The influence of the SARS-CoV-2 pandemic on in-hospital mortality in a gastroenterology service / Influencia de la pandemia por SARS-CoV-2 en la mortalidad intrahospitalaria en un servicio de aparato digestivo

Introduction: The pandemic caused by SARS-CoV-2 has drastically changed the global health landscape. Our objective was to verify if, after the start of the pandemic, there was an increase in in-hospital mortality in patients admitted to a Gastroenterology Service of a 3rd level hospital. Material and methods: The 1039 admissions registered at the Virgen de la Victoria University Hospital in Malaga (Spain) were retrospectively analysed in the period between 1 December 2019 and 30 November 2020 (12 months), which were divided into 4 quarters (pre-wave, first wave, inter-wave and second wave) and mortality and other variables (globally and by disease group) were analysed. Results: No statistically significant differences were observed in terms of overall in-hospital mortality in the different periods. (p 0.23). The greatest burden of disease corresponded to biliopancreatic group and, within them, acute pancreatitis (p 0.04), followed by non-variceal gastrointestinal bleeding. In the second semester, mortality increased in the biliopancreatic group (p 0.01). Patients admitted for gastrointestinal bleeding took longer to request care after the start of the pandemic, especially in the second wave (p 0.03). The same was observed in admissions due to tumours, with the time elapsed until the emergency visit more than double in the second semester, with a consequent increase in mortality (p 0.00). Conclusions: The global in-hospital mortality in a Gastroenterology Service in a 3rd level hospital has not increased with the onset of the SARS-CoV-2 pandemic, however, a higher in-hospital mortality has been recorded in biliopancreatic diseases and digestive tumours diagnosed on an in-patient basis between June and November 2020.(AU)

Introducción:La pandemia ocasionada por el SARS-CoV-2 ha modificado drásticamente el panorama sanitario mundial. Nuestro objetivo fue comprobar si tras el inicio de esta se produjo un aumento en la mortalidad intrahospitalaria en los pacientes ingresados en un servicio de aparato digestivo de un hospital de tercer nivel. Material y métodos: Se analizaron retrospectivamente 1.039 ingresos en el Servicio de Aparato Digestivo del Hospital Universitario Virgen de la Victoria en el periodo comprendido entre el 1 de diciembre de 2019 y el 30 de noviembre de 2020 (12 meses), se dividieron en 4 trimestres (preoleada, primera oleada, interoleada y segunda oleada) y se analizó la mortalidad y otras variables (de forma global y por grupo de enfermedades). Resultados: No se observaron diferencias estadísticamente significativas en cuanto a mortalidad intrahospitalaria global en los diferentes periodos (p=0,23). La enfermedad con mayor predominio fue la biliopancreática y, dentro de ella, las pancreatitis agudas (p=0,04), seguidas del sangrado digestivo no varicoso. En el segundo semestre aumentó la mortalidad en el grupo biliopancreático (p=0,01). Los pacientes que ingresaron por hemorragia digestiva tardaron más en solicitar asistencia tras la pandemia, especialmente en la segunda oleada (p=0,03). Esto mismo se objetivó en los ingresos por tumores, siendo el tiempo transcurrido hasta la consulta a Urgencias mayor del doble en el segundo semestre, con el consecuente aumento en la mortalidad (p=0,00). Conclusiones: La mortalidad global intrahospitalaria en el Servicio de Aparato Digestivo no ha aumentado con la sobrevenida de la pandemia por SARS-CoV-2, si bien se ha registrado una mayor mortalidad intrahospitalaria en las enfermedades biliopancreáticas y los tumores digestivos diagnosticados en régimen de hospitalización entre junio y noviembre de 2020.(AU)

The influence of the SARS-CoV-2 pandemic on in-hospital mortality in a gastroenterology service.

