abstract Introduction: Medical education has been changing, and the evaluation strategies that make it possible to address not only theoretical knowledge but also clinical skills. In Mental Health, these skills play a central role. The Objective Structured Clinical Examination (OSCE) is one of the evaluations that could assess clinical skills. This article describes the implementation and performance for the evaluation of undergraduate students since the OSCE's introduction in 2015. Methods: An explanation of the implementation is made, and a description of the OSCEs carried out to undergraduate medical students in the second semester of mental health, using the databases of the final practical examinations during those years. The perception of mental health teachers is also described. Results: The mental health OSCE implemented in 2015-2, is developed in the Simulated Hospital of the University and has five stations (interview, mental examination, diagnosis, treatment and information to the family and ethics). Between 2016-2 and 2019-2, 486 students performed OSCE with an average score of 3.85 (scale 0-5). It was observed that the grade obtained when evaluating anxiety disorders was below average, that of affective disorders above average, while that of psychotic disorders was within the average. The professors highlight the versatility, the comprehensive objective evaluation of the practical and theoretical aspects, and the possibility of comparison between the different groups. Conclusions: The OSCE is an examination that provides the possibility to evaluate the competences in psychiatry of medical students and allows the identification of the aspects to be improved in the teaching learning process.

resumen Introducción: La formación médica ha venido transformándose, así como las estrategias de evaluación, lo que permite abordar, además de los conocimientos, las habilidades clínicas. En salud mental estas habilidades desempeñan un rol central. El Examen Clínico Objetivo Estructurado (ECOE) es una de las evaluaciones que tiene este potencial. El objetivo del presente artículo es describir la implementación y el desempeño que han tenido los estudiantes de pregrado desde la introducción de este en el año 2015. Métodos: Se recuenta la implementación y se describen los ECOE realizados a estudiantes de pregrado de Medicina que cursan el segundo semestre de Salud Mental tomando las bases de datos de los exámenes prácticos finales. Además se describe la percepción de los docentes del área. Resultados: El ECOE de salud mental se implementó en 2015-2, se desarrolla en el Hospital Simulado de la Universidad y cuenta con 5 estaciones (entrevista, examen mental, diagnóstico, tratamiento e información a la familia y ética). Entre 2016-2 y 2019-2, 486 estudiantes pasaron el ECOE con una nota promedio de 3,85 (baremo de 0 a 5). Se observó que la nota obtenida al evaluarse trastornos de ansiedad estuvo por debajo del promedio; la de trastornos afectivos, por encima del promedio y la de trastornos psicóticos, dentro del promedio. Los docentes resaltan la versatilidad, la mirada objetiva integral de los aspectos prácticos y teóricos y la posibilidad de comparación entre los diferentes grupos. Conclusiones: El ECOE brinda la posibilidad de evaluar las competencias en acción de los estudiantes de Medicina y permite la identificación de qué aspectos mejorar en el proceso de enseñanza-aprendizaje.

