Background: The main prognostic factor for gastric cancer is the stage at the time of diagnosis, and it is essential to evalúate improvements in obtaining early-stage diagnoses. In Chile there are no studies focused on this point. Aim: To compare the cases of gastric cancer in the periods 2006-2011 and 2012-2017 in the Hospital Base Osorno and to evalúate any improvement in the stage at diagnosis during the second period. Materials and Method: A retrospective cohort study was carried out based on a prospective database from the Hospital Base San Jose Osorno. The analysis period was between January 2006-December 2017.The collected cases were divided into 2 groups according to the date of diagnosis: period 2006-2011 (G1) and period 2012-2017 (G2). Fisher test and x2 were applied. Results: A total of 353 patients were included, 233 (66%) were male, mean age of 64,34 (24-87). 182 (51.55%) patients with pathological staging and 171 (49.45%) with clinical staging. Both periods were evaluated in each group. There were no significant differences in demographic characteristics. In patients with pathological staging, G2 had a higher detection of incipient cancer but it was not significant p 0.201. In patients with clinical staging, there was a decrease in the proportion of stage IV diagnoses 59 (49.58%) p < 0.001. Conclusión: There was a statistically significant increase in the detection of gastric adenocarcinoma in clinical staging. Further studies are required to evaluate new factors.

Resumen Introducción: El principal factor pronóstico del cáncer gástrico es la etapa al momento del diagnóstico, siendo indispensable evaluar la mejoría en la obtención de diagnósticos estadios precoces. En Chile no existen estudios focalizados en este punto. Objetivos: Comparar los casos de cáncer gástrico en los períodos 2006-2011 y 2012-2017, en el Hospital Base Osorno y evaluar si se logró una mejora en el estadio al momento del diagnóstico en el segundo período. Materiales y Método: Estudio de cohorte retrospectivo, sobre base de datos prospectiva del Hospital Base San José Osorno. El período de análisis fue enero 2006-diciembre 2017. Los casos recopilados se dividieron en 2 grupos según fecha de diagnóstico: período 2006-2011 (G1) y período 2012-2017(G2). Para realizar el análisis se aplicó test estadístico de Fisher y x2. Resultados: Se incluyeron en total 353 pacientes, 233 (66%) corresponden a sexo masculino, con edad promedio de 64,34 (24-87). 182 (51,55%) pacientes con etapificación patológica y 171 (49,45%) con etapificación clínica. Se evaluaron ambos períodos en cada grupo. No hubo diferencias significativas en las características demográficas. En los pacientes con etapificación patológica el G2 hubo mayor detección de cáncer incipiente pero no fue significativo p 0,201. En los pacientes con etapificación clínica hubo una disminución en la proporción de diagnósticos en etapa IV 59 (49,58%) p < 0,001. Conclusión: Existió un aumento estadísticamente significativo en la detección de adenocarcinoma gástrico en etapificación clínica, se requieren mayores estudios para evaluar nuevos factores.

Neuromas of the bile duct develop from the sympathetic and parasympathetic nerve fibers that surround the wall of the bile duct. A 44-year-old woman with a history of conventional cholecystectomy six months prior to hospital admission attended emergency due to obstructive jaundice that lasted 15 days. In the imaging studies, the presence of a mass at the level of the bile ducts is considered, considering the diagnosis of a malignant neoplasm. Due to the antecedents, the absence of tumor markers, it was decided to perform a percutaneous biopsy without conclusive results, performing later a surgical intervention with anatomopathological study compatible with neuroma of biliary tract amputation. The amputation neuroma at the level of the bile duct is an infrequent tumor. It can manifest clinically as obstructive jaundice and usually simulates a malignant tumor of the bile ducts. Surgical management is the definitive treatment.

Los neuromas del conducto biliar se desarrollan a partir de las fibras nerviosas simpáticas y parasimpáticas que envuelven la pared de la vía biliar. Mujer de 44 años de edad con antecedente de colecistectomía convencional seis meses previos al ingreso acude a emergencia por ictericia obstructiva de 15 días de evolución. En los estudios de imagen impresiona la presencia de una masa a nivel de las vías biliares considerándose el diagnostico de una neoplasia maligna. Por los antecedentes, ausencia de marcadores tumorales se decide realizar una biopsia percutánea sin resultados concluyente, realizándose posteriormente una intervención quirúrgica con estudio anatomo-patológico compatible con neuroma de amputación de vía biliar. El neuroma de amputación a nivel de la vía biliar es un tumor infrecuente. Puede manifestarse clínicamente como una ictericia obstructiva y suele simular a un tumor maligno de las vías biliares. El manejo quirúrgico es el tratamiento definitivo.

