Surgeons vs ChatGPT: Assessment and Feedback Performance Based on Real Surgical Scenarios.

INTRODUCTION: Artificial intelligence tools are being progressively integrated into medicine and surgical education. Large language models, such as ChatGPT, could provide relevant feedback aimed at improving surgical skills. The purpose of this study is to assess ChatGPT´s ability to provide feedback based on surgical scenarios. METHODS: Surgical situations were transformed into texts using a neutral narrative. Texts were evaluated by ChatGPT 4.0 and 3 surgeons (A, B, C) after a brief instruction was delivered: identify errors and provide feedback accordingly. Surgical residents were provided with each of the situations and feedback obtained during the first stage, as written by each surgeon and ChatGPT, and were asked to assess the utility of feedback (FCUR) and its quality (FQ). As control measurement, an Education-Expert (EE) and a Clinical-Expert (CE) were asked to assess FCUR and FQ. RESULTS: Regarding residents' evaluations, 96.43% of times, outputs provided by ChatGPT were considered useful, comparable to what surgeons' B and C obtained. Assessing FQ, ChatGPT and all surgeons received similar scores. Regarding EE's assessment, ChatGPT obtained a significantly higher FQ score when compared to surgeons A and B (p = 0.019; p = 0.033) with a median score of 8 vs. 7 and 7.5, respectively; and no difference respect surgeon C (score of 8; p = 0.2). Regarding CE´s assessment, surgeon B obtained the highest FQ score while ChatGPT received scores comparable to that of surgeons A and C. When participants were asked to identify the source of the feedback, residents, CE, and EE perceived ChatGPT's outputs as human-provided in 33.9%, 28.5%, and 14.3% of cases, respectively. CONCLUSION: When given brief written surgical situations, ChatGPT was able to identify errors with a detection rate comparable to that of experienced surgeons and to generate feedback that was considered useful for skill improvement in a surgical context performing as well as surgical instructors across assessments made by general surgery residents, an experienced surgeon, and a nonsurgeon feedback expert.

Multivalent binding of the tardigrade Dsup protein to chromatin promotes yeast survival and longevity upon exposure to oxidative damage.

Tardigrades are remarkable in their ability to survive extreme environments. The damage suppressor (Dsup) protein is thought responsible for their extreme resistance to reactive oxygen species (ROS) generated by irradiation. Here we show that expression of Ramazzottius varieornatus Dsup in Saccharomyces cerevisiae reduces oxidative DNA damage and extends the lifespan of budding yeast exposed to chronic oxidative genotoxicity. This protection from ROS requires either the Dsup HMGN-like domain or sequences C-terminal to same. Dsup associates with no apparent bias across the yeast genome, using multiple modes of nucleosome binding; the HMGN-like region interacts with both the H2A/H2B acidic patch and H3/H4 histone tails, while the C-terminal region binds DNA. These findings give precedent for engineering an organism by physically shielding its genome to promote survival and longevity in the face of oxidative damage.

Modelling the risk of hospital admission of lab confirmed SARS-CoV-2-infected patients in primary care: a population-based study.

The objectives of this study are to develop a predictive model of hospital admission for COVID-19 to help in the activation of emergency services, early referrals from primary care, and the improvement of clinical decision-making in emergency room services. The method is the retrospective cohort study of 49,750 patients with microbiological confirmation of SARS-CoV-2 infection. The sample was randomly divided into two subsamples, for the purposes of derivation and validation of the prediction rule (60% and 40%, respectively). Data collected for this study included sociodemographic data, baseline comorbidities, baseline treatments, and other background data. Multilevel analyses with generalized estimated equations were used to develop the predictive model. Male sex and the gradual effect of age were the main risk factors for hospital admission. Regarding baseline comorbidities, coagulopathies, cancer, cardiovascular diseases, diabetes with organ damage, and liver disease were among the five most notable. Flu vaccination was a risk factor for hospital admission. Drugs that increased risk were chronic systemic steroids, immunosuppressants, angiotensin-converting enzyme inhibitors, and NSAIDs. The AUC of the risk score was 0.821 and 0.828 in the derivation and validation samples, respectively. Based on the risk score, five risk groups were derived with hospital admission ranging from 2.94 to 51.87%. In conclusion, we propose a classification system for people with COVID-19 with a higher risk of hospitalization, and indirectly with it a greater severity of the disease, easy to be completed both in primary care, as well as in emergency services and in hospital emergency room to help in clinical decision-making.Registration: ClinicalTrials.gov Identifier: NCT04463706.

