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Como consecuencia de la pandemia por covid-19, se ha forzado de manera abrupta la transformación digital de las prácticas de trabajo, lo cual no sólo ha impactado al ámbito laboral, sino también a la educación en todos sus niveles. El propósito de este estudio fue explorar el significado que adquiere para los estudiantes de quinto año de Psicología de la Universidad de Talca la experiencia de realización de su práctica profesional de manera completamente online. Para ello, desde un enfoque cualitativo, se realizaron tres entrevistas semiestructuradas a estudiantes de Psicología de diferentes menciones. Los relatos fueron analizados mediante análisis de contenido. En los resultados destaca la presencia de autonomía en el trabajo y la importancia del apoyo social como un factor que afecta tanto la percepción del proceso de práctica como el aprendizaje obtenido. La experiencia de práctica profesional fue caracterizada como una experiencia de profundo aprendizaje, tanto de la mención que escogieron como a nivel personal. Se concluye que la experiencia de práctica profesional en estudiantes de Psicología es percibida como una experiencia previa al mundo laboral que deberán enfrentar como psicólogos, siendo ésta la instancia que forma sus expectativas laborales futuras.

Resumen El presente artículo expone los resultados de una investigación empírica que se ha adentrado en las experiencias y discursos ciudadanos respecto del tema de la muerte en dignidad, y de la legitimidad de la implementación de medidas de acompañamiento de este proceso. A través del análisis de lo obtenido en siete grupos de discusión, llevados a cabo en la Región Metropolitana de Santiago de Chile, se ha podido concluir la existencia de altos niveles de consenso en la ciudadanía, respecto de la legitimidad de implementar medidas externas para terminar con la vida de pacientes que lo soliciten debido al padecimiento de enfermedades terminales, y de la necesidad de contar con una normativa legal que respalde su aplicación. Todo esto en el marco de una amplia valoración ciudadana de la autonomía personal y desde la narración de experiencias que revelan los grandes costos emocionales y monetarios que implica el cuidado de personas con enfermedades terminales. Abstract This article presents the results of empirical research that investigates the citizen's perspectives regarding the issue of death with dignity and the legitimacy of the implementation of measures to accompany this process. Through the implementation and analysis of seven discussion groups, carried out in the Metropolitan Region of Santiago de Chile, it can be concluded that there are high levels of consensus among the citizens supporting the need for implementation of external measures to end the life of patients who request it due to suffering related to terminal illnesses, and the need to have legal regulations that supports its application. All of this has been evaluated within the framework of a broad citizen assessment of personal autonomy and from the narration of experiences that reveal the great emotional and monetary burden involved in the process of caring for people with terminal illnesses. Resumo O presente artigo expõe os resultados de uma investigação empírica que adentrou as experiências e discursos cidadãos a respeito do tema da morte com dignidade e da legitimidade da implementação de medidas de acompanhamento deste processo. Através da análise do obtido em sete grupos de discussão, levados a cabo na Região Metropolitana de Santiago do Chile, se pode demonstrar a existência de altos níveis de consenso entre as pessoas no que diz respeito à legitimidade de implementar medidas externas para terminar com a vida de pacientes que as solicitem devido ao padecimento de enfermidades terminais e da necessidade de contar com uma normativa legal que respalde sua aplicação. Tudo isto no contexto de uma ampla valorização cidadã da autonomia pessoal e a partir da narrativa de experiências que revelam os grandes custos emocionais e econômicos implicados no cuidado de pessoas com enfermidades terminais.

