Primer caso reportado en Panamá de: Síndrome de Baraitser Winter

El síndrome cerebro-frontal-facial de Baraitser-Winter (BWCFF) se origina a partir de mutaciones sin sentido, heterocigóticas, en uno de los dos genes ubicuos que codifican la actina citoplásmica, ya sea ACTB o ACTG1. Este síndrome es una combinación de malformaciones faciales y cerebrales. Entre las malformaciones faciales que podemos observar, destacan el coloboma de iris, la ptosis bilateral, el hipertelorismo, el puente nasal ancho y los pliegues epicánticos prominentes. Las malformaciones cerebrales incluyen la paquigiria, la heterotopia de banda subcortical y las anomalías del cuerpo calloso. En este contexto, presentamos el caso de una niña de 11 años que presentaba algunos rasgos faciales distintivos, además de malformaciones cerebrales, baja estatura, discapacidad cognitiva moderada, y retraso del habla y lenguaje. Mediante secuenciación por exoma clínico dirigido, se identificó una variante sin sentido heterocigota de Novo en ACTB: c.617G>A (p. Arg206Gln). (provisto por Infomedic International)

The Baraitser-Winter cerebral-front-facial syndrome (BWCFF) is caused by heterozygous nonsense mutations in one of the two ubiquitous genes encoding cytoplasmic actin, either ACTB or ACTG1. The syndrome combines facial and cerebral malformations. Among the facial malformations that can be observed are iris coloboma, bilateral ptosis, hypertelorism, broad nasal bridge, and prominent epicanthic folds. The cerebral malformations include pachygyria, subcortical band heterotopia, and anomalies of the corpus callosum. We present the case of an 11-year-old girl who had some distinctive facial features, as well as cerebral malformations, short stature, moderate cognitive disability, and speech and language delay. Targeted clinical exome sequencing identified a heterozygous de novo nonsense variant in ACTB: c.617G>A (p. Arg206Gln). (provided by Infomedic International)

Non-linear association between long-term air pollution exposure and risk of metabolic dysfunction-associated steatotic liver disease

BACKGROUND@#Metabolic Dysfunction-associated Steatotic Liver Disease (MASLD) has become a global epidemic, and air pollution has been identified as a potential risk factor. This study aims to investigate the non-linear relationship between ambient air pollution and MASLD prevalence.@*METHOD@#In this cross-sectional study, participants undergoing health checkups were assessed for three-year average air pollution exposure. MASLD diagnosis required hepatic steatosis with at least 1 out of 5 cardiometabolic criteria. A stepwise approach combining data visualization and regression modeling was used to determine the most appropriate link function between each of the six air pollutants and MASLD. A covariate-adjusted six-pollutant model was constructed accordingly.@*RESULTS@#A total of 131,592 participants were included, with 40.6% met the criteria of MASLD. "Threshold link function," "interaction link function," and "restricted cubic spline (RCS) link functions" best-fitted associations between MASLD and PM2.5, PM10/CO, and O3 /SO2/NO2, respectively. In the six-pollutant model, significant positive associations were observed when pollutant concentrations were over: 34.64 µg/m3 for PM2.5, 57.93 µg/m3 for PM10, 56 µg/m3 for O3, below 643.6 µg/m3 for CO, and within 33 and 48 µg/m3 for NO2. The six-pollutant model using these best-fitted link functions demonstrated superior model fitting compared to exposure-categorized model or linear link function model assuming proportionality of odds.@*CONCLUSION@#Non-linear associations were found between air pollutants and MASLD prevalence. PM2.5, PM10, O3, CO, and NO2 exhibited positive associations with MASLD in specific concentration ranges, highlighting the need to consider non-linear relationships in assessing the impact of air pollution on MASLD.

Leptospirosis Knowledge, Attitude, and Practice of Town Service Workers in Kuching, Malaysia

@#Introduction: This study aimed to evaluate town service personnel’s knowledge, attitudes, and practices (KAP) regarding leptospirosis prevention and the influencing factors to its practice. Methods: A cross-sectional study was conducted in Kuching, Malaysia, involving town service workers using a self-administered validated questionnaire comprising sociodemographic and KAP information. The eligibility criteria included 18 years old and above and having worked for more than six months. The KAP was determined using descriptive analysis, and associations were identified using logistic regression analysis. Results: About 189 town service workers responded, giving a response rate of 87.5%, and a majority of them were Bumiputera Sarawak, with a mean age of 38.6 (±11.00) years old. The mean duration of employment was 9.3 (±6.99) years. About 88.9% had good knowledge of leptospirosis. Meanwhile, 85.2% and 79.9% had satisfactory attitudes and good practices. The knowledge on the aetiology of leptospirosis ranged from 25% to 94%. No significant association was found between the knowledge score and income with the practice score. The attitude score (AOR 1.161; 95% CI = 1.090, 1.238; p = 0.000) and working experience (AOR 1.174; 95% CI = 1.023, 1.346; p = 0.022) were found to be significantly associated with their practice score. Conclusion: Most town service workers have good knowledge and practice regarding leptospirosis prevention. Workers with good attitudes demonstrate good practising habits toward leptospirosis prevention. Awareness and activities related to disease prevention should be encouraged to ensure the continuity of a positive attitude.