Utility of indocyanine green as a single tracer for sentinel node biopsy in endometrial cancer.

AIM: Our study aims to investigate the safety and effectiveness of sentinel lymph node biopsy using indocyanine green (ICG) for the surgical staging of early-stage endometrial cancer in comparison to technetium-99 m use. METHODS: We conducted an observational retrospective study with patients diagnosed of endometrial cancer and FIGO stages I-II. All participants were injected technetium-99m the day prior to the surgery and underwent lymphoscintigraphy along with single-photon emission computed tomography. In addition, all patients were administered intraoperatively ICG injection to detect sentinel lymph node biopsy. The surgical staging was then completed according to the European Society for Medical Oncology preoperative risk category. Data obtained from the analysis of technetium-99m detection was compared to ICG detection. RESULTS: A total of 53 women with endometrial cancer were included in the study, 49 (92.5%) of them showed drainage preoperatively in the single-photon emission computed tomography and/or lymphoscintigraphy. The intraoperative bilateral detection rate for technetium-99 m was 26 (49.1%) patients compared to 40 (75.5%) patients with ICG (p = 0.013). We observed a 42.5% increase in the mean number of lymph nodes retrieved by ICG compared to technetium-99m (2.85 vs 2,0 nodes; p = 0.002). We intraoperatively identified 164 lymph nodes, 104 (63.4%) located in both obturator areas and external iliac vessels. CONCLUSION: The use of ICG for the performance of sentinel node biopsy in patients with endometrial cancer seems safe and could be superior to technetium-99 m, since it offers a higher bilateral detection rate and nodal retrieval, resulting in the possibility to perform safely less full staging lymphadenectomies.

[Low transmission of SARS-CoV-2 at school settings: a population-based study in the Basque Country.] / Baja transmisión del SARS-CoV-2 en el ámbito escolar: estudio poblacional en Euskadi.

OBJECTIVE: Studies about SARS-CoV-2 transmission at school settings have been outbreaks or schools clusters. There are scarce population-based studies has been studied. We aimed at describing SARS-CoV-2 school-related transmission and its relationship with baseline community cumulative incidence rate in the Basque Country after school reopening in order to inform Public Health decision-making. METHODS: We conducted a scholar surveillance population-based study of SARS-CoV-2 transmission from 7 September to 31 October 2020. We calculated percentages of cases in school-age population, secondary attack rates by education level among close contacts and correlation between population´s and scholars´ incidence rates at municipal level. RESULTS: There were 35,477 SARS-CoV-2 laboratory confirmed cases. Among them, 7.65% happened at school settings. Secondary attack rate at schools ranged from 2.9%, in preschools to 7.1% in high schools; Scholars caused a household and social secondary attack rate from 13% (high scholars) to 23.2% (elementary scholars). We found a low correlation between population´s and scholars´ incidence rates at municipal level (R2=0.047). CONCLUSIONS: Secondary attack rate at school settings increased as educational level did; conversely, to social and family secondary attack rate, that decreased with higher educational level. School attendance, during a SARS-CoV-2 high transmission period showed feasible and did not rise transmission. These findings happened under strict non-pharmaceutical measures at school settings and proper epidemiological surveillance, including tracing of laboratory confirmed cases of SARS-CoV-2 looking for close contacts, isolation and testing of close contacts during isolation period. The different degree of transmission of the circulating variants in the different periods of the pandemic must also be taken into account.