Abstract Introduction The aberrant expression of the inhibitor of DNA binding (ID1) gene has been frequently associated with the leukemogenesis and prognostication acute myeloid leukemia (AML), although its clinical importance has never been investigated in patients treated outside well-controlled clinical trials. Methods Using quantitative real-time polymerase chain reaction, we investigated the role of the ID1 expression in the clinical outcomes of non-selected patients with acute myeloid leukemia treated in a real-life setting. Results Overall, 128 patients were enrolled. Patients with high ID1 expression had a lower 3-year overall survival (OS) rate of 9%, with the 95% confidence interval (95%CI) at 3 to 20%, compared to patients with a low ID1 expression (22%, 95%CI: 11 - 34%) (p = 0.037), although these findings did not retain significance after adjustment (hazard ratio (HR): 1.5, 95%CI: 0.98 - 2.28; p = 0.057). The ID1 expression had no impact on post-induction outcomes (disease-free survival, p = 0.648; cumulative incidence of relapse, p = 0.584). Conclusions Although we are aware thar our data are confronted with many variables that cannot be fully controlled, including drug unavailability, risk-adapted treatment, comorbidities and the time from diagnosis to treatment initiation, we are firm believers that such an initiative can provide more realistic data on understudied populations, in particular those from low- and middle-income countries. ID (ID1 AML, AML , (AML) wellcontrolled well controlled trials realtime real reaction nonselected non selected reallife life setting Overall 12 enrolled 3year year OS (OS 9 9% 95 95%CI 95CI CI (95%CI 20 20% 22%, 22 (22% 1 34% 34 0.037, 0037 0.037 0 037 0.037) hazard HR (HR) 15 5 1.5 098 98 0.9 2.28 228 2 28 0.057. 0057 0.057 . 057 0.057) postinduction post induction diseasefree disease free 0.648 0648 648 relapse 0.584. 0584 0.584 584 0.584) unavailability riskadapted risk adapted initiation populations middleincome middle income countries (ID (AML 22% (22 003 0.03 03 (HR 1. 09 0. 2.2 005 0.05 05 0.64 064 64 058 0.58 58 (2 00 0.0 2. 0.6 06 6 0.5 (

Abstract Chagas disease (CD) is a neglected tropical disease (NTD) caused by Trypanosoma cruzi, a hemoflagellate protozoa. CD is diagnosed by epidemiologic history and two positive serological tests. The infection has two main clinical phases: acute, early after acquiring the infection, and chronic. The electrocardiogram (ECG) is the first tool to diagnose chronic Chagas heart disease after CD serological diagnosis. In addition, the different cardiac imaging modalities, including chest X-ray, echocardiography, single photon emission computed tomography (SPECT), computed tomography (CT), and magnetic resonance, play a crucial role in detecting the cardiac involvement, establishing the prognosis, stratifying patient risk, and addressing the management of CD patients. In this review of the current literature, we summarize the epidemiology, pathophysiology, and clinical presentation of CD. We also discuss the indications, advantages, and limitations of the different cardiac imaging modalities. We also present some case examples, where cardiac imaging proved helpful in cardiac CD (CCD). The early mortality and substantial disability caused by CD represents a health, social and economic burden, particularly in the Latin America. To harness the full potential of medical imaging for the effective management of patients with CD, a comprehensive approach is essential. This involves a concerted effort to invest in the education of medical providers and to facilitate widespread access to diagnostic tools. Accessible and timely diagnosis is crucial for initiating prompt and targeted interventions. Finally, continuous investment in research is vital to advance our understanding of CD and develop innovative solutions for improved patient care. (CD NTD (NTD cruzi protozoa tests phases acute ECG (ECG addition modalities Xray, Xray X ray, ray X-ray echocardiography SPECT, SPECT , (SPECT) CT, CT (CT) resonance involvement prognosis risk literature epidemiology pathophysiology indications advantages examples CCD. CCD . (CCD) health burden America essential tools interventions Finally care (SPECT (CT (CCD

ABSTRACT Objective: Evaluate the efficacy of the Alvarado score in the diagnosis of acute appendicitis in patients at the General Surgery Unit at Ciudad de Este Hospital Regional, Paraguay. Materials and methods: observational, descriptive, cross-sectional study. The past medical histories of patients with preoperative diagnosis of acute appendicitis were included in the study, the Alvarado score was applied, and the score was associated with its subsequent macroscopic postoperative finding. Patients were operated on at the General Surgery Unit of the HR-CDE from January 2020 through September 2020. Results: a total 100 patients were included; 61% of whom were men. The Alvarado score was applied, and they were categorized into 4 groups, low risk (16%), possible risk (23%), probable risk (39%), and high risk (22%). According to the macrosco¬pic postoperative finding they were categorized into congestive (14%), phlegmonous (42%), gangrenous (35%), and perforated appendicitis (8%). An 86% sensitivity rate, and a 29% specificity rate were obtained for this study. Conclusion: the Alvarado score is a simple tool, easy to apply, and a useful support in the diagnosis of this condition.