BACKGROUND: Laparoscopic Nissen fundoplication fails to control the gastroesophageal reflux in almost 15% of patients, and most of them must be reoperated due to postoperative symptoms. Different surgical options have been suggested. AIMS: This study aimed to present the postoperative outcomes of patients submitted to three different procedures: redo laparoscopic Nissen fundoplication alone (Group A), redo laparoscopic Nissen fundoplication combined with distal gastrectomy (Group B), or conversion to laparoscopic Toupet combined with distal gastrectomy with Roux-en-Y gastrojejunostomy (Group C). METHODS: This is a prospective study involving 77 patients who were submitted initially to laparoscopic Nissen fundoplication and presented recurrence of gastroesophageal reflux after the operation. They were evaluated before and after the reoperation with clinical questionnaire and objective functional studies. After reestablishing the anatomy of the esophagogastric junction, a surgery was performed. None of the patients were lost during follow-up. RESULTS: Persistent symptoms were observed more frequently in Group A or B patients, including wrap stricture, intrathoracic wrap, or twisted fundoplication. In Group C, recurrent symptoms associated with this anatomic alteration were infrequently observed. Incompetent lower esophageal sphincter was confirmed in 57.7% of patients included in Group A, compared to 17.2% after Nissen and distal gastrectomy and 26% after Toupet procedure plus distal gastrectomy. In Group C, despite the high percentage of patients with incompetent lower esophageal sphincter, 8.7% had abnormal acid reflux after surgery. CONCLUSIONS: Nissen and Toupet procedures combined with Roux-en-Y distal gastrectomy are safe and effective for the management of failed Nissen fundoplication. However, Toupet technique is preferable for patients suffering from mainly dysphagia and pain. RESUMO RACIONAL: A fundoplicatura de Nissen laparoscópica falha em controlar o refluxo gastroesofágico em quase 15% dos pacientes e a maioria deles deve ser reoperada devido aos sintomas. Diferentes técnicas cirúrgicas têm sido sugeridas. OBJETIVOS: Apresentar os resultados pós-operatórios de pacientes submetidos a 3 procedimentos diferentes: Reoperação e fundoplicatura de Nissen laparoscópica apenas (Grupo A), reoperação e fundoplicatura de Nissen laparoscópica combinado com gastrectomia distal (Grupo B) ou reoperação e conversão para Toupet laparoscópico combinado com gastrectomia distal e reconstrução em Y-Roux (Grupo C). MÉTODOS: estudo prospectivo incluindo 77 pacientes submetidos inicialmente a fundoplicatura de Nissen laparoscópica que apresentaram recidiva do refluxo gastroesofágico após a operação. Eles foram avaliados antes e após a reoperação com questionário clínico e estudos funcionais específicos. Reestabelecida a anatomia da junção esôfago-gástrica, procedeu-se às referidas cirurgias. Nenhum paciente perdeu seguimento. RESULTADOS: Os sintomas persistentes foram observados com maior frequência nos pacientes dos Grupos A ou B, associados à estenose da fundoplicatura, fundoplicatura intratorácico ou fundoplicatura torcida. No Grupo C, os sintomas recorrentes associados a essa alteração anatômica foram observados com pouca frequência. Esfincter esofágico inferior incompetente foi confirmado em 57,7% dos pacientes pertencentes ao Grupo A em comparação com 17,2% após fundoplicatura de Nissen laparoscópica combinado com gastrectomia distal, e 26% após a Toupet laparoscópico combinado com gastrectomia distal e reconstrução em Y-Roux. Nesse grupo, apesar do alto percentual de pacientes com esfincter esofágico inferior incompetente, 8,7% apresentaram refluxo ácido anormal após a cirurgia. CONCLUSÕES: As técnicas de Nissen ou Toupet combinados com a gastrectomia distal em Y de Roux são seguras e eficazes para o manejo da falha da fundoplicatura a Nissen. A técnica de Toupet é preferível para pacientes que sofrem principalmente com disfagia e dor.

Deep structural transformations aimed at strengthening climate action and community participation are occurring in Chile, especially after the social unrest of October 2019. The ongoing political crisis has even generated the unprecedented possibility of writing a new constitution through an entirely democratic process. This article explores to what extent these structural transformations are also associated with cognitive and relational changes in the population, especially in terms of community participation. An online survey (n = 1.117) was applied to people over 18 years old in Punta Arenas in November 2020. This is the southernmost city of the American continent, one of the areas most affected by climate change, highly isolated from the rest of the country, and with a strong regional ecological identity. Results show that climate change is perceived as the main environmental problem affecting the city, with multiple negative consequences, but also with some potentially positive impacts. At the same time, environmental and constitutional expectations suggest the state of the environment is deemed to be critical for the future of the city. However, a traditional top-down understanding of community participation still prevails as most participants perceive the citizens’ role in dealing with environmental issues as limited to individual, passive, and reactive actions, or reduced to being responsible consumers. These results show that transforming institutions, rules and regulations alone does not guarantee a broader engagement of local communities in more ambitious, committed, and lasting climate action, even with a high climate change concern in the population. Creating strategies aimed at more profound cognitive and relational changes from a bottom-up perspective will also be necessary to avoid negative transformation trajectories.

