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BACKGROUND: Common bile duct pressure (CBDP) after surgical exploration has not been fully detailed. The objective was to describe the changes of CBDP after open surgical exploration in patients with choledocholithiasis, considering clinical scenarios in remote locations. MATERIAL AND METHODS: A before-after study was designed. Patients with choledocholithiasis who required an open cholecystectomy with exploration of bile ducts were included in the study. Open cholecystectomy was performed and perioperative T-tube CBDP was registered immediately after the procedure and weekly thereafter, with a 6 week follow-up. Control T-tube cholangiogram was performed at week 6 to exclude residual stones. Data were analyzed with T test for paired samples. RESULTS: Thirteen patients were included (age range, 17-69 years; 38.69 ± 17.97). Mean CBDP (cm H2O) registered were as follows: Initial = 19.5, week 1 = 16.2, week 2 = 14.3, week 3 = 13.0, week 4 = 12.1, week 5 = 11.1, and week 6 = 9.7. There were significant differences shown when comparing week 2 (p = 0.05), week 3 (p = 0.036), week 4 (p = 0.023), week 5 (p = 0.010), and week 6 (p = 0.004) with the initial value. CONCLUSIONS: CBDP decreases between 2nd and 3rd post-operative weeks. The use of choledochomanometry is useful in clinical scenarios with no access to imaging or interventionism facilities as in remote populations or rural locations.

ANTECEDENTES: La presión del conducto biliar común (PCBC) después de exploración quirúrgica no ha sido totalmente detallada. El objetivo fue describir los cambios de la PCBC tras exploración por coledocolitiasis. MATERIAL Y MÉTODOS: Estudio de antes y después, en pacientes con coledocolitiasis, que requirieron colecistectomía con exploración de vías biliares, registrando la PCBC por 6 semanas. Con colangiografía por sonda en T en la semana seis. Análisis con T de Student para muestras pareadas. RESULTADOS: Se incluyeron 13 pacientes (rango 17-69 años; 38,69 ± 17,97). Las presiones medias del CBC fueron: Inicial = 19.5, semana 1 = 16.2, semana 2 = 14.3, semana 3 = 13.0, semana 4 = 12.1, semana 5 = 11.1 y semana 6 = 9.7. Se mostraron diferencias significativas al comparar la semana 2 (p = 0.05), la semana 3 (p = 0.036), la semana 4 (p = 0.023), la semana 5 (p = 0.010) y la semana 6 (p = 0.004) contra el valor inicial. DISCUSIÓN: La PCBC disminuye entre la segunda y la tercera semana posoperatoria. La coledocomanometría muestra ser útil en escenarios clínicos sin acceso a intervencionismo como en poblaciones remotas o localidades rurales.

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AIM: Competency-based medical education has become increasingly prevalent among surgical accreditation bodies that conduct assessments to ensure the competency of future professionals and judge the adequacy of training programs. MATERIALS AND METHODS: Cross-sectional study to validate an instrument to evaluate entrustable professional activities (EPA) according to the Single Program of Medical Specialties through content and construct validity by expert judgment, and internal consistency with Cronbach's alpha. RESULTS: Four of the rubrics scored high to optimal for univocity and relevance. Only one rubric had to be modified in two of its items. Internal consistency was high (Cronbach's alpha of 0.97). When applying the instrument, the residents showed differences in the level of competence according to postgraduate year, identifying better performance in the last year. DISCUSSION: The instrument was validated with a high degree of reliability in univocity and relevance, and high internal consistency. The residents demonstrated appropriate EPA to manage surgical patients safely, efficiently, with quality and warmth. The ability to reach the strategic level of performance is the main component of the competency-based medical education through the EPA.