RESUMEN Objetivo: Evaluar la eficacia de la Escala de Alvarado para el diagnóstico de la Apendicitis aguda en pacientes dentro del Servicio de Cirugía General del Hospital Regional de Ciudad de Este. Materiales y métodos: Estudio observacional, descriptivo, de corte trasversal. Se incluyeron historias clínicas de pacientes con diagnóstico pre operatorio de Apendicitis aguda, fue aplicada la Escala de Alvarado y se correlaciono el puntaje con su posterior hallazgo macroscópico post operatorio, operados en el Servicio de Cirugía General del HR-CDE en el periodo de enero a septiembre de 2020. Resultados: Se incluyeron un total de 100 pacientes; donde 61% eran del sexo masculino. Fue aplicada la Escala de Alvarado y se los agrupo en 4 grupos, Riesgo bajo (16%), Riesgo posible (23%), Riesgo probable (39%) y Riesgo alto (22%), y según el hallazgo macroscópico post operatorio se los clasifico en apendicitis congestiva (14%), flegmonosa (42%), gangrenosa (35%) y perforada (8%). Se obtuvo una Sensibilidad del 86% y Especificidad del 29% para este estudio. Conclusión: La Escala de Alvarado una herramienta sencilla, de fácil aplicación y un apoyo útil para el diagnóstico de esta patología.

RESUMEN Introducción: la calidad de vida puede alterarse en los pacientes con insuficiencia renal crónica, sobre todo si sufren concomitantemente de sarcopenia. Objetivo: determinar la relación entre sarcopenia y calidad de vida en pacientes adultos con insuficiencia renal crónica del Hospital Nacional (Itauguá) y Hospital Militar (Asunción) entre abril y noviembre del 2021. Metodología: se utilizó un diseño observacional, descriptivo, transversal. Se incluyó a sujetos adultos de ambos sexos, portadores de insuficiencia renal crónica. Se midieron variables antropométricas, clínicas y laboratoriales. La calidad de vida se evaluó con el cuestionario EQ-5D y la sarcopenia con la fuerza de prensión palmar y el índice de masa muscular. Los datos se sometieron a estadística descriptiva y analítica con el programa Epi Info 7™. El estudio contó con la aprobación del Comité de Ética de la Universidad Privada del Este, Paraguay. Resultados: ingresaron al estudio 62 varones con edad media 56 ± 15 años y 57 mujeres con edad media 51 ± 16 años. La más frecuente de la insuficiencia renal fue la hipertensión arterial asociada a la diabetes mellitus (45,4 %). La sarcopenia se confirmó en 38,6 % de los pacientes. La calidad de vida fue buena en 30,25 %, regular en 39,5 % y mala en 30,25 %. Conclusión: en pacientes adultos con insuficiencia renal crónica, la sarcopenia predominó en los sujetos con regular y mala calidad de vida.

ABSTRACT Introduction: the quality of life can be altered in patients with chronic renal failure, especially if they suffer concomitantly from sarcopenia. Objective: to determine the relationship between sarcopenia and quality of life in adult patients with chronic renal failure at the Hospital Nacional (Itauguá) and the Hospital Militar (Asunción) between April and November 2021. Methodology: an observational, descriptive, cross-sectional design was used. Adult subjects of both sexes, carriers of chronic renal failure were included. Anthropometric, clinical and laboratory variables were measured. Quality of life was evaluated with the EQ-5D questionnaire and sarcopenia with palm grip strength and muscle mass index. The data was submitted to descriptive and analytical statistics with the Epi Info 7™ program. The study was approved by the Ethics Committee of the Universidad Privada del Este, Paraguay. Results: 62 men with a mean age of 56 ± 15 years and 57 women with a mean age of 51 ± 16 years entered the study. The most frequent renal failure was arterial hypertension associated with diabetes mellitus (45.4 %). Sarcopenia was confirmed in 38.6 % of the patients. The quality of life was good in 30.25 %, regular in 39.5 % and bad in 30.25 %. Conclusion: in adult patients with chronic renal failure, sarcopenia prevailed in subjects with fair and poor quality of life.