INTRODUCTION: The pandemic caused by SARS-CoV-2 has drastically changed the global health landscape. Our objective was to verify if, after the start of the pandemic, there was an increase in in-hospital mortality in patients admitted to a Gastroenterology Service of a 3rd level hospital. MATERIAL AND METHODS: The 1039 admissions registered at the Virgen de la Victoria University Hospital in Malaga (Spain) were retrospectively analysed in the period between 1 December 2019 and 30 November 2020 (12 months), which were divided into 4 quarters (pre-wave, first wave, inter-wave and second wave) and mortality and other variables (globally and by disease group) were analysed. RESULTS: No statistically significant differences were observed in terms of overall in-hospital mortality in the different periods. (p 0.23). The greatest burden of disease corresponded to biliopancreatic group and, within them, acute pancreatitis (p 0.04), followed by non-variceal gastrointestinal bleeding. In the second semester, mortality increased in the biliopancreatic group (p 0.01). Patients admitted for gastrointestinal bleeding took longer to request care after the start of the pandemic, especially in the second wave (p 0.03). The same was observed in admissions due to tumours, with the time elapsed until the emergency visit more than double in the second semester, with a consequent increase in mortality (p 0.00). CONCLUSIONS: The global in-hospital mortality in a Gastroenterology Service in a 3rd level hospital has not increased with the onset of the SARS-CoV-2 pandemic, however, a higher in-hospital mortality has been recorded in biliopancreatic diseases and digestive tumours diagnosed on an in-patient basis between June and November 2020.

Involvement of the digestive system in covid-19. A review. / Afectación del aparato digestivo en la covid-19. Una revisión sobre el tema.

The SARS-CoV-2 pandemic is leading to high mortality and a global health crisis. The primary involvement is respiratory; however, the virus can also affect other organs, such as the gastrointestinal tract and liver. The most common symptoms are anorexia and diarrhea. In about half of the cases, viral RNA could be detected in the stool, which is another line of transmission and diagnosis. covid19 has a worse prognosis in patients with comorbidities, although there is not enough evidence in case of previous digestive diseases. Digestive endoscopies may give rise to aerosols, which make them techniques with a high risk of infection. Experts and scientific organizations worldwide have developed guidelines for preventive measures. The available evidence on gastrointestinal and hepatic involvement, the impact on patients with previous digestive diseases and operating guidelines for Endoscopy Units during the pandemic are reviewed.

Incidence of surgical abdominal emergencies during SARS-CoV-2 pandemic. / Incidencia de la patología abdominal quirúrgica urgente durante la pandemia por SARS-CoV-2.

INTRODUCTION: Since the appearance of SARS-CoV-2 in December 2019 in the Chinese city of Wuhan, we have experienced a reduction in admissions in our Service and a decrease in urgent surgical activity. Therefore, this study aimed to assess the incidence of potentially surgical abdominal emergency in our center during the epidemic of COVID-19. METHODS: A retrospective study was designed. It included all patients admitted for urgent abdominal pathology with potential surgical treatment in our General and Digestive Surgery Department from February 24, 2020 to April 19, 2020. RESULTS: Eighty-nine patients with a mean age of 58.85±22.2 were included. The median time from symptom onset to the Emergency Department (ED) visit was 48 (P25-P75 = 24-96) hours. On arrival at the ED, 18 (20%) patients presented with systemic inflammatory response syndrome criteria. Fifty-one (57%) surgical procedures were performed. The rate of post-surgical complications at 30 days was 31% and the mortality rate was 2%. Concerning the same period from 2017 to 2019, the mean number of admissions from the ED to our Department decreased by 14% during the epidemic period. CONCLUSION: There has been a decrease in the number of patients admitted for urgent, potentially surgical, abdominal pathology during the period of the COVID-19 epidemic in our center.

Cancer of the digestive system in Veracruz. The magnitude of the problem by 2025. / Cáncer del aparato digestivo en Veracruz. La magnitud del problema al año 2025.