Background: The identification of prognostic factors of esophageal cancer has allowed to predict the evolution of patients. Aim: Assess different prognostic factors of long-term survival of esophageal cancer and evaluate a new prognostic factor of long-term survival called lymphoparietal index (N+/T). Method: Prospective study of the Universidad de Chile Clinical Hospital, between January 2004 and December 2013. Included all esophageal cancer surgeries with curative intent and cervical anastomosis. Exclusion criteria included: stage 4 cancers, R1 resections, palliative procedures and emergency surgeries. Results: Fifty-eight patients were included, 62.1% were men, the average age was 63.3 years. A total of 48.3% were squamous, 88% were advanced cancers, the average lymph node harvest was 17.1. Post-operative surgical morbidity was 75%, with a 17.2% of reoperations and 3.4% of mortality. The average overall survival was 41.3 months, the 3-year survival was 31%. Multivariate analysis of the prognostic factors showed that significant variables were anterior mediastinal ascent (p=0.01, OR: 6.7 [1.43-31.6]), anastomotic fistula (p=0.03, OR: 0.21 [0.05-0.87]), N classification (p=0.02, OR: 3.8 [1.16-12.73]), TNM stage (p=0.04, OR: 2.8 [1.01-9.26]), and lymphoparietal index (p=0.04, RR: 3.9 [1.01-15.17]. The ROC curves of lymphoparietal index, N classification and TNM stage have areas under the curve of 0.71, 0.63 and 0.64 respectively, with significant statistical difference (p=0.01). Conclusion: The independent prognostic factors of long-term survival in esophageal cancer are anterior mediastinal ascent, anastomotic fistula, N classification, TNM stage and lymphoparietal index. In esophageal cancer the new lymphoparietal index is stronger than TNM stage in long-term survival prognosis.

Introducción: El tumor fibroso solitario del hígado (TFSH) constituye un hallazgo tan raro que se ha publicado únicamente como reportes de caso y hasta el presente se encontraron sólo 45 casos publicados en la literatura inglesa. El presente artículo describe el caso de un paciente que fue tratado en nuestra institución por un TFSH. Reporte de caso: Paciente masculino de 59 años de edad al que, en una tomografía abdominal computarizada que se tomó por otras causas, se encontró en forma incidental un gran tumor hepático localizado en el lóbulo caudado del hígado. El paciente no refería síntomas relacionados con el tumor. En la cirugía se observó que el tumor se originaba directamente del lóbulo caudado al cual lo unía un pedículo de aproximadamente 3 cm de diámetro transverso. Se seccionó el tumor desde su base de implantación en el hígado ligándose los vasos arteriales y venosos así como los conductos biliares que se encontraron. Este medía 15 x 9 x 6 cm y pesaba 794 g, se encontraba bien encapsulado. El diagnóstico histológico fue el de un TFSH, el cual se confirmó mediante inmunohistoquímica con anticuerpos monoclonales que resultaron positivos para CD34 y vimentina en las células tumorales y negativos para CD117, S100, α-actina de músculo liso y desmina. Conclusiones: El TFSH es un tumor raro. El presente caso de un TFSH es el primero reportado en la literatura médica chilena y presentó las características radiológicas, quirúrgicas y patológicas habitualmente descritas en estos casos.