RESUMO Objetivo: Analisar a retenção do conhecimento e habilidades dos profissionais de enfermagem após treinamento e retreinamento sobre ressuscitação cardiopulmonar. Método: Estudo de intervenção, prospectivo e analítico no qual 56 profissionais de enfermagem receberam treinamento teórico e prático de RCP em serviço. Nove meses após o primeiro treinamento (T1), esses profissionais participaram de um retreinamento (T2). Eles foram acompanhados por 18 meses. A tendência linear do conhecimento e habilidades no período subsequente aos treinamentos foi calculada e aplicou-se o teste de Wilcoxon. Resultados: As intervenções aumentaram significativamente o conhecimento e as habilidades dos profissionais; no entanto, no período subsequente, as competências reduziram. Apesar disso, após um período de nove meses elas ainda se mantiveram superiores àquelas identificadas previamente ao estudo. Houve redução de 18,2% após T1 vs 13,0% após T2 (p < 0,01) do conhecimento no teste teórico e de 7,6% após T1 vs 5,3% após T2 (p < 0,01) das habilidades no teste prático. Conclusáo: Os profissionais de enfermagem conseguiram reter mais conhecimento e habilidades em ressuscitação cardiopulmonar após o retreinamento, o que reforça a importância da regularidade das capacitações e da educação continuada em saúde.

ABSTRACT Objective: To analyze the retention of knowledge and skills of nursing professionals following training and retraining on cardiopulmonary resuscitation. Method: This is an intervention, prospective, and analytical study in which 56 nursing professionals received theoretical and practical training in in-service cardiopulmonary resuscitation. Nine months after the first training (T1), these professionals participated in a retraining (T2). They were followed up for 18 months. The linear trend of knowledge and skills in the period following training was calculated and the Wilcoxon test was applied. Results: Interventions increased the knowledge and skills of professionals significantly; however, in the subsequent period, skills decreased. Despite this, after a period of nine months, they were still higher than those identified before the study. There was a reduction of 18.2% in knowledge in the theoretical test after T1 vs 13.0% after T2 (p < 0.01) and a reduction of 7.6% in skills on the practical test after T1 vs 5.3% after T2 (p < 0.01). Conclusion: Nurses were able to retain more knowledge and skills on cardiopulmonary resuscitation after retraining, which stresses the importance of regular training and continuing education in health.

RESUMEN Objetivo: Analizar la retención del conocimiento y habilidades de los profesionales de enfermería tras entrenamiento y reentrenamiento sobre reanimación cardiopulmonar (RCP). Método: Estudio de intervención, prospectivo y analítico en el cual 56 profesionales de enfermería recibieron entrenamiento teórico y práctico de RCP en servicio. Nueve meses tras el primer entrenamiento (E1), esos profesionales participaron de un reentrenamiento (E2). Ellos fueron acompanados por 18 meses. La tendencia lineal del conocimiento y habilidades en el período subsecuente a los entrenamientos fue calculada y se aplicó el test de Wilcoxon. Resultados: Las intervenciones aumentaron significativamente el conocimiento y las habilidades de los profesionales, sin embargo, en el periodo subsecuente las competencias se redujeron. A pesar de ello, tras un período de nueve meses ellas todavía se mantuvieron superiores a aquellas identificadas previamente al estudio. Hubo reducción del 18,2% tras E1 contra el 13,0% tras E2 (p < 0,01) del conocimiento en el test teórico y del 7,6% tras E1 contra el 5,3% tras E2 (p < 0,01) de las habilidades en el test práctico. Conclusión: Los profesionales de enfermería lograron retener más conocimiento y habilidades en RCP tras el reentrenamiento, lo que refuerza la importancia de la regularidad de cursos de capacitación y de la educación continua en salud.