INTRODUCTION: Malignant tumors of the digestive system are a public health problem with epidemiologic variations attributed to factors resulting from the aging of the population and lifestyle changes. Therefore, estimating the future magnitude of the problem is prudent. AIM: To determine the epidemiologic projection up to 2025 of malignant tumors of the digestive system in Veracruz. MATERIALS AND METHODS: A predictive, analytic, observational study was conducted on patients belonging to the Public health sector of Veracruz that presented with digestive system cancer, within the time frame of 2000-2016, carrying out a disease projection up to 2025. The IBM SPSS 22.0 program was utilized for the statistical analysis, employing simple linear regression. A comparative analysis of the data was carried out and results are shown in scatter graphs. RESULTS: A total of 2,540 cases were included in the study. Mean patient age was 63.25±13.43, with a predominance of men at 56.65%. The most frequent tumor locations were in the colon and rectum (25.04%), liver (23.66%), and stomach (21.93%). Less frequent sites were the esophagus (4.88%) and small bowel (5.08%). A general 7.63% increase in the disease was predicted for 2025, with increases to 11.51% for esophageal cancer, 7.22% for gastric cancer, 9.09% for colorectal cancer, 5.98% for liver cancer, 7.88% for pancreatic cancer, and 6.86% for cancer of the gallbladder and bile ducts. Only cancer of the small bowel showed a predicted decrease to 3.33%. DISCUSSION AND CONCLUSIONS: The results of the present study predict that digestive system cancers in Veracruz will increase importantly by 2025, with colorectal cancer, hepatocellular carcinoma, and gastric cancer as the most frequent tumors, in descending order. The other cancers are estimated to maintain a discrete line of growth. In addition to predicting the behavior of those cancers, the results of the present study are useful for estimating the resources that will be needed for their care by 2025.

Desarrollo y cambios con la edad en el tubo digestivo, hígado y páncreas / Digestive tract, liver and pancreas: development and changes with age

An adequate functioning of the digestive tract, liver and pancreas is fundamental to providing the organism with the necessary conditions for its development and maintaining its digestive and systemic homeostasis. Life expectancy has increased, it is estimated that adults over 65 years old by 2050, will represent 25% of the local population. The morphological and functional changes associated with aging in the digestive system, liver and pancreas are modest except for those that occur in the microbiota. Recently it has been possible to establish the contribution of the microbiota to life expectancy and establish a link between gastrointestinal microbiota, inflammation associated with aging (inflammaging) and survival. This represents a shift in the paradigm of our understanding physiology, chronic diseases, neoplasms and for the development of new therapies.

Un adecuado funcionamiento del tubo digestivo, hígado y páncreas es fundamental para poder brindar al organismo las condiciones necesarias para su desarrollo y mantener su homeostasis digestiva y sistémica. La expectativa de vida se ha incrementado, estimándose a nivel nacional que para el año 2050 los adultos mayores de 65 años representarán el 25% de la población. Los cambios morfológicos y funcionales asociados al envejecimiento en el aparato digestivo, hígado y páncreas son modestos a excepción, de los que se producen en la microbiota. Recientemente se ha podido establecer la contribución de la microbiota a la esperanza de vida y establecer un nexo entre microbiota gastrointestinal, inflamación asociada al envejecimiento y sobrevida. Esto representa un cambio en el paradigma sobre cómo comprendemos la fisiología, las patologías crónicas, neoplásicas y en el desarrollo de nuevas terapias.

Frequency of human papillomavirus infection in patients with gastrointestinal cancer. / Frecuencia de infección por virus del papiloma humano en pacientes con cáncer del aparato digestivo.

INTRODUCTION AND AIM: Cancer is the result of the interaction of genetic and environmental factors. It has recently been related to viral infections, one of which is human papillomavirus. The aim of the present study was to describe the frequency of human papillomavirus infection in patients with digestive system cancers. MATERIALS AND METHODS: A prospective, multicenter, observational study was conducted on patients with gastrointestinal cancer at 2public healthcare institutes in Veracruz. Two tumor samples were taken, one for histologic study and the other for DNA determination of human papillomavirus and its genotypes. Anthropometric variables, risk factors, sexual habits, tumor location, and histologic type of the cancer were analyzed. Absolute and relative frequencies were determined using the SPSS version 24.0 program. RESULTS: Fifty-three patients were studied. They had gastrointestinal cancer located in: the colon (62.26%), stomach (18.87%), esophagus (7.55%), rectum (7.55%), and small bowel (3.77%). Human papillomavirus was identified in 11.32% of the patients, 66.7% of which corresponded to squamous cell carcinoma and 33.3% to adenocarcinoma. Only genotype 18 was identified. Mean patient age was 61.8±15.2 years, 56.60% of the patients were men, and 43.40% were women. A total of 15.8% of the patients had a family history of cancer and 31.6% had a personal history of the disease, 38.6% were tobacco smokers, and 61.4% consumed alcohol. Regarding sex, 5.3% of the patients said they were homosexual, 3.5% were bisexual, 29.8% engaged in oral sex, and 24.6% in anal sex. CONCLUSIONS: Our study showed that human papillomavirus infection was a risk factor for the development of gastrointestinal cancer, especially of squamous cell origin.

