Beliefs, attitudes and practices of physicians in patient situations: Online survey conducted in Latin American countries

 La invulnerabilidad del médico como mito social, miedo de afrontar y subestimar sus dolencias físicas y mentales, dificultan el manejo de su enfermedad. Objetivo: determinar las creencias, actitudes y prácticas del médico en situación de paciente en los países latinoamericanos. Material y Métodos: se realizó un estudio descriptivo, de corte transversal, empleando una encuesta en línea que generó un total de 533 respuestas efectivas procedentes 21 países de la región. Resultados. La mayoría fue de sexo femenino 57,6%, La media de edad de los participantes fue de 46,5 años y la especialidad con mayor participación fue medicina interna 48,4%. El 47,3% no tenía médico de cabecera y 7,5 % respondieron que no contaban con un seguro de salud. En el renglón de creencia, la mayoría de los encuestados 61,5% consideró que es más difícil tratar a un colega como paciente, y el 67,9% admitió la importancia de las acciones espirituales y religiosas en caso de enfermedad. En cuanto a la vulnerabilidad de los médicos frente las enfermedades, el miedo de cambiar su estado a paciente y pérdida de autonomía respondieron afirmativamente 95,5%. En relación a la actitud, el 79% respondió que buscaría a un médico de su misma especialidad, el 93,8% obedecería íntegramente las órdenes médicas y el 98,8% no pediría cambio de protocolo o de procedimiento. Así mismo, el 59,9% reportaría a un colega que no está en su plena facultad y el 75% divulgaría el estado de salud de otro colega si pone en peligro su vida o la de su paciente. En relación a la práctica, el 43,7% trataría a sus familiares de primer grado; el 21,5% seguiría laborando aun con una dolencia; el 37% haría su propia indicación de pruebas diagnósticas; el 21,4% se automedicaría; y el 4,3% y 7,7%, respectivamente, cambiaría las prescripciones y haría caso omiso a las recomendaciones de su médico tratante. Conclusión: los médicos en situación de pacientes temen estar enfermos y perder su autonomía, muchos no tienen médico de cabecera ni seguro de salud, le dan importancia a las acciones espirituales y religiosas, tienden a buscar a un médico de su propia especialidad y están llanos a aceptar las órdenes médicas, aun cuando también pueden decidir por la automedicación e indicar sus propias pruebas diagnósticas.The invulnerability of the physician as a social myth, fear of facing and underestimation of his physical and mental ailments, hinder the management of his disease. Objective: to determine the beliefs, attitudes and practices of the physician as a patient in Latin American countries. Material and Methods: a descriptive, cross-sectional study was carried out using an online survey that generated a total of 533 effective responses from 21 countries in the region. Results. The majority was female 57,6%, the mean age of the participants was 46,5 years and the specialty with the highest participation was internal medicine 48,4%. The mean age of the participants was 46,5 years and the specialty with the highest participation was internal medicine (48,4%), and 47,3% did not have a family doctor and 7,5% responded that they did not have health insurance. In the line of belief, the majority of the respondents 61,5% considered that it is more difficult to treat a colleague as a patient, and 67,9% admitted the importance of spiritual and religious actions in case of illness. As for the vulnerability of physicians to illness, fear of changing their status to patient and loss of autonomy, 95,5% responded affirmatively. In relation to attitude, 79% responded that they would look for a physician of their own specialty, 93,8% would obey medical orders in their entirety and 98,8% would not ask for a change of protocol or procedure. Likewise, 59,9% would report a colleague who is not in their full capacity and 75% would disclose the health status of another colleague if it endangered their life or that of their patient. In relation to practice, 43,7% would treat their first-degree relatives; 21,5% would continue to work even with an ailment; 37% would make their own indication for diagnostic tests; 21,4% would self-medicate; and 4,3% and 7,7%, respectively, would change prescriptions and disregard the recommendations of their treating physician. Conclusion: physicians as patients are afraid of being sick and losing their autonomy, many do not have a general practitioner or health insurance, give importance to spiritual and religious actions, tend to look for a physician of their own specialty and are willing to accept medical orders, even though they can also decide to self-medicate and indicate their own diagnostic tests

Phlebotominae (Diptera: psycodidae) fauna in the Chaco region and Cutaneous Leishmaniasis transmission patterns in Argentina