ABSTRACTThe objective of this experiment was to quantify the effects of feeding polymer-coated slow-release urea on nutrient intake and total tract digestion, milk yield and composition, nutrient balances, ruminal fermentation, microbial protein synthesis, and blood parameters in dairy cows. Sixteen Holstein cows (580±20 kg of live weight (mean ± standard deviation); 90 to 180 days in milk (DIM); and 28 kg/d of average milk yield) were used in a replicated 4 × 4 Latin square experimental design. The animals were assigned to each square according to milk yield and DIM. The animals were randomly allocated to receive one of the following experimental diets: 1) control (without urea addition); urea (addition of 1% on the diet DM basis); polymer-coated slow release urea 1 (addition of 1% on the diet DM basis); and polymer-coated slow release urea 2 (addition of 1% on the diet DM basis). All diets contained corn silage as forage source and a 50:50 forage:concentrate ratio. Milk and protein yield, production of volatile fatty acids, and propionate decreased when cows were fed diets containing urea. Addition of urea decreased nitrogen efficiency and nitrogen excreted in the feces. However, the diets did not change the cows' microbial protein synthesis, ruminal pH, or ammonia concentration. The inclusion of urea in cow diets decreases milk and protein yield due to lower production of volatile fatty acids. No advantages are observed with supplementation of polymer-coated slow-release urea when compared with feed-grade urea.

The objective of this study was to evaluate the utilization of different sources of unsaturated long-chain fatty acids in diets for dairy cows during the transition period and early lactation on the milk fatty acid profile and composition of the protein fraction. Thirty-six Holstein cows were divided into three groups, fed the following diets: control (C); soybean oil (SO); and calcium salts of long-chain unsaturated fatty acids (CS). The milk samples utilized for analysis were obtained weekly from parturition to twelve weeks of lactation; each one of the samples originated from two daily milkings. Milk composition and total nitrogen, non-protein nitrogen and non-casein nitrogen levels were analyzed. The cows receiving the diet with calcium salts had lower concentrations of non-protein nitrogen (%CP) in milk compared with the animals fed the diet with soybean oil. There was a decrease in concentration of medium-chain fatty acids C12-C16, and a concomitant increase in concentrations of long-chain fatty acids >C18 in milk fat for the animals fed the diets CS and SO when compared with diet C. Soybean oil and CS diets increased milk-fat concentrations of the acids C18: 1 trans-11, C18: 2 cis-9, trans-11 and C18: 2 trans-10 cis-12 in relation to diet C. The utilization of sources of long-chain fatty acids in the diet of dairy cows increases the biological value of milk in early lactation due to higher concentrations of specific fatty acids such as CLA C18: 2cis-9, trans-11.

This research was conducted with objective to evaluate the effect of different zinc (Zn) sources and doses in the diet for Santa Ines sheep. Forty lambs at weaning, with 18.4 kg of body weight were supplemented with three different sources of zinc (zinc oxide (ZnO), zinc amino acid and zinc proteinate) and three doses of zinc (200, 400 and 600 mg/kg DM) added to the basal diet. At every 28 days, animals were weighted and blood samples were collected for analyses of zinc (Zn), alkaline phosphatase and immunoglobulin G (IgG) and M (IgM). At the end of experiment, liver samples were collected for determination of the hepatic zinc levels. Zinc was analyzed with atomic absorption spectrophotometer, while phosphatase alkaline and immunoglobulins G and M were analyzed using Laborlab and Bioclin kits, respectively. There was no effect of diets on phosphatase alkaline levels and hepatic zinc, but there was difference in the plasmatic zinc levels and IgG and IgM levels. Based on the accumulation of hepatic zinc, the estimate of the zinc bioavailability, through the regression equation, showed that supplementation with organic and inorganic sources of zinc did not differ in the diet of Santa Ines sheep.