Fluoroscopic studies of the upper gastrointestinal tract: techniques and indications. / Estudios telemandados con control fluoroscópico del tracto digestivo superior: Técnicas e indicaciones.

Fluoroscopic studies of the gastrointestinal tract are becoming increasing less common due to the introduction of other imaging techniques such as computed tomography and magnetic resonance imaging and to the increased availability of endoscopy. Nevertheless, fluoroscopic studies of the gastrointestinal tract continue to appear in clinical guidelines and some of their indications are still valid. These studies are dynamic, operator-dependent examinations that require training to obtain the maximum diagnostic performance. This review aims to describe the technique and bring the indications for this imaging modality up to date.

Recommendations on the use of deep neuromuscular blockade by anaesthesiologists and surgeons. AQUILES (Anestesia QUIrúrgica para Lograr Eficiencia y Seguridad) Consensus. / Recomendaciones sobre el uso de bloqueo neuromuscular profundo por parte de anestesiólogos y cirujanos. Consenso AQUILES (Anestesia QUIrúrgica para Lograr Eficiencia y Seguridad).

INTRODUCTION: Neuromuscular blockade enables airway management, ventilation and surgical procedures. However there is no national consensus on its routine clinical use. The objective was to establish the degree of agreement among anaesthesiologists and general surgeons on the clinical use of neuromuscular blockade in order to make recommendations to improve its use during surgical procedures. METHODS: Multidisciplinary consensus study in Spain. Anaesthesiologists experts in neuromuscular blockade management (n=65) and general surgeons (n=36) were included. Delphi methodology was selected. A survey with 17 final questions developed by a dedicated scientific committee was designed. The experts answered the successive questions in two waves. The survey included questions on: type of surgery, type of patient, benefits/harm during and after surgery, impact of objective neuromuscular monitoring and use of reversal drugs, viability of a multidisciplinary and efficient approach to the whole surgical procedure, focussing on the level of neuromuscular blockade. RESULTS: Five recommendations were agreed: 1) deep neuromuscular blockade is very appropriate for abdominal surgery (degree of agreement 94.1%), 2) and in obese patients (76.2%); 3) deep neuromuscular blockade maintenance until end of surgery might be beneficial in terms of clinical aspects, such as as immobility or better surgical access (86.1 to 72.3%); 4) quantitative monitoring and reversal drugs availability is recommended (89.1%); finally 5) anaesthesiologists/surgeons joint protocols are recommended. CONCLUSIONS: Collaboration among anaesthesiologists and surgeons has enabled some general recommendations to be established on deep neuromuscular blockade use during abdominal surgery.

Role of the gastroenterologist in the management of the obese patient. / Papel del digestólogo en el manejo del paciente obeso.

Obesity is a highly prevalent disease worldwide, and one in which gastroenterologists can play an important role. Some digestive diseases are more common in obese patients, and preoperative evaluation may be required in some cases. Additionally, bariatric surgery can lead to digestive complications in the short and long term that require intervention, and endoscopic treatment can be an important factor in weight loss. The aim of this review is to highlight the role of the gastroenterologist in the management of obese patients who are either scheduled for or have undergone surgical or endoscopic treatment for obesity.

Incidental splenic injury and splenectomy: an overview based on available evidence / Lesión esplénica incidental y esplenectomía: una visión general basada en la evidencia disponible

Splenectomy indications are hematologic disease, traumatic damage and iatrogenic injury. The aim of this study was to present an evidence-based overview of some clinical aspects of interest related with iatrogenic splenic injury and subsequent splenectomy. An overview of the available evidence was conducted. Articles that evaluated clinical aspects of interest related with iatrogenic splenic injury and subsequent splenectomy, without language limits, publication date and designs. BVS, PubMed, SciELO and TRIP databases were reviewed. Evaluated variables were: Frequency and etiology of surgical spleen injuries, treatment options, frequency of splenectomy, associated postoperative morbidity (POM) and mortality, recommendation for splenectomy. Classification of the available evidence was made using the classification proposed by Oxford Centre of Evidence-based Medicine. 1144 records were obtained. 1109 were discarded for not meeting eligibility criteria, or were not relevant for the purpose of this research. Finally, the study consisted of 35 articles, 3 of evidence level type 3a, 31 of evidence level type 4 and 1 of evidence level type 5. Splenectomy is a complication of common abdominal procedures, prevalence and incidence of iatrogenic splenic injury is underestimated because of lack of information, there is evidence of risk factors of surgical spleen injuries, the etiology of surgical spleen injuries are bariatric, esophago-gastric, antireflux, colorectal, abdominal vascular and urological procedures. POM in patients undergoing splenectomy is more frequent in emergency splenectomy secondary to trauma. There was no significant risk reduction of infectious complications after implementation of routine vaccination. Available evidence is based on few and heterogeneous articles, which make a meaningful conclusions difficult. Studies with better evidence levels, methodological quality and population size are needed for conclusions and recommendations.

