Background: The adoption of sanitary measures due to the SARS-CoV-2 pandemic hampered teaching and learning methods in medicine. Aim: To communicate the results of a wound suture training workshop, based on the Basic Procedural Skills Training methodology and adapted to the pandemic context. Material and Methods: One hundred fourteen students were randomized in small groups due to sanitary measures and trained with a modification of the Basic Procedural Skills Training methodology. An informed consent was obtained from every student. The suturing skills were evaluated before and after the intervention with “The Objective Structured Assessment Of Technical Skills” (OSATS) instrument. The perception of the workshop and the implementation of the COVID-19 prevention measures were also evaluated. Results: The students showed a statistically significant improvement after the intervention. In the OSATS verification list, the average score increased from 4.5 to 8.6 (p < 0.01). In the OSATS global scale, the average score increased from 13.0 to 25.3 (p < 0.01). The perception of the workshop and the prevention measures were well evaluated. Conclusions: Despite all the limitations of the pandemic context, we achieved a significant improvement after the intervention and a very good perception by the students.

Abstract Background: The COVID-19 pandemic has affected millions of people around the world. Part of control strategies is testing a large proportion of the population to identify and isolate the infected subjects. Aim: To evaluate the SARS-CoV-2 detection by the performance of a reverse transcription and quantitative polymerase chain reaction (RT-qPCR) against SARS-CoV-2, using saliva as a matrix compared to a nasopharyngeal swab (NPS) to simplify obtaining a diagnostic sample. Methods: Adults in outpatient care were recruited, 95% of them symptomatic. We studied 530 paired saliva and NPS samples by SARS-CoV-2 RT-qPCR. Results: Fifty-nine individuals tested positive in NPS and 54 in saliva samples. Sensitivity for saliva sample was 91%, specificity 100%, positive predictive value (PPV) 100%, negative predictive value (NPV) 98%. The Kappa index was 0.95 and LR-0.08. On average, the cycle threshold (CT) of saliva was 3.99 points higher than those of NPS (p < 0.0001) showing that viral load (VL) is lower in saliva than in NPS. Viral load in both decreased over the time after onset of symptoms. Saliva sampling was preferred by subjects instead of NPS. Conclusion: This study demonstrates that SARS-CoV-2 RT-qPCR using saliva, even with lower VL, is suitable for the diagnosis of COVID-19 in outpatient adults, especially at early stage of symptoms.

Resumen Introducción: La pandemia de COVID-19 ha afectado a millones de personas en todo el mundo. La identificación de sujetos infectados ha sido importante para el control. Objetivo: Evaluar el rendimiento de una reacción de polimerasa en cadena (RPC) cuantitativa en tiempo real (en inglés: RT-qPCR) para SARS-CoV-2, utilizando saliva como matriz en comparación con un hisopado nasofaríngeo (HNF). Metodología: Se reclutaron adultos en atención ambulatoria, la mayoría sintomáticos. Fueron estudiadas 530 muestras pareadas de saliva e HNF con RT-qPCR. Resultados: Fueron positivas 59 muestras de HNF y 54 de saliva. La sensibilidad con saliva fue 91%, especificidad 100%, el valor predictor positivo (VPP) 100%, valor predictor negativo (VPN) 98%. El índice Kappa fue de 0,95 y LR-0,08. En promedio, el umbral de ciclo (en inglés cycle threshold-CT) de la saliva fue 3,99 puntos más alto que los de HNF (p < 0,0001) mostrando que la carga viral (CV) es menor en saliva. La carga viral en ambas disminuyó con el tiempo después del inicio de los síntomas. El muestreo de saliva fue preferido por los sujetos en lugar de HNF. Conclusión: Este estudio demuestra que la RPC para SARS-CoV-2 utilizando saliva, es adecuada para el diagnóstico de COVID-19 en adultos ambulatorios, especialmente en la etapa temprana de los síntomas.

