Empathy and Occupational Health and Well-Being in Ecuadorian Physicians Working with COVID-19 Patients: A Mixed-Method Study.

Approximately one out of ten COVID-19 cases in Ecuador was a physician. It has been reported that this situation has led to a serious detriment of physicians' health and well-being. This study aimed to (i) identify predictors of emotional exhaustion, somatization, and work alienation in Ecuadorian physicians working with COVID-19 patients and (ii) explore the pandemic impact on doctor-patient relationships and on empathy. In 79 Ecuadorian physicians (45 women) who worked with COVID-19 patients, two separate multiple regression models explained the following: 73% of the variability of emotional exhaustion was based on somatization, work alienation, working sector, and passing through a symptomatic infection (p < 0.001), and 56% of the variability of somatization was based on gender and emotional exhaustion (p < 0.001), respectively. Furthermore, intention to leave the profession was more frequent among physicians with greater work alienation (p = 0.003). On the contrary, more empathic physicians never considered leaving their profession during the COVID-19 pandemic (p = 0.03). In physicians' verbatim, cognitive empathy appeared associated to a positive change in doctor-patient relationships. On the contrary, having an overwhelming emotional empathy appeared associated to a negative change in doctor-patient relationships. These findings characterize differences in how physicians cope while working in the frontline of the pandemic.

Propuesta de un modelo ecosistémico para la atención integral a la salud mental perinatal / An ecosystemic model for comprehensive perinatal mental health care

La atención a la salud mental tradicionalmente ha prestado poca atención a las madres. Son muy escasos en nuestro medio los programas de atención integral a la salud mental perinatal. Proponemos un modelo de encuadre que sirva para la atención integral a la perinatalidad, incluyendo los cuidados a los procesos psíquicos de la reproducción, embarazo, parto y posparto desde una visión ecosistémica inspirada en las propuestas de Urie Bronfenbrenner y John Bowlby, entre otros, integrando las aportaciones de la neurobiología, la epigenética, los modelos de transmisión intergeneracional del apego y el trauma, la sistémica, y añadiendo una perspectiva de género y ecológica que permita visibilizar las necesidades de la díada madre-bebé en el centro como punto de partida para la prevención y la atención en perinatalidad. Proponemos una mirada perinatal como modelo para continuar profundizando en la atención a madres y familias en el inicio de la vida, así como para cuidar también a las profesionales que los atienden. Apostamos por la escucha, el acompañamiento y la psicoterapia como herramientas básicas en la atención comunitaria e individual a madres, bebés y familias. (AU)

Mental health care has traditionally paid little attention to mothers. Comprehensive perinatal mental health care programs are very scarce in our environment. We propose a framing model that serves for comprehensive perinatal care, including care for the mental processes of reproduction, pregnancy, childbirth, and postpartum from an ecosystemic vision inspired by the proposals of Urie Bronfenbrenner and John Bowlby, among others. The model integrates data from neurobiology and epigenetics and theories from systemic and intergenerational transmission of attachment and trauma. It is embedded in a gender and ecological perspective that allows making visible the mother-baby dyad's needs in the center as a starting point for prevention and attention during the perinatal period. We propose a perinatal view as a model to continue deepening care for mothers and families at the beginning of life, as well as to care for the professionals who care for them. We bet on listening, support and psychotherapy as basic tools in community and individual care for mothers, babies, and families. (AU)

Derecho Disciplinario en Colombia, desde la imposición de Sanciones ¿la pérdida de su vocación preventiva? / Disciplinary law in Colombia from the imposition of sanctions, is it the loss of its preventive vocation?

Resumen El aumento progresivo de las sanciones disciplinarias no es un hecho aislado o ajeno a las dinámicas sociales y políticas de Colombia, podemos decir, que tanto el desarrollo normativo en términos de creación de leyes así como las diferentes posturas jurisprudenciales respecto al tema influyen en la tendencia de crecimiento; también lo hacen las condiciones sociales y los eventos coyunturales que involucran responsabilidad de funcionarios del Estado y, específicamente, en el aumento de funcionarios públicos, se puede ver la relación entre la concentración de funcionarios en un territorio y las sanciones disciplinarias que se imponen en este.

Abstract The progressive increase in disciplinary sanctions is not an isolated or unrelated fact to the social and political dynamics of Colombia. It can be said that both regulatory development in terms of the creation of laws, as well as the different jurisprudential postures on the issue influence the growth trend, so do social conditions and contemporary events, which involve responsibility for State officials. Moreover, specifically, in the increase of public officials, the relationship between the concentration of civil servants in a territory and the disciplinary sanctions, which are imposed in it, can be appreciated.