Las indicaciones de esplenectomía son enfermedades hematológicas, daño por trauma y por lesiones iatrogénicas. El objetivo de este estudio es presentar una visión general basada en la evidencia actualmente disponible, respecto de algunos aspectos clínicos de interés relacionados con la lesión esplénica iatrogénica y posterior esplenectomía. Revisión global de la evidencia disponible. Se incluyeron artículos que evaluaron aspectos clínicos de interés relacionados con lesión esplénica iatrogénica y posterior esplenectomía; sin límites de lenguaje, fecha de publicación y diseño. Se revisaron las bases de datos BVS, PubMed, SciELO y Trip Database. Las variables evaluadas fueron: frecuencia y etiología de las lesiones, opciones de tratamiento, frecuencia de esplenectomía, morbimortalidad postoperatoria, recomendación de esplenectomía. La clasificación de la evidencia se realizó con la propuesta del Centro de Medicina Basada en la Evidencia de Oxford. Se obtuvieron 1144 registros. 1109 fueron descartados por no cumplir criterios de elegibilidad, o ser no relevantes para el objetivo de la investigación. La población en estudio quedó compuesta por 35 artículos, 3 de nivel de evidencia 3a, 31 de nivel de evidencia 4 y 1 de nivel de evidencia 5. La esplenectomía es una complicación propia de la cirugía abdominal. La prevalencia e incidencia de lesión esplénica iatrogénica es subestimada por falta de información. Hay evidencia de factores de riesgo de lesiones del bazo. La etiología de estas es: procedimientos bariátricos, esófago-gástricos, colorrectales, vasculares abdominales y urológicos. La morbilidad es más frecuente en esplenectomía de emergencia secundaria a trauma. No se ha registrado disminución significativa del riesgo de complicaciones infecciosas con la vacunación rutinaria. La evidencia disponible se basa en pocos artículos y heterogéneos, lo que impide sacar conclusiones. Se necesitan estudios de mejor nivel de evidencia, calidad metodológica y tamaño de muestra para obtener conclusiones válidas y recomendaciones adecuadas.

Endoscopic ultrasound and endoscopic retrograde cholangiopancreatography: Can they be successfully combined?

Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) have much in common, including their main indications (biliopancreatic disorders), powerful therapeutic capacities and a steep learning curve. Over the years they have evolved from novel diagnostic procedures to interventional therapeutic techniques, but along different paths (different scopes or devices and endoscopists specializing exclusively in one or the other technique). However, EUS has gradually developed into a therapeutic technique that requires skills in the use of ERCP devices and stents, leading some ERCP specialists to explore the therapeutic potential of EUS. The corresponding literature, which has grown exponentially, includes recent experiments on combining the two techniques, which have gradually come to be used in routine care in a number of centers, with positive technical, clinical and financial outcomes. We review EUS and ERCP as individual or combined procedures for managing biliopancreatic disorders.

[Digestive diseases in the epistolary collection of 16th century]. / La enfermedad digestiva en una colección epistolar del siglo XVI.

