Ventajas y desventajas de la modalidad virtual de enseñanza-aprendizaje percibidas en un curso de semiología en una facultad de medicina de Lima, Perú / Advantages and disadvantages of the virtual teaching modality perceived by the students in an introduction to clinical medicine course of a school of medicine in Lima, Peru

RESUMEN La pandemia de la Covid 19 forzó a las facultades de medicina a optar por una metodología virtual de enseñanza por la suspensión de las prácticas presenciales con pacientes reales en los establecimientos de salud, debido al confinamiento social y riesgo de contagio. Objetivo Determinar las ventajas y desventajas percibidas por los estudiantes de medicina en relación con la transición de las prácticas presenciales en hospitales a las sesiones virtuales de aprendizaje en un curso de semiología en una facultad de medicina de Lima, Perú. Material y métodos Estudio descriptivo de corte transversal realizado en estudiantes del 4to año de la carrera de Medicina. Los datos se recolectaron mediante una encuesta virtual no validada. Resultados 94 estudiantes respondieron la encuesta (tasa de respuesta: 51,1%). Las ventajas percibidas fueron: 57,4% tener mayor tiempo para estudio teórico y 38,3% en ahorro de tiempo en transporte y movilidad. Las desventajas fueron: 42,6% falta de contacto con pacientes reales y 39,4% no poder realizar una historia clínica adecuada. En cuanto al logro de objetivos de aprendizaje, el 72,3% consideró que logró identificar los problemas de salud del paciente, mientras que el 24,4% afirmó que logró realizar una adecuada historia clínica, y sólo el 9,6% que logró realizar un examen físico completo en pacientes. Conclusión La modalidad virtual de enseñanza permitió a los estudiantes tener más tiempo para revisar aspectos teóricos del curso, pero limitó la adquisición de habilidades prácticas, como realizar una anamnesis adecuada, presentar historias clínicas y examinar pacientes.

SUMMARY The COVID-19 pandemic forced the school of medicines to opt for a virtual teaching modality due to the suspension of face-to-face activities imposed by the lockdown. Objective To determine the advantages and disadvantages of the virtual teaching modality perceived by the students in an introduction to clinical medicine course of a school of medicine in Lima, Peru. Methods A virtual non-validated survey was circulated among fourth year medical students. Results 94 studentes answered the survey (51%). Perceived advantages were to have more time to study (57.4%) and saving time in transportation (39.4%). The disadvantages were lack of contact with real patients (42.6%) and not to be able to obtain a clinical history from patients (39.4%). The 72.3% of students were able to identify the medical problems of patients, but only 24.4% were able to obtain an adequate clinical history and just 9.6% performed an adequate physical examination. Conclusion The virtual teaching modality allowed the student to have more time for self-study but limited their abilities to obtain a clinical history and to perform a physical examination.

Validade baseada nos processos de respostas - Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial / Validity based on the response processes of the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofuncional Clinical History

RESUMO Objetivo Apresentar a etapa da evidência de validade baseada nos processos de respostas do Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial. Método Estudo desenvolvido conforme recomendações para validação de testes em Fonoaudiologia. Realizada análise da validade baseada nos processos de resposta do instrumento. Participaram dez fonoaudiólogos, que atuam em clínica e/ou pesquisa da Motricidade Orofacial com população entre 6 e 71 meses de idade, que aplicaram o Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial junto aos responsáveis pelas crianças. Os fonoaudiólogos emitiram apreciação sobre aplicabilidade do instrumento via formulário eletrônico do Google®, contendo questões dicóticas e/ou múltipla escolha, e escala likert com espaço para justificar respostas negativas. Os dados foram tabulados em planilhas Microsoft Excel 2016® e analisados pelo Índice de Validade de Conteúdo (IVC). Utilizado software R Core Team 2022 (Versão 4.2.2). Resultados Todos os itens do Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial foram válidos na aplicação em contexto real. Protocolo de História Clínica Miofuncional Orofacial - IVC 100% quanto à facilidade de aplicação e preenchimento, e uso na prática profissional; e IVC 90% quanto à utilidade para clínica fonoaudiológica. O Instrutivo obteve IVC 80% quanto à utilidade e 70% referente à necessidade de leitura prévia para preenchimento do Protocolo MMBGR Lactentes e Pré-escolares. Conclusão O Instrutivo e o Protocolo História Clínica Miofuncional Orofacial, pertencentes ao protocolo MMBGR - Lactentes e Pré-escolares tiveram comprovada validade baseada nos processos de resposta, para uso na clínica fonoaudiológica.

ABSTRACT Purpose Present the step of evidence of validity based on the responses to procedures of the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofunctional Clinical History. Methods Study developed according to phonoaudiologic tests validations recommendations. Validity analysis performed based on the process of instrument response. Ten speech therapists, that work on phonoaudiology clinic and/or orofacial myofunctional research on the population with age between 6 to 71 months, participated and applied the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofunctional Clinical History with those responsible for the children. The speech therapists appraised the instrument applicability via Google®️ electronic forms, containing dichotic and/or multiple-choice questions, and likert scale with space to justify negative answers. The data was tabulated on Microsoft Excel 2016®️ worksheets and analyzed by the content validity index (CVI). The software R Core Team 2022 (Versão 4.2.2) was used. Results All items from the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofunctional Clinical History were valid when applied to real contexts. Orofacial Myofunctional Clinic history protocol- IVC 100% in terms of ease of application and filling and usage in professional practice; IVC 90% in terms of usefulness for phonoaudiology clinic. The instructional got IVC 80% in terms of clinic usefulness and 70% regarding to the prior reading necessity to fill the MMBGR Protocol Infants and Preschoolers. Conclusion The Instrucional and Orofacial Myofunctional Clinical History, in the MMBGR Protocol Infants and Preschoolers had its validity proven based on the processes of responses to the usage on phonoaudiology clinic.