Two-Dimensional Geometric Morphometric Method on Frontal Sinus for Race Estimation: A Lateral Skull Radiograph Study

@#Introduction: Race estimation of unknown individual is essential in forensic investigation. The resiliency of frontal sinus makes it a potential tool for biological profiling, particularly in cases where fragmented skeleton persists. Geometric morphometrics is an efficient way to characterise shape. However, the use of frontal sinus to identify race of Malaysians is yet to be investigated. This research employed a two-dimensional (2D) geometric morphometric to examine the morphological differences of the frontal sinus among the major races in Malaysia. Methods: Lateral skull radiographs which comprising of 453 adult Malaysian (151 Malays, Chinese and Indian respectively) were used. The 2D landmarks of eight were placed on the digitalized radiographs and 2D geometric morphometric analysis was performed using MorphoJ software. Results: Procrustes ANOVA revealed a significantly different frontal sinus shape (p-value < 0.05) between races. Canonical variate analysis showed significantly different frontal sinus morphology (p-value < 0.05) between Malay and Indian as well as Chinese and Indian. Discriminant function analysis with cross-validation demonstrated a 57.4% accuracy rate. Conclusion: This population-specific study based on frontal sinus of Malaysians using the 2D geometric morphometric, though less reliable, sheds new light on the potential applicability of this method for race estimation purpose.

Internal auditing risk analysis for medical laboratories seeking accreditation through the Hong Kong Laboratory Accreditation Scheme (HOKLAS)

Objectives@#The primary aim of this study was to determine quantitatively the extent of coverage of the Hong Kong Laboratory Accreditation Scheme (HOKLAS 015) requirements by guidance checklists (HOKLAS 016‑02 and HOKLAS 021). @*Methods@#The level of conformance requirement coverage of HOKLAS 015 by HOKLAS 016‑02 and HOKLAS 021 was calculated by an evaluation checklist based on conformance requirements in HOKLAS 015. A distribution analysis of conformance requirements relating to the International Standard ISO 15189:2012 process‑based quality management system model was also performed to elicit further coverage information. @*Results@#HOKLAS 016‑02 was found to provide coverage of 76% while HOKLAS 021 was found to provide coverage of 11%. HOKLAS 015 was also found to have a distribution coverage of 78% relating to the International Standard ISO 15189:2012 process‑based quality management system model.@*Conclusion@#The results of this analysis should be of value to medical laboratories wishing to maintain the internal auditability required by HOKLAS 015 by gaining an awareness of the extent of coverage provided by HOKLAS 016‑02 and HOKLAS 021.

Dança do Ventre: imagens contemporâneas / Danza del vientre: imágenes contemporáneas / Belly dance: contemporary images

A história da dança do ventre costuma ser atribuída às práticas ritualísticas da Antiguidade no Oriente Médio. Essa narrativa dificilmente sustenta-se como fato histórico. Entretanto, algumas imagens desempenham papel importante ao gerar sentidos sobre essa dança enquanto manifestação expressiva na atualidade. O objetivo do artigo é investigar os principais fatores relacionados ao movimentar-se presentes na dança do ventre, levando em conta seus aspectos simbólicos e expressivos, de forma a identificar os sentidos desta dança para bailarinas e bailarinos brasileiros. O estudo segue uma orientação fenomenológica que busca descrever as imagens sobre a dança do ventre reveladas em pesquisas de campo. Narrativas associadas ao feminino são recorrentes e sugerem uma elaboração potente, que dialoga com a ancestralidade e se atualiza de forma contemporânea. A dança ganha um sentido existencial e único para quem dança, mas revela um potencial expressivo que é universal.

The history of belly dancing is often attributed to ancient ritualistic practices in the Middle East. This narrative hardly holds up as a historical fact. However, some images are essential in generating meanings about this dance as an expressive manifestation today. The article's objective is to investigate the main factors related to movement present in belly dancing, taking into account its symbolic and expressive aspects, to identify the meanings of this dance for Brazilian dancers. The study follows a phenomenological orientation that seeks to describe the images of belly dancing revealed in field research. Narratives associated with the feminine are recurrent and suggest a powerful elaboration, which dialogues with ancestry and is updated in a contemporary way. The dance takes on an existential and unique meaning for those who dance but reveals a universal expressive potential.