Correspondence is an important source of documentation for studying health and, therefore, the gastrointestinal symptoms of diseases. We studied the gastrointestinal disease described in the Monumenta Borgia collection, which contains documents from the 16th century, mainly letters about Francis Borgia, the last great figure of a family originally from Valencia and with universal significance. Of the 2769 documents examined, 1231 (44.5%) contained some health-related descriptions and 42 items were related to gastrointestinal disease, representing 7.5% of the specific diseases of natural causes. The most frequently mentioned organ in the whole human body was the stomach, with 20 references. The most frequent references were to symptoms related to the upper gastrointestinal tract, with 18 references, and the lower gastrointestinal tract, with 16. The comments made on health related to gastrointestinal disease usually reflect the typical galenism of the medicine of the times. The disorders attributed to the stomach are described in varied terminology and include an acute episode of gastrointestinal bleeding. The most frequently mentioned symptoms and processes are diarrhea, flatulence, hernias, and, among those attributed to the lower gastrointestinal tract, lower gastrointestinal hemorrhages. Also mentioned are hemorrhoids and intestinal colic. Although little mention is made of the liver and spleen, there are various allusions that Francis Borgia was affected by disease or pathogenic alterations in this area. However, the postmortem examination of his corpse, refuted the existence of these anomalies.

Anatomía del peritoneo digestivo del ñandú (Rhea americana) / Digestive peritoneum anatomy of the Rhea (Rhea americana)

El ñandú (Rhea americana) es un ave corredora autóctona de Sudamérica la cual hace ya algunos años ha despertado cierto interés productivo. Sin embargo, la morfología detallada a nivel de las aves domésticas aún se desconoce en muchos aspectos; entre ellos el peritoneo. El objetivo de este trabajo es describir el peritoneo parietal, visceral y de conexión del ñandú acorde con los principios de la Nómina Anatómica Aviar. Se utilizaron 7 animales adultos; 5 machos y 2 hembras de entre 8 y 25 kg. de peso procedentes de un criadero comercial. Fueron eutanasiados por sobredosis de tiopental sódico. La cavidad peritoneal estaba dividida en una parte craneal (equivalente a 1/3) y una parte caudal al estómago (equivalente a 2/3 del total del abdomen). En la parte caudal se encontraba la totalidad del intestino y el páncreas, mientras que en la parte craneal se observó el hígado y la vesícula biliar. Un omento menor fijaba el estómago al hígado cranealmente hacia la derecha y un omento mayor pequeño con una bolsa omental cerrada lo fijaba caudalmente hacia la izquierda. La raíz del mesenterio fijaba al yeyuno, al íleon y a ambos ciegos entre sus hojas a través de amplios pliegues ileocecales. Desde la raíz del mesenterio un corto mesoduodeno sujetaba al duodeno descendente y ascendente hacia la derecha. El colon estaba sostenido por un amplio mesocolon desde distal a la desembocadura de los ciegos hasta su terminación en la cloaca. Se concluye que esta especie corredora presenta similitudes con las aves domésticas. Sin embargo, lo relativamente grueso y fuerte del peritoneo de conexión sumado a lo compartimentado de la cavidad peritoneal hacen suponer que se trata de una adaptación para la carrera al permitir una gran sujeción de las vísceras abdominales.

The rhea (Rhea americana) is a native ratite from South America which has woken up since a few years ago a big productive interest. However the detailed morphology of the rhea at the level at the domestic birds is still unknown in many aspects, on of them is the peritoneum. The aim of this work is to describe the parietal, visceral and connection peritoneum of the rhea according to the anatomical avian nomenclature. Seven specimens of adult rhea were used, five males and two females about 8 and 25 kg of weight. All of them proceeding from a commercial farm. The animals were slaughtered before their study. The peritoneum that cover the abdominal wall and the visceral and connection peritoneum that support the abdominal viscera were observed and described. The peritoneal cavity were divided into two parts, one was craneal to the ventriculum (1/3 parts from the total of the abdomen) and the other was caudal (2/3). Into the cranial part we founded the liver and the gallbladder while into the caudal part we founded the intestine and the pancreas. The stomach was fixed to the liver cranially to the right by a minor omentus and caudally to the left was fixed by a small major omentus with a close omental bag. The root of the mesentery was fixing the yeyuno, ileum and both caecums between its sheets towards wide ileocecalis creases. From the mesentery root a short mesoduodenum was holding the descending and ascending duodenum towards the right. The colon was supported by a wide mesocolon. We concluded that this ratite has similarities with the domestic birds. Nevertheless, the thickness and strong connection peritoneum and the compartmentalization of the peritoneal cavity make us suppose that it is an adaption to the race since it is a big subjection to the abdominal viscera.