[Laparoscopic hysterectomy as first-line procedure in the treatment of women with benign uterine pathology]. / La histerectomía laparoscópica como procedimiento de primera línea en el tratamiento de mujeres con patología benigna del útero.

BACKGROUND: It is estimated that a total of 600,000 abdominal hysterectomies, vaginal and laparoscopic there are performed in USA, these figures make the hysterectomy the first ranked surgery. In our country, since the first description of the technique in 1989, laparoscopic hysterectomy (HL) has developed and evolved. However, the learning curve for mastering this procedure results in larger and more complex complications than other approaches. MATERIAL AND METHOD: Retrospective, longitudinal and descriptive study were carried out, the collection of data took place from the clinical records of patients who underwent total laparoscopic hysterectomy during January 1, 2007 through December 31 of the same year. It was performed in women older than 18 years with benign uterine pathology. Body mass index greater than 30 Kg/m2, uterus greater than 16 weeks of gestational age or more than 500 grams, illnesses than compromise life of patients o women that did not return to post-surgical evaluation were excluded. RESULTS: There were performe 75 laparoscopic hysterectonies, 72 underwent without any complication. The average hospital stay was 3 days. We founded 3 major surgical complications, a case of bleeding from the surgical area that was immediately attended by laparoscopic Vicril-00 single stitching. Also were founded 2 urinary lesions: 1 complex lesion of the trigonous. The follow up of this case was torpid it were needed to derivate for 15 day with a latex foley catheter after the secondary repair and was unsuccessfully. Thereafter a urogynecological team programed laparotomy for the final fistulectomy. And the third case of accident was referred to a ureteral section, was diagnosed by the leaking at opaquedye from the abdominal x ray, and the patient was programed to laparotomy to performed a termino-terminal anastomosis. CONCLUSIONS: Laparoscopic hysterectomy is a reliable treatment option for benign uterine pathology. We believe that this surgical technique should be offered as the regular way to perform the hysterectomy.

[Skene cyst: report of a case and review of the literature]. / Quiste de Skene: reporte de un caso y revisión de la bibliografía.

Paraurethral cyst or Skene cysts are rare at any age but particularly in newborns. In infants typically present as cystic formations, raised similar to a dermoid cyst. The treatment is established based on the findings, pathology and the age of the patient may be observational, puncture the cyst or surgical. We present a newborn with acute renal failure secondary to skene's cysts.

[Mayer-Rokitansky-Küster-Hauser syndrome. A report of two cases]. / Síndrome de Mayer-Rokitansky-Küster-Hauser: reporte de dos casos y revisión de la bibliografía.

The Mayer-Rokitansky-Kuster-Hauser is a rare congenital anomaly characterized by lack of vaginal and uterine development variable and normal ovaries. It results from agenesis or hypoplasia Müller duct system. Cervicovaginal agenesis as part of the complex syndrome, is even rarer. We report two cases: adolescent patient with primary amenorrhea, cervicovaginal agenesis and chronic pelvic pain, and a 28-year-old patient with primary amenorrhea, congenital absence of uterus and vagina.

[Transverse vaginal septum in the upper part of the vagina and pregnancy]. / Tabique vaginal transverso superior parcial y embarazo.

Transverse vaginal septum is a congenital Mullerian malformation resulting from a failure of the fusion or canalization of the urogenital sinus and the Müllerian ducts. It may cause hematocolpos, dyspareunia and infertility in adult patients. In some cases, it is associated with congenital malformations such as coarctation of the aorta or atrial septal defects. A case of a transverse vaginal septum identified during a vaginal check-up of a 39-week pregnant patient during labour is reported. A cesarean surgery was performed with no complications. Septal defect was diagnosed due to heart murmur. It was decided to treat the transverse vaginal septum as soon as the puerperium was over. The patient left the hospital after proper response to treatment.

[Placenta accreta: a surgical alternative that can save lives]. / Acretismo placentario: una alternativa quirúrgica que puede salvar vidas.

The placenta accreta is the second leading cause of obstetric hemorrhage, which often require the implementation of emergency obstetric hysterectomy increased morbidity and mortality. We present a surgical alternative to hysterectomy obstetric allowed us to reduce to zero until our rate of maternal deaths from obstetric hemorrhage. Improving surgical times, associated morbidity, without altering perinatal outcomes.