La historia de la danza del vientre a menudo se atribuye a antiguas prácticas rituales femeninas en las sociedades del Medio Oriente. Históricamente, estas narraciones no se sostienen. Aun así, estas imágenes juegan un papel importante en la afirmación de un arquetipo femenino, generando significados sobre esta danza y su importancia como manifestación expresiva en la actualidad. Este estudio fenomenológico busca describir y profundizar en estas y otras imágenes reveladas en testimonios e investigaciones de campo. A partir de esto, buscamos comprender cómo la práctica de la danza del vientre transforma percepciones y sentidos sobre el cuerpo y el mundo de quien baila. Lo femenino de la danza parece fortalecerse colectivamente y sugiere una intención de cambio constante, a partir de experiencias corporales, en contacto con el mundo, desde un lenguaje propio: una práctica de negociación y elaboración de un femenino mucho más contemporáneo que el mito supone.

Effects of a Free Electronic Book on Systemic Anatomy with Schematics on Student Learning / Efectos de un Libro Electrónico Gratuito sobre Anatomía Sistémica con Esquemas sobre el Aprendizaje de los Estudiantes

SUMMARY: For students in schools of nursing, health sciences, and premed, a systemic anatomy textbook with minimized contents, schematics, and mnemonics may be helpful for learning an otherwise often unappealing subject. In this study, we assess the educational effect of such a textbook. Schematic drawings, anatomy comics, and easily readable text were generated for the chapters of the book (e.g., skeletal system, articular system). The book was presented without charge via a webpage (anatomy.co.kr). Nursing students who were exposed to the book and those who were not exposed were compared; a survey was administered to those who were exposed. The students who read the presented textbook were more knowledgeable than those who used other textbooks. Hours spent reading the presented textbook and scores of fill-in-the-blank questions were positively correlated. In general, the students replied that the presented textbook was helpful for learning systemic anatomy. The systemic anatomy textbook accompanies preexisting textbooks in regional anatomy, neuroanatomy, and the histology, all of which are written by the same authors. We suggest anatomy instructors generate their own books with unique style to enrich the student learning process.

Para los estudiantes de las escuelas de enfermería, ciencias de la salud y premedicina, un libro de texto de anatomía sistémica con contenidos, esquemas y mnemónicos minimizados puede ser útil para aprender un tema que de otro modo sería poco atractivo. En este estudio, evaluamos el efecto educativo de dicho libro de texto. Se generaron dibujos esquemáticos, cómics de anatomía y texto de fácil lectura para los capítulos del libro (por ejemplo, sistema esquelético, sistema articular). El libro se presentó sin costo a través de una página web (anatomy.co.kr). Se compararon los estudiantes de enfermería que estuvieron expuestos al libro y los que no estuvieron expuestos. Se administró una encuesta a quienes estuvieron expuestos. Los estudiantes que leyeron el libro de texto presentado tenían más conocimientos que aquellos que usaron otros libros de texto. Las horas dedicadas a leer el libro de texto presentado y las decenas de preguntas para completar espacios en blanco se correlacionaron positivamente. En general, los estudiantes respondieron que el libro de texto presentado fue útil para aprender anatomía sistémica. El libro de texto de anatomía sistémica acompaña a los libros de texto preexistentes de anatomía regional, neuroanatomía e histología, todos escritos por los mismos autores. Sugerimos que los instructores de anatomía generen sus propios libros con un estilo único para enriquecer el proceso de aprendizaje de los estudiantes.

Clinical Adaptation According to Anatomical Types of Nasal Septum / Adaptación Clínica Según Tipos Anatómicos de Tabique Nasal

SUMMARY: The purpose of this study was to inform the anatomical types of the nasal septum of which including variations by dissection and to provide guidelines for clinical adaptation. For this purpose dissections were performed on 70 nasal septums of formalin fixed Korean adult cadavers (20 males, 11 females, and 39 of unknown sex) with an age at death of 13-105 years. The septal deviation was checked before midsagittal section the nasal cavity with the aid of a laryngoscope. The mucosa on the nasal septum was then removed to observe the morphology of the nasal septum. The shape of each component of the nasal septum was identified, and photographs were taken from a midsagittal plane. This study has discovered various anatomical types of the nasal septum and its variations. The correlations between septal types according to their proportions were also analyzed. The results reported herein provide detailed anatomical knowledge that can be used as a valuable reference for rhinoplasty procedures.

El propósito de este estudio fue informar los tipos anatómicos del tabique nasal incluyendo las variaciones por disección y brindar pautas para la adaptación clínica. Para este propósito, se realizaron disecciones en 70 tabiques nasales de cadáveres adultos coreanos fijados con formalina (20 hombres, 11 mujeres y 39 de sexo desconocido) con una edad de muerte de 13 a 105 años. La desviación septal se comprobó antes de la sección medio sagital de la cavidad nasal con la ayuda de un laringoscopio. A continuación, se retiró la mucosa del tabique nasal para observar la morfología del tabique nasal. Se identificó la forma de cada componente del tabique nasal y se tomaron fotografías desde un plano mediano sagital. En el estudio se descubrieron varios tipos anatómicos del tabique nasal y sus variaciones. También se analizaron las correlaciones entre los tipos septales según sus proporciones. Los resultados informados en este documento proporcionan un conocimiento anatómico detallado que se puede utilizar como una referencia valiosa para los procedimientos de rinoplastía.