Exceso de peso y antecedentes heredofamiliares, una oportunidad de acción desde la Universidad / Excess weight and hereditary family history, an opportunity for action from the University

Resumen Objetivo: Identificar a los estudiantes con sobrepeso y obesidad, con antecedentes heredofamiliares para hipertensión y diabetes mellitus y sus hábitos de salud. Materiales y métodos: Cuestionario en línea. Participaron estudiantes de primer ingreso de diferentes programas académicos. Se incluyeron aspectos de antecedentes heredofamiliares, índice de masa corporal, y hábitos de salud. Se estimó asociación por regresión logística. Resultados: De 1211 estudiantes el 68% fueron mujeres. Se reportó bajo peso 10%, normo peso 65% y exceso de peso 25%. El 28% tuvo antecedentes heredo familiares (AHF) para diabetes mellitus y 14% para hipertensión. En un análisis estratificado por sexo, el consumo de alcohol se asoció a exceso de peso en los hombres (OR = 2.3, IC95% [1.1-5.0], p = 0.031); y en las mujeres lo fue el AHF para hipertensión arterial (OR = 2.2, IC95% [1.3-3.7], p = 0.004). Conclusión: Ser hombre, fumar, consumo de alcohol y AHF para hipertensión arterial fueron factores asociados a exceso de peso. En las universidades todavía es tiempo para establecer un proyecto de acción para mantener y promocionar la salud.

Abstract Objective: Identify overweight and obese students with a family history of hypertension and diabetes mellitus and their health habits at the University Center of Health Sciences. Materials and methods: Online questionnaire. First year students of different academic programs participated. Aspects of hereditary family history, body mass index, and health habits were included. Association was estimated by logistic regression. Results: Out of 1755 students, 68% were women. Low weight 10%, normal weight 65% and excess weight 25% were reported. 28% had a hereditary family history (AHF) for diabetes mellitus and 14% for hypertension. In an analysis stratified by sex, alcohol consumption was associated with excess weight in men (OR = 2.3, IC95% [1.1-5.0], p = 0.031); and in women it was AHF for arterial hypertension (OR = 2.2, IC95% [1.3-3.7], p = 0.004). Conclusion: Being a man, smoking, alcohol consumption and AHF for arterial hypertension were factors associated with excess weight. At universities, is still time to an action project to maintain and promote health.

Epilepsy in art: a historical exploration of representations across eras / Epilepsia na arte: uma exploração histórica de representações através de épocas

This narrative review explores the diverse representations of epilepsy in art across different historical periods, examining the intersection of artistic expression with evolving cultural, medical, and societal perceptions. Beginning with ancient and medieval depictions intertwined with religious symbolism, the paper progresses through the Renaissance, and Baroque, and transitions into modern and avant-garde movements. Each period reflects changing attitudes towards epilepsy, from divine interpretations, and religious concerns to anatomical realism and, later, explorations of psychological themes. The contemporary lens focuses on inclusive and empathetic portrayals, utilizing digital media to challenge stigmas and foster understanding.

Esta revisão narrativa explora as diversas representações da epilepsia na arte em diferentes períodos históricos, examinando a intersecção da expressão artística com a evolução das percepções culturais, médicas e sociais. Começando com representações antigas e medievais entrelaçadas com simbolismo religioso, o artigo avança através da Renascença e do Barroco, e transita para movimentos modernos e de vanguarda. Cada período reflete mudanças de atitudes em relação à epilepsia, desde interpretações divinas e preocupações religiosas até o realismo anatômico e, mais tarde, explorações de temas psicológicos. A lente contemporânea centra-se em representações inclusivas e empáticas, utilizando meios digitais para desafiar estigmas e promover a compreensão.

Desempenho no Teste Dicótico de Sentenças em Adultos com queixa comunicativa / Dichotic Sentences Test Performance of Adults with communication complaints

RESUMO Objetivo Analisar o desempenho de adultos normo-ouvintes com queixa comunicativa no Teste Dicótico de Sentenças. Método Selecionou-se em banco de dados, 15 participantes normo-ouvintes com resultados normais no Teste Dicótico de Dígitos, idades entre 19 a 44 anos, destros, que referiram queixa comunicativa. O Teste de Dicótico de Sentenças foi aplicado por meio de dois protocolos compostos por quatro diferentes combinações de listas denominados de sequências 1 e 2, de acordo com a seguinte ordem: treino, etapa de atenção dividida, etapas de atenção direcionada à direita e à esquerda. Resultados Na sequência de aplicação 1, a média de desempenho na etapa de atenção dividida foi 84,67% na orelha direita e 60,67% na esquerda, com diferença estatística entre orelhas, com assimetria entre orelhas variando de -50% a 60%. Na etapa de atenção direcionada, a média de desempenho foi 99,33% na orelha direita e 98% na esquerda, sem diferença estatística. Na sequência de aplicação 2, houve tendência de melhores resultados, mais acentuada na orelha esquerda, sem significância estatística, mantendo elevadas a variação de desempenho e a assimetria entre orelhas. Verificou-se na comparação entre as sequências, na etapa de atenção dividida, que na orelha direita 40% dos indivíduos não variaram, 33% pioraram, 26,7% melhoraram; na orelha esquerda, 6,6% não variaram, 20% pioraram e 73,33% melhoraram. Na etapa de atenção direcionada houve estabilidade nos resultados. Conclusão Os adultos normo-ouvintes, com queixas comunicativas, apresentaram um perfil heterogêneo, especialmente na etapa de atenção dividida, com acentuada diferença entre as orelhas e variabilidade de respostas.

ABSTRACT Purpose To analyze the performance of normal-hearing adults with communication complaints in the Dichotic Sentences Test. Methods We selected from the database 15 normal-hearing participants with normal results in the Digits Dichotic Test, aged between 19 and 44 years, right-handed, who reported communicative complaints. The Dichotic Sentences Test was applied using two protocols consisting of four different combinations of lists called sequences 1 and 2, in the following order: training, divided attention step, right and left directed attention steps. Results In the first application sequence, the average performance in the divided attention step was 84.7% for the right ear and 60.67% for the left, with statistical difference between ears. The asymmetry between ears varied from -50% to 60%. In the directed attention step, the average performance was 99.33% for the right ear and 98% for the left, with no statistical difference. In the second application sequence, there was a tendency for better results, more pronounced for the left ear, with no statistical significance, with the performance variation and asymmetry between ears remaining high. In the comparison between the sequences, in the divided attention step, it was found that, for the right ear, 40% of the individuals did not vary, 33% performed worse, and 26.7% performed better; for the left ear, 6.6% did not vary, 20% performed worse, and 73.33% performed better. There was result stability in the directed attention step. Conclusion The normal-hearing adults with communication complaints presented a heterogeneous profile, especially in the divided attention step, with a marked difference between ears and response variability.