Up-regulation of FOXP3 and induction of suppressive function in CD4+ Jurkat T-cells expressing hepatitis C virus core protein.

HCV (hepatitis C virus) infection is a serious health care problem that affects more than 170 million people worldwide. Viral clearance depends on the development of a successful cellular immune response against the virus. Interestingly, such a response is altered in chronically infected patients, leading to chronic hepatitis that can result in liver fibrosis, cirrhosis and hepatocellular carcinoma. Among the mechanisms that have been described as being responsible for the immune suppression caused by the virus, Treg-cells (regulatory T-cells) are emerging as an essential component. In the present work we aim to study the effect of HCV-core protein in the development of T-cells with regulatory-like function. Using a third-generation lentiviral system to express HCV-core in CD4+ Jurkat T-cells, we describe that HCV-core-expressing Jurkat cells show an up-regulation of FOXP3 (forkhead box P3) and CTLA-4 (cytotoxic T-lymphocyte antigen-4). Moreover, we show that HCV-core-transduced Jurkat cells are able to suppress CD4+ and CD8+ T-cell responses to anti-CD3 plus anti-CD28 stimulation.

[A surgical alternative for placenta accreta]. / Una alternativa quirúrgica para acretismo placentario.

The placenta accreta is the second leading cause of obstetric hemorrhage in the world. In many occasions it is necessary to make an obstetric hysterectomy, a circumstance that increases morbidity, and maternal mortality. Communicates a surgical alternative to hysterectomy obstetric that has enabled us to reduce until the time to zero our rate of maternal deaths by obstetric hemorrhage, in addition to reducing the surgical time and the associated morbidity, without changing the perinatal outcome.

[Urethral myomas: report of two cases and literature review]. / Miomas uretrales: reporte de dos casos y revisión de la bibliografía.

Leiomyomas of the bladder and urethra are extremely rare. Depending on their location and size, they can produce diverse clinical manifestations. At urethral level in particular, formed near the vaginal wall, symptoms include recurrent urinary tract infections, voiding dysfunction, foreign body sensation, heaviness and dyspareunia. We present two cases of urethral leiomyomas, one expressed during pregnancy, which resolved successfully with surgical resection without damage to the urinary tract and no recurrence so far.

[Partial molar pregnancy. A case report and literature review]. / Embarazo molar parcial: reporte de un caso y revisión de la bibliografía.

We report the case of a 17 year old patient with partial molar pregnancy and coexistent live fetus of 13 gestational weeks diagnosed by ultrasound, which required the termination of pregnancy for maternal decompensation.

[Publications in respiratory nursing and physiotherapy]. / Publicaciones de enfermería y fisioterapia respiratoria.

The Respiratory Nursing and Physiotherapy Section of the Spanish Society of Pneumology and Thoracic Surgery, established as a working group more than 19 years ago, has been characterized by a high degree of involvement and collaboration with all the research studies requiring nursing and physiotherapy techniques. However, publication of articles by this collective is scarce compared with that of the rest of the Society and the characteristics, attitudes and limitations of this section pose an obstacle to increasing the number of its publications. This article aims to explain some of the possible reasons that could have given rise to this situation. The new tendencies and the attitude of this collective and the rest of the Society are encouraging and suggest that the work of the Respiratory Nursing and Physiotherapy Section will be better reflected in the future.

Publicaciones de enfermería y fisioterapia respiratoria / Publications in respiratory nursing and physiotherapy

La enfermería y la fisioterapia respiratoria, pertenecientes a SEPAR desde su nacimiento como grupo de trabajohace ya más de 19 años, se han caracterizado por el grado de implicación y de colaboración en todos los trabajosde investigación en los que los cuidados o las técnicas eran imprescindibles. La producción propia deartículos es ciertamente escasa por parte de nuestro colectivo comparada con el resto de la SEPAR. Nuestrascaracterísticas y peculiaridades, las actitudes y limitaciones históricas impiden poder tener una mayor presenciaen nuestra revista. En este artículo trataremos de explicar algunas de las posibles razones y motivosque creemos son los causantes de estas circunstancias.Las nuevas tendencias y la actitud de nuestro colectivo y del resto de la sociedad nos hace tener esperanzas ypensar que esta precariedad en el reflejo de nuestro trabajo se irá modificando en el proceso de cambio(AU)

