General empathy and medical empathy in Mexican medical students: Integration of an empathic profile.

OBJECTIVE: To identify the association between general empathy and medical empathy. Detect predictors of the level of medical empathy from general empathy. To determine the psychosocial profile that describes the relationship between general empathy, medical empathy, and demographic and academic characteristics in medical students. METHOD: Descriptive cross-sectional design. Medical students completed the Interpersonal Reactivity Index (IRI) and the Jefferson Scale of Physician Empathy-student version (JSPE-S). RESULTS: Relatively high levels of general and medical empathy were detected. The total score of the IRI and the JSPE-S and their dimensions correlated positively (r = 0.14-0.52), except for the dimension personal distress of the IRI. The score of the IRI dimension empathic concern was the best predictor of the JSPE-S score and its dimensions (b = 0.27-0.54). Four profiles were detected: 1) men, preference for technology-oriented specialty, less empathy; 2) pre-clinical period students, less empathy; 3) students of the clinical period, greater empathy; and 4) women, preference for patient-oriented specialty, greater empathy. CONCLUSIONS: General and medical empathy are associated. Differentiated empathic profiles will allow the design of instructional strategies in empathy according to the specific needs of each one.

OBJETIVO: Identificar la asociación entre empatía general y empatía médica. Detectar predictores del nivel de empatía médica a partir de la empatía general. Determinar el perfil psicosocial que describa la relación entre empatía general, empatía médica y características demográficas y académicas en estudiantes de medicina. MÉTODO: Estudio transversal descriptivo. Estudiantes de medicina completaron el Índice de Reactividad Interpersonal (IRI) y la Escala de Empatía Médica de Jefferson versión estudiantil (EEMJ-E). RESULTADOS: Se detectaron niveles relativamente altos de empatía general y médica. El puntaje total del IRI y la EEMJ-E y sus dimensiones se correlacionaron positivamente (r = 0.14-0.52), excepto para la dimensión malestar personal del IRI. El puntaje en la dimensión preocupación empática del IRI fue el mejor predictor del puntaje de la EEMJ-E y sus dimensiones (b = 0.27-0.54). Se detectaron cuatro perfiles: 1) hombres, preferencia por especialidad orientada a la tecnología, menor empatía; 2) estudiantes del periodo preclínico, menor empatía; 3) estudiantes del periodo clínico, mayor empatía; y 4) mujeres, preferencia por especialidad orientada al paciente, mayor empatía. CONCLUSIONES: La empatía general y la empatía médica se encuentran asociadas. Unos perfiles empáticos diferenciados permitirán el diseño de estrategias de instrucción en empatía acordes con las necesidades específicas de cada uno.

Disparities in Compliance With National Guidelines for the Treatment of Malignant Pleural Mesothelioma.

BACKGROUND: Current guidelines support cancer-directed surgery, chemotherapy, or active surveillance for clinical stages 1 to 3 of epithelial malignant pleural mesothelioma (MPM). Definitive chemotherapy is recommended for sarcomatoid/biphasic histologies. Our objective is to assess compliance with recommendations, measuring their impact on overall survival. METHODS: The National Cancer Database participant user file (2004 to 2014) was queried for patients diagnosed with MPM clinical stages 1 to 3. Multivariable logistic regression model identified factors independently associated with guideline compliance. Kaplan-Meier analysis and Cox proportional hazards were used for overall survival comparison with histologic subgroup analysis. RESULTS: A total of 3419 patients with clinical stages 1 to 3 met criteria for analysis and comprised epithelial (68.5%), sarcomatoid (17.2%), and biphasic subtypes (14.3%). Cancer-directed surgery was significantly underutilized in epithelial MPM, with 29.3% having no treatment. On multivariable analysis, insurance status and facility type were the strongest predictors of guideline compliance. High-volume hospitals were the most compliant with guidelines (odds ratio 3.58, 95% confidence interval (CI), 2.34 to 5.49, P < .001). Median survival estimates for no treatment, chemotherapy alone, surgery plus chemotherapy, and trimodal therapy were 10.2, 15.4, 21.1, and 21.7 months, respectively (log rank P < .001). In epithelial MPM, a significant increase in overall survival was observed in surgery plus chemotherapy (hazard ratio 0.62, 95% CI, 0.53 to 0.73, P < .001) and trimodality (hazard ratio 0.61, 95% CI, 0.49 to 0.76, P < .001; reference: no treatment). CONCLUSIONS: There is a suboptimal compliance with national guidelines for the treatment of MPM, particularly in low-volume nonacademic settings. Adherence to recommended surgery-based multimodal therapy is associated with an overall survival improvement.