Programa de escritura para estudiantes sobre la redacción de historias clínicas estomatológicas

Introducción: La correcta redacción de las historias clínicas es imprescindible para ofrecer un tratamiento óptimo a los pacientes. Objetivo: Evaluar en qué medida un programa dirigido a la redacción de historias clínicas favorece la competencia comunicativa escrita en los estudiantes de la carrera Estomatología de la Universidad de Ciencias Médicas de Camagüey. Método: Se realizó un preexperimento en el periodo de marzo a diciembre de 2020 a estudiantes de la carrera de Estomatología de la Clínica Estomatológica Provincial Docente "Ismael Clark y Mascaró", ubicada en la facultad antes mencionada. La población estuvo constituida por los 101 estudiantes de quinto año y una muestra de 30 de ellos. Se aplicaron entrevistas a 10 docentes. El estudio tuvo lugar en tres momentos: Diagnóstico, Intervención y Evaluación, se eligió el taller como forma organizativa. Se usó la estadística descriptiva para el procesamiento de los datos. Resultados: La aplicación de las normas, la coherencia, la cohesión y la calidad de las entrevistas estaban afectadas porque los estudiantes desconocían el proceso de redacción y porque el poco tiempo limita la lectura y corrección. Conclusiones: La evaluación del programa permitió conocer las dificultades que presentan los estudiantes. Propicia el conocimiento y concientización de procesos que intervienen en la escritura y el respeto a la recursividad de cada uno de los momentos por los que esta transcurre.

Introduction: The correct writing of medical records is essential for the correct treatment of patients. Objective: To assess how a writing program aimed at writing clinical histories favors written communicative competence in students of Dentistry at the Universidad de Ciencias Médicas in Camagüey. Method: A pre-experimental study was carried out from March to December 2020 in students of dentistry career at the Clínica Estomatológica Provincial Docente "Ismael Clark y Mascaró", located in the faculty with the same name. The population studied involved a total of 101 fifth year students and 30 of them were selected as sample. The method of interview was conducted on 10 professors. The study took place in three moments: Diagnosis, Intervention and Evaluation. The workshop procedure was chosen as the organizational form. Descriptive statistics were used for data processing. Results: The application of rules, coherence, cohesion and the interviews quality were affected by the students unfamiliar practice on the writing process and because the short time of procedures limits reading and correction. Conclusions: Assess of the program proposed has made the possibility of getting to know the difficulties presented by the students. It promotes knowledge and awareness of the processes involved in writing and giving respect for each recursive moments through which writing takes place.

Introdução: A escrita correta das histórias clínicas é essencial para oferecer um tratamento ideal aos pacientes. Objetivo: Avaliar em que medida um programa de escrita de histórias clínicas favorece a competência comunicativa escrita em estudantes da carreira de Estomatologia da Universidade de Ciências Médicas de Camagüey. Método: Foi realizado um pré-experimento de março a dezembro de 2020 para alunos da carreira de Odontologia de la Clínica Estomatológica Provincial Docente "Ismael Clark y Mascaró", localizada na referida faculdade. A população foi composta por 101 alunos do quinto ano e uma amostra de 30 deles. Foram aplicadas entrevistas a 10 professores. O estudo ocorreu em três momentos: Diagnóstico, Intervenção e Avaliação, sendo a oficina escolhida como forma de organização. A estatística descritiva foi utilizada para o tratamento dos dados. Resultados: A aplicação das normas, a coerência, a coesão e a qualidade das entrevistas foram afetadas porque os alunos desconheciam o processo de escrita e porque o pouco tempo limitava a leitura e a correção. Conclusões: A avaliação do programa permitiu conhecer as dificuldades apresentadas pelos alunos. Promove o conhecimento e a sensibilização dos processos envolvidos na escrita e o respeito pela recursividade de cada um dos momentos por que passa.

Third molar-related knowledge, attitudes, behaviors, and medical history of 904 Chinese adults: a cross-sectional survey / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

This study investigated the perceptions and medical history of third molars (M3s) and assessed the prevalence of visible M3s (V-M3s) among 904 Chinese adults. The enrolled participants were interviewed to complete a structural questionnaire focused on sociodemographic information and their understanding of, attitudes toward, behaviors regarding, and medical history with respect to M3s. In addition, the number of V-M3s in the cohort was determined by oral examination. Logistic regression analysis was performed to explore the association between individuals' sociodemographic characteristics and their perception of M3s or the presence of V-M3s. The Chi-square test was used to compare the actions taken against symptomatic M3s and the corresponding outcomes among different groups divided according to respondents' sociodemographic factors. In total, 904 completed questionnaires were gathered and analyzed. Nearly half (43.9%) of the respondents knew nothing about M3s, and only 12.7% provided correct answers to all the questions asked. Male sex, older age, occupation involving physical labor, and no previous dental experience were active factors in unawareness of M3s. Male sex was also significantly associated with the presence of at least one V-M3 and negative behavior about symptomatic M3s. In terms of medical history, 192 participants reported having had at least one M3 extracted (438 in total), and 72.6% of the M3s were removed due to the presence of related symptoms or pathologies. In conclusion, the population investigated had a shortage of knowledge about M3s and adopted negative attitudes and actions about M3-related problems.