The Respiratory Nursing and Physiotherapy Section of the Spanish Society of Pneumology and ThoracicSurgery, established as a working group more than 19 years ago, has been characterized by a high degree ofinvolvement and collaboration with all the research studies requiring nursing and physiotherapy techniques.However, publication of articles by this collective is scarce compared with that of the rest of the Society andthe characteristics, attitudes and limitations of this section pose an obstacle to increasing the number of itspublications. This article aims to explain some of the possible reasons that could have given rise to thissituation. The new tendencies and the attitude of this collective and the rest of the Society are encouragingand suggest that the work of the Respiratory Nursing and Physiotherapy Section will be better reflected in thefuture(AU)

Cirugía toracoscópica monoportal utilizando el instrumento SILS(R) como un método novedoso en el tratamiento quirúrgico del neumotórax / Single Port Thorascopic Surgery Using the SILS(R) Tool as a Novel Method in the Surgical Treatment of Pneumothorax

La single incision laparoscopic surgery (SILS, ‘cirugía laparoscópica a través de incisión única’) ha sido recientemente utilizada por cirujanos generales para realizar colecistectomías y reparación de hernias preperitoneales con malla mediante cirugía de minima invasión diminuyendo así el dolor postoperatorio y obteniéndose un resultado más cosmético de la cirugía. Describimos los primeros casos de cirugía torácica videoasistida en neumotórax espontáneos utilizando el sistema SILS. No hay reportes previos del uso del SILS en cirugía torácica videoasistida para el neumotórax espontáneo. Este sistema además de permitirnos obtener un resultado quirúrgico más cosmético, también disminuye la estancia media postoperatoria y la necesidad de analgésicos a fin de reducir el dolor postoperatorio(AU)

Single Incision Laparoscopic Surgery (SILS) has recently been used by general surgeons to perform cholecystectomies and pre-peritoneal hernia repairs with mesh using minimally invasive surgery, thus decreasing post-operative pain and a more cosmetic result of the surgery being obtained. We describe the first cases of video-assisted thoracic surgery (VATS) in spontaneous pneumothorax using the SILS system. There are no previous reports on the use of the SILS system in VATS for spontaneous pneumothorax. This system also allows us to obtain a more cosmetic surgical result, as well as decreasing the mean post-operative hospital stay and the need for analgesics to improve the post-operative pain(AU)

[Single port thorascopic surgery using the SILS tool as a novel method in the surgical treatment of pneumothorax]. / Cirugía toracoscópica monoportal utilizando el instrumento SILS como un método novedoso en el tratamiento quirúrgico del neumotórax.

Single Incision Laparoscopic Surgery (SILS) has recently been used by general surgeons to perform cholecystectomies and pre-peritoneal hernia repairs with mesh using minimally invasive surgery, thus decreasing post-operative pain and a more cosmetic result of the surgery being obtained. We describe the first cases of video-assisted thoracic surgery (VATS) in spontaneous pneumothorax using the SILS system. There are no previous reports on the use of the SILS system in VATS for spontaneous pneumothorax. This system also allows us to obtain a more cosmetic surgical result, as well as decreasing the mean post-operative hospital stay and the need for analgesics to improve the post-operative pain.

Alianza de universidades por la salud pública / Alliance of universities for public health

Introducción: La salud pública es el abordaje de los problemas de salud desde una perspectiva colectiva poblacional. Pensar, saber y hacer salud pública en Colombia implica lograr cambios en los órdenes político, económico y social, para la afectación de los determinantes de los procesos de salud y enfermedad en las dimensiones, proximales, intermedias y estructurales, que obliga a la interacción entre actores civiles e institucionales, con diferentes roles y responsabilidades. Objetivo: Contribuir al fortalecimiento de la formación y capacitación del talento humano, de pregrado y posgrado en salud pública, mediante alianzas estratégicas entre la Secretaría Distrital de Salud de Bogotá, unidades y organizaciones académicas, la OPS/ OMS y otros actores sociales del Distrito Capital. Método: Desarrollo de procesos solidarios y de cooperación técnica, en lo conceptual, operativo e instrumental, de lo que abarca la salud pública y la definición de los contenidos mínimos que debe contemplar un proceso de formación en este aspecto. Discusiones y encuentros académicos que han incluido directivos, docentes, estudiantes, aseguradoras y prestadoras de servicios de salud. Investigaciones del estado del arte de la salud pública en los procesos de formación de profesionales en pregrado y posgrado. Conclusión: la Alianza por la Salud Pública es una oportunidad para fortalecer la formación y prestación de servicios en salud pública, individuales y colectivos, en el marco de una política que se fundamenta en el derecho a la salud, la igualdad social y la participación.