OBJETIVO: La educación médica basada en competencias se ha vuelto cada vez más frecuente entre los organismos de acreditación quirúrgica que realizan evaluaciones para asegurar la competencia de los futuros profesionales y juzgar la idoneidad de los programas de formación. MATERIAL Y MÉTODOS: Estudio transversal para validar un instrumento para evaluar las actividades profesionales confiables (APC) según el Programa Único de Especialidades Médicas mediante validez de contenido y constructo por juicio de expertos, y consistencia interna con alfa de Cronbach. RESULTADOS: Cuatro de las rúbricas obtuvieron nivel alto a óptimo para univocidad y relevancia. Solo una rúbrica debió ser modificada en dos de sus ítems. La consistencia interna fue alta (alfa de Cronbach de 0.97). Al aplicar el instrumento, los residentes mostraron diferencias en el nivel competencial según el año de posgrado, identificando mejor desempeño el último año. DISCUSIÓN: El instrumento fue validado con un alto grado de fiabilidad en univocidad y relevancia, y una alta consistencia interna. Los residentes demostraron poseer las APC necesarias para tratar pacientes quirúrgicos de manera segura, eficiente, con calidad y calidez. La capacidad para alcanzar el nivel estratégico de desempeño es el componente principal de la educación médica basada en competencias a través de las APC.

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Although zoos are committed to wildlife conservation and have a long-term positive impact on visitors' attitudes towards wildlife, the question of whether maintaining wild animals in human care is justified remains as animal welfare concerns grow and human understanding of animal intelligence and capacities broadens. Zoos have always been the subject of debate, with conflicts between those who argue they save endangered species and educate visitors, and animal rights activists who believe that conditions of wild animals are inadequate and that zoos should not exist. In this review, we do not discuss the moral side of the issue, but the scientific one. This manuscript aims to show the scope of literature available on the strengths and weaknesses of modern zoos regarding wild animal welfare. We provide information useful to argue why zoos are important in modern society and factors that influence welfare are examined. Some potentially stressful stimuli may diminish animal welfare in zoo animals, while some of the benefits zoos offer to conservation and science include the opportunity to study and learn about different aspects necessary to improve management practices; the possibility of breeding wild animals in zoos has been a key factor in the recovery of species that have improved their conservation status. Animal welfare is an essential part of wildlife conservation, so efforts should be directed to ensure the best possible quality of life and optimum conditions of all zoo animals in our care.

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Although zoos are committed to wildlife conservation and have a long-term positive impact on visitors' attitudes towards wildlife, the question of whether maintaining wild animals in human care is justified remains as animal welfare concerns grow and human understanding of animal intelligence and capacities broadens. Zoos have always been the subject of debate, with conflicts between those who argue they save endangered species and educate visitors, and animal rights activists who believe that conditions of wild animals are inadequate and that zoos should not exist. In this review, we do not discuss the moral side of the issue, but the scientific one. This manuscript aims to show the scope of literature available on the strengths and weaknesses of modern zoos regarding wild animal welfare. We provide information useful to argue why zoos are important in modern society and factors that influence welfare are examined. Some potentially stressful stimuli may diminish animal welfare in zoo animals, while some of the benefits zoos offer to conservation and science include the opportunity to study and learn about different aspects necessary to improve management practices; the possibility of breeding wild animals in zoos has been a key factor in the recovery of species that have improved their conservation status. Animal welfare is an essential part of wildlife conservation, so efforts should be directed to ensure the best possible quality of life and optimum conditions of all zoo animals in our care.(AU)

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Although zoos are committed to wildlife conservation and have a long-term positive impact on visitors' attitudes towards wildlife, the question of whether maintaining wild animals in human care is justified remains as animal welfare concerns grow and human understanding of animal intelligence and capacities broadens. Zoos have always been the subject of debate, with conflicts between those who argue they save endangered species and educate visitors, and animal rights activists who believe that conditions of wild animals are inadequate and that zoos should not exist. In this review, we do not discuss the moral side of the issue, but the scientific one. This manuscript aims to show the scope of literature available on the strengths and weaknesses of modern zoos regarding wild animal welfare. We provide information useful to argue why zoos are important in modern society and factors that influence welfare are examined. Some potentially stressful stimuli may diminish animal welfare in zoo animals, while some of the benefits zoos offer to conservation and science include the opportunity to study and learn about different aspects necessary to improve management practices; the possibility of breeding wild animals in zoos has been a key factor in the recovery of species that have improved their conservation status. Animal welfare is an essential part of wildlife conservation, so efforts should be directed to ensure the best possible quality of life and optimum conditions of all zoo animals in our care.(AU)