Resumen En los últimos años se ha hecho frecuente el empleo del desnudo en los espacios públicos para impulsar o rechazar determinadas políticas, de modo que son numerosos los movimientos que recurren a lo que ha sido denominado «political porn». El argumento central del artículo recurre a la fenomenología de MerleauPonty para mostrar cómo la exposición política del cuerpo anula la posibilidad de ser reconocido por lo que uno es y desliza a los interlocutores (exhibicionistaespectador) hacia una dialéctica negativa del mutuo desconocimiento. Finalmente, se muestra por qué, en una sociedad democrática y plural, la exhibición política del propio cuerpo desnudo tiende, por su propia naturaleza cosificadora, a menoscabar las condiciones del ejercicio racional de deliberación pública.

Abstract In recent years, the use of nudity in public spaces has frequently become used to promote or reject certain policies, in such a way that the movements that turn to what has been called «political porn» are now numerous. The central argument of the article uses Merleau-Ponty’s phenomenology to show how the political exposition of the body cancels the possibility of being recognized for what one is and shifts the interlocutors (exhibitionist-spectator) towards a negative dialectic of mutual ignorance. Finally, it is shown why, in a democratic and plural society, the political display of the naked body itself tends, by its own reifying nature, to undermine the conditions of the rational exercise of public deliberation.

Aim: To compare the learning of basic surgical skills among medical students according to the type of theoretical and practical instruction they had prior to a standardized wound suturing workshop. Materials and Method: Quasi-experimental before and after study intended to fourth year students for the 2018. The wound suturing workshop was carried out with help of a biological model (pork leg), prior to an informed consent and the approval of the Ethics Committee. The suturing skills were evaluated by the tool “The Objective Structured Assessment Of Technical Skills” (OSATS) before and after the training. All of the participating students were sorted in groups by their previous surgical knowledge: Group A: received theoretical and practical instruction in patients. Group B: received theoretical and practical instruction in simulation models. Group C: without previous suturing knowledge. The students perception was evaluated by a validated survey. The OSATS score before and after the workshop and the perception survey were compared between the groups, using SPSS24® and ANOVA. p < 0,05 was considered significant. Results: 124 students were evaluated. Group A: 17 (13.7%); Group B: 38 (30.7%); Group C: 69 (55.6%) accordingly. There was a OSATS score difference before the workshop Group A: 19.4 ± 4,9; Group B: 13.7 ± 6.3; Group C: 11.1 ± 4.5 (p < 0.05). OSATS score after the intervention Group A: 28.8 ± 1.5; Group B: 28.0 ± 1.9; Group C: 27.9 ± 2.2 (p = 0.48), without a significant difference. The intervention was well perceived, without significant differences among the groups. Discussion: The OSATS score post workshop is independent of experiences, theoretical and practical instruction or previous knowledge. Conclusion: Training programs with standardized evaluation can even out the results among students with different previous knowledge.

Resumen Objetivo: Comparar la adquisición de habilidades quirúrgicas básicas en estudiantes de medicina según el tipo de instrucción teórico-práctica recibida previo a un taller estandarizado de sutura de heridas. Materiales y Método: Estudio cuasiexperimental antes-después para estudiantes de cuarto año durante el 2018. Se realizó taller de sutura de heridas aplicado en modelo biológico (pata de cerdo), previo consentimiento informado y aprobación Comité Ético Científico. Mediante instrumento “The Objective Structured Assessment Of Technical Skills” (OSATS) se evaluó técnica de sutura antes y después del entrenamiento. Se dividió a los participantes según conocimientos previos al taller: Grupo A: recibió instrucción teórico-práctica en pacientes in vivo. Grupo B: recibió instrucción teórico-práctica en modelos de simulación. Grupo C: sin conocimientos previos en suturas. Se evaluó percepción de estudiantes mediante encuesta validada. Se comparó puntaje OSATS antes-después del taller y encuesta de percepción según grupo, utilizando SPSS24® y ANOVA. Se consideró significativo p < 0,05. Resultados: Se evaluaron 124 estudiantes. Grupo A: 17 (13,7%); Grupo B: 38 (30,7%); Grupo C: 69 (55,6%) respectivamente. Existió diferencia en puntaje OSATS de ingreso al taller Grupo A: 19,4 ± 4,9; Grupo B: 13,7 ± 6,3; Grupo C: 11,1 ± 4,5 (p < 0,05). Puntaje OSATS finalizada la intervención Grupo A: 28,8 ± 1,5; Grupo B: 28,0 ± 1,9; Grupo C: 27,9 ± 2,2 (p = 0,48), sin diferencia significativa. La intervención fue bien percibida, sin diferencias significativas entre grupos. Discusión: El resultado de evaluación OSATS finalizado el taller es independiente de experiencias, instrucción teórico-práctica o conocimientos previos a la intervención. Conclusión: Los programas de entrenamiento con evaluación estandarizada pueden equiparar los resultados entre estudiantes con diferentes conocimientos previos.