A Simple and Consistent Rule for Easy Learning of Neuroanatomy: Three Neurons of Afferent Nerves / Una Regla Simple y Consistente para Facilitar el Aprendizaje de la Neuroanatomía: Tres Neuronas de los Nervios Aferentes

SUMMARY: Many students regard neuroanatomy as a terrifying subject due to the complicated neuronal connections. Purpose of this research was to promote the easy and logical learning of neuroanatomy by systematizing a rule "three neurons of afferent nerves." The rule, in which the second neuron decussates and reaches the thalamus, was applied to as many structures as possible. The three neurons are drawn in a constant pattern to intuitively demonstrate the rule. The rule could be applied not only to the spinothalamic tract, medial lemniscus pathway, sensory cranial nerves (visual pathway, trigeminothalamic tract, taste pathway, and auditory pathway) and ascending reticular activating system, but also to the pontocerebellum (afferent to cerebrum), basal nuclei (direct pathway), and limbic system (medial limbic circuit). Exceptionally, some afferent nerves do not exactly follow the suggested rule. This simple rule, which corresponds to many pathways of the neuroanatomy, is expected to make the learning by novice students easier.

Muchos estudiantes consideran la neuroanatomía como un tema aterrador debido a las complicadas conexiones neuronales. El propósito de esta investigación fue promover el aprendizaje fácil y lógico de la neuroanatomía mediante la sistematización de una regla "tres neuronas de los nervios aferentes". La regla, en la que la segunda neurona se decusa y llega al tálamo, se aplicó a todas las estructuras cuando esto fue posible. Las tres neuronas se dibujan en un patrón constante para demostrar la regla intuitivamente. La regla podría aplicarse no solo al tracto espinotalámico, la vía del lemnisco medial, los nervios craneales sensoriales (vía visual, tracto trigeminotalámico, vía gustativa y vía auditiva) y el sistema de activación reticular ascendente, sino también al pontocerebelo (aferente al cerebro), núcleos basales (vía directa) y sistema límbico (circuito límbico medial). Excepcionalmente, algunos nervios aferentes no siguen exactamente la regla sugerida. Se espera que esta simple regla, que corresponde a muchas vías de la neuroanatomía, facilite el aprendizaje de los estudiantes principiantes.

Effects of different combinations of radical nephroureterectomy and bladder cuff excision procedures for upper tract urothelial carcinoma on bladder recurrence

ABSTRACT Purpose: To compare the effects of different combinations of radical nephroureterectomy (RNU) and bladder cuff excision (BCE) surgical procedures on intravesical recurrence (IVR) in patients with upper tract urothelial carcinoma (UTUC). Materials and Methods: This retrospective observational study included 452 patients who underwent RNU with BCE for UTUC between January 2010 and December 2020. The patients were classified into three groups based on different combinations of RNU and BCE surgical procedures: open RNU with open BCE (group 1, n=104), minimally invasive (MIS) RNU with open BCE (group 2, n=196), and MIS RNU with intracorporeal BCE (group 3, n=152). Data on demographics, body mass index, history, preoperative renal function, perioperative status, tumor characteristics, histopathology, and recurrence conditions were collected. Multivariate Cox regression analyses were performed to determine the impact of the surgical procedures on IVR. P-values <0.05 were considered statistically significant. Results: After a median follow-up of 29.5 months, the IVR rate was 29.6% and the IVR-free survival rate was the lowest in group 2 (group 1 vs. group 2 vs. group 3: 69.0% vs. 55.1% vs. 67.5%; log-rank P=0.048). The overall survival rate was comparable among the three groups. Multivariate analysis revealed that group 2 had a significantly higher risk of IVR than group 1 (hazard ratio=1.949, 95% confidence interval=1.082-3.511, P=0.026), while groups 1 and 3 had similar risks. Conclusions: For patients with UTUC, MIS RNU with open BCE is associated with a higher risk of IVR than open RNU with open BCE and MIS RNU with intracorporeal BCE.