In Argentina, the incidence of American Cutaneous Leishmaniasis (ACL) has shown a steady increase over the last few decades. In the Chaco biogeographical region, specifically, several outbreaks of ACL were recently reported in addition to the usual time-space scattering of ACL cases. However, little is known about the sandfly composition in the eastern, humid Chaco (HC) region or the western, dry Chaco (DC) region. Therefore, phlebotomine captures were performed throughout this region and an analysis of the distribution of reported ACL cases was conducted in order to assess the vector diversity in ACL endemic and epidemic scenarios in the Chaco region. The results support the hypothesis of two distinct patterns: (1) the DC, where Lutzomyia migonei was the most prevalent species, had isolated ACL cases and a zoonotic cycle; (2) the HC, where Lutzomyia neivai was the most prevalent species, had an increase in ACL incidence and outbreaks and an anthropozoonotic cycle. The epidemic risk in the Chaco region may be associated with the current climate trends, landscape modification, connection with other ACL foci, and Lu. neivai predominance and abundance. Therefore, changes in sandfly population diversity and density in the Chaco region are an indicator of emergent epidemic risk in sentinel capture sites.Facultad de Ciencias Naturales y Muse

Introducción breve a la ingeniería dirigida por modelos

The software crisis is a concept that has started to be used in 1968, at the first conference organized by the North Atlantic Treaty Organization (NATO) on software development. There, Edsger Dijkstra criticized that projects were not completed in compliance with the classic triple constraint of project management (scope, time and cost), since most of them do not reach the expected requirements, are delivered out of time or exceeds the expected cost. Unfortunately, the current reality is that while there have been proposed new methodologies aimed at solving the usual problems related to software development, there is still no reliable method to estimate the development of computer systems. This work introduces the Model-Driven Engineering approach that, according to the experts, will help to solve many of the problems that thousands of software development teams have daily worldwide.La crisis del software es un concepto que comenzó a utilizarse en 1968, en la primera conferencia organizada por la Organización del Tratado del Atlántico Norte (OTAN) en el desarrollo de software. Allí, Edsger Dijkstra criticó que los proyectos no se completaban debido a la clásica triple restricción de la gestión de proyectos —alcance, tiempo y costo—, ya que la mayoría de ellos no alcanzaban los requisitos previstos, se entregaban fuera de plazo o superaban el costo esperado. Por desgracia, la realidad actual es que; si bien se han propuesto nuevas metodologías destinadas a la solución de los problemas habituales relacionados con el desarrollo de software, todavía no existe un método fiable para estimar el desarrollo de los sistemas informáticos. En este artículo se presenta el enfoque de Ingeniería Dirigida por Modelos que, según los expertos, ayudará a resolver muchos de los problemas que miles de equipos de desarrollo de software tienen a diario en todo el mundo

Late Plasma Cell Depletion After Thymoglobulin Induction in Kidney Transplant Recipients

Objectives: Induction therapy with rabbit antithymocyte globulin is frequently used in kidney transplant recipients and contributes to regulating the humoral alloantibody response. However, the effect of rabbit antithymocyte globulin on B-cell subpopulations, including plasma cells, has not been previously studied in humans in vivo. Materials and methods: We prospectively studied a cohort of 39 adult kidney transplant recipients. Twenty patients received rabbit antithymocyte globulin as induction therapy. Peripheral blood samples were obtained pretransplant and at 6 and 12 months posttransplant. T and B cells were acquired by flow cytometry. Results: Total lymphocytes and CD3 and CD4 cells significantly decreased at 6 and 12 months only in patients who received rabbit antithymocyte globulin. In contrast, the CD19 population did not change after rabbit antithymocyte globulin induction. One-year circulating plasma cells remained significantly lower than pretransplant levels in patients who received rabbit antithymocyte globulin. We observed sig-nificant differences in plasma cell numbers at 12 months after transplant between patients who received rabbit antithymocyte globulin and those patients who did not receive it (median of 5 and interquartile range of 3-17 vs median of 25 and interquartile range of 12-35; P = .001). Conclusions: Rabbit antithymocyte globulin induction leads to a late reduction in the number of circulating plasma cells at 1 year after kidney transplant. This effect can contribute to down-regulation of the humoral alloantibody response

Hallazgo incidental de hueso interparietal wormiano en un caso de fractura múltiple de cráneo