Background: Boot camps are used to acquire skills in simple surgical procedures, such as sutures, in a short period of time. Aim: To assess the retention of the procedural skills of medical students who participated in a simulation-based suture workshop. Material and Methods: One hundred five medical students were trained using the EPROBA methodology (Entrenamiento PROcedimental BAsico), with prior informed consent. The instrument “Objective Structured Assessment Of Technical Skills” (OSATS) was applied prior to and after the workshop, and during retention module, which was carried out between three and four months after the suture workshop. Participants were classified according to the level of previous knowledge in sutures. Results: The students showed significant improvement in their scores after the workshop (improvement from 12.9 to 28.5 points, p < 0.001). No significant differences were found between scores after the workshop and those obtained in the retention module (28.5 to 28.1 points, respectively, p = 0.235). No difference in scores were observed when retention was evaluated according to previous knowledge levels. Conclusions: Simulation programs are useful for the acquisition of procedural skills which are retained over time.

Abstract: On this paper, we intend to make a psychological description of Creon as presented in Antigone, Sophocles tragedy. First, we will make a general description of the narcissistic personalities, based on the descriptions that the DSM-V and some authors (particularly Otto Kernberg) make of this personality disorder. Then we will show that Creon’s case corresponds to this psychological description and intend to study the cause of his behavior. Finally, we will answer possible objections that could be made to the fact that we are applying psychological categories to the Greek tragedy. Based on Kierkegaard’s description of the Greek tragedy, we will show that it cannot be understood on purely moral terms and how psychoanalysis allows us to rescue the tragic character of Creon.

Resumen: En este trabajo se intenta realizar un retrato psicológico de Creonte tal como se presenta en Antígona, la tragedia de Sófocles. En primer lugar, se caracteriza a las personalidades narcisistas en general sobre la base de las descripciones que el DSM-V y algunos autores contemporáneos (en particular Otto Kernberg) realizan de este cuadro. Luego se muestra cómo el caso de Creonte corresponde a estas descripciones y se estudia cuál podría ser la causa de su comportamiento. Por último, se responde a una posible objeción a propósito de la pertinencia de aplicar estas categorías psicológicas a la tragedia griega. A la luz de una descripción de Kierkegaard se muestra que la tragedia no puede ser entendida en términos puramente morales y se hace ver cómo el psicoanálisis permite rescatar el carácter trágico de la figura de Creonte.