The contribution of concentric electrode-evoked potentials and nociceptive withdrawal reflex to the routine neurophysiological assessment of neuropathic pain: cross-sectional study / A contribuição dos potenciais evocados por eletrodo concêntrico e reflexo de retirada nociceptiva para a avaliação neurofisiológica de rotina da dor neuropática: estudo observacional transversal

ABSTRACT BACKGROUND AND OBJECTIVES: Conventional electrodiagnostic studies (EDX) are frequently used to support the diagnosis of peripheral neuropathic pain. However, routine EDX has poor diagnostic yield for identifying small fiber neuropathy, which may be cause of neuropathic pain in some patients. This study aimed to assess the gain in diagnostic yield brought by adding pain-related evoked potentials with concentric electrode (CN-PREP) and nociceptive withdrawal reflex (NWR) assessments to EDX. METHODS: Transversal observational accuracy study which included patients referred to routine EDX in a tertiary-care hospital who reported chronic neuropathic pain in their lower limbs. Besides routine EDX, subjects underwent CN-PREP and NWR assessments. Diagnostic yield and tolerability were examined and compared between test studies. RESULTS: The study enrolled 100 patients (54% female), with 57 ± 12 years. EDX was altered in 47% of all patients. The addition of CN-PREP alone, and NWR combined with CN-PREP increased diagnostic yield to 69% and 72%, respectively. CN-PREP proved to be well tolerable, while NWR was associated with higher test-related pain intensity and discontinuation rate (9% vs. 0%). Considering EDX as the reference test, CN-PREP sensitivity was 85.1% and specificity 58.5%. CONCLUSION: Combining CN-PREP with the routine EDX for patients with neuropathic pain is feasible and results in increased diagnostic yield. Conversely, the addition of NWR to the aforementioned tests provides little improvement to this yield and is less tolerable to the patient. Further studies are needed to determine the actual sensitivity and specificity of CN-PREP when compared to the gold-standard for small fiber neuropathy diagnosis, i.e. intraepidermal nerve fiber density assessment.

RESUMO JUSTIFICATIVA E OBJETIVOS: Estudos convencionais de eletrodiagnóstico (EDX) são frequentemente usados para apoiar o diagnóstico de dor neuropática periférica. No entanto, o EDX de rotina tem baixo rendimento diagnóstico para identificar neuropatia de pequenas fibras. O objetivo deste estudo foi avaliar o ganho no rendimento diagnóstico pela adição de avaliações de potenciais evocados relacionados à dor com eletrodo concêntrico (CN-PREP) e reflexo de retirada nociceptiva (NWR) ao EDX. MÉTODOS: Estudo de precisão observacional transversal que incluiu pacientes encaminhados para EDX de rotina com dor neuropática crônica em membros inferiores. Além do EDX de rotina, os indivíduos foram submetidos às avaliações CN-PREP e NWR. O rendimento diagnóstico e a tolerabilidade foram examinados e comparados entre os estudos de teste. RESULTADOS: O estudo envolveu 100 pacientes (54% mulheres), com 57 ± 12 anos. O EDX estava alterado em 47%. A adição de CN-PREP sozinho e NWR combinado com CN-PREP aumentou o rendimento diagnóstico para 69% e 72%, respectivamente. O CN-PREP provou ser bem tolerável, enquanto o NWR foi associado a maior intensidade de dor relacionada ao teste e taxa de descontinuação (9% vs. 0%). Considerando o EDX como teste de referência, a sensibilidade do CN-PREP foi de 85,1% e a especificidade de 58,5%. CONCLUSÃO: A combinação do CN-PREP com o EDX de rotina para pacientes com dor neuropática é viável e resulta em maior rendimento diagnóstico. Já a adição de NWR aos testes mencionados fornece pouca melhora nesse rendimento e é menos tolerável para o paciente. Mais estudos são necessários para determinar a real sensibilidade e especificidade do CN-PREP quando comparado ao padrão-ouro para diagnóstico de neuropatia de pequenas fibras, ou seja, a avaliação da densidade de fibras nervosas intraepidérmicas.

STUDY ACCLIMATIZED SEED SAMPLE SAPOSHNIKOVIA DIVARICATA (TURCZ) SCHISCHK IN VIETNAM

In this study, we evaluated several agronomic characteristics of S. divaricata when grown in various regions in Vietnam, including Northeast, Northwest, and Central Highlands. Among the three regions, S. divaricata grown in Northwestern Vietnam has the highest yield reaching 6.21 tons/ha, with a total active ingredient content of 0.655% (Prim-O-glucosylcimifugin 0.383% and 5-O-methylvisamminoside 0.272%). This is followed by the Central Highlands of which S. divaricata yielded 4.12 tons/ha, with a total active ingredient content is 0.543% (Prim-O-glucosylcimifugin 0.292% and 5-O-methylvisamminoside 0.251%). The lowest yield of S. divaricata was recorded in Northeast with 3.13 tons/ha, of which a total active ingredient content was 0.394% with 0.253% for Prim-O-glucosylcimifugin and 0.141% for 5-O- methylvisamminoside. With the applied analytical conditions, HPLC - DAD chromatograms are obtained with sharp peaks of prim-O-glucosylcimifugin (tR = 7.51 min) and 5-O-methylvisamminoside (tR = 20.23 min) , balanced, clear on the background of the medicinal plants Saposhnikovia divaricata (Turcz.) Schischk. In particular, the applicable analytical conditions allow for simultaneous qualitative and quantitative analysis of both prim-O-glucosylcimifugin and 5- O-methylvisaminoside. The results of building the standard curve prim-O-glucosylcimifugin Y = (16146)X – 4020.3, R2 = 0.9992, standard curve 5-O- methylvisamminoside Y = (20490)X – 6921.8, R2 = 0.9999. The quantitative results of prim-O-glucosylcimifugin and 5-O- methylvisamminoside in all regions were slightly higher than that of the pharmacopoeias of Vietnam, China and Hong Kong with the total active ingredient content not less than 0.24%. Thus, The study concluded that Vietnam is a country that can develop medicinal plants Saposhnikovia divaricata (Turcz.) Schischk