Los huesos wormianos son estructuras óseas craneales supernumerarias. Su origen es multifactorial, estando en varias ocasiones relacionado a enfermedades del metabolismo óseo. En esta publicación, el objetivo es describir el hallazgo de un hueso wormiano interparietal en el contexto de un caso de fractura múltiple de cráneo por trauma. Presentación del caso: una paciente pediátrica de sexo femenino, sin antecedentes personales de relevancia, sufrió un traumatismo de cráneo moderado. Es evaluada en el departamento de Emergencias, evidenciándose un cefalohematoma parietal izquierdo. Se realizó una tomografía computada de encéfalo, en la que se observó dos fracturas lineales, longitudinal y transversal, correspondientes a los huesos parietal y occipital, asociadas a la presencia de un hueso wormiano interparietal (os incarum). No se observaron lesiones intracraneales. La paciente fue hospitalizada, presentando una buena evolución hasta el momento de la externación. Luego de un seguimiento de 8 meses, no se evidenció ninguna complicación, mostrándose mejoría radiológica. Conclusión: los huesos wormianos constituyen variaciones anatómicas craneales. Su hallazgo incidental en los estudios por imágenes puede originar dificultades diagnósticas en determinadas situaciones, como puede ocurrir en el traumatismo de cráneo con presencia de fracturas, por lo que resulta importante conocer sus características relevantes.Fil: Mamani Rodríguez, Carlos Enrique. Hospital Zonal General de Agudos “Mariano y Luciano de la Vega”; ArgentinaFil: Soler Murillo, Carlos Alberto. Hospital Zonal General de Agudos “Mariano y Luciano de la Vega”; ArgentinaFil: De Sampaio Ricardo, Mauricio Emanuel. Universidad Nacional de La Matanza; ArgentinaFil: Arias Suárez, Freddy. Universidad Autónoma del Beni; BoliviaFil: Paredes Jarro, Mauricio Ariel. Universidad Autónoma del Beni; BoliviaFil: Valdez Carlomagno, Pascual Rubén. Universidad Nacional de La Matanza; Argentin

Effect of the re-use of the osmotic solution on the stability of osmodehydro-refrigerated grapefruit

Osmotic dehydration (OD) of grapefruit (55 degrees Brix sucrose solution, 30 degrees C) was carried out to obtain 75 g water/100 g sample in the final product. Although the grapefruit was replaced each time, the osmotic solution (OS) was reused for five OD cycles, with or without pasteurization. The samples obtained in cycles 1, 3 and 5, were stored at 10 degrees C. Changes in degrees Brix, water content, water activity, pH, total acidity, ascorbic acid content, cation concentration, respiration rate and total microbial counts at different storage times were analyzed and compared to fresh-cut grapefruit stored under the same conditions. During OD, a partial loss of the natural soluble substances present in the fruit was observed. In terms of the dehydration level reached by the fruit, it is possible to reuse the OS in up to 5 OD, without any reconcentration treatment. Nevertheless, it is advisable to pasteurize the OS before each cycle in order to obtain a product with a shelf-life of between 7 and 12 days in refrigeration, depending on the number of cyclesThe authors thank the Ministerio de Ciencia y Tecnologia and the Fondo Europeo de Desarrollo Regional (FEDER) for the financial support throughout the project AGL2005-05994.Moraga Ballesteros, MJ.; Moraga Ballesteros, G.; Martínez Navarrete, N. (2011). Effect of the re-use of the osmotic solution on the stability of osmodehydro-refrigerated grapefruit. Food Science and Technology. 44(1):35-41. https://doi.org/10.1016/j.lwt.2010.05.018S354144

Sexualidad del paciente : ¿Sabemos entrevistarla?