Does the Approach Matter? Comparing Survival in Robotic, Minimally Invasive, and Open Esophagectomies.

BACKGROUND: Our objective was to determine how surgical approach impacts overall survival and postoperative outcomes when comparing robotic-assisted minimally invasive esophagectomy (RAMIE), minimally invasive esophagectomy (MIE), and open esophagectomy (OE). METHODS: The National Cancer Database was queried for patients diagnosed with pathologic Stage 0 to III esophageal cancer from 2010 to 2015. Primary outcome measures evaluated were length of stay, 30-day unplanned readmissions, mortality rates at 30 and 90 days, and overall survival rates. The surgical cohorts underwent 1:1 propensity score matching, and Kaplan-Meier survival estimates were compared by surgical approach. Cox proportional hazards regression was utilized to estimate factors associated with overall survival. RESULTS: Of 5,553 patients that met criteria, 28.4% were MIE, 7.8% RAMIE, and 63.8% OE. From 2010 to 2015, an increasing trend was seen for both minimally invasive approaches, with MIE surpassing the number of OEs. Unplanned 30-day readmissions and 30-day and 90-day mortality rates were not significantly different between the different groups. Median length of stay was significantly shorter in MIE (9 [interquartile range (IQR), 8 to 14] days) and RAMIE (9 [IQR, 7 to 14] days), compared with OE (10 [IQR, 8 to 15] days; p < 0.001). MIE and RAMIE had comparable survival rates compared with OE, with no significant differences in median overall survival estimates after propensity score matching (log-rank p = 0.603), with a trend for increased survival in MIE (adjusted hazard ratio, 0.97; 95% confidence interval, 0.89 to 1.06; p = 0.530) and RAMIE (hazard ratio, 0.81; 95% confidence interval, 0.69 to 0.95; p = 0.012). Both minimally invasive approaches had a significantly higher median lymph node counts (MIE: 15 [IQR, 9 to 22]; RAMIE: 17 [IQR, 11 to 24]; OE: 13 [IQR, 8 to 20]), which may highlight important differences in postoperative upstaging. CONCLUSIONS: Trends in MIE use is surpassing the open approach. Minimally invasive approaches are becoming the preferred approach, with noninferior long-term results compared with OEs. A significantly higher lymph node yield was seen for RAMIE and MIE.

Prometastatic Molecular Profiles in Breast Tumors From Socially Isolated Women.

BACKGROUND: Social isolation is associated with accelerated breast cancer progression and increased disease recurrence and mortality, but the underlying biological mechanisms remain poorly understood. In preclinical models, beta-adrenergic signaling from fight-or-flight stress responses can stimulate prometastatic processes in the tumor microenvironment including upregulation of M2 macrophages, epithelial-mesenchymal transition (EMT), and lymphovascular invasion. This study examines whether the same pathways are upregulated in breast tumors from socially isolated cancer patients. METHODS: EMT and M1/M2 macrophage gene expression programs were analyzed by genome-wide transcriptional profiling, and lymphatic and vascular density were assessed by immunohistochemistry in primary tumors from 56 early-stage breast cancer patients who were part of the UCLA RISE study. Social isolation was quantified by the Social Provisions Scale, and disease characteristics were assessed by medical record review. General linear models were used to quantify differential gene expression across risk factor groups. Linear regression models were used to examine associations between social isolation and lymphovascular invasion. RESULTS: Tumors from socially isolated patients showed upregulated expression of genes involved in EMT (average score difference = +0.080 log2 mRNA abundance ± 0.034 standard error) and M2 macrophage polarization (+0.033 ± 0.014) as well as increased density of lymphatic vessels (ß= -.29) but no difference in blood vessel density. TELiS promoter-based bioinformatics analyses indicated activation of CREB family transcription factors that mediate the gene-regulatory effects of ß-adrenergic signaling (log2 fold-difference in promoter binding site prevalence: mean ± standard error = +0.49 ± 0.19). CONCLUSIONS: Primary breast tumors from socially isolated patients show multiple prometastatic molecular alterations, providing a plausible biological pathway through which poor social support may accelerate breast cancer progression and defining new targets for intervention.

