Latex vascular injection as method for enhanced neurosurgical training and skills.

Background: Tridimensional medical knowledge of human anatomy is a key step in the undergraduate and postgraduate medical education, especially in surgical fields. Training simulation before real surgical procedures is necessary to develop clinical competences and to minimize surgical complications. Methods: Latex injection of vascular system in brain and in head-neck segment is made after washing out of the vascular system and fixation of the specimen before and after latex injection. Results: Using this latex injection technique, the vascular system of 90% of brains and 80% of head-neck segments are well-perfused. Latex-injected vessels maintain real appearance compared to silicone, and more flexible vessels compared to resins. Besides, latex makes possible a better perfusion of small vessels. Conclusions: Latex vascular injection technique of the brain and head-neck segment is a simulation model for neurosurgical training based on real experiencing to improve surgical skills and surgical results.

Mortalidad de médicos por COVID-19 de acuerdo con su especialidad en la primera y segunda ola de la pandemia en el Perú

Introducción : El COVID-19 es una enfermedad infecciosa, declarada pandemia por la OMS en marzo 2020. Ha causado millones de muertes, incluidos médicos en el mundo. El objetivo fue determinar las características de la mortalidad de médicos por COVID-19 y la tasa de mortalidad específica por especialidad durante la pandemia del COVID-19 en el Perú. Material y métodos: Estudio descriptivo que evalúo la totalidad de médicos fallecidos reportados por el Colegio Médico del Perú hasta noviembre 2021 y que cumplieron con tener su certificado de defunción. Se definió tres grupos: médicos especialistas con alto (EMACC) y bajo contacto (EMBCC) con pacientes COVID-19 y médicos sin especialidad. Resultados: La edad >60 años y tener el sexo masculino en los EMACC mostraron un p=0,003 y 0,016 respectivamente. El 69,4% de médicos fallecieron en Lima y donde más fallecieron fue Hospital Rebagliati Martins (21%). La mayor tasa de mortalidad específica por especialidad (TME) fue 29,7 y 25,0 en epidemiología y administración de salud respectivamente. En la ciudad de Lima, fallecieron 69,4% de médicos, principalmente el grupo de EMBCC. Conclusión: Los médicos varones y >60 años son los que murieron con mayor frecuencia, sobre todo en la ciudad de Lima y en el grupo de EMACC. Las mayores tasas de mortalidad por el COVID-19 ha sido en el grupo de EMBCC.

Introduction: COVID-19 is an infectious disease declared a pandemic by the WHO in March 2020. It has caused millions of deaths, including among doctors in the world. The objective was to determine the characteristics of physician mortality from COVID-19 and the specific mortality rate by specialty during the COVID-19 pandemic in Peru. Material and methods: Descriptive study that evaluated all deceased physicians reported by the Medical College of Peru until November 2021 and who complied with having their death certificate. Three groups were defined: specialist physicians with high (EMACC) and low (EMBCC) contact with COVID-19 patients and physicians without a specialty. Results: Age >60 years and males in the EMACC showed p=0.003 and 0.016, respectively. 69.4% of doctors died in Lima, and most died at Rebagliati Martins Hospital (21%). The highest specialty-specific mortality rate was 29.7 and 25.0 in epidemiology and health administration, respectively. In Lima, 69.4% of physicians died, mainly in the EMBCC group. Conclusion: Male physicians >60 years old are the ones who die more frequently, especially in the city of Lima and in the EMACC group. The highest mortality rates from COVID-19 were in the EMBCC group.

Efecto fotodinámico de Azul de metileno y Azul de toluidina, sobre biofilm de Streptococcus mutans y Candida albicans / Photodynamic effect of methylene blue and toluidine blue on Streptococcus mutans and Candida albicans biofilm