OBJETIVO: La transmisión del SARS-CoV-2 en escolares se ha estudiado en brotes o en conjuntos de escuelas y apenas hay estudios poblacionales. El objetivo de este estudio fue describir la transmisión de SARS-CoV-2 relacionada con el ámbito escolar y su relación con la incidencia acumulada comunitaria en Euskadi tras la reapertura de las escuelas para contribuir a la toma de decisiones en salud pública. METODOS: Se trató de un estudio poblacional, basado en el sistema de vigilancia epidemiológica, que analizó la transmisión de SARS-CoV-2 en el ámbito escolar tras la reapertura escolar el 7 de septiembre de 2020 hasta el 31 octubre de 2020. Se calcularon porcentajes de casos en población escolar, tasas de ataque secundaria por nivel educativo entre contactos estrechos, así como la correlación entre tasas de incidencia acumulada municipal y tasa en escolares. RESULTADOS: Se diagnosticaron 35.477 casos confirmados de SARS-CoV-2. Entre ellos el 7,65% sucedieron en el ámbito escolar. La tasa de ataque secundaria en dicho ámbito osciló entre un 2,9%, en educación infantil y un 7,1% en bachiller; los alumnos causaron, en el ámbito familiar y social, tasas de ataque secundarias de entre un 13% (bachiller) y un 23,2% (educación primaria). Encontramos una baja correlación entre las tasas de incidencia acumulada a nivel municipal y la de los escolares (R2=0,047). CONCLUSIONES: La tasa de ataque secundaria en ámbito escolar aumentó según el grado escolar, al contrario que la del ámbito social y familiar que disminuyó. La educación presencial no condujo a un incremento de la transmisión de SARS-CoV-2. Estos hallazgos sucedieron bajo estrictas medidas no farmacológicas en el ámbito escolar y una vigilancia epidemiológica adecuada que incluyó la búsqueda de contactos estrechos de casos de SARS-CoV-2 confirmados por laboratorio, así como el aislamiento y testeo de los contactos estrechos durante el periodo de aislamiento. Ha de tenerse en cuenta también, el diferente grado de transmisión de las variantes circulantes en los diferentes periodos de la pandemia.

Speech and language therapy students' perception of learning through the incorporation of clinical simulation workshops: a mixed-methods study

ABSTRACT Purpose: this study had two aims: (1) Analyse students' perceptions of achieved learning in the simulation workshops implemented in multiple areas in a Speech and Language Therapy curricula, and (2) Establish the effect of incorporating simulation workshops in the students' comprehensive evaluation of the course. Methods: a survey on perceived learning was validated, including quantitative and qualitative sections, and applied to students that participated in the simulation workshops (n=241). Additionally, quantitative information from a survey of systematic application on the comprehensive perception of the courses that implemented workshops was analysed (n=277). Results: the quantitative section showed a positive perception of learning through the simulation workshop and coincided with the qualitative section's positive opinions. Additionally, the courses that implemented simulation workshops showed a positive evaluation in methodology, feedback, and organization. Conclusion: the students had a positive perception of the incorporation of clinical simulation workshops. The survey's sections provided complementary information regarding learning through clinical simulation.

Repercusiones vocales del síndrome de hiperlaxitud articular / Vocal repercussions of the joint hypermobility syndrome

Introducción: La hiperlaxitud articular es un síndrome frecuente en niños y mujeres; sus repercusiones en el sistema musculoesquelético son variadas y cursan con distintos grados de severidad. Sus consecuencias en la función vocal han sido estudiadas escasamente impidiendo así, muchas veces, su óptimo abordaje clínico. Objetivo: Describir el comportamiento vocal de mujeres con síndrome de hiperlaxitud articular. Material y método: Se estudió a una muestra de 40 mujeres con diagnóstico médico de síndrome de hiperlaxitud articular. La evaluación se llevó a cabo utilizando videolaringoestroboscopia, electroglotografía, análisis acústico, pruebas de intensidad y de sobrecarga vocal. Resultados: En la videolaringoestroboscopia se pudo evidenciar menor desarrollo muscular, asimetría vibratoria y desbalance aritenoideo. En la electroglotografía el CQ de la muestra fue de 0.4+/-0.05. La intensidad máxima promedio fue de 85.8+/-6.2dB y el tiempo máximo fonatorio, de 11.8+/-3.1s. En las tareas de sobrecarga la muestra presentó rápida fatigabilidad. Conclusiones: El comportamiento vocal de los sujetos que presentan síndrome de hiperlaxitud articular expresa insuficiencia glótica, debido a la falta de resistencia muscular de los pliegues vocales