Rehabilitación propioceptiva del síndrome de hombro doloroso / Proprioceptive rehabilitation of painful shoulder syndrome / Reabilitação proprioceptiva da síndrome do ombro doloroso

El hombro es una de las regiones anatómicas de mayor movilidad en la vida cotidiana, siendo una de las causas de consulta más frecuentes en el área de fisioterapia para su rehabilitación, pues la primera línea de acción es el tratamiento conservador del hombro; por ello, es de suma importancia conocer y evaluar el complejo articular del hombro, así como también de la región cervicotorácica, con los resultados de la valoración establecer una estrategia de tratamiento que pueden ir desde la terapia manual, el masaje terapéutico, cambios de temperatura hasta el empleo de otros agentes físicos. Paciente femenino de 42 años, con ocupación de asistente odontológica; no reporta discapacidad previa. Como antecedente médico se presenta accidente de tránsito en motocicleta sin producir fractura de hueso ni luxación, ocurrido ocho años antes de la consulta en fisiatría, la paciente tiene afectado el desarrollo de las actividades de la vida cotidiana. Recibió serie de tratamientos durante 10 sesiones, en las cuales se aplican agentes físicos, dado que anteriormente recibió tratamiento farmacológico sin resultados favorables. Se aplica protocolo de rehabilitación fundamentado en las técnicas de propiocepción y al finalizar la terapia la paciente reporta dolor leve, y mejora en la realización de actividades de la vida diaria.

The shoulder is one of the anatomical regions of greater mobility in daily life, being one of the most frequent causes of consultation in the area of physiotherapy for rehabilitation, since the first line of action is the conservative treatment of the shoulder; therefore, it is of utmost importance to know and evaluate the articular complex of the shoulder, as well as the cervicothoracic region, with the results of the assessment to establish a treatment strategy that can range from manual therapy, therapeutic massage, temperature changes to the use of other physical agents. Female patient, 42 years old, with occupation as a dental assistant; she reports no previous disability. As medical history, she had a traffic accident on a motorcycle without bone fracture or dislocation, which occurred eight years before the physiatry consultation, the patient has affected the development of activities of daily living. She received a series of treatments during 10 sessions, in which physical agents are applied, since she had previously received pharmacological treatment without favorable results. Rehabilitation protocol based on proprioception techniques is applied and at the end of therapy the patient reports mild pain and improvement in the performance of activities of daily living.

O ombro é uma das regiões anatômicas de maior mobilidade na vida diária, sendo uma das causas mais freqüentes de consulta na área de fisioterapia para reabilitação, pois a primeira linha de ação é o tratamento conservador do ombro; portanto, é extremamente importante conhecer e avaliar o complexo articular do ombro, bem como a região cervicotorácica, com os resultados da avaliação para estabelecer uma estratégia de tratamento que pode variar desde a terapia manual, massagem terapêutica, mudanças de temperatura até o uso de outros agentes físicos. Paciente do sexo feminino, 42 anos de idade, trabalhando como assistente odontológica; nenhuma deficiência anterior foi relatada. O histórico médico inclui um acidente de trânsito em uma motocicleta sem fratura ou deslocamento ósseo, que ocorreu oito anos antes da consulta ao fisiatra; as atividades de vida diária do paciente são afetadas. Ela recebeu uma série de tratamentos durante 10 sessões, nas quais foram aplicados agentes físicos, já que ela havia recebido anteriormente tratamento farmacológico sem resultados favoráveis. Um protocolo de reabilitação baseado em técnicas de propriocepção foi aplicado e ao final da terapia o paciente relatou dor leve e melhora no desempenho das atividades da vida diária.

Prevalence of hepatitis B & C infections in prospective blood donors deferred due to history of jaundice

Background & objectives: As per national guidelines, prospective blood donors with a history of jaundice of unknown cause are deferred permanently to prevent the transmission of hepatitis B and C. The validity of this guideline was tested by comparing prevalence rates of hepatitis B and C in prospective blood donors deferred due to a history of jaundice, with that of donors who were found fit. Methods: Blood samples of 212 consecutive donors (male, n=203) deferred due to a history of jaundice were studied for hepatitis B and C by rapid test kits as well as by chemiluminescence (n=115) or ELISA (n=97). Consecutive healthy donors (n=549; male, n=518) were also studied by ELISA (n=266) or chemiluminescence (n=283). Results: The cumulative prevalence detected by rapid test kit and ELISA/chemiluminescence tests of hepatitis B (n=10) and C (n=2) among donors deferred due to a history of jaundice (n=212) was 5.7 per cent [95% confidence interval (CI): 2.9, 9.9]. The prevalence of reactive results among healthy donors (n=549) by ELISA/chemiluminescence tests was 3.3 per cent (95% CI: 1.9, 5.2), which included hepatitis B (n=15) and hepatitis C (n=3) cases. Compared to healthy donors, the odds of seropositivity among jaundice-deferred donors was 1.7 (95% CI: 0.8, 3.6), P=0.15. For rapid test-negative deferred donors, the odds of seropositivity by ELISA/chemiluminescence declined to 0.4 (0.1, 1.5), P=0.19. Interpretation & conclusions: The prevalence rates of hepatitis B and C in prospective blood donors deferred due to a history of jaundice of unknown aetiology did not differ significantly from that in healthy donors. The current practice of permanently deferring such donors depletes valuable donor pool. A strategy of rejecting only those donors who are found reactive on pre-donation testing by rapid test needs further validation.

Los biodatos del expediente clínico odontológico en México: análisis jurídico y bioético / The biodata of the dental clinical record in Mexico: legal and bioethical analysis

Objetivo: analizar los biodatos que integran el expediente clínico odontológico desde el derecho mexicano y la bioética. Métodos: hermenéutica analógica aplicada a los documentos jurídicos y bioéticos que determinan los biodatos mínimos constitutivos de los expedientes clínicos estomatológicos en México. Resultados: jurídicamente se identificaron los biodatos y se categorización en función de su naturaleza (antecedentes heredo-familiares, antecedentes personales patológicos y no patológicos, padecimiento actual e interrogatorio por aparatos y sistemas) y de los datos personales sensibles (datos: personales, identificativos, laborales, patrimoniales, académicos, de tránsito y migración, de salud, biométricos, de características físicas, y, especialmente, protegidos). Conclusiones: el análisis de la aplicación de los principios bioéticos a los biodatos del expediente clínico odontológico identificó como medidas mínimas las siguientes: la existencia de consentimiento(s) informado(s); el buen tratamiento de los biodatos; el correcto tratamiento y manejo de seguridad de las bases de datos que contengan un expediente o un conjunto de ellos y la bioseguridad del material biológico y genético en biobancos.

