculty of Medicine of the University of Chile. He also promoted a diffusion program about medical ethics through meetings, conferences and symposia. He was responsible for the Ministry of Health's decision to create ethics committees in public hospitals in 1988 and for the Presidental decision about organ transplantation in 1995. He carried out anthropology courses and gave numerous lectures on humanistic aspects of medicine. His ethical principles are resumed in what he called the "ethics of generosity", in which the dignity of human beings is respected above all, in his opinion, the way civilizations see goodwill has been preponderant in the course of history. The recent proposal to teach humanistic fundamentals to medical students is a tribute to the memory of Professor Roa.

[Adult cyclic neutropenia: acute ileitis as an initial clinical manifestation]. / Neutropenia cíclica del adulto: Ileítis aguda como manifestación clínica inicial.

Cyclic neutropenia is a rare disease in which blood neutrophils periodically decrease and almost disappear, ensuing acute infections of variable severity. We report a 37 years old female presenting with severe abdominal pain, fever and neutropenia. During a surgical abdominal exploration, an acute ileitis was found. During a follow-up of 6.5 months, transient episodes of neutropenia (mean count of 0.33 x 10(9)/l), every 22-28 days, were detected. Coinciding with these episodes, band and segmented neutrophils disappeared from the bone marrow and its response to functional stimulation with prednisone was insufficient. No cyclical changes in lymphocytes, monocytes and packed red cell volume were observed. The episodes of severe transient neutropenia and infections persist after three years of follow up.

Effects of dopaminergic blockade upon carotid chemosensory activity and its hypoxia-induced excitation.

The effects of domperidone, antagonist of D2 receptors, on arterial chemoreceptor activity were studied in spontaneously breathing and pentobarbitone anesthetized cats, in which recordings of chemosensory impulse activity were obtained simultaneously from both cut carotid (sinus) nerves. Intravenous injections of domperidone 50 micrograms/kg produced a maintained increase in the basal frequency of chemosensory discharges, after which hyperoxic tests (breathing 100% O2 for 30 s) evoked larger falls in the rate of chemosensory impulses. Chemosensory responses evoked by hypoxic hypoxia (100% N2 tests) and by cytotoxic hypoxia (i.v. injections of NaCN) reached higher impulse rates after domperidone treatment. The effects of domperidone reveal that a resting release of dopamine from glomus cells maintains a low level of basal chemosensory activity under normoxic conditions. Domperidone turns off such restraining dopaminergic control and enhances the transient chemosensory responses to hypoxic stimuli. Present data support a modulatory role for dopamine within the chemoreceptor process, but not its participation as excitatory transmitter between glomus cells and sensory nerve endings.

[Congenital blood coagulation factor X deficiency. Successful result of the use prothrombin concentrated complex in the control of ++cesarean section hemorrhage in 2 pregnancies]. / Deficiencia congénita en factor X de la coagulación sanguínea. Resultado exitoso del empleo de concentrados de complejo protrombínico en el control de la tendencia hemorrágica en operación cesárea en 2 embarazos.

There is little experience in the prevention of the severe hemorrhagic diathesis of factor X coagulation factor deficiency, before surgical procedures. A female with congenital deficiency of factor X that received prothrombin complex concentrates that contained 1.000 IU of factor X (16.7 U/l Kg BW) immediately prior to a cesarean section in two occasions, is reported. Factor X concentration rose from 1 to 25% in the first occasion and from 10 to 63% in the second. In both episodes, factor X decreased in the first 24 h of the postoperative period and required new infusions of prothrombin complex concentrates. No episodes of abnormal bleeding were observed. It is concluded that the infusion of prothrombin complex concentrates prevents the hemorrhagic diathesis of factor X deficiency, despite its modest increase in plasma. A initial infusion of 1.000 UI of factor X (16-20 IU/Kg BW), followed by 500 IU (8-10 IU/Kg) every 24 hours is suggested for an adequate management of this condition.

A report on the evolution of this journal and an analysis of its present state and perspectives.

This journal appeared as Archivos de Biología y Medicina Experimentales between 1964 and 1992, its name being changed into Biological Research in 1992. This is a report on the past and present of the journal, analyzing the problems of a scientific journal published in English but produced in Latin America, those that its contributors must deal with in the preparation of the manuscripts, those involved in the evaluation procedures and editing of material for the press, and those about coverage by indexing services and the international recognition of the journal quality.

Phrenic nerve activity during artificial ventilation at different body temperatures and its relationships with carotid chemosensory activity.

While the chemoreceptor discharges of carotid bodies in vitro are highly dependent on temperature, these chemoreceptors in situ contribute only moderately to the ventilatory adjustment to changing body temperature (Tb), probably because of the concomitant and reverse changes in natural chemoreceptor stimuli in closed-loop preparations. Accordingly, we studied the frequency of carotid chemosensory discharge (fx) and the phrenic integrated electroneurogram (IENGph) in pentobarbitone anesthetized cats, paralyzed with alcuronium and artificially ventilated, at three steady-state levels of Tb (35.5, 37.5 and 40.2 degrees C), modifying the frequency and volume of the ventilator to maintain PETCO2 within normal range. While fx increases along with Tb when PETCO2 is allowed to fluctuate freely, its mean basal value was not consistently different at the three Tb's studied under controlled conditions. The amplitude of IENGph was reduced and the frequency of phrenic inspiratory cycles was increased as Tb was raised from 35.5 to 37.5 degrees C and then to 40.2 degrees C. Brief 100% O2 inhalations and i.v. injections of dopamine produced minimal depressions of IENGph amplitude in hypothermia, but pronounced although similar depressions in normothermia and hyperthermia. i.v. injections of NaCN augmented fx and IENGph in dose related manner, and the relationships between both variables showed larger changes in IENGph at the hypothermic and normothermic conditions when expressed in absolute terms, but not when expressed in relative terms. Thus, the chemosensory input is not consistently modified by thermal levels under controlled ventilatory conditions, but the chemosensory drive of the ventilatory output is less pronounced in hypothermia. The chemosensory input is similarly affected by varying degrees of cytotoxic hypoxia at different Tb's, but the ventilatory output is less vigorously increased in hyperthermia, pointing to a decreased reflex gain in that condition.

A report on the evolution of this journal and an analysis of its present state and perspectives

This journal appeared as Archivos de Biología y Medicina Experimentales between 1964 and 1992, its name being changed into Biological Research in 1992. This is a report on the past and present of the journal, analyzing the problems of a scientific journal published in English but produced in Latin America, those that its contributors must deal with in the preparation of the manuscripts, those involved in the evaluation procedures and editing of material for the press, and those about coverage by indexing services and the international recognition of the journal quality