Notes

Country wide tendencies pertaining to axillary lymph node dissection along with survival outcomes pertaining to clinical T3/T4 node-negative breast cancer sufferers considering mastectomy using beneficial lymph nodes.
Human antibody-driven autoimmunity can interfere with cytokines that are essential for protective immunity to specific infectious agents but that are otherwise redundant, thereby underlying specific infectious diseases.
Ultraviolet radiation exposure is an important modifiable risk factor for keratinocyte carcinoma (KC) in fair-skinned non-Hispanic White populations; however, the evidence for this relationship in darker-skinned populations is less certain.

To assess and synthesize the published data concerning the association between UV exposure and the risk of KC in individuals with skin of color.

PubMed, Cochrane, and Web of Science databases were searched from database origin through January 2022. Studies deemed eligible included UV exposure as a risk factor for KC in individuals with skin of color, defined as any race other than non-Hispanic White, Fitzpatrick skin types IV to VI, or tanning ability of rarely or never burns. The UV index, irradiance, latitude, history of phototherapy, history of sunburn, or occupational exposure were used as measures of exposure. The Oxford Centre for Evidence-Based Medicine guidelines were used to assess evidence quality.

A total of 72 716 articles appeared in the search. After ong Black individuals, and only 1 study among a Hispanic population. Further research is required to better assess whether these associations exist across populations of patients with darker skin types.
Results of this systematic review show that the evidence assessing the association of UV exposure with KC is of moderate to low quality. The studies that found no association were among patients receiving phototherapy. Studies assessing nonphototherapy-related UV exposure, such as geographic location or occupation, found small positive associations in primarily East Asian individuals. There were no studies performed in the US, no studies among Black individuals, and only 1 study among a Hispanic population. Further research is required to better assess whether these associations exist across populations of patients with darker skin types.
Surgery plays a critical role in the management of all stages of gastric cancer.

For patients with early gastric cancer and low risk of lymph node metastasis, endoscopic therapy or surgery alone is potentially curative. Novel techniques, such as sentinel lymph node biopsy, may allow for greater use of stomach-sparing procedures that could improve quality of life without compromising oncologic outcomes; however, experience with these techniques is rare outside of East Asia, and studies of long-term outcomes are still ongoing. Patients with later-stage localized gastric cancer benefit from more extensive lymphadenectomy and multimodality therapy, as they are at risk for nodal and distant metastases. There have been recent advances in chemotherapy that have led to improved survival, but the optimal sequencing of multimodality therapy is still being investigated. Better systemic therapy may also increase the role of surgery for patients with oligometastatic disease. There are ongoing studies examining the efficacy of peritoneal-directed therapies in both patients with low-volume peritoneal disease and patients at high risk of peritoneal recurrence.

The management of gastric cancer continues to evolve. Surgeons should be aware of novel surgical approaches currently under investigation as well as how surgery fits into the contemporary multidisciplinary approach to this disease.
The management of gastric cancer continues to evolve. Surgeons should be aware of novel surgical approaches currently under investigation as well as how surgery fits into the contemporary multidisciplinary approach to this disease.Digestive tract primary melanoma is uncommon. However, metastatic lesions are more frequent and occur mainly in the small intestine. check details We report a 69-year-old male patient who consulted for a hyperpigmented skin lesion on the left thigh associated with multiple subcutaneous nodules. The biopsy was compatible with melanoma and PET/CT was positive for metastases in nodules and in an inguinal lymph node. Radiotherapy and chemotherapy with pembrolizumab were performed with good response, associated with posterior resection of the inguinal lymph node and melanocytic lesions. At three years of follow-up, a new hypermetabolic focus in the proximal jejunum was found in a control PET/CT. An endoscopic biopsy confirmed that it was a recurrence of the melanoma. Laparoscopic resection with primary anastomosis was performed with good clinical evolution. The definitive biopsy showed a melanoma metastasis with two of three lymph nodes positive for metastasis and a non-mutated BRAF gene. In conclusion, a single intestinal recurrence of melanoma is rare and requires an active search, since it can be resected using minimally invasive techniques.Primary myocardial involvement of Diffuse Large B-Cell lymphoma is extremely rare, accounting for 0.5 % of all lymphomas. We report a 65-year-old male, presenting with an acute cardiac tamponade, which was drained. A pericardial window with myocardial biopsy was carried out, disclosing a diffuse large B cell lymphoma. He received 6 cycles of rituximab, cyclophosphamide, vincristine, and prednisone (R-CVP), without response. Finally, a palliative chemotherapy with gemcitabine plus oxaliplatin was prescribed.Acute Coronary Syndrome with ST segment elevation requires rapid reperfusion, which is why the timely identification of these conditions, based on the patient's symptoms and the correct interpretation of the EKG, is essential for therapeutic decisions. We report three patients with True Posterior Infarction and their difficult EKG diagnosis. The classic 12-lead EKG method is often not capable of supporting the diagnosis, so we recommend the use of posterior leads and mirror images observing inverted V1-V2-V3 leads on the classic EKG.
Medical students have a higher prevalence of mental health problems and are more likely to drop out their studies as a result.