Objective: To analyze the biodata that make up the dental clinical record from Mexican law and bioethics. Methods: Analogical hermeneutics applied to the legal and bioethical documents that determine the minimum biodata constituting the stomatological clinical records in Mexico. Results: Legally, biodata were identifed and categorized according to their nature (inherite-family history, pathological and non-pathological personal history, current condition and questioning by devices and systems) and according to sensitive personal data (data: personal, identifcation, labor, patrimonial, academic, transit and migration, health, biometric, physical characteristics, and especially protected). Conclusion: The analysis of the application of Bioethical principles to the biodata of the dental clinical record identifed as minimun measures: the existence of informed consent(s), the good treatment of the biodata, good treatment and security of the databases that contain a fle or a set them, the biosecurity of biological and genetic material in biobanks.

Distribuição da semiologia do adulto nas escolas médicas do Brasil / Distribution of adult semiology in medical schools in Brazil

Resumo: Introdução: A semiologia é a base da prática clínica e seu ensino é essencial no curso de Medicina. Este estudo foi desenvolvido por haver uma lacuna no conhecimento sobre sua distribuição no Brasil. Objetivo: Este estudo teve como objetivo analisar a distribuição da semiologia do adulto nas escolas médicas brasileiras. Método: Trata-se de um estudo transversal descritivo realizado com 226 escolas médicas brasileiras que disponibilizavam a distribuição de semiologia na internet entre as 335 ativas, em dezembro de 2020 (67,5%). As variáveis estudadas foram região geográfica, administração, gratuidade e tempo de existência da escola, carga horária do curso, do internato e de semiologia, e ano(s) ou semestre(s) em que a semiologia era ofertada no currículo. A análise dos dados foi descritiva, e analisaram-se as associações com os testes: t de Student, análise de variância, qui-quadrado de Pearson, U de Mann-Whitney, Kruskal-Wallis e Wilcoxon. Admitiu-se um nível de significância de p < 0,05. Resultado: A semiologia foi mais frequentemente ofertada apenas no quarto semestre (n = 40), seguida por sua oferta em dois semestres: quarto e quinto e terceiro e quarto. Entre as 226 escolas, 142 integravam os conteúdos em módulos ou eixos (62,8%). Entre 117 escolas que forneciam a carga horária de semiologia, mediana foi de 240,0 horas (P25-75 = 165,4 - 338,2), sem diferença estatística por região geográfica, administração, gratuidade e tempo de existência da escola. A mediana da carga teórica de semiologia [77,5 horas (P25-75 = 51,7 - 123,5)] foi menor do que a carga prática [147,0 horas (P25-75 = 64,5 - 180,0)], Z = -3,99, p < 0,01. A mediana da porcentagem da carga horária de semiologia no curso foi de 2,9% (P25-75 = 2,0 - 4,0). Conclusão: A semiologia é mais frequentemente ofertada no quarto semestre, e sua carga horária não difere por características geográficas, de administração e tempo de existência das escolas estudadas.

Abstract: Introduction: Semiology is the basis of clinical practice and its teaching is essential in the medical course. This study was developed to fill a gap in the knowledge about its distribution in Brazil. Objective: To analyze the distribution of adult semiology in Brazilian medical schools. Method: Cross-sectional descriptive study with 226 Brazilian medical schools that provided the distribution of semiology on the Internet among the 335 active schools in December 2020 (67.5%) The variables studied were school geographic region, administration and free tuition, time of existence of the course, course load of the regular course, clerkship and semiology, and year(s) or semester(s) in which semiology was offered in the curriculum. Data analysis was descriptive and the associations were analyzed using: Student's t, Chi-square, Analysis of Variance, Mann-Whitney-U, Kruskal Wallis and Wilcoxon tests. The significance level was set at p < 0.05. Result: Semiology was more frequently offered only in the 4th semester (n = 40), followed by its offer in two semesters, the 4th and 5th and 3rd and 4th. Among the 226 schools, 142 integrated semiology into modules or axes (62.8%). Among the 117 schools that provided the semiology course load, its median was 240.0 hours (P25-75 = 165.4 - 338.2), with no statistical difference by geographic region, type of administration and time of existence of the course. The median of the theoretical course load [77.5 hours (P25-75 = 51.7 - 123.5)] was lower than the practical course load [147.0 hours (P25-75 = 64.5 - 180.0)], Z = - 3,99, p < 0,01. The median of the percentage of semiology course load during the course was 2.9% (P25-75 = 2.0 - 4.0). Conclusion: Semiology is more frequently offered in the 4th semester and its median course load is similar in Brazilian geographic regions and by school administration type and time of existence of the assessed schools.

A liberdade de (se) narrar no ensino da semiologia médica / The freedom to (self) narrate in teaching medical semiology

Resumo: Introdução: Ao escrever sobre o ensino de semiologia, escrevo sobre histórias, imagens, signos e símbolos; sobre percepções, interpretações, encontros e desencontros. É a história do outro que se entrelaça com a minha, pois, ao ouvir, ver e examinar um paciente, vou além do que é aprendido nos livros de medicina. Neste artigo, falo de uma insurreição contra essa ditadura técnico-cognitiva no ensino da semiologia. Desenvolvimento: A anamnese médica é o relato da história do paciente, além de conter a descrição do exame físico realizado. Basicamente, é o resumo do encontro clínico, que vai guiar o caminho do médico na sua formulação diagnóstica e no planejamento dos cuidados necessários para cada paciente, e é ensinada de forma metódica e rígida, sem considerar a "história" da pessoa que conta, e sim a doença que ela tem. A abordagem deste trabalho é qualitativa, e adotou-se o método da cartografia, que se associa bem com a fenomenologia e permite acompanhar o meu percurso nesta narrativa. É o meu percurso como professora de semiologia médica que trago neste artigo, como material de estudo. Vou dividir essa trajetória da docência em três momentos ("O começo", "O 'divisor de águas'" e "Redescoberta"). Conclusão: A inserção das humanidades e das narrativas no curso de Medicina traz uma reflexão fundamental e necessária sobre o fazer médico e o próprio ensino na saúde. Usar o método da cartografia e as reflexões surgidas nesse caminhar pode contribuir para uma formação docente mais humanizada, com uma visão mais ampla da saúde e do ensino na saúde.

