Desempeño académico, y su relación con calidad de vida y hábitos saludables / Academic Performance and its Association with Quality of Life and Healthy Habits

Introducción: El estudiante de Medicina enfrenta, en muchas ocasiones, entornos de vida y condiciones de aprendizaje poco favorables, así como aspectos psicológicos que pueden impactar de modo negativo en su calidad de vida y rendimiento académico. Objetivo: Evaluar el desempeño académico de los aspirantes a estudiar Medicina en relación con la autopercepción de la calidad de vida y los hábitos saludables. Métodos: Se realizó un estudio transversal, observacional y analítico. Se aplicó una encuesta sociodemográfica y la encuesta WHOQOL-Bref a una muestra de estudiantes del curso propedéutico de Medicina. Resultados: Se encontraron diferencias entre los alumnos que aprobaron y no aprobaron el curso propedéutico en autopercepción de Calidad de Vida (p = 0,01), y los dominios de Salud Física (p = 0,04), Salud Psicológica (p = 0,02) y Ambiente (p = 0,003). También entre los alumnos que desayunaban y los que omitían el desayuno en Autopercepción de Calidad de Vida (p = 0,012), Autopercepción de Salud Física (p = 0,009), y los dominios Salud Psicológica (p = 0,009) y Ambiente (p = 0,024). Conclusiones: Los altos puntajes en la prueba WHOQOL-Bref se correlacionan con el elevado desempeño académico; además, el hábito de omitir el desayuno conlleva a un bajo rendimiento escolar y una menor calidad de vida en los discentes(AU)

Introduction: Medical students face, many times, unfavorable living environments and learning conditions, as well as psychological aspects that can impact negatively on their quality of life and academic outcomes. Objective: To assess the academic performance of applicants to study Medicine in association with self-perception of quality of life and healthy habits. Methods: A cross-sectional, observational and analytical study was carried out. A sociodemographic survey and the WHOQOL-Bref survey were conducted on a sample of medical students of the propaedeutic course. Results: Differences were found between students who passed and those who did not pass the propaedeutic course regarding self-perception of quality of life (p=0.01), and the domains of physical health (p=0.04), psychological health (p=0.02) and environment (p=0.003). Also, we found differences between students who had breakfast and those who omitted breakfast regarding self-perception of quality of life (p=0.012), physical health (p=0.009), and domains of psychological health (p=0.009) and environment (p=0.024). Conclusions: The high scores in the WHOQOL-Bref test are in correlation with high academic performance; also, the habit of omitting breakfast leads to poor school performance and lower quality of life in students(AU)

[Construction and validation of the "La Salle Instrument" to evaluate the ethical aspects in biomedical research on human beings]. / Construcción y validación del Instrumento «La Salle¼ para evaluar los aspectos éticos en la investigación biomédica.

INTRODUCTION: Research projects must demonstrate not only a rigorous scientific methodology, but also the ethical aspects that require profound reflection of the reviewers. Current regulations establish criteria for research projects on human health, but many of these aspects are subjective. How can the evaluation of such projects be standardized? This is the main subject of the current project. MATERIALS AND METHODS: This project comprises two phases. First, the design and construction of an instrument of evaluation based on the fundamental principles of bioethics, which are autonomy, beneficence, non-maleficence, and justice, and other aspects. The second phase consists of content validation through expert. RESULTS: During the phase of reviewing the instrument, it was necessary to make changes by adding, removing, or changing the concepts or criteria, which lead to the construction of the second version of the format. This new instrument was reviewed and analyzed by using the AGREE II instrument, and this version was validated by experts by greater than 95%. CONCLUSIONS: There are some recommendations to analyze the ethical aspects in research protocols involving human subjects, but they define the concepts and criteria to be evaluated. By presenting the criteria to be evaluated individually, the "La Salle instrument" allows the evaluation to be more objective and standardized.

[The venous thromboembolic disease]. / Enfermedad tromboembólica venosa.

Venous thromboembolic disease (VTD) is a frequent medical problem. The VTD includes deep vein thrombosis (DVT), the posthrombotic syndrome (PTS) and pulmonary embolism (PE). The generation of a thrombus in the venous system, is caused by several abnormalities that induce the loss of the most important characteristic of the blood, the liquid state. DVT is due to the formation of a thrombus. Main causes for thrombus formation are thrombophilias which may be classified as primary and secondary. All thrombophilias may affect the homeostasis favoring a hypercoagulable state. In the XIX Century, Virchow classified all the causes of hypercoagulable states as follows: due to stasis of the venous blood flow, due to damage of the endothelium an a hypercoagulable clinical condition. Several risk factors for VTD has been described, during the hospitalization to both, medical and surgical conditions. Among the last, orthopedic and vascular surgery of the legs. Although nearly 50 % of DVTs are asymptomatic and 3 % of the patients with VTD develop PE and 30 % of them die. Thromboprophylaxis is the main strategy to prevent and to diminish the incidence of DVT and its complications. Thromboprophylaxis is useful to improve the quality of life of the patients at risk and it is an effective economical strategy for health care institutions.

Extra-skeletal Ewing's sarcoma resembling acute abdomen. Case report.