ABSTRACT Objective Describe the current status of the implementation of the Model of Comprehensive Care in Family and Community Health (MAIS, by its acronym in Spanish) in primary care in Chile. Methods Cross-sectional study that evaluated the implementation of MAIS in a total of 1 263 primary care facilities. Through correlations, the relationship between internal self-evaluation and external evaluation of health services for each center was studied. The factors of facilities, communes and regions associated with the level of implementation of the MAIS were evaluated with multilevel analyses. Results The correlation between internal self-evaluation and the external evaluation of the total implementation of the MAIS was very high (0.819, p <0.001). The technology axis presented the highest implementation (83.0% compliance), and family focus the lowest (37.8% compliance). The facilities with the highest implementation were family health centers, the urban communes, those with the highest number of enrollees and those with the lowest poverty index. A statistically significant association was not identified between the implementation of the MAIS and the total community expenses (p = 0.122) nor specific health expenditures (p = 0.244). Conclusions Most of the primary care health facilities have evaluated the level of implementation of the MAIS. The accompanying strategies for its implementation are priorities for primary care facilities located in rural areas and with a low number of registered users. Improving the family focus and the quality of care —key aspects of health care— are still a challenge.

RESUMEN Objetivo Describir el estado actual de la implementación de Modelo de Atención Integral en Salud Familiar y Comunitaria (MAIS) en la atención primaria de Chile. Métodos Estudio transversal que evaluó la implementación del MAIS en un total de 1 263 establecimientos de atención primaria. Por medio de correlaciones se estudió la relación entre la autoevaluación (interna) y la evaluación de los servicios de salud (externa) para cada centro. Con los análisis multinivel se evaluaron los factores de establecimientos, comunas y regiones asociados con el nivel de implementación del MAIS. Resultados La correlación entre autoevaluación interna y la evaluación externa de la implementación total del MAIS fue muy alta (0,819, p < 0,001). El eje tecnología presentó mayor implementación (83,0% de cumplimiento) y enfoque familiar (37,8% de cumplimiento), el menor. Los centros de salud familiar, las comunas urbanas, aquellas con mayor número de inscritos y con menor índice de pobreza, fueron los establecimientos que presentaron mayor implementación. No se identificó una asociación estadísticamente significativa entre la implementación del MAIS y los gastos comunales totales (p = 0,132) ni específicos de salud (p = 0,244). Conclusiones La mayoría de los establecimientos de salud de atención primaria han evaluado el nivel de implementación del. MAIS. Las estrategias de acompañamiento para su implementación son prioritarias para establecimientos de atención primaria ubicados en zonas rurales y con bajo número de usuarios inscritos. Aún persiste el desafío de avanzar en la instalación del enfoque familiar y la calidad del cuidado como centro de la atención de salud.

RESUMO Objetivo Descrever o estado atual da implementação do Modelo de Assistência Integral em Saúde da Família e da Comunidade (MAIS) na atenção primária no Chile. Métodos Estudo transversal que avaliou a implementação do MAIS em um total de 1 263 estabelecimentos de atenção primária. Por meio de correlações, foi estudada a relação entre a autoavaliação (interna) e a avaliação dos serviços de saúde (externa) para cada centro. Os fatores dos estabelecimentos, municípios e regiões associados ao nível de implementação do MAIS foram avaliados com análises multiníveis. Resultados A correlação entre a autoavaliação interna e a avaliação externa da implementação total do MAIS foi muito alta (0,819, p <0,001). O eixo tecnológico apresentou maior implementação (83,0% de cumprimento) e foco familiar o menor (37,8% de cumprimento). Os centros de saúde da família, as comunas urbanas, aqueles com maior número de inscritos e com o menor índice de pobreza, foram os estabelecimentos que apresentaram a maior implementação. Não foi identificada associação estatisticamente significativa entre a implementação do MAIS e as despesas totais da comunidade (p = 0,122) nem gastos específicos com saúde (p = 0,244). Conclusões A maioria dos estabelecimentos de atenção primária avaliaram o nível de implementação do MAIS. As estratégias de acompanhamento para sua implementação são prioritárias para estabelecimentos de atenção primária em áreas rurais e com baixo número de usuários cadastrados. Enfatiza-se o desafio de avançar na instalação do enfoque familiar e na qualidade de atenção.

