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La evaluación del aprendizaje es parte fundamental del sistema de residencias médicas e incluye aspectos teóricos, prácticos y desempeño académico. Se diseñó una herramienta de evaluación formativa con el propósito de orientar el proceso de aprendizaje y lograr un nivel uniforme de desempeño en los pediatras formados en el sistema del GCBA (Gobierno de la Ciudad de Buenos Aires). El examen consistió en una prueba de opción múltiple compuesta por 100 preguntas en el que participaron 72 residentes. El 58% de los participantes lograron el punto de corte establecido. Este examen nos brindó información acerca de cuáles son las áreas en las que los residentes enfrentaron mayores dificultades. Podría ser una herramienta complementaria para mejorar continuamente el programa de formación de la residencia y garantizar una atención pediátrica de calidad.

Con el objetivo de priorizar políticas públicas para disminuir el consumo de bebidas azucaradas en Argentina, Brasil, El Salvador y Trinidad y Tobago e identificar las necesidades de información relacionadas con la carga de enfermedad atribuible a su consumo se realizó un diálogo de políticas en el que participaron miembros de gobierno, organizaciones de la sociedad civil, investigadores y comunicadores de países de Latinoamérica y el Caribe. Se llevaron a cabo exposiciones y talleres deliberativos utilizándose herramientas de recolección de datos semiestructuradas y discusiones grupales facilitadas. Las intervenciones priorizadas fueron el incremento de impuestos, el etiquetado frontal, la restricción de la publicidad, promoción y patrocinio y las modificaciones del entorno escolar. La principal barrera percibida fue la interferencia de la industria alimentaria. La realización de este diálogo de decisores permitió la identificación de las políticas públicas prioritarias para disminuir el consumo de bebidas azucaradas en la región.

Spindle cell hemangioma is a rare benign vascular tumor. It has been linked to Maffucci syndrome, Klippel-Trenaunay syndrome, and other venous malformations. They are usually purplish dermal nodules on the distal extremities of children and young adults, with no sex predilection. A case of a 22-years-old patient who suffered from a subcutaneous nodule, painful on pressure, in the right leg is presented. On physical examination, a 1.5 cm violaceous round tumor was observed. The presence of a hemangioma was suspected. A simple excision was performed and sent to the pathology department. The sample was described as an intraluminal nodule made up of a proliferation of spindle-shaped cells with moderate atypia and isolated mitotic figures, and the diagnosis of intravascular spindle cell hemangioma was confirmed. The diagnosis of spindle cell hemangioma is anatomopathological and simple excision is usually sufficient as treatment, although they frequently recur. Since spindle cell hemangioma is a little-known entity and can be confused with other vascular lesions, the communication of this case is considered interesting. Knowledge of this type of injury can increase reported cases.

El artículo plantea la experiencia de Tormenta de Lagartos, en relación a la creación de su último espectáculo “La Chupósfera”, que navegó del estado previo a la emergencia sanitaria transitando el espacio virtual, el aislamiento, la relación con las restricciones y cómo llegamos a la actualidad. Se formulan preguntas y reflexiones, además de compartir nuestro teatro de muñecos, máscaras y formas animadas y nuestro método de escritura y registro a través de las llamadas: “bitácoras”.

Several equids have gone extinct and many extant equids are currently considered vulnerable to critically endangered. This work aimed to evaluate whether domestic horse oocytes support preimplantation development of zebra embryos obtained by intracytoplasmic sperm injection (ICSI, zebroid) and cloning, and to study the Hippo signaling pathway during the lineage specification of trophectoderm cells and inner cell mass cells. We first showed that zebra and horse sperm cells induce porcine oocyte activation and recruit maternal SMARCA4 during pronuclear formation. SMARCA4 recruitment showed to be independent of the genetic background of the injected sperm. No differences were found in blastocyst rate of ICSI hybrid (zebra spermatozoon into horse egg) embryos relative to the homospecific horse control group. Interestingly, zebra cloned blastocyst rate was significantly higher at day 8. Moreover, most ICSI and cloned horse and zebra blastocysts showed a similar expression pattern of SOX2 and nuclear YAP1 with the majority of the nuclei positive for YAP1, and most SOX2+ nuclei negative for YAP1. Here we demonstrated that horse oocytes support zebra preimplantation development of both, ICSI and cloned embryos, without compromising development to blastocyst, blastocyst cell number neither the expression of SOX2 and YAP1. Our results support the use of domestic horse oocytes as a model to study in vitro zebra embryos on behalf of preservation of valuable genetic.

Background The burden of disease attributable to tobacco use in Latin America is very high. The objective of this study was to evaluate the potential impact of implementing cigarette plain packaging (PP), 100% smoke-free environments (SFE) and complete ban on advertising, promotion and sponsorship of tobacco (BAPS) in Argentina, Bolivia, Brazil, Chile, Colombia, Mexico and Peru. Methods A mathematical model was used to estimate the chances people have to get sick or die because of 17 smoking-related conditions. A systematic review was carried out to identify the epidemiological and cost data relevant to each country, as well as the effectiveness of the interventions. The model considered each country's legislation and level of compliance for each intervention. Then, we modeled the expected impact on health and costs of different potential scenarios for these interventions. Results We estimated the following benefits for all seven countries: PP could avoid 204 073 deaths, 212 867 cardiovascular events, 26 456 cancer diagnoses, 99 784 COPD cases, and 23 739 USD on direct medical costs in the next ten years. 100% SFE could lead to avoid 150 361 deaths, 247 171 cardiovascular events, 77 400 cancers and 311 129 COPD cases, and 15 413 USD on direct medical costs in the next ten years. 100% BAPS could save 86 911 deaths, 327 390 cardiovascular events, 38 883 cancers, 142 104 COPD cases, and 10 505 USD on direct medical cost to the health system in the next ten years. Different scenarios were modeled for each country. An example-the case for Colombia- is shown in the table. COLOMBIA Medium warnings Strong warnings Plain packaging 100% SFE (LoC: 50%) 100% SFE (LoC: 100%) Complete BAPS (LoC: 75%) Complete BAPS (LoC: 100%) Avoided deaths 3465 7038 24 086 11035 18 151 7 797 10584 Avoided events 22 775 46 256 158 300 72 524 119 293 60 961 69 561 Avoided costs (USD millions) 196 399 1 365 625 1 029 442 600 USD, United States dollars. 1 USD = 2743,39 Colombian pesos (December, 2015). SFE, Smoke-Free Environment. BAPS, Ban on Advertising, Promotion and Sponsorship of tobacco. LoC, Level of Compliance. [Potential impact of different scenarios, Colombia] Conclusions The potential impact of fully implementing PP, 100% SFE and BAPS could avoid a large burden of disease and costs for the health systems in Latin America. This information could be useful for decision makers to promote these policies.