Se indaga la relación entre el procesamiento traumatogénico de experiencias de violencia sexual en niñas, con bcaracterísticas de la victimización sufrida. Una muestra de 40 niñas víctimas de violencia sexual respondió una escala de sentimientos de estigmatización, indefensión, traición y culpa, mientras que el profesional tratante completó una ficha sociodemográfica con datos de la vulneración ocurrida. Los resultados sugieren que; abusos más intrusivos, crónicos, con empleo de fuerza e intrafamiliares se relacionan con mayores puntajes en los sentimientos de estigmatización, indefensión, traición y culpa. Adicionalmente, la edad de la víctima y el apoyo familiar ante la develación arrojaron correlaciones con el procesamiento traumatogénico de experiencias de violencia sexual.

Performance of Boey score and physiologic Portsmouth-POSSUM in patients with perforated peptic ulcer Introduction: Surgical scores such as Boey and physiologic Portsmouth-POSSUM have been in-dependently applied to patients with perforated ulcer to stratify their surgical risk. However,there are no studies comparing both scores. The purpose of this study was to compare the performance of Boey score and Portsmouth-POSSUM in patients with perforated peptic ulcer. Methods: A retrospective comparative study was performed including 108 consecutive patients older than 15-years submitted to emergency surgery from January 2002 to June 2012. Patients operated on for perforated gastric cancer were excluded. The primary outcome measure was to compare the performance of Portsmouth-POSSUM and Boey score. Secondary outcome measures were to determine cutoff points for Portsmouth-POSSUM, Boey score, C-reactive protein (CRP), and white blood cells (WBC) count, to predict patients at risk for complications.

Simultaneous surgical management of a patient with distal pancreatic cancer, gastric gastrointestinal tumors (GIST) and hepatic hemangioma Introduction: The occurrence of gastric Gastrointestinal Stromal Tumors (GIST) associated to pancrea- tic adenocarcinoma has been reported in 0.2% pancreatic cancers. There are no published reports on distal pancreatic adenocarcinoma associated to gastric antral GIST and the surgical management of this clinical condition. Case report: Herein, we discuss a 75 years-old female patient who was admitted to our institution with upper digestive hemorrhage. The endoscopy showed large, superficial erosions over the cardia and on the posterior wall of the antrum a rounded sub-mucosal non-eroded lesion suspected of gastric GIST. An ab- dominal computed tomography scan found a hepatic hemangioma on the left hepatic lobe. In the pancreatic distal body and tail a solid exophytic lesion was identified. In the gastric antrum a rounded submucosal tumor in close contact with the pancreatic lesion was found. The patient was subjected to distal pancreatectomy, splenectomy, and distal gastrectomy. The biopsy identified a well-differentiated ductal adenocarcinoma locali - zed in the pancreatic tail and the proximal part of the body, resected with negative margins. The gastric tumor was positive for CD117, CD34, and DOG-1; it had a positive Ki67 in less than 2%, and 2 or less mitoses per 50 high-power fields. Conclusion. This uncommon case illustrates the occurrence of synchronous tumors of different cellular origins incidentally diagnosed and their simultaneous surgical treatment. The individual incidence of these tumors is low and if associated they probably will continue to be found incidentally.

Introducción: La progresión de la respuesta inflamatoria sistémica en pacientes con apendicitis desde el inicio de los síntomas hasta el diagnóstico no ha sido caracterizada. Los objetivos del presente estudio son describir y caracterizar la respuesta inflamatoria sistémica a la apendicitis. Pacientes y Métodos: Se realizó un estudio descriptivo. Ciento ochenta y tres pacientes fueron estudiados y divididos en cuatro grupos de acuerdo al tiempo transcurrido entre el inicio de los síntomas y el diagnóstico. El objetivo principal fue determinar la respuesta inflamatoria sistémica a la apendicitis de acuerdo a los grupos de tiempo establecidos. El objetivo secundario fue el análisis de la proteína C reactiva para el mismo propósito. Resultados: La variable leucocitosis de la respuesta inflamatoria sistémica de acuerdo con los períodos de evolución no mostró diferencias significativas. La temperatura y la frecuencia cardíaca se elevan constantemente después de 48 h llegando a su nivel máximo después de las 72 h (p = 0,001). La frecuencia respiratoria aumenta después de 73 h de evolución (p < 0,0001). Después de las 73 h desde el inicio de los síntomas, la mayoría de los pacientes presentan 3 ó 4 variables del síndrome de respuesta inflamatoria sistémica. La proteína C reactiva se eleva progresivamente mostrando sus valores máximos después de 48 h (p = 0,005). Conclusiones: La respuesta inflamatoria sistémica a la apendicitis es progresiva y más marcada a lo largo del tiempo desde el inicio de los síntomas hasta el diagnóstico.