Abstract: Three different epistemological approaches to the Law of the Indies can be evidenced throughout the 20th century. First, the one proposed by Rafael Altamira and Ricardo Levene, emphasizing historical and sociological aspects. Alfonso García-Gallo, on the other hand, explores a new perspective that criticizes said vision and stands for a rather markedly legal approach to the matter under consideration. However, this conception is based on a few arguable epistemological assumptions, as this study shows from the hermeneutics᾿ criticism of these types of reductionism. This situation has been worked out by Víctor Tau Anzoátegui who proposes a third conception of the Law of the Indies seeking to integrate both perspectives.

Resumen: A lo largo del siglo XX cabe constatar tres diversas aproximaciones epistemológicas al derecho indiano. La primera, representada por Rafael Altamira y Ricardo Levene, lo estudian poniendo énfasis en los aspectos históricos y sociológicos. Con Alfonso García-Gallo, en cambio, se abre paso una nueva perspectiva, que somete a crítica dicha visión, y aboga por una aproximación de carácter acentuadamente jurídico-legal al objeto de estudio. Con todo, esta concepción parte de algunos supuestos epistemológicos que resultan discutibles, como se muestra en este artículo apoyándose en la crítica que hace la hermenéutica a esas formas de reduccionismo. Estos inconvenientes han sido resueltos por una tercera concepción del derecho indiano, representada por Víctor Tau Anzoátegui, que busca integrar las dos perspectivas anteriores.

In his discussion about the status of the inhabitants of the New World, Ginés de Sepúlveda and Bartolomé de Las Casas evoke arguments from the book I of Aristotle's Politics to justify their position. The first one says that the Indians correspond to what Aristotle understood as slaves by nature. Although Sepúlveda was not in favor of slavery, he considered that it was legitimate to submit them by force to civilize them and dispose them to receive the Christian doctrine. Spaniards, on their behalf, corresponded, according to him, to the Aristotelian model of the masters by nature. Las Casas, on the other hand, seeks to destroy both assumptions. In the case of the indians, he shows that they have virtues that Aristotle attributes to free men, and that they participate in the experience of the polis, thing that manifests itself by the characteristics of their cities, that Las Casas seeks to exalt to achieve a similarity to the Aristotelian model. On the other hand, the bad habits and behavior of the conquerors do not correspond to the ones that a master by nature should have, with which he ends up dismantling the intellectual construction of his contradictor.

En su discusión acerca del estatuto de los habitantes del Nuevo Mundo, Ginés de Sepúlveda y Bartolomé de Las Casas invocan razones tomadas del libro I de la Política para justificar sus respectivas posiciones. El primero de ellos, sostiene que los indios corresponden a lo que Aristóteles entendía por esclavos por naturaleza. Aunque Sepúlveda no era partidario de esclavizarlos, sí consideraba legítimo someterlos por la fuerza, para civilizarlos y disponerlos a recibir la doctrina cristiana. Los españoles, por su parte, correspondían, según él, al modelo aristotélico de los amos por naturaleza. Las Casas, por su parte, busca destruir ambos supuestos. En el caso de los indios, hace ver que gozan de las virtudes que Aristóteles atribuye a los hombres libres y participan de la experiencia de la pólis, como se manifiesta por el carácter de sus ciudades, que Las Casas busca engrandecer, para conseguir que se asemejen al modelo aristotélico. Por otra parte, los vicios y el comportamiento de los conquistadores no corresponden a lo que sería propio de los hombres que son amos por naturaleza, con lo que termina por desmontar la construcción intelectual de su contradictor.

En el "Canto al hombre", recogido en Antígona, Sófocles puso de relieve la ambigüedad moral de la técnica. Ya que puede ser usada tanto para bien como para mal, requiere una orientación superior, representada por las leyes divinas. Este tema es retomado por Aristóteles, aunque sobre bases seculares, con su idea de que hay cosas que son justas o injustas por naturaleza. Para él, la recta orientación de la técnica no depende primeramente del conocimiento de ciertas reglas éticas, sino de la formación del carácter, ya que el conocimiento del bien depende de las disposiciones morales del sujeto.