Abstract: Introduction: When writing about teaching semiology/clinical skills, I write about stories, images, signs and symbols; about perceptions, interpretations, encounters and mismatches. It is the other's story that intertwines with mine, because when listening, seeing, examining a patient, one goes beyond what is learned in medical books. In this paper, I talk about an insurrection against this technical cognitive dictatorship in the teaching of semiology. Development: Medical anamnesis is the reporting of the patient's history, in addition to the description of the physical examination performed. Basically, it is a summary of the clinical encounter, which will guide the doctor's path in his diagnostic formulation and planning of the necessary care for each patient. Moreover, it is taught in a methodical and rigid manner, without taking into account the "story" of those who tell it, but rather of the disease that the patient is carrying. This qualitative approach involved the method of cartography, which is tightly associated with phenomenology; it allows me to follow my path in this narrative. It is my journey, as a professor of clinical skills, that I bring here as study material. I divide this trajectory of teaching into three moments (the beginning, the watershed and rediscovery). Final considerations: The inclusion of humanities, narratives, in the medical course, brings a fundamental and necessary reflection on medical practice, and on health education itself. Using the cartography method and the reflections that emerged along this path can contribute to a more humanized teacher education, with a broader view of health, and of teaching in health.

Protocolo MMBRG - Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial / MMBGR Protocol - infants and preschoolers: Instructive and Orofacial Myofunctional Clinical History

RESUMO Objetivo Apresentar Instrutivo e Protocolo de História Clínica Miofuncional Orofacial pertencentes ao Protocolo MMBGR - Lactentes e Pré-escolares, incluindo adaptação e validação do conteúdo e aparência destes. Método Estudo tipo validação, descritivo e transversal. Adaptação a partir do Protocolo MBGR, fundamentada em estudos teóricos e experiência dos autores. Considerados lactentes entre 6 e 23 meses de vida e pré-escolares entre 24 e 71 meses. Obtido consentimento e consenso da versão adaptada pelos autores (originais e atuais). Analisados aparência e conteúdo do novo instrumento por 10 fonoaudiólogos especialistas em Motricidade Orofacial. Realizadas duas rodadas de análise: Primeira com formulário eletrônico contendo questões dicóticas (sim/não), com espaço para justificar as respostas negativas; calculado Índice de Validade de Conteúdo e Teste Binomial Exato; e Segunda com escala Likert 5 posições. Resultados Produzido instrutivo inédito e adaptado o Protocolo de História Clínica, com manutenção de 23 itens pertinentes à faixa etária em questão. Excluídas informações em 7 itens e acrescidas em 8 itens. Inicialmente obteve-se concordâncias de 70% do instrutivo, por pelo menos 70% dos especialistas; e 64% dos itens da História Clínica, por ao menos 90% dos especialistas. Obteve-se na segunda rodada 100% de respostas "Concordo totalmente" dos especialistas. Conclusão "Instrutivo" e "História Clínica Miofuncional Orofacial" tiveram validade de conteúdo e aparência concluída, e junto ao "Exame Clínico" integram o "Protocolo MMBGR - Lactentes e Pré-escolares", com potencial contribuição para atuação clínica e na pesquisa em Motricidade Orofacial na faixa etária de 6 meses a 5 anos e 11 meses de idade.

ABSTRACT Purpose To present Myofunctional Orofacial Clinical History Instructive and Protocol belonging to the MMBGR Protocol - Infants and Preschoolers, including the adaptation and validation of content and appearance. Methods Validation, descriptive and cross-sectional study. Adaptation based on the MBGR Protocol, based on theoretical studies and the authors' experience. Infants between 6 and 23 months of age and preschoolers between 24 and 71 months were considered. Consent and consensus of the version adapted by the authors (original and current) was obtained. The appearance and content of the new instrument were analyzed by 10 speech therapists specialized in Orofacial Motricity. We performed two analysis rounds. First: an electronic form containing dichotic questions (yes / no), with justification for negative answers; Content Validity Index and Exact Binomial Test; Second: 5 points-Likert scale. Results We produced an unprecedented instructional and adapted Clinical History protocol maintaining 23 age group related items. We excluded information from 7 items and included information in 8. Initially, we achieved agreement in 70% instructional specialist items by at least 70% of the specialists; and 64% of Clinical History items, by at least 90% of specialists. In the second round, there were 100% of "I totally agree" responses from the experts. Conclusion "Instructive" and "Myofunctional Clinical History, Orofacial" had validity of content and appearance concluded, and together with the "Clinical Examination" they integrate the "Protocol MMBGR - Infants and Preschoolers", being able to contribute to clinical practice and research in Motricity Orofacial area in the age group between 6 months and 5 years and 11 months of age.

Protocolos fonoaudiológicos de história clínica: revisão integrativa / Clinical history speech-language pathology protocols: integrative review

RESUMO Objetivo identificar, coletar e analisar, na literatura científica, evidências da existência de protocolos fonoaudiológicos de levantamento da história clínica, conforme classificação de risco, especialmente para distúrbios oromiofuncionais, em lactentes e pré-escolares. Estratégia de pesquisa foram selecionados estudos publicados, sem delimitação temporal, nas bases de dados eletrônicas LILACS, SciELO e PubMed e na literatura cinza (Google Acadêmico). Critérios de seleção estudos disponíveis na íntegra nas línguas portuguesa e inglesa, que identificassem protocolos fonoaudiológicos de história clínica aplicáveis a lactentes (6 a 23 meses de vida) e pré-escolares (24 a 71 meses de vida). Foram excluídas as revisões narrativas e de literatura (integrativa, sistêmica e escopo). Resultados foram encontradas 1371 publicações brasileiras no período de 1980 a 2022. Destas, foram identificadas apenas cinco que tratavam de protocolos fonoaudiológicos para levantamento de dados pregressos a partir da história clínica da faixa etária de 6 a 71 meses. Apenas um desses protocolos possuía classificação de risco para distúrbios fonoaudiológicos, distribuídos na área de linguagem e fluência. Os outros três eram da área de motricidade orofacial (MO) e não continham classificação de risco para distúrbio miofuncional orofacial. Conclusão existem poucos protocolos fonoaudiológicos para levantamento da história clínica de lactentes e pré-escolares que contenham, ou não, classificação de risco, publicados em revistas de acesso aberto e que passaram por processos completos de validação, sendo necessário ampliar estudos e publicações desses instrumentos, inclusive na área de MO.