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Canine distemper virus (CDV) is one of the most significantinfectious disease threats to the health and conservation of free-ranging and captive wild carnivores. CDV vaccination using recombinant canarypox-based vaccines has been recommended for maned wolf (Chrysocyon brachyurus) after the failure of modified live vaccines that induced disease in vaccinated animals. Here, we report a CDV outbreak in a captive population of maned wolves that were previously vaccinated. Five juveniles and one adult from a group of seven maned wolves housed in an outdoor exhibit died in April-May 2013 in a zoo in the Metropolitan Region, Chile. Clinical signs ranged from lethargy to digestive and respiratory signs. Diagnosis of CDV was confirmed by histopathology, antibody assays, and viral molecular detection and characterization. The phylogenetic analyses of the nucleotide sequence of the H gene of the CDV genome identified in the two positive samples suggest a close relation with the lineage Europe 1, commonly found in South America and Chile. CDV infections in maned wolves have not been previously characterized. To the authors' best knowledge, this is the first report of the clinical presentation of CDV in a canine species previously immunized with a recombinant vaccine.

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INTRODUCTION: Ambulatory laparoscopic cholecystectomy (ALC) reduces the use of hospital beds and benefits the patient by returning home sooner. Therefore, it is important to evaluate the degree of patient satisfaction. MATERIALS AND METHODS: A controlled clinical trial was designed to assess the efficacy, safety, and satisfaction of ALC, compared to the usual laparoscopic cholecystectomy (ULC). Efficacy and safety were evaluated based on; recovery of the oral route, spontaneous urination, gas channeling, presence of pain, nausea, vomiting, bleeding, pain, penrose expense. Satisfaction was explored through an adaptation of the SATISCORE questionnaire. RESULTS: We included 71 patients, 38 from the experimental group (ALC) and 33 from the control group (ULC). There was a higher proportion of women, average age at the fifth decade, and a similar distribution of comorbidities. In safety and efficacy, the results were similar. In the survey, the ALC group showed an 89.5% high degree of satisfaction. DISCUSSION: There was a good postoperative recovery in both groups as they reincorporated earlier, identified in a better satisfaction index referred by the patient. CONCLUSION: The ALC is as effective and safe as ULC, so it can be considered as the new "gold standard" for the surgical management of uncomplicated biliary pathology.

INTRODUCCIÓN: La colecistectomía laparoscópica ambulatoria (CLA) disminuye la utilización de camas y beneficia al paciente al no hospitalizarse, siendo importante evaluar su grado de satisfacción. MATERIAL Y MÉTODOS: Se diseñó un ensayo clínico controlado para eficacia, seguridad y satisfacción de CLA comparándola con colecistectomía laparoscópica habitual (CLH). Eficacia y seguridad se evaluaron en cuanto; recuperación de vía oral, micción espontánea, canalización de gases, dolor, nausea, vómito, sangrado, y gasto del penrose. La satisfacción a través de una adaptación del cuestionario SATISCORE. RESULTADOS: Se incluyeron 71 pacientes, 38 del grupo experimental (CLA) y 33 del control (CLH). En ambos hubo una mayor proporción de mujeres, edad promedio en la quinta década, y distribución de comorbilidades semejante. En seguridad y eficacia, los resultados fueron semejantes. En la encuesta el grupo de CLA manifestó 89.5% de alto grado de satisfacción. DISCUSIÓN: Hubo una buena recuperación en ambos grupos, con una reincorporaron más temprana y un mejor índice de satisfacción referido por el enfermo en el grupo experimental (CLA). CONCLUSIÓN: La CLA es tan efectiva y segura como la CLH, por lo que se puede considerar como el nuevo "Estándar de oro" para el manejo quirúrgico de la patología biliar no complicada.