In the "Ode to Man," in Antigone, Sophocles stressed the moral ambiguity of the technique. Since it can be used for both good and bad, it requires a higher guidance, one represented by divine law. This theme is taken up by Aristotle, but on a secular basis, with his idea that some things are right or wrong by nature. For Aristotle, the straight orientation of the technique does not depend primarily on knowledge of certain ethical rules, but on the formation of character, since knowledge of what is good depends on the moral disposition of the subject.

No "Canto ao homem", coletado em Antígona, Sófocles ressaltou a ambiguidade moral da técnica. Como pode ser usada tanto para bem quanto para mal, requer uma orientação superior, representada pelas leis divinas. Esse tema é retomado por Aristóteles, embora sobre bases seculares, com sua ideia de que há coisas que são justas ou injustas por natureza. Para ele, a reta orientação da técnica não depende primeiramente do conhecimento de certas regras éticas, mas sim da formação do caráter já que o conhecimento do bem depende das disposições morais do sujeito.

Background: Foodborne diseases have increased considerably. Aim: To report a foodborne outbreak, remarking the importance of early notification to activate the epidemiological surveillance system. Results: During February 2011 we observed a Salmonella Enteritidis outbreak. 31.6% of the cases were seen in the same Emergency Care Unit where all required intravenous fluid rehydration, and 41.7% were hospitalized because of severe dehydration. In the Emergency Room 45.5% of cases required a second visit to be diagnosed correctly. Discussion: Physicians under report the cases of this disease, delaying the activation of the epidemiological surveillance system. Conclusions: Besides providing good treatment to patients, physicians need to be qualified to recognize foodborne diseases and communicate early the suspicion of an outbreak to the epidemiological surveillance system in order to prevent new cases of disease in the community.

Introducción: Las enfermedades transmitidas por alimentos (ETA) han aumentado considerablemente. Objetivo: Reportar un grave brote de ETA destacando la importancia de la notificación precoz para la activación del sistema de vigilancia epidemiológica. Resultados: Durante febrero de 2011 se observó un brote de Salmonella Enteritidis. Un 31,6% de los casos fueron atendidos en un mismo servicio de urgencia, donde todos requirieron la administración de fluidos endovenosos y 41,7% fueron hospitalizados por deshidratación grave. El 45,5% de los casos necesitó de una segunda consulta para ser diagnosticados correctamente. Discusión: La identificación de pacientes integrantes de un brote de ETA es difícil en los servicios de urgencia y los médicos sub-reportan los casos, retrasando al sistema de vigilancia epidemiológica. Conclusiones: Junto con brindar un adecuado tratamiento, los médicos deben estar capacitados para reconocer las ETA y comunicar tempranamente la sospecha de un brote para prevenir nuevos casos en la comunidad.

Background: During the last few years, multiple new medical schools have emerged in Chile, associated to the constant preoccupation to provide a good quality medical care. This created the need to evaluate medical training programs and to open a discussion about the attributes that a good physician should have. Aim: To evaluate the medical student's perception of the ideal medical doctor profile. Material and methods: An analytical, descriptive and cross sectional study was designed. Eleven second year, 11 third year, nine fourth year, 13 fifth year, 6 sixth year and 8 seventh year students were studied. Data collection was gathered by focus groups. Codes and triangulation were used for data analysis. Results: As attitudes and moral-ethical values, students valued the absence of discrimination a listening attitude and empathy. Among job related issues, they valued responsibility and punctuality. Emotional and legal self-care were valued as self related attitudes. Among skills, competences and capacities, a value was given to communicational skills, team work and professional easiness. Knowledge about medical and non medical topics was appraised. The valued attributes among duties and activities were patient diagnosis, treatment and education, team leadership and continuous medical training. Conclusions: These findings should help to design new curricula for medical schools (Rev Méd Chile 2006; 134: 947-54)