Introduction: Public health is basically to address health problems from a collective population perspective. Thinking, knowing and doing public health in Colombia involves making political, economic and social changes, in order to influence the determinants of health and disease processes in their proximal, intermediate and structural dimensions, which leads to an interaction between civil and institutional actors with different roles and responsibility levels. Objective: To contribute to the strengthening of the training of human talent, both at undergraduate and raduate levels on public health by means of strategic alliances between the District Secretariat of Health of Bogotá, academic organizations and organizations, PAHO/ WHO and other social actors of the District Capital. Method: Development of solidarity and technical cooperation processes, taking into account conceptual, operational and instrumentation aspects dealing with public health and the definition of the minimum contents which must be included by a training process in this regard. There were discussions and meetings which have included directors, scholars, teachers, students, insurance companies and health care service providers, as well as research about the state-of-the-art of public health in the training of professionals atndergraduate and graduate levels. Conclusion: The Alliance for Public Health is an opportunity to strengthen the training and provision of public health services, both individual and collective, as part of a policy based on the rights to have health care service, social equality and participation.

[Results and complications following the placement of the transobturator tension free tape for the treatment of stress urinary incontinence]. / Resultados y complicaciones posteriores a la colocación de la cinta transobturadora libre de tensión en el tratamiento de pacientes con incontinencia urinaria de esfuerzo.

OBJECTIVE: Evaluate the complications and short term sucess rate of the transobturator tape for the treatment of stress urinary incontinence. MATERIAL AND METHODS: It is a retrospective study of the transobturator tapes perform in 2005 and 2006. All the procedures were done with epidural anesthesia. The success rate, the immediate, short-term and long term complications were recorded at the first, second and third year. RESULTS: 28 women were included in the study, 54% of them with stress urinary incontinence. 25% were solely transobturator procedures. mong the complications were 2 vesical puntures, 1 periurethral fascia trauma and 5 urinary retention during the first 24 hours. In the 1 and 2 year follow-up were 2 cases of overactive detrusor. Objective sucess was 90% and subjective sucess was 92%. CONCLUSIONS: Transobturator tape is a highly successful and a low morbility procedure.

[Horizons in respiratory care]. / Horizonte de los cuidados respiratorios.

As nurses and physiotherapists, we truly wish that our work could be rewarded with sufficient time, support, training and recognition so that it could be reflected in studies, publications and research. It does not seem right and it is unjust that the care profession framed within a multidisciplinary need and reality, with the largest number of professionals and hours of health care, does not have the recognition of its space. Too much blame. We need that space to continue growing and in particular to improve the quality of life or our population. Stop looking back and consolidate ourselves in the new possibilities that are being proposed to us without being dragged down by the autocracy of the market. Perhaps it is time to review and give each thing its label. Lit is our situation and to many of us it does not motivate us, or allow us to flow, but something is changing and change is the only thing that is permanent.

Horizonte de los cuidados respiratorios / Horizons in Respiratory Care

En verdad, las enfermeras y los fisioterapeutas desearíamos que nuestro trabajo pudiera ser recompensadocon suficiente tiempo, apoyo, formación y reconocimiento para que se pudiera ver reflejado en estudios,publicaciones e investigación.No parece real y es injusto que la profesión de cuidar, enmarcada en una necesidad y realidad multidisciplinaria,con el mayor número de profesionales y de horas de asistencia, no tenga el reconocimiento de suespacio. Culpables, hay demasiados.Necesitamos ese espacio para seguir creciendo y sobre todo para mejorar la calidad de vida de los ciudadanos.Dejar de mirar atrás y afianzarnos en las nuevas posibilidades que se nos proponen sin arrastrarnospor la autocracia del mercado.Quizás sea tiempo de repasar y ponerle a cada cosa su calificativo; es nuestra situación y a muchos de nosotrosno nos motiva, ni nos deja fluir, pero algo está cambiando y es lo único permanente, el cambio(AU)

As nurses and physiotherapists, we truly wish that our work could be rewarded with sufficient time, support,training and recognition so that it could be reflected in studies, publications and research.It does not seem right and it is unjust that the care profession framed within a multidisciplinary need andreality, with the largest number of professionals and hours of health care, does not have the recognition ofits space. Too much blame.We need that space to continue growing and in particular to improve the quality of life or our population.Stop looking back and consolidate ourselves in the new possibilities that are being proposed to us withoutbeing dragged down by the autocracy of the market.Perhaps it is time to review and give each thing its label. Lit is our situation and to many of us it does notmotivate us, or allow us to flow, but something is changing and change is the only thing that is permanent(AU)