Primary thyroid lymphoma is uncommon and usually of non-Hodgkin type. We report four female patients with thyroid lymphoma. An 81 year-old patient that was operated and received three cycles of chemotherapy and was lost from follow up. A 16 year-old patient that is operated and received full chemotherapy and was discharged free of disease. A 80 year-old patient that was operated and died due to a multiple organ failure, 50 days after hospital admission and a 54 year-old female that was operated but rejected chemotherapy and was lost from follow up.

Peer methodology (PM) is an adaptation of the privileged access interviewer methodology and is used for prevalence studies. PM estimates higher drug consumption frequencies among school and college students than self reports, since it minimizes underreporting.To assess drug abuse among students using PM.A random sample of 234 school students of middle and low-middle socioeconomic status, aged 9 to 14 years (53% women) were interviewed using PM about drug consumption.The frequency of illicit drug consumption during the last year was 29% and 15% during the last month (current consumption). The consumption of tobacco and alcohol was 20% and 18% respectively during the last year. The figures for the last month were 11% and 8% respectively. The beginning age for smoking and alcohol consumption were 11.1 +/-1.5 and 11.3+/- 1.8 years respectively. The frequency of illicit drug consumption was 3.5%. Illicit drug users began illicit drug consumption at earlier ages their non user peers.There is a high frequency of illicit drug consumption among school age children.

Primary thyroid lymphoma is uncommon and usually of non-Hodgkin type. We report four female patients with thyroid lymphoma. An 81 year-old patient that was operated and received three cycles of chemotherapy and was lost from follow up. A 16 year-old patient that is operated and received full chemotherapy and was discharged free of disease. A 80 year-old patient that was operated and died due to a multiple organ failure, 50 days after hospital admission and a 54 year-old female that was operated but rejected chemotherapy and was lost from follow up.

Background: Peer methodology (PM) is an adaptation of the privileged access interviewer methodology and is used for prevalence studies. PM estimates higher drug consumption frequencies among school and college students than self reports, since it minimizes underreporting. Aim: To assess drug abuse among students using PM. Material and methods: A random sample of 234 school students of middle and low-middle socioeconomic status, aged 9 to 14 years (53% women) were interviewed using PM about drug consumption. Results: The frequency of licit drug consumption during the last year was 29% and 15% during the last month (current consumption). The consumption of tobacco and alcohol was 20% and 18% respectively during the last year. The figures for the last month were 11% and 8% respectively. The beginning age for smoking and alcohol consumption were 11.1 ±1.5 and 11.3± 1.8 years respectively. The frequency of illicit drug consumption was 3.5%. Illicit drug users began licit drug consumption at earlier ages their non user peers. Conclusions: There is a high frequency of illicit drug consumption among school age children.

Se presenta el caso de una mujer en la edad media de la vida, hipertensa en tratamiento, con el antecedente de cirugía bariátrica, que desarrolla cuadro de masa cervical asintomática en la que, luego de descartar otras patologías por imágenes y evolución, se diagnosticó Angioedema cervical, el que tuvo regresión total, prácticamente espontánea, en los días siguientes.