Current status of research and treatment for non-small cell lung cancer in never-smoking females.

Lung cancer is the leading cause of cancer-related deaths worldwide with over 1 million deaths each year. The overall prognosis of lung cancer patients remains unsatisfactory, with a 5-year overall survival rate of less than 15%. Although most lung cancers are a result of smoking, approximately 25% of lung cancer cases worldwide are not attributable to tobacco use. Notably, more than half of the lung cancer cases in women occur in non-smokers. Among non-small-cell lung cancer (NSCLC) cases, cigarette-smokers have a greater association with squamous cell carcinoma than adenocarcinoma, which is more common in non-smokers. These findings imply that specific molecular and pathological features may associate with lung adenocarcinoma arising in non-smoker female patients. Over the past decade, whole genome sequencing and other '-omics' technologies led to the discovery of pathogenic mutations that drive tumor cell formation. These technological developments may enable tailored patient treatments throughout the course of their disease, potentially leading to improved patient outcomes. Some clinical and laboratory studies have shown success outcomes using epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKI) in patients with EGFR mutations and ALK rearrangements, respectively. In fact, these 2 mutations are predominantly present in female non-smokers with adenocarcinoma. Immunotherapy has also recently emerged as a major therapeutic modality in NSCLC. In this review, we summarize the current understanding of NSCLC biology and new therapeutic molecular targets, focusing on the pathogenesis of non-smoker female NSCLC patients.

[Injury mechanisms in extreme violence settings]. / Mecanismos de lesión en actos de violencia extrema.

Extreme violence events are consequence of current world-wide economic, political and social conditions. Injury patterns found among victims of extreme violence events are very complex, obeying several high-energy injury mechanisms. In this article, we present the basic concepts of trauma kinematics that regulate the clinical approach to victims of extreme violence events, in the hope that clinicians increase their theoretical armamentarium, and reflecting on obtaining better outcomes.

Ethnic and sex disparities in colorectal neoplasia among Hispanic patients undergoing screening colonoscopy.

BACKGROUND & AIMS: Colorectal cancer (CRC) has a high prevalence among the US Hispanic population. In Puerto Rico, CRC is the third leading cause of cancer death in men and the second in women. There are limited published data on the prevalence of colorectal neoplasia (CRN) among the US Hispanic population. We determined the prevalence of CRN (colorectal adenomas and cancer) among asymptomatic, Hispanic subjects who were screened in Puerto Rico and evaluated risk factors associated with CRN. METHODS: We performed a retrospective review of the medical, endoscopic, and pathology records of individuals who underwent first-time screening colonoscopies at an ambulatory gastroenterology practice from January 1, 2008, to December 1, 2009. The prevalence of CRN (overall and advanced), documented by colonoscopy and pathology reports, was calculated for the complete cohort and by sex. RESULTS: Of the 745 Hispanic individuals who underwent screening colonoscopies during the study period, the prevalence for overall CRN was 25.1% and for advanced CRN (≥ 1 cm and/or with advanced histology) was 4.0%. The prevalence of CRN was higher for men than women (32.0% vs 20.6%; P = .001; odds ratio, 1.92; 95% confidence interval, 1.4-2.6). CRN was more frequently located in the proximal colon (67.7% proximal vs 32.3% distal). A family history of CRC was associated with advanced CRN (odds ratio, 2.73; 95% confidence interval, 1.10-6.79). CONCLUSIONS: CRN was more common among Hispanic men than women and increased with age. CRNs among Hispanic individuals were predominantly located in the proximal colon. These findings indicate that there are ethnic and sex disparities in patterns of CRN that might be related to genomic admixture and have important implications for screening algorithms for Hispanic individuals.