Resumo Este artigo tem como objetivo analisar a influência da vizinhança sobre o desempenho escolar dos alunos da rede pública de ensino do Recife. Especificamente, o trabalho investiga empiricamente a existência de uma relação entre o desempenho do aluno e as características de sua vizinhança e os mecanismos pelos quais atua essa influência. Para tanto, utiliza-se a base de dados da Fundaj (2013) para construir, de forma pioneira no Brasil, as variáveis de vizinhança dos alunos da cidade considerando pequenas escalas geográficas. Os resultados dos exercícios econométricos indicam que os alunos residentes em uma vizinhança mais privilegiada tendem a apresentar, em média, melhor desempenho em matemática. Na análise que considera a composição dos pares de vizinhança, os resultados sugerem que a proporção de repetentes influenciaria o desempenho de matemática.

Abstract This study aims to investigate the influence of the neighborhood over the students' performance in the public school system of Recife, Brazil. Specifically, we investigate empirically the existence of a relation among the students’ performance and the characteristics of their neighborhoods, and the mechanisms by which this influence occurs. For that, we use the data set of the Fundaj (2013) to build, in a pioneer way in Brazil, the neighborhood variables of the students regarding small geographic scales. Our econometric results indicate that the students that live in privileged neighborhoods tend to show higher scores than the others. The peer composition analysis suggests that only the proportion of the grade repetition influences the students' math grades.

ABSTRACT Objective: Determine the presence of anterior chamber bacterial contamination during cataract surgery. Methods: A cross-sectional case-series study was conducted of patients undergoing cataract surgery at the Ocular Microsurgery Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology from January 2015 to December 2016. Personal ocular and systemic pathological antecedents, associated risk factors and perioperative complications, were related to the presence of anterior chamber bacterial contamination at the end of surgery. Patients were randomly selected in the operating room. The sample was composed of 200 patients, who were divided into three groups according to the surgeons' experience. Results: At the start of the surgical procedure, 100 % of the cultures were negative, whereas at the end 3 % bacterial growth was detected. Gram-positive germs were the most common (66.6 %), with Staphylococcus epidermidis isolated in 50 % of the cases. No significant relationship was found between personal ocular or systemic pathological antecedents and associated risk factors. Posterior capsule rupture was the most frequent intraoperative complication, with 4.7 % bacterial growth detected. Conclusion: Low frequency of anterior chamber contamination was detected at the end of cataract surgery, and the germs commonly found are related to the ocular surface microbiota.

RESUMEN Objetivo: Determinar la existencia de contaminación bacteriana en cámara anterior durante la cirugía de catarata. Métodos: Se realizó un estudio transversal de serie de casos, en el cual participaron los pacientes sometidos a cirugía de catarata en el Servicio de Microcirugía Ocular del Instituto Cubano de Oftalmología “Ramón Pando Ferrer”, en el período comprendido de enero del año 2015 a diciembre 2016. Se relacionaron los antecedentes patológicos personales oculares y sistémicos, los factores de riesgo asociados y las complicaciones transoperatorias con la presencia de bacterias en la cámara anterior al final de la cirugía. Los pacientes fueron seleccionados aleatoriamente en el salón de cirugía. La muestra quedó constituida por 200 pacientes y divididos en tres grupos dependiendo de la experiencia de los cirujanos. Resultados: Al inicio del proceder quirúrgico, el 100 % de los cultivos fueron negativos, mientras que al final de la cirugía se detectó crecimiento bacteriano en el 3 %. Los gérmenes Gram positivos fueron los de mayor frecuencia (66,6 %) donde el Staphylococcus epidermidis se aisló en un 50 % de los casos. No existió relación significativa entre antecedentes patológicos personales oculares, sistémicos y los factores de riesgo asociados. La ruptura de la cápsula posterior fue la complicación transoperatoria más frecuente y al 4,7 % se le detectó crecimiento bacteriano. Conclusión: Se detecta una baja frecuencia de contaminación de la cámara anterior al final de la cirugía de catarata y los gérmenes comúnmente encontrados están relacionados con la microbiota de la superficie ocular.