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OBJECTIVE: This study was designed to explore the presence of a prothrombotic state, fibrinolytic dysfunction and inflammation in impaired glucose tolerance subjects, by evaluating serum markers of thrombosis, fibrinolysis and inflammation. METHODS: In 48 consecutive adults, 25 patients with impaired glucose tolerance (nine men and 16 women, 50.0 ± 9.2 years) were compared with 23 control subjects (six men and 17 women, 48.0 ± 11 years). The markers of thrombotic activation used were D-dimer and fibrinogen. Fibrinolysis dysfunction was evaluated with plasminogen activator inhibitor 1 (PAI-1) and the inflammatory marker studied was hs-C reactive protein (hs-CRP). RESULTS: The markers of thrombotic state were significantly higher in patients with impaired glucose tolerance (IGT) than in controls: D dimer (489.6 ± 277.3 vs. 345.8 ± 158.9 ng/mL) (p< 0.01) and fibrinogen (317.7 ± 32.1 vs. 266.7 ± 25.4 mg/dL) (p < 0.0001). Fibrinolytic marker PAI-1 also differed significantly between the two study groups (66.4 ± 30.7 vs. 35.5 ± 31.0 ng/mL) (p < 0.006). However, hs-CRP, as inflammation marker, (0.45 ± 0.62 mg/dL vs. 0.38 ± 0.47) did not differ significantly between the two study groups (<0.28). CONCLUSION: This result suggests the presence of a prothrombotic state with fibrinolytic dysfunction in subjects with impaired glucose tolerance.

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Objetivo: Este estudio fue diseñado para explorar la presencia de un estado protrombótico, disfunción fibrinolítica e inflamación en sujetos con intolerancia a la glucosa, mediante la evaluación de los marcadores séricos de trombosis, fibrinólisis e inflamación. Métodos: Se estudiaron 48 individuos consecutivos, 25 intolerantes a la glucosa: (nueve hombres y 16 mujeres, 50.0 ±9.2 años) y 23 sujetos control (seis hombres y 17 mujeres, 48.0 ±11 años). Se compararon entre ambos grupos los niveles de dímero-D y fibrinógeno como marcadores de trombosis, el PAI-1 como marcador de fibrinólisis y la proteína C reactiva ultrasensible (PCR-us) como marcador de inflamación. Resultados: En los sujetos intolerantes a la glucosa respecto al grupo control, se observaron diferencias significativas en los marcadores de trombosis: fibrinógeno 317.7 ± 32.1 vs. 266.7 ± 25.4 mg/dL (p<0.0001), dímero-D 489.6 ± 277.3 vs. 345.8 ± 158.9 ng/mL (p<0.01) y en el marcador de fibrinólisis PAI-1 66.4 ± 30.7 vs. 35.5 ± 31.0 ng/mL (p<0.006). En el marcador de inflamación, PCR-us no se observó diferencia significativa, respecto al grupo control 0.45 ± 0.6 vs. 0.38 ± 0.4 mg/dL (p<0.28). Conclusiones: Estos resultados sugieren la presencia de un estado protrombótico con disfunción del sistema fibrinolítico, en sujetos intolerantes a la glucosa.