OBJETIVOS: Identificar el conocimiento y la consejería adecuada de los médicos clínicos acerca de la historia sexual de los pacientes. MATERIALES Y MÉTODOS: Estudio descriptivo, observacional y transversal, mediante una encuesta estructurada, anónima, autoadministrada que consta de preguntas cerradas que incluyen datos demográficos, y comportamiento ante los antecedentes sexuales de los pacientes, relaciones satisfactorias, riesgosas, con uso de sustancias adictivas o prostitución, orientaciones sexuales y consejería sobre prácticas preventivas. Se realiza un análisis comparativo según el género del médico. RESULTADOS: Se encuestaron 101 médicos clínicos, 52% mujeres; edad promedio 44 años; El 80% considera que siempre la esfera sexual es un componente importante en la salud de las personas. El 57% registra sistemáticamente en la historia clínica la historia sexual. El 56% dice que no le resulta embarazoso hablar de sexo con los pacientes. El 55% no investiga si las relaciones sexuales son satisfactorias. El 65% indaga el número de contactos sexuales de sus pacientes. El 71% la orientación sexual de los mismos. El 44% supone que el paciente es heterosexual. El 81% investiga sobre prácticas de riesgo sexual de sus pacientes; el 90% registra antecedentes de infecciones de transmisión sexual (ITS), 78% aconseja sobre prevención de las mismas y 87% aconseja sobre uso de anticonceptivos a las personas en edad fértil. El 85% habla de sexo con los pacientes adolescentes. El 60% admitió que no habla del uso /consumo de la prostitución ni del tipo o preferencia de prácticas sexuales. El 82% no averigua las fantasías sexuales de sus pacientes. La mitad no registra el consumo de sustancias adictivas en el contexto de las relaciones sexuales. Las patologías en las que se investiga menos sobre la historia sexual de los pacientes fueron pacientes con colostomía, cáncer, con problemas osteomioarticulares y polimedicados. El 70% dice estar actualizado en relación a los nuevos conocimientos de las orientaciones sexuales; sin embargo, reconoce que las principales dificultades para hablar de sexo en la consulta son: la escasa formación en el 51%, falta de tiempo en el 65%, considerar la privacidad de la esfera sexual en el 35% y falta de interés por parte del paciente en el 20%. En el análisis comparativo las médicas clínicas indagan menos: conductas adictivas, uso de prostitución, conductas de riesgo, relaciones satisfactorias, orientación sexual, tipo y práctica sexual, no hablan de sexo con los adolescentes y aconsejan menos sobre la prevención de ITS y están menos actualizadas. (p<0.05). CONCLUSIONES: A través de la encuesta se ha podido evidenciar que si bien el 80% considera importante la esfera sexual en la salud de las personas, los médicos clínicos no la jerarquizan lo suficiente. Si bien se autoperciben actualizados, consideran que la falta de abordaje del tema es por carecer de tiempo, pero sobre todo por escasa formación (nos mentimos?).OBJECTIVES: Identify clinicians' knowledge and appropriate counseling about patients' sexual history. MATERIALS AND METHODS: Descriptive, observational, cross-sectional study, using a structured, anonymous, self-administered survey consisting of closed-ended questions including demographic data, and behavioral data on patients' sexual history, satisfactory relationships, risky relationships, substance use or prostitution, sexual orientations, and counseling on preventive practices. A comparative analysis is made according to the physician's gender. RESULTS: 101 clinicians were surveyed, 52% women; mean age 44 years; The 80% always consider sexuality to be an important component in people's health. 57% systematically recorded sexual history in the medical record. 56% say that they do not find it embarrassing to talk about sex with patients. 55% do not ask If the sexual relations are satisfactory. 65% inquire about the number of sexual contacts of their patients. 71% query about their patients' sexual orientation. 44% assume that the patient is heterosexual. 81% inquire about their patients' sexual risk practices; 90% record a history of sexually transmitted infections (STIs), 78% advise on prevention of STIs, and 87% advise on contraceptive use for persons in child-bearing age. 85% discuss sex with adolescent patients. 60% admitted, not discuss the use/consumption of prostitution or preference, type of sexual practices. 82% do not investigate about their patients' sexual fantasies. Half of them do not record the use of addictive substances in the context of sexual relations. The pathologies in which patients' sexual history is least investigated were with colostomy, cancer, osteomyoarticular alterations and polypharmacy patients. However, they recognized that the main difficulties in talking about sex in the medical office were: poor training (51%), lack of time (65%), sexuality is a private matter (35%) and lack of interest patient (20%). In the comparative analysis, female clinicians inquired less about: addictive behaviors, use of prostitution, risk behaviors, satisfactory relationships, sexual orientation, sexual type and practice, did not talk about sex with adolescents and gave less advice on STI prevention and were less updated (p<0.05). CONCLUSIONS: The survey has shown that although 80% consider sexuality to be important in people's health, clinicians do not give it enough importance. Although they perceive themselves to be up to date, they consider that the lack of approach to the subject is due to lack of time, but above all due to lack of training (are we lying to ourselves?).Fil: Ferri, Emmanuel. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Cohen, Paola. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Valdez, Pascual. Sociedad Argentina de MedicinaFil: Gisbert, Patricia. Universidad Nacional de Cuyo. Facultad de Ciencias MédicasFil: Di Pietro, Janina. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Casarotto, Mariana. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Ticera, Erica. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Lante, Cecilia. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Adarme, Gonzalo. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Pont, Diego. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Chacón, Romina. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Salomón, Susana Elsa. Universidad Nacional de Cuyo. Facultad de Ciencias Médica