ABSTRACT Swine production generates every day a large amount of residues, including nutrients and microorganisms, which potentially contribute to contamination of air, water and soil, and generation of unpleasant odors. Many strategies have been developed in order to mitigate the contaminant effect of swine manure and to take advantage of its nutrients and beneficial compounds; silage is an example of these, and consists in swine manure fermentation mainly under anaerobic conditions. The aim of this study was to assess the effect of applying a process of silage to swine manure added with two different sources of carbohydrates and two different sources of lactic-acid bacteria, under the reduction of different microbiological indicators. Through the process, it was observed the reduction of pH levels (until reaching 4.6) and microbial content, mainly for coliforms (reduction greater than 5 log), molds and yeasts, and total elimination of enterococci. On the other hand, significant decline was not reported for the lactic-acid bacteria content, main responsible of fermentation process. Best results were observed through using sorghum as a source of carbohydrates and cheese whey as a source of lactic-acid bacteria, for both, decrease of pH and reduction of some microbiological indicators, including bacteria that produce sulfuric acid. Therefore, silage process, applied to swine manure, induces the decrease of pH for action of lactic-acid bacteria until limit the survival of bacteria associated with fecal contamination, making of swine a transformed and microbiologically safe residue for its handling and subsequent use.

RESUMEN La actividad porcina genera diariamente una gran cantidad de residuos conformados por nutrientes y microorganismos que potencialmente contribuyen a la contaminación de agua, aire y suelos, y la subsecuente generación de olores desagradables. Diversas estrategias se han desarrollado para mitigar el efecto contaminante de las excretas porcinas y aprovechar sus nutrientes; tal es el caso del ensilaje, que consiste en la fermentación de las excretas. En este estudio se evaluó el efecto del ensilaje del estiércol porcino adicionado con dos fuentes diferentes de carbohidratos y dos fuentes de bacterias ácido lácticas, sobre la reducción de diferentes grupos de microorganismos. Durante el proceso se observó la disminución del pH (hasta 4.6) y la carga microbiana, sobre todo para organismos coliformes (reducción mayor a 5 logaritmos) y hongos y levaduras, así como la eliminación total del grupo de enterococos; mientras que el contenido de bacterias ácido lácticas, principales responsables de la fermentación, permaneció constante. Los mejores resultados se observaron mediante el uso de sorgo como fuente de carbohidratos en combinación con suero de leche, subproducto de la elaboración de queso, como fuente de bacterias ácido lácticas, tanto en disminución del pH como en la reducción de algunos indicadores microbiológicos, incluidas las bacterias productoras de ácido sulfhídrico. Mediante el ensilaje del estiércol porcino se favorece la disminución del pH por acción de las bacterias ácido lácticas a niveles que limitan la sobrevivencia de microorganismos asociados a contaminación fecal, y lo transforman en un producto seguro, desde la perspectiva microbiológica, para su manejo y posible aprovechamiento subsecuente.

RESUMEN Objetivo: En Latinoamérica no se conoce a ciencia cierta la cantidad o la calidad de las comunidades terapéuticas disponibles en los distintos países de la región. El objetivo de este estudio es identificar y describir la cantidad y la calidad de las comunidades terapéuticas existentes en 5 países de la región. Diseño: Se realizó un estudio multicéntrico descriptivo cuantitativo de las comunidades terapéuticas en Argentina, Brasil, Colombia, México y Perú. Métodos: Mediante las entidades reguladoras de las comunidades terapéuticas de cada país, se realizó una encuesta a las que aceptaran participar en el estudio. Resultados: De las 285 comunidades terapéuticas identificadas en los 5 países, 176 (62%) aceptaron participar en el estudio. La calidad de las comunidades terapéuticas se evaluó por las puntuaciones establecidas con los criterios de De León; se encontró que el 70% de las instituciones tienen puntuaciones de 11/12 o 12/12 según estos criterios. También se encontró que cumplen la mayoría de los criterios de De León más del 90% de las instituciones; sin embargo, las dimensiones «separación de la comunidad» y «grupos de encuentro entre residentes» fueron los menos cumplidos (el 63 y el 85% de las comunidades respectivamente). Las principales razones de abandono de las comunidades terapéuticas fueron no aceptar las normas de la institución, falta de recursos económicos y no sentirse a gusto con ella. El 98% de las comunidades terapéuticas prestaban servicios para problemas de abuso de otras sustancias, el 94% para abuso de alcohol y el 40% para otros tipos de abusos. Conclusiones: La mayoría de las comunidades terapéuticas identificadas en nuestra muestra cumplen los criterios de calidad establecidos por De León, y en su gran mayoría prestan servicios para abuso de sustancias, pero deben instaurarse políticas para mejorar las condiciones no cumplidas e indagar los motivos de las disconformidades y el abandono de estas instituciones.