Background Tobacco use is the leading cause of preventable deaths worldwide. The objective of this study was to estimate the burden of disease attributable to tobacco use and to evaluate the potential impact of increasing cigarette´s price through taxes in Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, Honduras, Mexico, Paraguay, Peru and Uruguay-countries which encompass 84% of Latin America´s population. Methods A microsimulation model was used to estimate the chances people have to get sick or die from 17 smoking-related conditions. An extensive review was conducted to identify key epidemiological and cost data relevant to each country. Results Every year, smoking is responsible for 293,364 deaths, 862,484 COPD cases (Chronic Obstructive Pulmonary Disease), 832,791 cardiovascular events, 131,037 cancer diagnoses and 28,098 USD millions in direct medical costs to the health systems in these countries. The proportion of health expenditure that these burden represent range from 3.2% in Honduras to 16,6% in Uruguay; and the proportion of the total GDP (Gross Domestic Product) ranged from 0.3% to 1.5% respectively. The percentage of attributable health expenditures recovered through tobacco taxes also varies widely: Mexico, Honduras, Argentina and Chile recover over 45%; in Ecuador tax revenues reach 40%; Brazil, Costa Rica, Paraguay and Uruguay recover less than 30%, and Bolivia, Colombia and Peru, less than 10%. Different scenarios of cigarette price increases through taxes were modeled for each country. An example -the case for Brazil- is shown in the table below. Cigarette price increase through taxes 25% 50% 100% Avoided deaths 68,241 136,482 272,964 Avoided events 336,099 672,199 1,344,398 Direct costs avoided (USD millions) 4,866 9,732 19,464 Indirect costs avoided (USD millions) 2,995 8,980 8,411 [Potential benefts on different scenarios, Brazil] Conclusions The burden of disease and related direct health expenditure in Latin America is very high and tax revenues from the sale of tobacco products are far below the levels needed to cover it. Increasing cigarette´s price through taxes is an effective intervention to reduce tobacco-attributable burden of disease and health expenditures in Latin America.

The purpose of this paper is to know the experience of health professionals in situations of perinatal death and grief and to describe their action strategies in the management of perinatal loss. A qualitative study with a phenomenological approach was carried out through interviews conducted with 19 professionals. Three thematic categories were identified: Healthcare practice, feelings aroused by perinatal loss and meaning and beliefs about perinatal loss and grief. The results revealed that the lack of knowledge and skills to deal with perinatal loss are identified as the main reason behind unsuitable attitudes that are usually adopted in these situations. This generates anxiety, helplessness and frustration that compromise professional competency. The conclusion reached is that the promotion of training programs to acquire knowledge, skills and abilities in management of perinatal bereavement and the development of a clinical practice guideline for perinatal loss are necessary.El objetivo de este artículo es conocer la experiencia vivida por los profesionales de la salud en situaciones de muerte y duelo perinatal y describir las estrategias de actuación ante la pérdida perinatal. Se trata de un estudio cualitativo con un enfoque fenomenológico realizado a 19 profesionales a través de entrevistas. Se identificaron 3 categorías temáticas: la práctica asistencial, los sentimientos que despierta la pérdida perinatal y significado y creencias sobre la pérdida y el duelo perinatal. Los resultados ponen de manifiesto que la falta de conocimientos y de recursos para enfrentar la pérdida perinatal hace que se adopten actitudes poco adecuadas en estas situaciones, generando una sensación de ansiedad, impotencia y frustración que compromete la competencia profesional. Se concluye que es fundamental promover programas de formación para adquirir conocimientos y destrezas sobre el duelo perinatal y elaborar una guía de práctica clínica para la atención a la pérdida perinatal.O objetivo deste artigo foi conhecer a experiência dos profissionais de saúde em casos de morte perinatal e o pesar decorrente e, ainda, descrever as estratégias de ação frente à perda perinatal. Trata-se de estudo qualitativo com abordagem fenomenológica, por meio de entrevista com 19 profissionais. Três categorias temáticas foram identificadas: a prática de cuidados de saúde, os sentimentos despertados pela perda perinatal e o significado e crenças sobre perda e pesar perinatal. Os resultados mostram que a falta de conhecimento e recursos para lidar com a perda perinatal torna inadequada as atitudes nessas situações, gerando sensação de desamparo, ansiedade e frustração que compromete a competência profissional. Conclui-se que é fundamental promover programas de treinamento para adquirir conhecimentos, aptidões e habilidades em pesar perinatal e desenvolver uma diretriz de prática clínica para o cuidado da perda perinatal.