Risk of skin cancer in kidney, liver and heart recipients: A nationwide population-based study in Taiwan

Background: Previous population-based studies in western countries had revealed increased skin cancer risk among transplant recipients compared to the general population. However, population-based studies in Asia on skin cancer among recipients of different transplanted organs were lacking in the literature. Aims: This study aims to estimate skin cancer risk among recipients in Taiwan, examine the association between each specific type of skin cancer and each type of transplanted organ, and compare skin cancer risk between different immunosuppressive regimens. Methods: This population-based retrospective cohort study identified 7550 patients with heart, lung, kidney or liver transplantation and 30,200 controls matched for gender, age and comorbidity index from the National Health Insurance Research Database in Taiwan between 2000 and 2015. Using multivariable Cox proportional hazard models, we estimated the hazard ratios and 95% confidence intervals for the correlation of skin cancer with organ transplantation as well as immunosuppressive regimen. Results: Organ transplant recipients in Taiwan had an increased risk of skin cancer with adjusted hazard ratios of 4.327 (95% confidence intervals 2.740–6.837, P < 0.001), with the greatest risk, observed among heart recipients (adjusted hazard ratios 6.348, 95% confidence intervals 3.080–13.088, P < 0.001). The risk of non-melanoma skin cancer and melanoma was 4.473 (95% confidence intervals 2.568–7.783, P < 0.001) and 3.324 (95% confidence intervals 1.300–8.172, P < 0.001), respectively. When comparing immunosuppressants, those with calcineurin inhibitors carried the highest risk of skin cancer (adjusted hazard ratios 4.789, 95% confidence intervals 3.033–7.569, P < 0.001), followed by those with antimetabolites (adjusted hazard ratios 4.771, 95% confidence intervals 3.025–7.541, P < 0.001). Limitations: We could not evaluate confounding behavioural risk factors of skin cancers that were not documented in the database, nor could we recognize patients’ compliance with immunosuppressants. Conclusion: Organ recipients have a greater risk of skin cancer. Clinicians should inform recipients of the importance of photoprotection and regular dermatologic follow-up

Effects of an easy neuroanatomy book with schematics on student learning / Efectos de un libro sencillo de neuroanatomía con esquemas sobre el aprendizaje de los estudiantes

SUMMARY: Numerous students perceive neuroanatomy as a particularly difficult subject due to its overwhelming complexity. Therefore, a neuroanatomy book that concentrates on easy-to-read stories with schematics rather than exhaustive details has been published. This study evaluates the effect of a trial of the new neuroanatomy book on student learning. From the book, a printout on the brainstem and cranial nerve was extracted. Medical students read the printout, and subsequently were examined on their knowledge of and interest in neuroanatomy. Students who read the extract answered examination questions relatively well and were more interested in neuroanatomy. The printout seemed to enhance the knowledge and concentration of the students. After grasping the fundamental information in the book, students are expected to be able to learn advanced concepts comfortably and confidently. In addition, the book with its concise and simple content is suitable not only for short- duration neuroanatomy courses but also for self-learning.

Muchos estudiantes perciben la neuroanatomía como un tema particularmente difícil debido a su abrumadora complejidad. Por lo tanto, se ha publicado un libro de neuroanatomía que se concentra en historias fáciles de leer con esquemas en lugar de detalles exhaustivos. Este estudio evalúa el efecto de una prueba del nuevo libro de neuroanatomía en el aprendizaje de los estudiantes. Del libro, se extrajo una impresión sobre el tronco encefálico y los nervios craneales. Los estudiantes de medicina leyeron la copia impresa y, posteriormente, se les examinó su conocimiento e interés por la neuroanatomía. Los estudiantes que leyeron el extracto respondieron relativamente bien a las preguntas del examen y estaban más interesados en la neuroanatomía. La impresión parecía mejorar el conocimiento y la concentración de los estudiantes. Después de comprender la información fundamental del libro, se espera que los estudiantes puedan aprender conceptos avanzados con comodidad y confianza. Además, el libro con su contenido conciso y simple es adecuado no solo para cursos de neuroanatomía de corta duración, sino también, para el autoaprendizaje.