Objetivo: Determinar el efecto fotodinámico de azul de metileno (MB) y azul de toluidina (TBO) activadas con láser terapéutico sobre biofilms de Streptococcus mutans y Candida albicans. Material y métodos: Se analizaron 61 muestras de biopelículas, en medios de cultivo cerebro corazón (BHI) por 6 días, las muestras se dividieron en 4 grupos y se sumergieron en: grupo experimental en MB al 0,01% y TBO al 0,05%, grupo control positivo en gluconato de clorhexidina (CHX) al 0,12% y grupo control negativo en cloruro de sodio (NaCl) al 0,9%. Las muestras de MB y TBO fueron irradiadas con láser terapéutico con una longitud de onda de 660 nm, y 9 J/cm2 de potencia, cada bloque de esmalte estuvo en cultivo post irradiación. las muestras pasaron a cultivo, para la cepa S. mutans y C. albicans por separado, El método empleado fue el de diluciones seriadas para la cuantificación de UFC luego de 5 días de cultivo. Para el análisis se usó T de student y Anova de un factor. Resultados: encontrando diferencias estadísticas entre los cuatro grupos de experimentación en el crecimiento microbiano (ANOVA p<0,05), al análisis con el grupo control positivo, no hubo diferencias significativas entre MB frente al S. mutans y C. albicans, en contraste con el TBO que mostro diferencias significativas (p<0,05). Conclusión: el MB y TBO muestran en laboratorio, una disminución en el crecimiento de las cepas del biofilm, el TBO mostró mejor efecto a la reducción de crecimiento del S. mutans y C. albicans.

Objetive: To determine the photodynamic effect of methylene blue (MB) and toluidine blue (TBO) activated with therapeutic laser on Streptococcus mutans and Candida albicans biofilms. Material and methods: Sixty-one biofilm samples were analyzed in brain heart culture media (BHI) for 6 days, the samples were divided into 4 groups and immersed in: experimental group in 0.01% MB and 0.05% TBO, positive control group in 0.12% chlorhexidine gluconate (CHX) and negative control group in 0.9% sodium chloride (NaCl). The MB and TBO samples were irradiated with 2 therapeutic laser with a wavelength of 660 nm, and 9 J/cmof power, each enamel block was in post-irradiation culture. The samples were cultured separately for the S. mutansand C. albicans strains, the method used was that of serial dilutions for the quantification of CFU after 5 days of culture. For the analysis, Student's Tand Anova of one factor were used. Results: finding statistical differences between the four experimental groups in microbial growth (ANOVAp<0.05), in the analysis with the positive control group, there were no significant differences between MB versus S. mutansand C. albicans, in contrast to the TBO that showed significant differences (p<0.05). Conclusion: MB and TBO show in laboratory, a decrease in the growth of biofilm strains, TBO showed better effect in reducing the growth of S. mutansand C. albicans.

[Analysis of production, impact, and collaboration networks in scientific research in Scopus for Peru from 2000 to 2019]. / Análisis de producción, impacto y redes de colaboración en investigaciones científicas en Scopus en Perú de 2000 a 2019.

INTRODUCTION: Peru is a developing country with increasing scientific production. However, it is necessary to understand the trends, impact, and collaborative networks of research to plan for policy improvements. OBJECTIVE: We analyzed the production, impact, and collaboration networks in the Peruvian scientific production between 2000 and 2019. METHODS: We did an observational analytical study. We searched Scopus for all the publications with at least one author with a Peruvian affiliation declared in the author byline. A descriptive analysis of the different characteristics, trends, and scientific collaboration was carried out. Collaboration networks were plotted using VOSviewer. RESULTS: Between 2000 and 2019, Peru had a total of 24 482 publications in scientific journals, with an average annual growth of 13.6%. Of the total, 70% of all the articles were cataloged as Clinical Medicine and Biomedical Sciences. Only half of the articles had a Peruvian affiliation. The countries with the largest share of collaboration were the United States and Brazil, and the articles with international collaboration had the highest number of citations per publication. CONCLUSIONS: Scientific production in Peru has increased in recent years, with a significant percentage of publications based on international collaboration and led by authors with non-Peruvian affiliations. It is necessary to strengthen collaboration ties between Peruvian and foreign institutions. Furthermore, it is essential to propitiate further research that will help solve the country's problems.