ABSTRACT Objective: In Latin America is not known for certain the quantity or quality of therapeutic communities (TCs) available in the region. The objective of this study is to describe and quantify the quantity and quality of the existing TCs in 5 different countries. Design: A multicenter quantitative description of the TCs was conducted in Argentina, Brazil, Colombia, Mexico and Peru. Methods: A survey was realized through the TCs regulatory entities of each country that accepted to participate in the study. Results: Of the 285 TCs identified in the 5 countries, 176 (62%) accepted to participate in this study. The TCs quality vas evaluated according to the scoring system stablished by De Leon, finding that 70% of the facilities have scores of 11/12 or 12/12 using these criteria. We also found that the majority of the De Leon criteria are known by more than 90% of the institutions, however, the dimensions of "separation of the community" and "encounter groups between residents" were the least known with 63 and 85% respectively. The main reasons for abandonment of TCs were "not accepting the rules of the institution", "lack of money" and "not feeling comfortable with the facilities". 98% of the TCs provided services to other substance abuse problems, 94% for alcohol and 40% for other types of substances. Conclusions: The majority of the TCs identified in our sample meet the quality criteria stablished by De Leon, mostly providing services for substance abuse. However, they should put in place additional policies to improve the unfulfilled conditions and investigate the reasons for the dissatisfaction and abandonment of these institutions.

RESUMEN El propósito de este estudio consistió en reportar los resultados de la aplicación de la escala de actitud hacia la estadística (EAE) a una muestra no aleatoria de 92 estudiantes de la Escuela Profesional de administración de una universidad privada de Lima Este correspondiente a los turnos mañana, tarde y noche, en relación a las siguientes dimensiones; valor que le dan a la estadística, nivel de dificultad percibida, el afecto hacia la estadística y la competencia cognitiva de los estudiantes, que cursaban la materia de estadística. Alrededor de un 60% manifiestan una actitud favorable o muy favorable hacia la estadística y solo un 4.3% desfavorable. No se encontraron diferencias significativas en el puntaje total de la escala de los estudiantes de esta muestra en función del turno de estudio: mañana, tarde y noche.

ABSTRACT The purpose of this study was to report the results of the application of the scale of attitude towards Statistics (EAE) to a non-random sample of 92 students of Business School from Lima private university. This corresponds to morning, afternoon and evening shifts, in relation to the following dimensions; value statistics, level of perceived difficulty, affection towards statistics and cognitive proficiency of students, who were in the field of statistics. About 60% express a favorable or very favorable attitude towards statistics and only 4.3% unfavorable. No significant differences were found in the total scale score of students in this sample depending on the shift of study: morning, noon and night.