ResumenIntroducciónLa hernioplastia incisional laparoscópica en casos seleccionados presenta evidentes ventajas en términos de recuperación posoperatoria y complicaciones, y es comparable en términos de recurrencia; sin embargo, esta técnica no constituye la técnica de elección en la reparación de las hernias incisionales. En el presente estudio proponemos la hernioplastia laparoscópica como la técnica de elección en hernias incisionales primarias de la línea media supraumbilical con un anillo herniario no mayor de 10cm sin pérdida de domicilio.Pacientes y métodoEstudio prospectivo descriptivo de casos y controles consecutivos seleccionados de pacientes operados de hernia incisional mediante técnica laparoscópica y técnica abierta, en cuyo seguimiento y evaluación se aplicaron instrumentos de medición de resultados y complicaciones, previamente descritos y validados, sin intervención directa en los resultados quirúrgicos de la muestra en estudio.ResultadosSe estudiaron 112 pacientes con hernias incisionales de tipo M2, de los cuales 28 fueron operados con cirugía laparoscópica y 84 con cirugía abierta. Ambos grupos fueron comparables en términos de características generales de los pacientes y de sus hernias. Las complicaciones fueron más frecuentes en el grupo de pacientes operados mediante la técnica abierta, y las relacionadas con piel fueron las más importantes. Todos los pacientes cumplieron con el seguimiento de 2 años. En este periodo se midieron los resultados con el instrumento disponible. Se evidenciaron como mejores resultados los de la técnica laparoscópica.ConclusionesLos resultados de la hernioplastia laparoscópica en hernias incisionales seleccionadas de la línea media supraumbilical demuestran la superioridad de esta técnica sobre la hernioplastia intraperitoneal abierta.AbstractIntroductionLaparoscopic incisional hernioplasty has demonstrated advantages in selected cases in terms of postoperative recuperation and complications, and it is comparable in recurrence to open incisional hernioplasty; however, this technique does not constitute the gold standard for incisional hernia repair. We recommend that laparoscopic incisional hernioplasty should be considered the gold standard technique to repair upper midline incisional hernias with rings of less than 10cm and without loss of domain.Patients and methodsProspective case-control study of patients operated for incisional hernia with laparoscopic and open techniques that were followed-up with previously validated instruments for the measurement of incisional hernia outcomes and postoperative complications, without direct intervention over the study population.ResultsOne-hundred twelve patients with M2 incisional hernia were included, of them 28 were submitted to laparoscopic surgery and 84 to open surgery. Both groups of patients were comparable in their general and hernia characteristics. Complications were more common in patients submitted to open surgery, being skin-related complications the most frequent. All patients complied with the two-year follow-up. During this period, outcomes were measured with the available instrument, evidencing the better outcomes of the laparoscopic technique.ConclusionsThe outcomes of laparoscopic incisional hernioplasty in selected upper midline hernias showed the superiority of this technique compared with the open technique.

ResumenEn el presente artículo se discute un caso muy raro de hernia incisional lumbar complicada, secundaria a artroplastia total de cadera. Se trata de una paciente con el antecedente de artroplastia bilateral de cadera (5 años atrás en otra institución), hospitalizada por pancreatitis aguda edematosa que se trató en forma conservadora. En el momento del ingreso se tomó una tomografía abdominal que describía, como hallazgo incidental, la presencia de una hernia lumbar izquierda en estrecha relación con una prótesis de cadera. Notablemente, la paciente refería solo ocasionales molestias inespecíficas en el sitio de su hernia. En el día 30.̊ de hospitalización la hernia se incarceró y posteriormente se estranguló. La severidad de esta complicación llevó al fallecimiento de la paciente. A pesar de su rareza, estas hernias deben incluirse dentro del diagnóstico diferencial de cualquier masa lumbar y de las complicaciones tardías en pacientes sometidos a artroplastia de cadera.AbstractThis article discusses an uncommon case of complicated incisional lumbar hernia secondary to total hip arthroplasty. A female patient with the antecedent of bilateral total hip arthroplasty 5 years ago at another institution was hospitalized for acute edematous pancreatitis, conservative treatment was instituted. An initial abdominal computerized tomography showed the incidental finding of a left lumbar hernia in close relationship with a hip prosthesis. Remarkably, the patient had only occasional unspecific nuisances located over her hernia. During the 30th day of hospital stay, the incisional hernia became incarcerated and the intestinal contents strangulated. The severity of this complication, finally lead to the patient's decease. Despite its rarity, these hernias should be included within the differential diagnosis of flank masses and late hip arthroplasty symptomatic complications.