ABSTRACT Purpose to identify, collect and analyze in the scientific literature evidence of the existence of speech therapy protocols for collecting clinical history, according to risk classification, especially for oromyofunctional disorders, in infants and preschoolers. Research Strategy We selected published studies, without temporal delimitation, in the electronic databases LILACS, SciELO and PUBMED; and in the gray literature (Google Academic). Selection criteria available in full in Portuguese and English, which identify speech-language pathology protocols of clinical history applicable to infants (6 to 23 months of age) and preschoolers (24 to 71 months of age). Narrative and literature reviews (integrative, systemic, and scope) were excluded. Results 1371 Brazilian publications were found in the period from 1980 to 2022. Of these, only five publications on speech therapy protocols were identified for collecting previous data from the clinical history of the age group between 6 and 71 months. Only two of these protocols have a risk classification for speech-language disorders, distributed in the areas of language and fluency. The other three are from the Orofacial Motricity (OM) area and do not carry a risk classification for orofacial myofunctional disorder. Conclusion There are few speech therapy protocols for surveying the clinical history of infants and preschoolers, whether or not they contain risk classification, published in open access journals that have a complete validation process.Therefore there is a need for more research and publication of these instruments, including in the area of OM.

Construction and application of intelligent outpatient pre-admission medical history collection system / 中华医院管理杂志

Digital and intelligent technology is an important driving force to promote the transformation and innovation of medical service mode and improve service quality. In February 2020, Peking Union Medical College Hospital established an intelligent outpatient pre-admission medical history collection system in order to improve the intelligent level of clinical application business system and the medical experience of outpatients.The system consisted of artificial intelligence capability layer, application service layer, capability resource layer and user application layer and hardware technology architecture. By docking with the hospital information system and using mobile terminal App, patients could submit pre-admission medical history information by themselves, and generate structured patient history for the visiting doctors to call. By November 2021, the pre-admission medical history collection system had covered 80% of the departments of the hospital, serving 1.68 million people in total, and the patient filling rate had reached 60%. The duration of patient′s medical history collection and the duration of doctor′s outpatient electronic medical record writing had been continuously shortened, greatly improving the efficiency of outpatient medical services.

Legado del profesor Arturo Teodoro Menéndez Cabezas a las nuevas generaciones de profesionales de la Salud / Legacy of Professor Arturo Teodoro Menéndez Cabezas to the new generations of Health professionals

RESUMEN Fundamento: en la historia de la educación médica, varios han sido los docentes que han dejado su impronta en la formación de las nuevas generaciones. Objetivo: caracterizar la prolífera actividad profesional desarrollada por el Dr. C. Arturo Teodoro Menéndez Cabezas, con énfasis en los procesos investigativos, como legado pedagógico en la enseñanza médica. Métodos: se realizó una investigación etnográfica, a través del análisis histórico lógico de su vida, para caracterizar su actuación. Se utilizó la observación participante y la entrevista con informantes claves, como métodos cualitativos. Sin hacer énfasis en la descripción bibliográfica, se abordaron elementos de la vida y obra pedagógica, aspectos a destacar por la transcendencia de su legado a las nuevas generaciones de profesionales de la salud dentro y fuera del país. Resultados: se establecen las características sociopolíticas y educacionales que constituyen antecedentes a la actuación educacional del bioquímico, se pormenorizan las actividades realizadas en cada uno de los aspectos que caracterizan al profesor universitario de la Cuba actual y se revela mediante el criterio valorativo los aportes que caracterizan su actuación, como médico-educador social. Conclusiones: el análisis y las valoraciones realizadas en el transcurso de la investigación permitieron, caracterizar la obra educativa del profesor Arturo, en relación con los componentes asistencial, docente, gerenciales e investigativos. Se fundamentan sus aportes a la Educación Médica, sobre la base de: ejemplo personal, concepciones pedagógicas, pensamiento ideológico, relaciones interpersonales y sobre todo su condición y preparación científico-técnica como bioquímico, en la dualidad en su labor como médico y profesor.

ABSTRACT Background: there have been several professors in the history of medical education that have left their imprint in the formation of new generations. Objective: to characterize the prolific professional activity developed by PhD. Arturo Teodoro Menéndez Cabezas, with emphasis in the investigative processes, as pedagogic legacy in the medical education. Methods: an ethnographic research was carried out through a historic-logical analysis of his life to characterize his way of acting. The observation and the interview with key informants were used as qualitative methods. Without making special attention to the bibliographic description, element of his life and work were approached as aspects to highlight due to the transcendence of his legacy to the new generations of health professionals in and out of the country. Results: the sociopolitical and educational characteristics that constitute the antecedents of the biochemist educational acting were established, the activities that characterize the university professor in Cuba are detailed, and the contributions that characterize his acting as doctor-social educator were revealed. Conclusions: the analysis and appreciations carried out during the research allowed characterizing the educative work of Professor Arturo, related to the assistance, docent, managerial and investigative components. His contributions to the Medical Education are found out on the base of his personal example, pedagogical conceptions, ideological thinking, interpersonal relations and above all his scientific-technical condition and preparation as biochemist, in his double work as doctor and professor.