El Síndrome De Down al pasar de los años

El síndrome de Down es una condición genética muy conocida, causada por una alteración cromosómica numérica caracterizada por la presencia de un tercer cromosoma 21. Tiene una distribución mundial, en todas las razas y data de hace cientos de años. Bajo el lema "NOS DECIDIMOS", este año se conmemora el Día Mundial del Síndrome de Down, como cada 21 de marzo desde su instauración en el 2011. Este lema se originó en los temas discutidos durante la Convención de las Naciones Unidas sobre los Derechos de las Personas con Discapacidad y fue escogido con el propósito de enfatizar la necesidad de que las personas con este síndrome se involucren en la toma de sus propias decisiones, siendo este un derecho humano básico. El Día Mundial del Síndrome de Down brinda la oportunidad de ampliar panoramas, apoyar la igualdad y la inclusión. (provisto por Infomedic International)

Down syndrome is a well-known genetic condition caused by a numerical chromosomal alteration due to the presence of a third chromosome 21. It has a worldwide distribution, in all races and has been known for hundreds of years. Under the slogan WE DECIDE, this year we commemorate the World Down Syndrome Day, as every 21st of March since it was established in 2011. This motto was originated during the United Nations Convention on the Rights of Persons with Disabilities, and it was selected to emphasize the need for people with this syndrome to be involved in their decision-making process, as it is a basic human right. The World Down Syndrome Day provides an opportunity to broaden panoramas, support equality and inclusion. (provided by Infomedic International)

La COVID-19 y sus consecuencias en la salud física, psicológica y social de obstetras

Introducción: La pandemia por la COVID-19 ha tenido efectos en la salud de los trabajadores sanitarios, dentro de ellos, los obstetras, pero se desconocen las consecuencias en este grupo ocupacional. Objetivo: Determinar las consecuencias de la COVID-19 en la salud física, psicológica y social de obstetras del Perú. Métodos: Estudio observacional, descriptivo, transversal, realizado a 511 obstetras asistenciales, en la primera línea de atención. Se aplicó un cuestionario en línea, previamente validado y confiable para medir las variables: características generales y de exposición a la COVID-19, salud física, salud psicológica y salud social. Los datos fueron analizados mediante estadística descriptiva. Resultados: 468 (91,6 %) obstetras son mujeres, 287 (56,2 %) de 40-59 años, 213 (41,7 %) casadas, 292 (57,1 %) laborando en el primer nivel de atención; 216 (42,3 %) se infectaron de la COVID-19, 165 (32,3 %) tuvieron cefalea, 127 (24,9 %) dolor de garganta y 121 (23,7 %) fatiga; 167 (77,3 %) requirieron tratamiento ambulatorio y 3 (1,3 %) cuidados intensivos. La obesidad reportada por 102 (20,0 %) obstetras fue la principal comorbilidad, seguida de hipertensión con 38 (7,4 %) y diabetes con 14 (2,7 %); 263 (51,5 %) reportaron síntomas depresivos y 464 (90,8 %) estrés; 238 (46,6 %) sintieron discriminación y 118 (23,1 %) llevaban la carga laboral del hogar en solitario. Conclusiones: La salud física, psicológica y social de los obstetras se afecta por la pandemia; genera trastornos de sobrepeso/ obesidad, depresión, estrés; así como discriminación y sobrecarga laboral en el hogar.

Introduction: The COVID-19 pandemic has had effects on the health of health workers, including obstetricians, but the consequences in this occupational group are unknown. Objective: Determine the consequences of COVID-19 on the physical, psychological and social health of obstetricians in Peru. Methods: Observational, descriptive, cross-sectional study, carried out on 511 attending obstetricians, in the first line of care. An online questionnaire, previously validated and reliable, was applied to measure the variables: general characteristics and exposure to COVID-19, physical health, psychological health, and social health. Data were analyzed using descriptive statistics. Results: 468 (91.6%) obstetricians are women, 287 (56.2%) aged 40-59 years, 213 (41.7%) married, 292 (57.1%) working at the first level of care; 216 (42.3%) were infected with COVID-19, 165 (32.3%) had headache, 127 (24.9%) sore throat and 121 (23.7%) fatigue; 167 (77.3%) required outpatient treatment and 3 (1.3%) intensive care. Obesity reported by 102 (20.0%) obstetricians was the main comorbidity, followed by hypertension with 38 (7.4%) and diabetes with 14 (2.7%); 263 (51.5%) reported depressive symptoms and 464 (90.8%) stress; 238 (46.6%) felt discrimination and 118 (23.1%) carried the workload of the home alone. Conclusions: The physical, psychological and social health of obstetricians is affected by the pandemic; generates disorders of overweight/obesity, depression, stress; as well as discrimination and work overload at home.