O objetivo deste trabalho foi avaliar a utilização de diferentes fontes de gordura nas rações de vacas em lactação e seus efeitos sobre o consumo de matéria seca e as concentrações dos parâmetros sangüíneos. Foram utilizadas 12 vacas da raça Holandês, agrupadas em três quadrados latinos balanceados 4x4 e alimentadas com as seguintes rações: 1) controle; 2) óleo de soja refinado; 3) grão de soja in natura; e 4) sais de cálcio de ácidos graxos (Megalac-E). As concentrações de colesterol total, colesterol, lipoproteína de baixa densidade (LDL) e colesterol de alta densidade (HDL) foram maiores (P<0,05) para as vacas alimentadas com as rações contendo fontes de gordura em relação à ração controle. As concentrações de uréia e nitrogênio ureico no soro foram semelhantes entre as rações utilizadas, com exceção da ração contendo sais de cálcio de ácidos graxos, que apresentou concentrações menores (P<0,05). O consumo de matéria seca foi menor (P<0,05) nas vacas que receberam sais de cálcio nas rações. Os animais que receberam a ração contendo grão de soja como fonte de gordura apresentaram menor (P<0,05) produção de leite quando comparada às demais rações utilizadas. A utilização de fontes de gordura em rações de vacas em lactação alterou os parâmetros sanguíneos, dependendo da fonte de gordura utilizada.

This study was carried out to evaluate the use of different fat sources in dairy cows rations and its effects on dry matter intake, milk yield and composition, and blood parameter. Twelve Holstein cows were allocated in three balanced latin square 4x4, and fed with the following rations: 1) Control, with 2.5%; 2) Refined soybean oil; 3) Whole soybean; and 4), Calcium salts of fatty acids (Megalac-E). The concentrations of total cholesterol and lipoprotein low density (LDL) were higher (P<0.05) for cows that received rations with fat sources, which also causes increased (P<0.05) e concentration of high density lipoprotein (HDL). The concentrations of urea and blood urea nitrogen were similar among the rations, except for the diet containing calcium salts of fatty acids, which showed lower (P<0.05). The dry matter intake was lower (P<0.05) in cows that received calcium salts in the rations. The animals that received a diet containing whole soybeans as a source of fat had lower (P<0.05) yield milk when compared to other rations used. The use of fat sources in dairy cows rations influenced the blood parameters, especially for parameters related to lipidogram.

Resumo: A pesquisa em Capacitação Docente e Educação Médica visa formar profissionais de saúde com novas atitudes, habilidades, conhecimentos e competências, que realmente contribuirão para ampliar a equidade, a qualidade, a eficiência e a relevância no processo global de atenção à saúde. O Brasil ingressou no movimento inovador de educação em saúde: a capacitação docente é necessária para favorecer a evolução em educação, não havendo mais justificativas aceitáveis que a impeçam, nem para persistir numa educação baseada unicamente na repetição de fórmulas comprovadamente ultrapassadas. A capacitação de tutores, orientadores, consultores, preceptores e de outros docente comprometidos com os novos modelos educacionais deve reconhecer que aprender é mais importante que ensinar, e que os estudantes devem ser ativos e guiados por problemas de saúde reais e prioritários. A atenção às competências profissionais esperadas e necessárias permitirá que os futuros profissionais obtenham conhecimentos e habilidades para abordar problemas de saúde e participar das soluções dos mesmos. Numa educação de vanguarda em saúde é necessário incluir a prevenção de doenças, o estabelecimento de prioridades, o desenvolvimento de habilidades para o trabalho interdisciplinar e a responsabilidade no estabelecimento de um melhor sistema de saúde, onde todos possam ser incluídos. Iniciativas impetuosas voltadas para a promoção de mudanças educacionais baseadas em simples cópia de modelos educacionais importados são imprudentes e perigosas. Os autores discutem alguns aspectos gerais da capacitação docente voltada para o desenvolvimento da educação em saúde no contexto da América Latina.

Abstract: Faculty Development and Medical Education research aim at produce better health professionals, with new attitudes, skills, awareness and abilities that will truly help increase equity, quality, efficiency and relevance of the entire health process. Brazil has joined the health education innovation movement: Faculty training to enhance the contribution of educators is now recognized, since there is no time for excuses or for insisting on spontaneity or intuitive education. Training of tutors, facilitators, evaluators, planners, advisors, preceptors, evidence-based professionals, and educators should take into account that learning is more important than teaching and that students play an active role in the process, focused on real health priorities. Focusing on necessary professional competencies will provide future professionals with both the knowledge and professional skills to approach health problems and participate in the appropriate solutions. Education in health promotion and disease prevention, addressing health priorities, and the development of a better sense of inter-disciplinarity and better contributing to health for all must be included. Hasty attempts to promote change or to establish educational clones general aspects of faculty development that aim to improve education for health professionals in the Latin American context.