[Impact of the Covid-19 pandemic on specialized healthcare training in a teaching center]. / Impacto de la pandemia COVID-19 en la formación sanitaria especializada en un centro docente.

OBJECTIVE: Evaluation of the impact of the health crisis caused by the Covid-19 pandemic on specialized healthcare training in a teaching center. METHODS: Cross-sectional descriptive study, by means of an electronic questionnaire sent to 167 residents in June 2020, to evaluate the burden of care, suspension of rotations and Covid-19 symptoms. The impact on the acquisition of professional competencies was measured using a four-level Likert scale (none, a little, quiet, a lot). The profile of acquired competencies was constructed and its association with the professional profile was studied using Generalized Linear Models. The qualitative approach was carried out through an open question on how it influenced their learning and the different categories were extracted through triangulation. RESULTS: The impact on learning was important for 94.8% of the residents. A total of 81.4% left the rotations they were doing and reported high workload, loss of training opportunities, uncertainty and ethical conflicts. They appreciated significant learning in the competencies of teamwork (93.2%), professionalism (86.2%), ethics (79.9%) and communication (78%). Technical competencies were deficient. The final balance of learning was perceived as positive by 54.4%, especially residents in central services and medical specialties. A total of 67.8% felt overwhelmed at times due to fatigue-emotional impact, care overload, ethical conflicts and lack of resources. CONCLUSIONS: The Covid-19 pandemic had an exceptional impact on specialized health care training. It is necessary to re-evaluate training programs to ensure the acquisition of the technical competencies that are lacking.

[Myocardial perfusion reserve studied by single-photon emission-computed tomography with thallium-201 and a drug stress test with adenosine triphosphate in patients with cardiovascular risk factors]. / Estudio de la reserva de perfusión miocárdica mediante tomografía de emisión de fotón único con talio-201 y estrés farmacológico con adenosina trifosfato en pacientes con factores de riesgo cardiovascular.

INTRODUCTION AND OBJECTIVE: Recent studies have suggested that the evaluation of coronary reserve is a sensitive method in the early detection of vascular alterations before plaques exist, and certainly before clinical detection of atherosclerotic lesions. Single-photon emission-computed tomography (SPECT) with thallium-201 (201Tl) provides a noninvasive tool for evaluating myocardial perfusion reserve. The objective of this study was to measure the myocardial perfusion reserve in two groups of subjects, some with and some without cardiovascular risk factors and in a group of patients with coronary artery disease. METHODS: Seventy-four subjects, divided into three groups, were recruited to assess regional and global myocardial perfusion reserve. The control group consisted of 11 asymptomatic individuals without cardiovascular risk factors. The second group was composed of 49 patients with one or more risk factors. Finally, the third group included 14 patients with coronary artery disease. 201Tl-SPECT at rest and after pharmacological stress with a 7 minute adenosine triphosphate (ATP) infusion (140 micrograms/kg/min) was performed in all patients. ATP minus rest value subtraction was applied in order to obtain the stress data. Relative myocardial perfusion reserve indices were calculated as the ratio between stress and rest values. RESULTS: Global and regional myocardial perfusion reserves of the vascular territories were significantly lower in patients with cardiovascular risk factors than in control subjects (Global: 1.48 +/- 0.19 vs 1.81 +/- 0.08, LAD: 1.52 +/- 0.21 vs 1.85 +/- 0.09, CX: 1.45 +/- 0.2 vs 1.79 +/- 0.86, RCA: 1.47 +/- 0.2 vs 1.79 +/- 0.86) and higher than in patients with coronary artery disease (Global: 1.48 +/- 0.19 vs 1.31 +/- 0.14, LAD: 1.52 +/- 0.21 vs 1.35 +/- 0.15, CX: 1.45 +/- 0.2 vs 1.2 +/- 0.24). Univariate linear regression analysis in a group of 40 patients with high risk lipid profiles revealed a significant negative correlation between myocardial perfusion reserve and total cholesterol (r = -0.35; p = 0.01), LDL-cholesterol (r = -0.38; p = 0.036) and LDL/HDL ratio (r = -0.39; p = 0.029). CONCLUSION: Determination of myocardial perfusion reserve with 201Tl-SPECT allows the detection of abnormal vasodilatory response to intravenous ATP in patients with cardiovascular risk factors. These patients have higher reserves than patients with coronary disease, which might suggest an early phase of atherosclerosis.