Burden of disease due to amphetamines, cannabis, cocaine, and opioid use disorders in South America, 1990–2019: a systematic analysis of the Global Burden of Disease Study 2019

Background: South America's substance use profile, poverty, income inequality, and cocaine-supplier role make it a unique place for substance use research. This study investigated the burden of disease attributable to amphetamine use disorder, cannabis use disorder (CAD), cocaine use disorder, and opioid use disorder (OUD) in South America from 1990 to 2019, on the basis of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods: GBD 2019 estimated the incidence, prevalence, mortality, years of life lost (YLL), years of life lived with disability (YLD), and disability-adjusted life-years (DALYs) due to substance use disorders in each of the 12 South American countries (Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Guyana, Paraguay, Peru, Suriname, Uruguay, and Venezuela). Data were modelled using standardised tools (ie, the Cause of Death Ensemble model, spatio-temporal Gaussian process regression, and disease modelling meta-regression) to generate estimates of each quantity of interest by sex, location, and year. The analysis included comparisons by sex and country, and against regional and global estimates. Findings: In 2019, the highest amphetamine use disorder burden per 100 000 population in South America was in Peru (66 DALYs). CAD DALY rates per 100 000 in South America were stable between 1990 and 2019, except in Chile and Colombia, which had the highest rates in 2019 (19 DALYs for Chile and 18 DALYs for Colombia). OUD DALYs per 100 000 increased during the period in Brazil and Peru, which in 2019 had the highest rates in South America (82 DALYs for Brazil and 70 DALYs for Peru). In 2019, Brazil had the highest cocaine use disorder DALYs per 100 000 (45 DALYs), nearly double its rate in 1990. DALY rates were higher in males than females for each substance use disorder, except in Paraguay. The overall burden of substance use disorders was higher in males than in females, mainly because of cocaine use disorder and CAD, whereas for amphetamine use disorder, the difference between sexes was minimal, and for OUD there was no difference. For males and females, the highest rate of substance use disorders DALYs per 100 000 was for OUD except in Argentina (in males, 58 DALYs for cocaine use disorder vs 52 DALYs for OUD) and in Paraguay (in females, 77 for amphetamine use disorder vs 50 for OUD). CAD DALY rates were generally the lowest among the substance use disorders for males and females. Amphetamine use disorder YLD rates were reasonably stable throughout the period and were highest in Peru, Paraguay, and Uruguay (>40 YLD per 100 000). For CAD, YLD rates were stable in all countries except Chile and Colombia. Cocaine use disorder YLD rates per 100 000 for the top four countries (Argentina, Uruguay, Chile, and Brazil) increased from 1990 to 2010 (eg, from 19 to 33 in Brazil), but decreased between 2010 and 2019 (eg, from 36 to 31 in Chile). For OUD, YLD rates showed a slight increase in most countries apart from Brazil, which increased from 52 in 1990 to 80 in 2019 and was top among the countries. Amphetamine use disorder YLL rates per 100 000 were highest in Suriname and Peru during the period, although in Suriname it increased from 2·7 in 2010 to 3·2 in 2019, whereas in Peru it decreased from 2·1 to 1·7. The highest YLL rate for cocaine use disorder was in Brazil, which increased from 3·7 in 1990 to 18·1 in 2019. Between 2000 and 2019, Chile and Uruguay showed the highest OUD YLL rates (11·6 for Chile and 10·9 for Uruguay). A high incidence of CAD was found in Chile, Colombia, Guyana, and Suriname. There were high incidences of amphetamine use disorder in Paraguay, cocaine use disorder in Argentina, and OUD in Ecuador. A decrease in annual prevalence for substance use disorders during the period was observed in Venezuela (amphetamine use disorder, CAD, and OUD), Brazil (CAD and amphetamine use disorder), Colombia (amphetamine use disorder and cocaine use disorder), Peru (amphetamine use disorder and cocaine use disorder), Chile and Suriname (amphetamine use disorder), Uruguay (CAD), and Bolivia (OUD). Overall, the cocaine use disorder burden stabilised then decreased. OUD was less prevalent than other substance use disorders but its burden was the highest. Interpretation: The decrease in the burden of cocaine use disorder probably reflects the success of national standardised treatment programmes. Programmes for amphetamine use disorder, CAD, and OUD management should be improved. We did not find an increase in CAD burden in Uruguay, the country with the highest degree of cannabis decriminalisation in the region. Countries in South America should improve monitoring of substance use disorders, including regular surveys to provide more accurate data on which to base policy decisions