Introduction: Joint hypermobility is a frequent syndrome in children and women, its impact on the musculoskeletal system are diverse and occur with different degrees of severity. Its consequences on vocal function have been studied sparingly, often preventing its optimal clinical approach. Objective: To describe the vocal behaviour of women with joint hypermobility syndrome. Material and method: A sample of 40 women with a medical diagnosis of joint hypermobility syndrome was studied. The assessment was carried out using video laryngeal stroboscopy, electroglottography, acoustic analysis, intensity and vocal overload tests. Results: In video laryngeal stroboscopy it was possible to demonstrate less muscle development, vibratory asymmetry and arytenoid imbalance. In the electroglottography, the CQ of the sample was 0.4+/-0.05. The average maximum intensity was 85.8+/-6.2dB and the maximum phonatory time was 11.8+/-3.1s. In the tasks of the overload the sample showed rapid fatigability. Conclusions: The vocal behaviour of the subjects suffering from joint hypermobility syndrome implies glottic insufficiency, due to a lack of muscular development of the vocal folds

Implementación de un modelo de atención kinesiológico, temprano y prospectivo, en personas con cáncer de mama / Implementation of an early and prospective physical therapy model care in people with breast cancer

Resumen El cáncer de mama es un problema de salud pública en Chile y el mundo por su alta incidencia. La cirugía es un pilar fundamental en el tratamiento del cáncer de mama. Hasta un 60% de las personas tratadas por cáncer de mama presentan alteraciones funcionales en el miembro superior. Existen modelos sanitarios para la rehabilitación de las alteraciones funcionales, sin embargo, en Chile no es un estándar en la atención de salud. Este artículo describe: 1) las alteraciones del miembro superior secundarias a la cirugía por cáncer de mama y 2) un modelo de atención kinesiológico, temprano y prospectivo, para personas tratadas por cáncer de mama.

Breast cancer is a public health problem in Chile and the world due to high incidence. Surgery is the mainstay in the breast cancer treatment. Up to 60% of people receiving this management have functional morbidity in the upper limb. There are rehabilitation health models care for the functional morbidity, however, in Chile is not a standard in the health care. This article describes: 1) upper limb morbidity secondary to breast cancer surgery, and 2) early and prospective physical Therapy model care for people with breast cancer.

Direct trocar insertion without previous pneumoperitoneum versus insertion after insufflation with Veress needle in laparoscopic gynecological surgery: a prospective cohort study.

The aim of this study was to determine whether direct trocar entry without prior pneumoperitoneum at umbilical level (DTI) can be a safe alternative to access the abdominal cavity in gynaecological laparoscopic surgery. We present a prospective observational analytical study of cohorts, comparing DTI with umbilical entry with trocar after previous insufflation with a Veress needle at umbilical level (V). The study period was performed from June 2013 to April 2016; data was collected on 600 patients who underwent gynaecological laparoscopic surgery. There were no significant differences in the risk of suffering a complication during the access manoeuvres between DTI (6.49%) and V (7.39%), OR 0.89 (95% CI: 0.42-1.81). The duration of the access manoeuvres was 69 s in DTI and 193 s in V (p < .001). The percentage of patients in whom two or more access attempts were performed was lower in DTI (7.8%) than in V (12.3%) (p > .05). We concluded that DTI is at least as safe as V, regarding the risk of suffering complications arising from access into the abdominal cavity. DTI has advantages with regard to V, such as: the shorter duration of access manoeuvres or the lesser number of unsuccessful entry or insufflation attempts. Impact statement What is already known on this subject? There are few international publications comparing DTI and V. When we conducted a search in PubMed for the terms 'Veress needle and direct trocar insertion', 51 publications were obtained. When we increased the restriction and added the terms 'laparoscopic entry and laparoscopy complications', 27 publications were obtained; thus, the uniqueness of our study. What do the results of this study add? We present a 3-year observational prospective study of cohorts that included 600 patients. The aim of this study was to determine that in laparoscopic gynaecological surgery, DTI is an access method to the abdominal cavity at least as safe as V, with respect to the risk of complications. On the other hand, DTI has some advantages such as the shorter duration of access manoeuvres or the lower number of failed entry attempts. What are the implications of these findings for clinical practice and/or further research? Given the limited number of publications that compared both techniques, our study indicates that DTI can be a safe alternative for access to abdominal cavity in gynaecological surgery, compared to the traditional V.