INTRODUCCIÓN: Perú es un país en vías de desarrollo, con una producción científica en aumento. Sin embargo, es necesario entender las tendencias, el impacto y la colaboración de sus investigaciones para promover una mejora continua de las mismas. OBJETIVO: Buscamos analizar la producción, el impacto y las redes de colaboración en la producción científica peruana entre los años 2000 y 2019. MÉTODOS: Realizamos un estudio analítico observacional haciendo una búsqueda en Scopus de todas las publicaciones que hayan tenido al menos un autor peruano en su filiación. Sobre eso, realizamos un análisis descriptivo de las diferentes características, tendencias y tipo de colaboración científica. Graficamos las redes de colaboración mediante VOSviewer. RESULTADOS: Entre los años 2000 y 2019, Perú tuvo un total de 24 482 publicaciones en revistas científicas, con un crecimiento anual promedio de 13,6%. Del total de artículos científicos, 70% de todas las publicaciones pertenecieron a las áreas de medicina clínica y ciencias biomédicas. Solo la mitad de los artículos contaban con filiación peruana. Los países con mayor colaboración fueron Estados Unidos y Brasil, y los artículos con colaboración internacional tuvieron mayor cantidad de citas por publicación. CONCLUSIONES: En años recientes, ha habido un incremento de la producción científica en Perú, con un gran porcentaje de publicaciones basadas en la colaboración internacional y lideradas por autores con filiación no peruana. Es necesario fortalecer lazos de colaboración entre instituciones peruanas y extranjeras. Además, es fundamental el incitar un mayor liderazgo en investigaciones que solucionen problemas del país.

Modified Pure Endoscopic Approach to Pineal Region: Proof of Concept of Efficient and Inexpensive Surgical Model Based on Laboratory Dissections.

OBJECTIVE: In recent decades endoscopic techniques have been increasingly used in neurosurgery as they may offer a valuable close-up view of the working area through a minimally invasive surgical corridor. Herein, we present an inexpensive and efficient endoscopic surgical model using a borescope, which was used for a "modified pure endoscopic approach" to the pineal region. METHODS: A borescope video camera was connected to a 16-inch personal computer monitor. A standard midline suboccipital craniotomy was performed on 2 cadaveric heads in the Concorde position. Then, a "borescopic" supracerebellar infratentorial approach was executed, thus reaching the pineal region, which was exposed through an extensive arachnoid dissection. RESULTS: Using the previously described model, we were able to provide excellent exposure of the main neurovascular structures of the pineal region, as shown by the intraoperative videos. In 1 specimen we identified an incidental pineal cyst that was meticulously dissected and removed. CONCLUSIONS: Our proposed "borescopic" surgical model may represent an inexpensive and efficient alternative to conventional endoscopic techniques and could be used for training purposes, as well as even for clinical procedures, after a proper validation, particularly in economically challenging environments.

Subdiagnóstico de carcinoma quístico adenoide de senos paranasales po sinusitis y pólipos nasales: a propósito de un caso / Under-diagnosis of adenoid cystic carcinoma of the paranasal sinuses for sinusitis and nasal polyps: a case report

La posibilidad de subdiagnosticar el cuadro, al confundirlo con enfermedades más comunes y benignas como: sinusitis y pólipos nasales. El tumor raro en senos paranasales; caracterizado por presentar metástasis tardía, ser persistente y agresivo; tener predilección por invadir y crecer siguiendo el trayecto de fibras nerviosas. Varón de 65 años, mecánico durante 25 años; con cuadro antiguo de sinusitis supurativa y poliposis nasal, a repetición; con extirpación quirúrgica hasta en dos oportunidades, teniendo diagnóstico de papiloma invertido. Doce años después se diagnostica carcinoma quístico adenoide con compromiso de maxilar superior, hueso malar y globo ocular. Efectuándosele maxilectomía ampliada y resección de globo ocular derechos.(AU)

The possibility of under-diagnosis, by frequent and benign diseases such as sinusitis and nasal polyposis. The rare tumor in sinuses, characterized by: late metastasis, being persistent and aggressive, predilection for invading and growing along the nerve fibers. A 65-year-old male, mechanic for 25 years, with repetitive suppurative sinusitis and nasal polyps; underwent surgical removal twice, diagnosis of inverted papilloma. Twelve years later was diagnosed with Cystic Adenoid Carcinoma with compromise of the maxilla, malar bone and eyeball, performing extended maxillectomy and resection of right eyeball.(AU)