A construção de competências nas etapas iniciais da formação médica: Um relato de experiência / The building of skills in the initial stages of medical training: An experience report

Introdução: A graduação em Medicina tem passado por diversas mudanças curriculares, com transferência gradativa do ensino tradicional para metodologias ativas, as quais preconizam a aprendizagem significativa e a participação ativa dos discentes. Orientado pelas Diretrizes Curriculares Nacionais vigentes, o curso de graduação em Medicina da Universidade Federal do Pampa (UNIPAMPA), contempla essa nova perspectiva formativa. Apresenta como foco as construções de competências médicas, desenvolvidas desde etapas iniciais do curso, com ênfase no vínculo entre teoria e prática. Método: O presente estudo aborda um relato de experiência e tem por objetivo refletir acerca da implementação da disciplina "Introdução à Psicologia e Habilidades Médicas" (IPHM). Resultados: Por meio das atividades do referido componente curricular, é ofertado desde o primeiro semestre o contato dos discentes com a entrevista médica, com ênfase na construção da anamnese e na compreensão dos aspectos relacionais e comunicacionais englobados. Ainda que outras instituições desenvolvam a construção de aspectos relacionados à anamnese médica em fases iniciais, o curso de Medicina da Unipampa apresenta inovações na forma como conduz esse trabalho, com emprego de metodologias ativas associadas às situações clínicas simuladas (Role-play), com foco tanto na redação, como nas relações interpessoais e qualidade da comunicação na relação médico-paciente. Conclusões: Por meio da abordagem dos desafios e potencialidades do processo de implementação do referido componente curricular, cumpre reconhecer a adequação e a pertinência da experiência, no sentido de estabelecer um espaço de construção de competências profissionais para a entrevista médica, em momento inicial da formação acadêmica.

Introduction: Graduation in Medicine has experienced several changes in the training curriculum, by changing from the traditional way of teaching to active methodologies, providing meaningful learning and active participation by students. Guided by the National Curriculum Guidelines, the undergraduate course in Medicine, from the Federal University of Pampa (Unipampa), contemplates this new formative perspective, through curricular innovations in the methodological and organizational fields. It focuses on the construction of medical skills, developed since the initial stages of the course, with emphasis on the link between theory and practice. Method: This study is an experience report, with a qualitative approach and aims to reflect on the implementation of the IPHM discipline. Results: Through the activities of this curricular component, student´s contact with the medical interview is offered in the first semester, emphasis on the construction off the anamnesis and the knowlegment of its relational and communicational aspects. Although other academies develop the construction of aspects related to medical anamnesis in early stages, the Unipampa's Medicine course introduced a inovation in the way that conducts it's work, using active methodologies associated with simulated clinical situations (Roleplay), focusing both writing, interpersonal relationship and quality of communication between doctor and patient. Conclusions: Through addressing the challenges and potentialities of the implementation process of the said curricular component, it is important to recognize the adequacy and relevance of the experience, in order to establish a space for the construction of professional skills for the medical interview, at the beginning of academic training.

Analysis of clinical data of 3 cases of hemophagocytic syndrome and literature review / 中国基层医药

Objective:To analyze the clinical characteristics, diagnosis, treatment and prognosis of three children with hemophagocytic syndrome (HPS) and provide diagnosis and treatment clues for reasonable treatment and prevention of serious complications and reduction of misdiagnosis and mistreatment.Methods:The clinical data of three children with HPS who received treatment in Taiyuan Maternal and Child Health Care Hospital from March 2018 to March 2020 were retrospectively analyzed. Related literature was retrieved. The clinical data of the three children were summarized to analyze the outcomes.Results:Fever (≥ 39 ℃) was the first symptom in all three cases. In the end, red blood cell line, white blood cell line, and platelet line were reduced to different degrees in all three cases. Hepatosplenomegaly was found in two cases. Transaminase highly increased in two cases, and slightly increased in one case. Ferritin greatly increased, fibrinogen decreased, and hypertriglyceridemia did not occur in all three cases. Two cases had skin rash during fever. Skin rash appeared late in one of them.All three cases had different degrees of lymphadenopathy. Bone puncture examination showed reticulocyte phagocytosis in bone marrow in one case and leishmania in bone marrow smear in another case. These two cases were cured and discharged. One case died of multiple organ failure due to rapid disease progression, and adrenal masses were found at autopsy.Conclusion:HPS has diverse clinical manifestations, complex etiology and different clinical prognoses. HPS should be considered in case of unexplained fever with hemocytopenia. The medical history and living history should be inquired in detail and relevant auxiliary examinations should be improved as soon as possible.

Characteristics of gastric microbiota in children with Helicobacter pylori infection family history / 北京大学学报(医学版)

OBJECTIVE@#To explore the characteristics of gastric microbiota in children with and without (Helicobacter pylori, H. pylori) infection who had family history of H. pylori infection.@*METHODS@#Mucosal biopsy samples of the gastric corpus and gastric antrum were collected during the gastroscope. And the gastric mucosa flora's information of the two groups of children were obtained after sample DNA extraction, PCR amplification of the 16S ribosomal DNA (rDNA) V3-V4 region, high-throughput sequencing and data processing. All the samples with family history of H. pylori infection were divided into two groups, the H. pylori infection group (n=18) and the H. pylori non-infection group (n=24). Then the α-, β-diversity and bacteria abundance of the gastric microbiota were compared between the H. pylori infection and non-infection groups at different taxonomic levels. The differential microbiota was found out by LEfSe analysis, and then the function of microbiota predicted using phylogenetic investigation of communities by reconstruction of unobserved states (PICRUSt) method.@*RESULTS@#There was statistically significant difference in α-diversity (P < 0.05) between the two groups, indicating that the H. pylori non-infection group had higher microbial richness than the H. pylori infection group. Moreover, the β-diversity was significantly different as well (P < 0.05), which meant that the microbiota composition of the two groups was different. At the phyla level, Proteobacteria, Firmicutes, Bacteroides, Actinobacteria, and Fusobacteria were dominant in the two groups. At the genus level, Bacteroides, Prevotella, Streptococcus, and Neisseria, etc. were dominant in the H. pylori non-infected group. Meanwhile, Helicobacter and Haemophilus etc. were dominant in the H. pylori infected group. LEfSe analysis showed that the relative abundance of Bacteroides etc. at the genus level in the H. pylori non-infected group was significantly higher than that in the H. pylori infected group. Functional prediction showed that Bacteroides were positively correlated with amino acid and vitamin metabolism, mitogen-activated protein kinase (MAPK), mammalian target of rapamycin (mTOR) signaling pathway and ansamycin synthesis pathway.@*CONCLUSION@#The gastric microbiota between H. pylori positive and H. pylori negative in children with family history of H. pylori infection is significant different. Some gastric microbiota, such as Bacteroides, may have a potential relationship with H. pylori infection in children.