TICs aplicadas a la enseñanza del aparato digestivo / TICs applied to teaching the digestive apparatus

Las Tecnologías de la Información y de la Comunicación (TICs) son tecnologías digitales para almacenamiento, transmisión y recepción de informaciones. La sociedad cambió y la educación universitaria debe adecuarse a la presencia de la informática y otras TICs. Las formas de estudio y abordajes del sistema digestivo, sumados a la importancia de sus relaciones anatómicas, lo constituyen un vasto campo para la implementación de TICs. El objetivo de este trabajo fue evaluar la importancia de las TICs como herramienta pedagógica en la enseñanza del sistema digestivo a alumnos universitarios, y correlacionarla con características socioeconómicas y educativas. Se realizó una encuesta estandarizada a 305 alumnos universitarios (ciclo 2007) de la asignatura Anatomía (UBA) y se estudiaron los datos con pruebas estadísticas. El 89,1 por ciento considera útil las TICs durante los trabajos prácticos del sistema digestivo (TPSD), prefiriendo a las presentaciones Power Point® (68,1 por ciento). El 78 por ciento consideró los casos clínico-quirúrgicos necesarios para fijar conocimientos y mantener la atención en los TPSD. El 82 por ciento utiliza el Museo Virtual como una herramienta de aprendizaje y estudio. Los alumnos que no trabajan manifestaron mayor adherencia a los casos clínico-quirúgicos mientras que los otros eligieron herramientas que maximizasen su tiempo de estudio y fijasen conocimientos. Observamos una correlación (R2=0,72) entre las horas trabajadas y la utilización de TICs. Las TICs son la base para un entorno nuevo en el que tendrán que desenvolverse los procesos de enseñanza y aprendizaje. Se evidencia la necesidad de fomentar una concepción "integradora-educacional" de las TICs.

TICs (Technologies of Information and Communication) are digital technologies for saving, transmitting and receiving information. The society has changed and the University education must be updated due to the presence of computers and other TICs. The ways of studying the digestive system, together with the importance of its anatomical relations, makes it a wide field for the use of TICs. The objective of this study were to evaluate the importance of TICs as a pedagogic tools in teaching the digestive system to University students, and connect it with the social, educational and economic characteristics. A standardized poll was done to 305 university students (year 2007) from the course Anatomy (UBA) and the data was studied with statistic tests. 89,1 percent finds TICs useful during the digestive system TP., preferring Power Point presentations (68.1 percent). 78 percent considered the clinical surgical cases necessary to fixate Knowledge and concentrate during the TPSD. 82 percent uses the Virtual Museum as a tool for learning and study. The students that don't work showed more adherence to the clinic-surgical cases. Meanwhile, the others chose tools that maximize their study time and fixate knowledge. We saw a correlation (r2=0.72) between the amount of hours worked and the use of tics. Tics are a base for a new background in which the process of teaching and learning will have to develop. It can be seen that there is a need to encourage an "educational-integrative" conception of TICs.

Respuesta a la pregunta: ¿Simpleza en órganos de los seres vivos? / Answer to the question: Simplicity in organs of living beings?

Existen en la actualidad especies que han adquirido por evolución muchas variaciones incluyendo el del tubo digestivo que las hace capaces de utilizar alimentos de composición o calidad variables, que van desde el néctar (colibríes y otras aves) hasta el material vegetal fibroso y grueso (elefantes y otras especies silvestres herbívoras, caballos y algunos rumiantes), teniendo así órganos altamente especializados y presentando algunas diferencias básicas favorables que son: a) Mayor capacidad, lo que permite utilizar enormes cantidades de alimento basto (forraje). b) Adaptación del aparato digestivo para digerir alimentos bastos, antes de que entren en el intestino delgado. c) Sistema digestivo más eficiente, para usar la fibra de los alimentos…

Cáncer en la región de Antofagasta, con especial referencia al cáncer vesical y al cáncer pulmonar / Cancer in the Antofagasta region of Chile, with special reference