BACKGROUND: Extraosseous Ewing's sarcoma is a rare tumor of neuroectodermal origin. It presents mainly in the soft tissue of the extremities and thorax. Histologically, it is similar to Ewing's sarcoma of the bone. CLINICAL CASE: We present the case of a male who arrived at the emergency room with acute abdomen, leucocytosis and imaging techniques (abdominal ultrasound and computed tomography) suggestive of complicated diverticular disease. He was treated with emergency surgery. Intraoperative findings were an unsuspected tumor (20 x 15 x 15 cm). Treatment consisted of extirpation of the tumor, separating it from the adjacent viscera and followed by chemotherapy based on epirubicin, cyclophosphamide and vincristine for six cycles. Because the control abdominal CT demonstrated tumor activity in the retroperitoneum adjacent to the ascending colon and cecum, further resection was decided upon. CONCLUSIONS: In a review of the literature, no previous reports of extraosseous Ewing's sarcoma were found presenting as acute abdomen. Due to the rarity of this tumor, only case reports or series have been found in the literature without randomized or comparative studies. Surgery was the cornerstone of treatment, without reports of preoperative chemotherapy. If the patient's condition permits, percutaneous needle biopsy is mandatory to obtain optimum treatment as well as to improve prognosis.

Sarcoma de Ewing extraesquelético que semeja abdomen agudo / Extra-skeletal Ewing's sarcoma resembling acute abdomen: case report

Introducción: El sarcoma de Ewing extraóseo es un tumor raro de origen neuroectodérmico que se ha presentado principalmente en las partes blandas de las extremidades y del tórax; histológicamente es similar al sarcoma de Ewing en el tejido óseo. Caso clínico: Paciente con abdomen agudo y leucocitosis, en quien por imagen (ultrasonido y tomografía axial computarizada) se diagnosticó enfermedad diverticular complicada del colon, por lo que fue intervenido quirúrgicamente, encontrando lesión localizada en el espacio de Retzius con extensión a la cavidad abdominal de 20 x 15 x 15 cm. El tratamiento consistió en extirpación del tumor, separándolo de las vísceras adyacentes y el paciente fue tratado con quimioterapia: epirrubicina, ciclofosfamida y vincristina por seis ciclos; la tomografía abdominal de control mostró actividad tumoral en el retroperitoneo, adyacente al colon ascendente y ciego, por lo que se requirió nuevo tratamiento resectivo. Conclusiones: En la revisión de la literatura no hay informes previos de sarcoma de Ewing extraóseo cuya presentación sea abdomen agudo. Por la rareza de esta lesión, en la literatura solo hay registro de casos o algunas series de casos, por lo que no fue posible llevar a cabo comparaciones; la extirpación de la lesión es el pilar del tratamiento. No se define el papel de la quimioterapia preoperatoria. La biopsia percutánea guiada por algún método de imagen es de utilidad para otorgar al paciente un tratamiento óptimo que le permita un mejor pronóstico.

BACKGROUND: Extraosseous Ewing's sarcoma is a rare tumor of neuroectodermal origin. It presents mainly in the soft tissue of the extremities and thorax. Histologically, it is similar to Ewing's sarcoma of the bone. CLINICAL CASE: We present the case of a male who arrived at the emergency room with acute abdomen, leucocytosis and imaging techniques (abdominal ultrasound and computed tomography) suggestive of complicated diverticular disease. He was treated with emergency surgery. Intraoperative findings were an unsuspected tumor (20 x 15 x 15 cm). Treatment consisted of extirpation of the tumor, separating it from the adjacent viscera and followed by chemotherapy based on epirubicin, cyclophosphamide and vincristine for six cycles. Because the control abdominal CT demonstrated tumor activity in the retroperitoneum adjacent to the ascending colon and cecum, further resection was decided upon. CONCLUSIONS: In a review of the literature, no previous reports of extraosseous Ewing's sarcoma were found presenting as acute abdomen. Due to the rarity of this tumor, only case reports or series have been found in the literature without randomized or comparative studies. Surgery was the cornerstone of treatment, without reports of preoperative chemotherapy. If the patient's condition permits, percutaneous needle biopsy is mandatory to obtain optimum treatment as well as to improve prognosis.

[Para-median or midline approach in the insertion of a Tenckhoff catheter in patients with ambulatory continuous peritoneal dialysis. Comparative study]. / Abordaje por línea media o paramedia en la colocación de catéter de Tenckhoff en pacientes con diálisis peritoneal continua ambulatoria. Estudio comparativo.

HYPOTHESIS: Insertion of a Tenckhoff catheter through a small para-median incision results in less catheter dysfunction than in cases where insertion is made through a midline incision. MATERIAL AND METHODS: This is a prospective, longitudinal, comparative, observational study of cause and effect; in other words, it is a study of two cohorts. The study included patients with chronic renal insufficiency aged 16 years and over of either sex who required insertion of a Tenckhoff catheter for peritoneal dialysis treatment. A total of 44 patients were recruited and were divided randomly into two groups: Group A, numbering 23 patients, had their catheter inserted through midline below umbilicus, while Group B numbering 21 patients had their catheter inserted through via para-median approach. The study employed Student t parametric test and chi square trial hypothesis for non-parametric variables. Rejection criterion was p < 0.05. RESULTS: In both groups, cause of chronic renal insufficiency was diabetic nephropathy. After a 30-day follow-up period, the group of patients with catheter inserted through midline incision, i.e., Group A, presented dysfunction in 43.5% of cases. In the group with catheter inserted through para-median incision, i.e., Group B, dysfunction presented in 38% of cases with no other significant statistical difference occurring. Main cause of dysfunction occurring in Group A was catheter migration, whereas in Group B the main cause was dialysis fluid leakage. CONCLUSIONS: This study concluded that there was no significant difference between the two surgical techniques employed for Tenckhoff catheter insertion with regard to incidence of catheter migration, leakage of dialysis solution, catheter obstruction due to adhesions, or post-incisional hernias during the immediate post-surgical period (30 days). Furthermore, no significant difference was found between the two groups with respect to other types of complications such as peritonitis, infection along the subcutaneous catheter pathway, or catheter obstruction due to blood clots.