Diseño, implementación y evaluación de la metodología aprendizaje servicio en la carrera de fonoaudiología / Design, implementation and evaluation of the learning methodology Phonoaudiology career service

Introducción: el perfil de egreso de la carrera de Fonoaudiología de la Pontificia Universidad Católica de Chile (UC) compromete que los estudiantes desarrollen habilidades transversales esenciales para entregar un servicio de excelencia. Para este desarrollo, uno de los elementos claves es que los cursos utilicen metodologías activas con desafíos progresivos y monitoreados. Una de estas metodologías es Aprendizaje Servicio (A+S). El objetivo de este estudio es describir el diseño, implementación y evaluación de la metodología A+S en el plan de estudios de la carrera de Fonoaudiología. Método: en base al modelo UC de institucionalización de A+S y un proyecto de docencia institucional adjudicado, se definen habilidades transversales a desarrollar en los cursos. Se inicia el proceso de incorporación de la metodología a través de un piloto y se aplican encuestas institucionales para evaluar los resultados de la implementación. Resultados: se seleccionan cinco cursos para trabajar las habilidades transversales de compromiso social, trabajo en equipo, habilidades comunicativas, pensamiento crítico y resolución de problemas en 3 niveles de desempeño según la progresión curricular del estudiante. Los alumnos manifiestan una alta contribución de la metodología al proceso de enseñanza-aprendizaje, superando el 85 por ciento de aprobación en todos los cursos. El 100 por ciento de los profesores considera importante su incorporación en la malla curricular. Discusión: se logra adaptar e implementar un modelo de incorporación de la metodología A+S en la carrera de Fonoaudiología, lo que permite que los estudiantes tengan oportunidades de desarrollo de las habilidades transversales declaradas en el perfil de egreso, de manera organizada, monitoreada, y progresiva a lo largo del plan de estudios.(AU)

Background: the graduate profile of the Speech and Language Pathology program at the Pontificia Universidad Católica de Chile (UC)describes that students will develop essential transversal skills that will allow them to deliver excellent care as health professionals. Thisrequires the use of active learning methodologies in its courses, one of which is Service Learning (S+L). This study aims to describe the design, implementation and evaluation of S+L in the curriculum of Speech and Language Pathology program. Method: based on the UC model of implementation of S+L and an institutional teaching project grant, the transversal skills to be developed in each of the courses were defined. The process of incorporating the methodology began with a pilot. Institutional surveys were applied to evaluate the results of the implementation. Results: five courses were selected to work on the transversal skills of social commitment, teamwork,communication skills, critical thinking and problem-solving in 3 levels of performance according to the student's curricular progression. The students saw a high contribution of the methodology to the research process, surpassing the 85 percent approval in all the courses. 100 percent of teachers consider important to incorporate S + L into the curriculum. Discussion: it was possible to adapt and implement a model of incorporation of the S + L methodology in the Speech and Language Pathology career, which allows students to develop the transversal skills declared in the graduation profile, in an organized, monitored, and progressive way throughout the curriculum.(AU)

Percepción de los estudiantes de kinesiología sobre la incorporación de la metodología b-learning y uso de dispositivos móviles en el curso de análisis del movimiento / Kinesiology students' perception of the incorporation of the b-learning methodology and the use of mobile devices in the course of movement analysis