Se presenta el perfil oncológico de la Región de Antofagasta. Mediante la comparación de la mortalidad regional por las distintas localizaciones de cáncer con la mortalidad nacional y de otras áreas se deduce que persiste un exceso de mortalidad por cáncer vesical (2002-2004) y broncopulmonar (2001-2004), en hombres y en mujeres; y que hay un exceso de cáncer renal y hepático en varones y un exceso de cáncer pancreático en mujeres. Se descarta el papel del envejecimiento poblacional en lo que respecta a los cánceres de vejiga y de pulmón. Se discuten las características de estos cánceres en Chile y en otros países: mortalidad, incidencia, tendencias, relación con el sexo y con otros factores posibles. Se citan las investigaciones nacionales relativas a la presencia y papel del arsénico en el aire, agua, alimentos y procesos laborales en la región. Las diferencias por sexo sugieren que: el cáncer vesical se relaciona con el ambiente general más que con el ambiente laboral (los excesos son similares en ambos sexos); el cáncer pulmonar, con el ambiente general y con el ambiente laboral (proceso metalúrgico); el cáncer renal y el del hígado, con circunstancias atingentes al género masculino pero probablemente no con el arsénico en el caso del cáncer hepático; y el cáncer de páncreas, posiblemente con el ambiente general. En Antofagasta y regiones vecinas hay menos mortalidad por cánceres digestivos y de próstata y ovario. Esta extensión en el espacio contrasta con la especificidad regional de los excesos. Se recomienda continuar e intensificar la investigación, monitoreo y control multisectorial de aquellos cánceres cuyo exceso persiste desde hace varias décadas en la Región de Antofagasta.

We present the oncological profile of Antofagasta Region, within a general regional approach to the state of health of the population. Through the comparison of regional mortality for the different cancer localizations with mortality in the country and in other regions, we show a persistent excess of bladder and lung cancer in men and women; an excess in kidney and liver cancer in men, and an excess of pancreatic cancer in women. The role of age structure is discarded, at least as far as bladder and lung cancer are concerned. The characteristics of these cancers in Chile and other countries are discussed: mortality, incidence, trends, relationships with gender, and to other possible factors. The previous national investigations related to the presence and the role of arsenic in the air, in drinking water, in food and in occupational processes in the region are cited. Gender associations suggest that: bladder cancer is related to the general environment more than to occupation (the excess is similar for both sexes); lung cancer is related both with the general and the occupational (copper smelting) environment; kidney and liver cancer, with men-related circumstances but probably not with arsenic, in the case of hepatic cancer; and pancreatic cancer, possibly with the general environment. In both Antofagasta and neigh boring regions there is less mortality than in the country as a whole from cancers of the digestive tract and of prostate and ovary. This spatial extension does not apply to the cancers found to be in excess in Antofagasta. We conclude that research, monitoring and multisector control must continue and be intensified regarding the types of cancer for which a regional excess has persisted over several decades.

Razones para revaluar la formación de especialistas en aparato digestivo / Reasons to take into account when reassessing training in digestive diseases

Boards in digestive diseases were implemented a long time ago in health organizations and until now no in-depth reassessment of those programs has been performed. Several reasons justify the need of such reassessment including the huge advance of knowledge in this field over the last 10-15 years, the important development of hepatology, and the innovative procedures introduced in endoscopy. Moreover, the latest changes in health organizations demand a reorientation of the tasks of digestive specialists in relation to the increasing role of family physicians in the field of digestive diseases. In the light of this perspective, the need for digestive specialists with different qualifications is emerging. This comprehends a basic profile that would cover the needs of general hospitals and another profile for university hospitals that use high technology where specialists need a sound training in research and in specific areas of expertise such as hepatology or advanced endoscopic techniques

Los programas de formación de residentes en Aparato Digestivo fueron implementados hace más de 25 años y desde entonces no han sufrido ningún proceso de revaluación profunda. Muchos son los cambios que justifican esta revisión y entre los más importantes cabe citar el incremento del volumen de conocimiento de la especialidad en los últimos 10 a 15 años, el enorme desarrollo de la hepatología en este período y las innovaciones endoscópicas, tanto diagnósticas como terapéuticas. Además, los cambios organizativos de la medicina hacen necesario que los especialistas de Aparato Digestivo reubiquen sus funciones en relación con las competencias crecientes de los médicos de Atención Primaria en esta especialidad y que se definan perfiles distintos de especialistas que se ajusten a la demanda laboral, que es diferente para un hospital general o para un hospital de alta tecnología, donde la razón de ser de los especialistas debe basarse en una sólida formación en investigación y una capacitación específica para áreas determinadas de la especialidad, como la hepatología y la endoscopia avanzada