ABSTRACT Objective: Cardiovascular diseases are the leading cause of death in Brazil, imposing substantial economic burden on the health care system. Familial hypercholesterolemia (FH) is known to greatly increase the risk of premature coronary artery disease (CAD). This study aimed to estimate the economic impact of hospitalizations due to CAD attributable to FH in the Brazilian Unified Health Care System (SUS). Subjects and methods: Retrospective, cross-sectional study of data obtained from the Hospital Information System of the SUS (SIHSUS). We selected all adults (≥ 20 years of age) hospitalized from 2012-2014 with primary diagnoses related to CAD (ICD-10 I20 to I25). Attributable risk methodology estimated the contribution of FH in the outcomes of interest, using international data for prevalence (0.4% and 0.73%) and relative risk for events (RR = 8.56). Results: Assuming an international prevalence of FH of 0.4% and 0.73%, of the 245,981 CAD admissions/year in Brazil, approximately 7,249 and 12,915, respectively, would be attributable to an underlying diagnosis of FH. The total cost due to CAD per year, considering both sexes and all adults, was R$ 985,919,064, of which R$ 29,053,500 and R$ 51,764,175, respectively, were estimated to be attributable to FH. The average cost per FH-related CAD event was R$ 4,008. Conclusion: Based on estimated costs of hospitalization for CAD, we estimated that 2.9-5.3% are directed to FH patients. FH can require early specific therapies to lower risk in families. It is mandatory to determine the prevalence of FH and institute appropriate treatment to minimize the clinical and economic impact of this disease in Brazil.

ABSTRACT Objectives. To determine the rate of optimal cytoreduction in patients with advanced ovarian cancer who received neoadjuvant chemotherapy with dose-dense carboplatin and paclitaxel followed by interval debulking surgery (IDS). Materials and Methods. A retrospective study of a series of cases of Peruvian women treated with neoadjuvant chemotherapy with carboplatin (6 AUC mg/mL/min) and paclitaxel (80 mg/m2 weekly) followed by IDS, at the National Institute of Neoplastic Diseases during the 2010-2014 period. Results. The 41 patients who made it to the interval surgery had a median age of 59 years (range: 47-73 years). In 37 (90.2%) patients, high-grade serous adenocarcinoma histology was reported. Thirty-four (82.9%) achieved optimal cytoreduction and five (14.7%), a complete pathological response. Progression-free survival at one year and two years was 74.7% and 51.8%, respectively. Overall survival at one year and two years was 85.2% and 71.4%, respectively. The risk of progression and death was greater in patients without optimal cytoreduction and in patients with postsurgery levels of carcinoembryonic antigen 125 > 30 U/mL. Conclusions. Neoadjuvant therapy with dose-dense carboplatin and paclitaxel achieved an elevated frequency of optimal cytoreduction. The post-surgery levels of carcinoembryonic antigen 125 and optimal cytoreduction were independent factors of progression-free survival and overall survival.

RESUMEN Objetivos. Determinar la tasa de citorreducción óptima en pacientes con cáncer de ovario avanzado que recibieron quimioterapia neoadyuvante con carboplatino y paclitaxel dosis densa seguido de cirugía de citorreducción de intervalo (CCI). Materiales y métodos. Estudio de una serie de casos retrospectiva de mujeres peruanas tratadas con quimioterapia neoadyuvante con carboplatino (AUC 6 mg/ml/min) y paclitaxel (80 mg/m2 semanal) seguido de CCI, en el Instituto Nacional de Enfermedades Neoplásicas durante el período 2010-2014. Resultados . Los 41 pacientes que alcanzaron cirugía de intervalo, tuvieron una mediana de edad de 59 años (rango: 47-73 años). En 37 (90,2%) pacientes se reportó histología de adenocarcinoma seroso de alto grado. Treinta y cuatro (82,9%) lograron citorreducción óptima y cinco (14,7%) respuesta patológica completa. La sobrevida libre de progresión al año y 2 años fueron 74,7% y 51,8%, respectivamente. La sobrevida global al año y 2 años fue 85,2% y 71,4%, respectivamente. El riesgo de progresión y muerte fue mayor en pacientes sin citorreducción óptima y pacientes con niveles de dosaje del antígeno carcinoembrionario 125 postoperatorio > 30 U/ml. Conclusiones . La neoadyuvancia con carboplatino y paclitaxel dosis densa logró una frecuencia elevada de citorreducción óptima. Los niveles de antígeno carcinoembrionario 125 postoperatorios y citorreducción óptima resultaron factores independientes de sobrevida libre de progresión y sobrevida global.