Introducción: el aumento del número de estudiantes en carreras de la salud hace necesario incluir nuevas metodologías de enseñanza-aprendizaje. La literatura avala el uso de las tecnologías de la información y comunicación (TICs) y el b-learning como recursos para abordar esta problemática. El propósito fue evaluar la percepción de los estudiantes universitarios de la carrera de kinesiología sobre la incorporación de TICs y b-learning en el curso Análisis del Movimiento. Material y Método: se aplicó un cuestionario a 94 estudiantes. Se determinó evidencia de validez de constructo a través de análisis confirmatorio de factores y confiabilidad mediante Alpha de Cronbach. Se estimó la mediana (Q1-Q3) de cada dimensión, determinando posibles diferencias mediante la prueba de Kruskal-Wallis. Resultados: se definió una encuesta con 5 dimensiones y 27 ítems. Los enunciados cargaron en las 5 dimensiones. El coeficiente de Alpha de Cronbach fue de α=0,83. Los resultados según la Mediana (Q1-Q3) por dimensión fueron: Percepción General de la Metodología 4,83 (4,67-5), Percepción de los materiales utilizados 4,75 (4,5-5), Percepción del Autoaprendizaje 4,09 (3,82-4,27), Interacción con los docentes y compañeros 4,75 (4,25-5), Evaluación 5 (4,67-5) y la nota global fue de 6 (6-7). Discusión: el cuestionario posee adecuada evidencia de validez y confiabilidad, hubo diferencias estadísticamente significativas entre dimensiones, especialmente en Percepción del Autoaprendizaje. Los estudiantes valoran positivamente la organización en los procesos de innovación en metodologías de enseñanza y evaluación, el uso de sistemas digitales como facilitadores de su aprendizaje y la oportunidad de aprendizaje autónomo.(AU)

Introduction: physiotherapy has systematically increased its students, being necessary to include new teaching and learning methodologies. The literature supports the use of information and communication technologies (ICT) and b-learning as resources to address this problem. The aim was to evaluate the perception of Physiotherapy students about the incorporation of ICTs and b-learning in the course of Movement Analysis. Methods: experts designed an instrument that applied to 94 students. The construct validity determined through a factor confirmatory analysis and reliability by Cronbach's Alpha. The median (Q1-Q3) of each dimension was estimated, determining the existence of possible differences through the Kruskal-Wallis test. Results: a survey with five categories and 27 items was defined and loaded in the five dimensions. The coefficient of Cronbach's alpha was α = 0.83. The results according to the Median (Q1-Q3) for the measure were: General Perception of the Methodology 4.83 (4.67-5), Perception of the materials used 4.75 (4.5-5), Perception of Self-Learning 4.09 (3.82-4.27), Interaction with teachers and classmates 4.75 (4.25-5), Evaluation 5 (4.67-5) and overall score was 6 (6-7). Discussion: the questionnaire has validity and reliability, statistical differences between measures were found, especially in the Perception of Self-Learning. The students valued positively the organization in the processes of innovation in teaching and evaluation methodologies, the use of digital systems as facilitators of their learning and the opportunity for autonomous learning.(AU)

Updates in the correlation of electroneuromyographic findings in diabetic polyneuropathy / Actualidades en la correlación de hallazgos electroneuromiográficos en polineuropatía diabética

Background: The diabetic neuropathy is the most common microvascular complication of diabetes mellitus. The reported prevalence ranges from 10-90%. Electrophysiological alterations can be demonstrated in nearly 100% of diabetics. Objective: To know the current profile of the patient with diabetic polyneuropathy. Methods: Retrospective and descriptive study from 2015 to 2016. Reports of electroneuromyography with diabetic polyneuropathy result were analyzed, evaluating neuroconduction parameters of motor and sensory nerves, late F responses and myography. Descriptive statistics, Student's t-test and Pearson's correlation coefficient were used. Results: The sample included 72 men (65.5%) and 38 women (34.5%), mean age 61.2 years, mean duration of diabetes of 9.9 years. The most affected nerve was superficial peroneus, absent in 70% of the population.A positive correlation was found (p < 0.001) for the affection of all the nerves symmetrically and predominantly in neuroconduction velocities of the lower and upper limbs. Conclusion: The most frequent electrophysiological finding in diabetic polyneuropathy was sensory affection, being more severe in lower limbs. A finding in patients with recent diagnosis is the prolongation of proximal latencies in the lower extremities.