Tratamiento artroscópico de la artrosis patelofemoral / Atrhroscopic management of the patellofemoral arthrosis

Las alteraciones degenerativas del cartílago articular fémoropatelar son un hallazgo frecuente en las cirugías artroscópicas de rodilla...El objetivo de este trabajo fue analizar el resultado obtenido con 70 pacientes los cuales fueron operados en el servicio de Ortopedia y Traumatología de la Clínica Güemes de Luján. A los mismos se les realizó tratamiento artrocópico durante el período enero 1995 y abril 2003, quienes presentaban artrosis monocompartimental fémoropatelar, con dolor en la cara anterior de la rodilla, limitación para estar sentados por períodos prolongados, ponerse en cuclillas, subir o bajar escaleras, correr saltar, presentaban también hidrartrosis a repetición y limitación de la flexión máxima por dolor

Descompresión subacromial artroscópica y reparación biomecánica "mini open" / Arthroscopic subacromial decompression with mini open

Analizamos el resultado de la descompresión subacromial en pacientes con rupturas totales del manguito rotador reparadas con técnica "mini open" basadas en principios biomecánicos...La edad promedio fue de 60 años, con un rango entre 37 y 63 años. El seguimiento promedio fue de 21 meses. El diagnóstico se basó en el examen clínico y las imágenes, outlet view y RMN

Tratamiento artroscópico de la artrosis patelofemoral / Atrhroscopic management of the patellofemoral arthrosis

Las alteraciones degenerativas del cartílago articular fémoropatelar son un hallazgo frecuente en las cirugías artroscópicas de rodilla...El objetivo de este trabajo fue analizar el resultado obtenido con 70 pacientes los cuales fueron operados en el servicio de Ortopedia y Traumatología de la Clínica G³emes de Luján. A los mismos se les realizó tratamiento artrocópico durante el período enero 1995 y abril 2003, quienes presentaban artrosis monocompartimental fémoropatelar, con dolor en la cara anterior de la rodilla, limitación para estar sentados por períodos prolongados, ponerse en cuclillas, subir o bajar escaleras, correr saltar, presentaban también hidrartrosis a repetición y limitación de la flexión máxima por dolor

Descompresión subacromial artroscópica y reparación biomecánica "mini open" / Arthroscopic subacromial decompression with mini open

Analizamos el resultado de la descompresión subacromial en pacientes con rupturas totales del manguito rotador reparadas con técnica "mini open" basadas en principios biomecánicos...La edad promedio fue de 60 años, con un rango entre 37 y 63 años. El seguimiento promedio fue de 21 meses. El diagnóstico se basó en el examen clínico y las imágenes, outlet view y RMN

Aplicacion de criterios diagnostico y valoracion de tratamiento acortado sin Estreptomicina en tuberculosis infantil / Application criteria of diagnosis and validation of shorten treatment without streptomicin in children with tuberculosis

El presente estudio introduce un sistema de diagnostico de tuberculosis infantil en base a criterios epidemiologicos clinicos y radiologicos en pacientes menores de 15 anos, en el departamento de Pediatria del hospital M.I German Urquidi, durante 4 anos, a quienes se les aplico en forma gratuita un tratamiento acortado, triconjugado sin estreptomicina, de 6 meses de duracion con 2 fases de 2 y 4 meses respectivamente. Se logra estudiar a 121 pacientes, mayoritariamente del area rural, desnutridos y en extrema pobreza. El 74 por ciento con alteraciones radiograficas pulmonares u osteoarticulares, el 37 por ciento con diagnostico confirmado por bacteriologia, 67 por ciento con localizacion pulmonar y 13 por ciento con 2 o mas localizaciones clinicas. Se logra curacion en 84 por ciento , fallecieron 6 pacientes y abandonaron 11 por ciento . las complicaciones presentes en 7.4 por ciento relacionadas en su mayoria a intoleranci gastrica.