To comprehend the academic experiences of medical students who dropped out medical studies in a university that experienced an increase in drop out by medical students and consultations to mental health services.

A qualitative study with a phenomenological design, in which in-depth interviews were conducted with eight medical students who dropped out studies. The analysis was carried out by means of the constant comparison method up to the level of open coding.

Two categories were identified, namely experiences prior to interrupting studies, which comprised the subcategories of academic and social experiences, and motives that lead to drop-out, which considered the subcategories related to vocation, mental health and pursuing other projects.

These results identified the challenges faced by students prior to stopping-out, that are related to academic aspects, peer relations and student-teacher relationship. The main motives for drop-out reported by students were mental health problems.
These results identified the challenges faced by students prior to stopping-out, that are related to academic aspects, peer relations and student-teacher relationship. The main motives for drop-out reported by students were mental health problems.
Healthcare workers' mental health was affected by SARS-CoV-2 pandemic.

To evaluate healthcare workers' mental health and its associated factors during the pandemic in Chile.

An online self-reported questionnaire was designed including the Goldberg Health Questionnaire, the Patient Health Questionnaire, (PHQ-9), and the Columbia-Suicide Severity Rating Scale among other questions. It was sent to 28,038 healthcare workers.

The questionnaire was answered by 1,934 participants, with a median age of 38 years (74% women). Seventy five percent were professionals, and 48% worked at a hospital. Fifty nine percent of respondents had a risk of having a mental health disorder, and 73% had depressive symptoms. Significant associations were found with sex, workplace, and some of the relevant experiences during the pandemic. Fifty one percent reported the need for mental health support, and 38% of them received it.

There is a high percentage of health workers with symptoms of psychological distress, depression, and suicidal ideas. The gender approach is essential to understand the important differences found. Many health workers who required mental health care did not seek or received it.
There is a high percentage of health workers with symptoms of psychological distress, depression, and suicidal ideas. The gender approach is essential to understand the important differences found. Many health workers who required mental health care did not seek or received it.Telemedicine has had a significant role during the outbreak of COVID-19. The experience in the United States has shown advantages and some challenges that need to be addressed to include telemedicine as an established part of the health system. This article aims to determine the United States' main challenges, associating them with the Chilean reality. In this study, we classify the barriers and difficulties for telemedicine into three areas accessibility, cyber security, and medical liability.We argue that Chile will have to deal with similar obstacles to include telemedicine as a regular health service for the entire population.
In Chile, public health training grew both in enrollment and in the number of universities offering programs on the subject.

To compare the academic characteristics and the contents of the master's programs in public health offered by Chilean universities.

A search of all master's programs that include the word "public health " in their title was made, excluding those that did not declare current students in 2020. The academic characteristics and content of each program were compiled according to the information declared by each university. The contents were grouped according to the list of core competencies for the public health professional of the Association of Schools of Public Health in the European Region (ASPHER).

Eleven programs were included, most of them are carried out in face-to-face modality. The academic load is expressed in Transferable Credit System credits (62-71), credits (87-125) or teaching hours (1252-2048). All programs declare to have a graduation activity, with a heterogeneous academic load. All programs have basic subjects in epidemiology and more than 60% include introductory topics in public health, research methodology, and health services management. No program declares demography or food safety as compulsory subjects.

There is heterogeneity in the academic load and the contents between the programs. It is necessary to establish common criteria in the training of future public health professionals, at least in the compulsory subjects and the minimum academic load.
There is heterogeneity in the academic load and the contents between the programs. It is necessary to establish common criteria in the training of future public health professionals, at least in the compulsory subjects and the minimum academic load.Recent randomized controlled trials confirmed the beneficial outcomes with coronary artery bypass grafting (CABG) compared with percutaneous coronary intervention (PCI) in patients with severe three-vessel coronary artery and left main disease. An increased long-term survival after CABG is associated with a reduction in spontaneous myocardial infarction and repeat revascularization rates. While PCI treats only flow-limiting lesions, CABG treats the whole coronary artery, preventing events in the future. Due to different clinical and anatomic factors affecting the outcomes, the heart team should formulate treatment assignment recommendations.
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