Endoscopic ultrasound-guided transvascular needle biopsy of thoracic and abdominal lesions: a multicenter experience

Background and study aims Traditionally in the case of a vascular interposition, endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) has been contraindicated. A transvascular route (TV) is feasible and probably a safe alternative approach in selected patients, but data are scarce. The primary aim of this study was to analyze the diagnostic yield and safety of EUS-TV-FNA in thoracic and abdominal lesions. Secondary aims included evaluation of the clinical impact and technical aspects. Patients and methods A retrospective multicenter study was conducted with inclusion of all consecutive patients that underwent EUS-TV-FNA from July 2007 to January 2020. Feasibility, cytopathology, procedure details, and safety were evaluated. Univariate analysis was performed to identify variables associated with incidents, cytopathological diagnosis, and clinical impact. Results Data were collected from a total of 49 cases and 50 EUS-TV-FNAs. The aorta (n = 19) and portal system (n = 17) were the most frequently punctured. The most frequent lesions were mediastinal lymph nodes (n = 13) and pancreatic tumors (n = 11). The diagnostic yield was 86 %, and there were nondiagnostic samples in seven cases. Overall sensitivity, specificity, and accuracy were 88% (95 % CI, 0.74-0.96), 100% (95 % CI, 0.59-1), and 90% (95 % CI, 0.78-0.96), respectively. Only three incidents were detected: two mural hematomas and a self-limited bleeding of gastroduodenal artery. In most patients, there was a significant impact on clinical management (88%). Arterial vessel and ASA-III had a trend with incidents (both, P < 0.08). Rapid on-site evlauation was found to be an independent predictor for obtaining a conclusive sample (OR 6.2; 95%CI, 1.06-36.73, P < 0.04). Conclusions EUS-TV-FNA is feasible, seems to be safe, and can be recommended when no other targets are available, and the information obtained would impact on the clinical plan

Efecto de un programa de formación médica en el desarrollo de competencias clínicas para identificar y manejar la enfermedad renal crónica

Introduction:Chronic kidney disease is a worldwide epidemic and represents one of the most important challenges for the health personal; because of this, the importance of generating competent human resources is crucial to the correct treatment and prevention of this disease. Objective: To measure the effect of a medical formation curriculum on the development of clinical competencies to identify and manage chronic kidney disease. Methods: A quasi-experimental study was carried out at the Guadalajara LAMAR University Campus Vallarta in the first scholar semester of 2019 (2019A cycle). With a sample of 133 medical students, which 18 were from second semester (G1), 31 from fourth semester (G2), and 84 medical interns (G3); additionally, we included 22 college students with no medical formation to form the fixed group (G0). The Instrument used was a Spanish-language scale that evaluated the knowledge on chronic kidney disease, whose total sum allows the identification of the clinical competencies. The analysis was made by means of non-parametric inferential statistics (p-Value of ≤0.05). Results: The clinical competency was higher in those who were exposed to the medical formation program: G1 attained 38.8% of competence, G2 achieved 35.5%, and G3 had 61.91% of competence expectations. Meanwhile, G0 achieved only 18.1% of competence. Conclusion: The evaluation of the curriculum, during the 2019A cycle, showed a gradual growth of professional competences in chronological form, which gets higher when the theoretical knowledge is combined with the clinical practice.Introducción: La enfermedad renal crónica es una epidemia mundial y representa uno de los mayores desafíos para el personal de salud; por este motivo, es crucial generar recursos humanos competentes para el tratamiento correcto y la prevención de esta enfermedad. Objetivo: Medir el efecto de un plan de estudios de medicina sobre el desarrollo de competencias clínicas para identificar y tratar la enfermedad renal crónica. Material y métodos: Se desarrolló un estudio cuasiexperimental en la Universidad LAMAR de Guadalajara, campus Vallarta, durante el primer semestre de 2019 (ciclo 2019A). Participaron 133 estudiantes de medicina: 18 de ellos del segundo semestre (G1), 31 del cuarto semestre (G2) y 84 residentes (G3); además, se incluyó a 22 alumnos universitarios sin formación en medicina para establecer el grupo control (G0). El instrumento utilizado fue una escala en idioma español que evaluó los conocimientos sobre enfermedad renal crónica, cuya suma total permite identificar las competencias clínicas. El análisis se realizó mediante estadística no paramétrica (valor p ≤0,05). Resultados: La competencia clínica fue mayor en los que estuvieron expuestos al programa de formación médica: G1 alcanzó el 38,8% de competencia; G2, 35,5%, y G3, 61,91%. Mientras tanto, G0 alcanzó solo el 18,1% de competencia.  Conclusión: La evaluación del plan de estudios durante el ciclo 2019A mostró un crecimiento paulatino de las competencias profesionales en orden cronológico, que se eleva cuando se combinan los conocimientos teóricos con la práctica clínica

Experiencias interdisciplinarias en alimentación y daños a la salud en las fronteras sur y norte de México

El estudio de los problemas de salud y alimentación en diferentes contextos políticos, económicos, sociales y culturales, demanda de trabajo grupal entre disciplinas, acuerdos mutuos y la construcción de lenguajes y bases comunes para conformar grupos académicos de investigación interdisciplinarios. El objetivo de este artículo es presentar las experiencias del Seminario de “Alimentación y Daños a la Salud” (ADAS), el cual busca consolidar una propuesta de colaboración interinstitucional e interdisciplinaria para el abordaje de los problemas de salud relacionados con la alimentación y vulnerabilidad social en las zonas fronterizas sur y norte de México. El grupo ADAS está formado por investigadores-as que pertenecen a seis Centros de Investigación en padrón de Consejo Nacional de Ciencia y Tecnología (CONACyT) y Universidades