Objective: This study was designed to explore the presence of a prothrombotic state, fibrinolytic dysfunction and infammation in impaired glucose tolerance subjects, by evaluating serum markers of thrombosis, fibrinolysis and infammation. Methods: In 48 consecutive adults, 25 patients with impaired glucose tolerance (nine men and 16 women, 50.0 ±9.2 years) were compared with 23 control subjects (six men and 17 women, 48.0 ±11 years). The markers of thrombotic activation used were D-dimer and fibrinogen. Fibrinolysis dysfuntion was evaluated with plasminogen activator inhibitor 1 (PAI-1) and the infammatory marker studied was hs-C reactive protein (hs-CRP). Results: The markers of thrombotic state were significantly higher in patients with impaired glucose tolerance (IGT) than in controls: D dimer (489.6 ± 277.3 vs. 345.8 ± 158.9 ng/mL) (p < 0.01) and fibrinogen (317.7 ±32.1 vs. 266.7 ±25.4 mg/dL) (p < 0.0001). Fibrinolytic marker PAI-1 also differed significantly between the two study groups (66.4 ± 30.7 vs. 35.5 ± 31.0 ng/ mL) (p < 0.006). However, hs-CRP, as infammation marker, (0.45 ± 0.62 mg/dL vs. 0.38 ± 0.47) did not differ significantly between the two study groups (<0.28). Conclusion: This result suggests the presence of a prothrombotic state with fibrinolytic dysfunction in subjects with impaired glucose tolerance.

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We examined 1,092 skulls of captive and free-living individuals, representing 33 felid species, to determine the prevalence of focal palatine erosion (FPE). FPE was detected in 3.2% of cats evaluated, including cheetah (Acinonyx jubatus) and 14 other felid species. The prevalence of FPE between cheetah (9.4%; n = 64) and non-cheetah species (2.8%; n = 1,028) (χ(2) test; P = 0.004) and between captive (5.7%; n = 246) and free-living (2.4%; n = 824) individuals (χ(2) test; P = 0.010) were significantly different, with prevalence between captive (19%; n = 21) and free-living (2.9%; n = 34) cheetahs approaching significance (Fisher's exact test; P = 0.064). FPE was diagnosed with equal prevalence in skulls from individuals in which the lower molars did not meet the palatine bone (60.6%) and individuals in which it did (39.4%; n = 33) (χ(2) test; P = 0.139). In cheetahs with FPE, one was a captive animal in Germany, one a free-living cheetah from Mali, one captive cheetah from Kenya, and three captive cheetahs of unknown origin. Additionally, we evaluated the medical records of 49 captive cheetahs in Namibia. Of these cheetahs, 48 (98.0%) had clinical signs consistent with FPE, although only 16 of these 48 (39.6%) had perforation of the palatine bone. Based on physical examinations, FPE was diagnosed in two caracals (Caracal caracal) and one fishing cat (Prionailurus viverrinus) from a North American Zoo. Results from this study confirm FPE in cheetahs outside of Namibia, in a minimum of 15 felid species, and a higher FPE prevalence in captive individuals than free-living ones. Clinical implications of these findings and recommendations for future studies are provided.

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BACKGROUND: Adhesion formation in the peritoneal cavity is the most common cause of intestinal obstruction and secondary female infertility. A great effort has been dedicated to reduce adhesion formation because of the associated morbidity and its complications. MATERIALS AND METHODS: This study was designed as a before-after comparative trial and included 14 rabbits, with a weight between 300 and 500 g. All rabbits were appendectomized and 1 month later laparotomized to assess adhesion formation. Rabbits were randomized into two groups, Group I (control group), with no intervention, and Group II (experimental group), treated with an intraperitoneal sponge of collagen-polyvinylpyrrolidone (Clg-PVP). The laparotomy procedure was repeated 1 month later for a new assessment of adhesion formation and histological evaluation by H-E and Masson staining. RESULTS: Histological findings showed abundant infiltrate in the control group, which was mild in the experimental group. With the Masson stain the control group showed a significantly higher amount of collagen than the experimental group and the fibrous tissue was more compact. We found a mean number of adhesions of 3.29 +/- 1.98 for the control group, which decreased to 2.57 +/- 0.79 after the second laparotomy. For the experimental group the mean number of adhesions decreased from 1.86 +/- 0.90 to 0.71 +/- 0.49 after the second laparotomy, with no statistical difference between both groups before Clg-PVP application, but a significant statistical difference after the implantation of Clg-PVP (Student's t test; P < 0.001, two-tailed). CONCLUSION: Collagen-polyvinylpyrrolidone decreases the incidence and size of intraabdominal adhesions after secondary adhesion formation after appendectomy.

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