Influence of Intolerance of Uncertainty on Preoccupation With Coronavirus Disease 2019 Among Frontline Nursing Professionals: Mediating Role of Reassurance-Seeking Behavior and Adherence to Physical Distancing

Background@#This study investigated the relationship between preoccupation with coronavirus disease 2019 (COVID-19), reassurance-seeking behavior, viral anxiety, intolerance of uncertainty, and adherence to physical distancing among frontline nursing professionals working in COVID-19 inpatient wards. Additionally, the study aimed to determine whether the commitment to physical distancing mediates the influence of intolerance of uncertainty on viral anxiety. @*Methods@#Frontline healthcare professionals working in the COVID-19 inpatient wards at three tertiary-level affiliated hospitals in Korea were surveyed between April 7 and 26, 2022.The survey included scales—such as the Obsession with COVID-19 Scale, Coronavirus Reassurance-Seeking Behaviors Scale, Fear of COVID-19 Scale, and Intolerance of Uncertainty Scale-12 and a questionnaire on adherence to physical distancing. A total of 256 responses were analyzed after excluding inappropriate or incomplete responses. @*Results@#Pearson’s correlation analysis found that age was significantly associated with the Obsession with COVID-19 Scale (r = −0.12, P < 0.05) and adherence to physical distancing (r = 0.27, P < 0.01). Linear regression analysis ascertained that age (β = −0.07, P = 0.002), Coronavirus Reassurance-Seeking Behaviors Scale (β = 0.35, P < 0.001), and Fear of COVID-19 Scale (β = 0.24, P < 0.001) were predictors of obsession with COVID-19 (Adjusted R 2 = 0.60, F = 78.1, P < 0.001). The indirect pathway by mediation analysis showed that reassurance-seeking and viral anxiety mediated the effect of intolerance of uncertainty on the preoccupation with COVID-19. @*Conclusion@#During the pandemic, there may be a strong association between reassuranceseeking behavior, viral anxiety, and a heightened preoccupation with COVID-19 among frontline healthcare workers. Thus, from the early stages of infectious disease, a psychological support team for medical staff responding to the disease should be established, and periodic evaluations should be conducted to identify high-risk groups.

Emotional and Behavioral Correlates of Exposure to Electronic Media in School-Aged Children: A Prospective Study

Background@#Exposure to electronic media is increasing from early childhood. This study aimed to examine the association between screen time and behavioral outcomes in schoolaged children with a prospective birth-cohort. @*Methods@#We examined the association between screen time and behavioral outcomes in school-aged children with a Korean birth-cohort study. Participants were 2,150 children, recruited during their fetal period, assessed annually for developmental outcomes. Media exposure was assessed at T4 (3.2 y/o), T8 (7.3 y/o), and T10 (9.4 y/o). After exclusions for missing data, 1,368 children were categorized into four groups (Low-Low, Low-High, HighLow, and High-High) based on average daily media time in early childhood and during schooldays, respectively. Children's temperament was assessed from T1 (0.5 y/o) to T4.Emotional and behavioral outcomes were assessed using the Child Behavior Checklist (DSMoriented subscales) at T8 and T10. @*Results@#We found that early-years temperament was generally similar between the mediatime groups: they only differed significantly on Activity at T1 and Emotionality at T2 (1.2 y/o).However, compared to the Low-Low group, the Low-High group had significantly higher odds of high-risk scores for Conduct Problems (increased odds ratios [ORs] of 1.82 at T8 and 1.83 at T10) and Anxiety Problems (increased ORs of 1.60 at T8 and 1.82 at T10). Self-rated self-esteem and overall happiness at T10 also significantly differed among the four groups. @*Conclusion@#Our findings suggest the negative impacts of media exposure on the emotional and behavioral development of school-aged children, which substantiates the guidelines that restrict media exposure during childhood.

Comparison of Two Variant Analysis Programs for Next-Generation Sequencing Data of Whole Mitochondrial Genome

Background@#With advance of next-generation sequencing (NGS) techniques, the need for mitochondrial DNA analysis is increasing not only in the forensic area, but also in medical fields. @*Methods@#Two commercial programs, Converge Software (CS) and Torrent Variant Caller for variant calling of NGS data, were compared with a considerable amount of sequence data of 50 samples with a homogeneous ethnicity. @*Results@#About 2,300 variants were identified and the two programs showed about 90% of consistency. CS, a dedicated analysis program for mitochondrial DNA, showed some advantages for forensic use. By additional visual inspection, several causes of discrepancy in variant calling results were identified. Application of different notation rules for mitochondrial sequence and the minor allele frequency close to detection threshold were the two most significant reasons. @*Conclusion@#With prospective improvement of each program, researchers and practitioners should be aware of characteristics of the analysis program they use and prepare their own strategies to determine variants.