Introducción: la neuropatía diabética es la complicación microvascular más frecuente de la diabetes mellitus. Las prevalencias reportadas oscilan del 10 al 90%. Se pueden demostrar alteraciones electrofisiológicas en casi el 100% de los diabéticos. Objetivo: conocer el perfil actual del paciente con polineuropatía diabética. Métodos: estudio retrospectivo y descriptivo del año 2015 a 2016. Se analizaron reportes de electroneuromiografía con resultado de polineuropatía diabética, evaluando parámetros de neuroconducción de nervios motores y sensoriales, respuestas tardías F y miografía. Se utilizó estadística descriptiva, la prueba de t de Student y el coeficiente de correlación de Pearson. Resultados: la muestra incluyó a 72 hombres (65.5%) y 38 mujeres (34.5%), con edad media de 61.2 años, todos con diagnóstico de diabetes mellitus tipo 2, con duración media de la diabetes de 9.9 años. El nervio más afectado fue el peroneo superficial, ausente en el 70% de la población. Se encontró una correlación positiva(p < 0.001) para la afección de todos los nervios de forma simétrica y de predominio en velocidades de neuroconducción de miembros inferiores y superiores. Conclusión: el hallazgo electrofisiológico más frecuente en polineuropatía diabética fue la afección sensorial, siendo más severa en miembros inferiores. Un hallazgo en pacientes con reciente diagnóstico es la prolongación de latencias proximales en extremidades inferiores.

Screening for Depressive Mood During Acute Chikungunya Infection in Primary Healthcare Settings.

Background: We aimed to screen for depressive mood experienced during acute chikungunya (CHIKV) infection, and to evaluate the association of several exposures with the risk of depressive symptoms. Methods: A cross-sectional analysis of a multicenter cohort study took place and data from 354 adult individuals with confirmed CHIKV infection were analyzed. Participants were recruited in primary health care settings and the Patient Health Questionnaire-2 (PHQ-2) was used. Prevalence odds ratios (OR) and 95% confidence intervals (CIs) estimated by means of logistic models were used. Results: Depressive mood (PHQ-2 score 3 or higher) was reported by 44.1% of individuals. Subjects with articular effusion (OR = 3.37, 95% CI 1.77⁻8.11), gastrointestinal manifestations (diarrhea, vomiting or abdominal pain, OR = 1.97, 95 CI 1.21⁻3.19), and higher length of severe arthralgia (reference ≤ 14 days: 15⁻30 days, OR = 3.38, 95% CI 1.78⁻6.41; ≥ 30 days, OR = 1.69, 95% CI 0.95⁻3.01) were more likely to self-report depressive mood. Increasing age (≥ 40 years old, OR = 0.55, 95% CI 0.31⁻0.95) and rash (OR = 0.54, 95% CI 0.30⁻0.98) were associated with a decreased risk of depressive mood. Conclusions: Depressive mood seemed to be a frequent event among analyzed individuals, and markers associated with its risk were identified.

Safety and patients' satisfaction after hysteroscopic sterilisation.

The aim of this study was to understand the potential complications of the Essure® device as well as the factors influencing its onset and patient satisfaction. We present a 9-year descriptive prospective study that included 1068 patients. The device was placed in 1056 of them (98.8%); 894 had no pain or mild pain during the insertion and only 12 patients experienced pain greater than menstrual pain. The proportion of patients without pain was greater in the group that took NSAIDs or NSAIDs and BZD and the unmedicated group had the highest rate of severe pain (p = .00). In all, 161 of the 1064 patients who had the Essure® inserted reported having an adverse effect during the 3-months post-insertion (pelvic pain or discomfort). The mean score out of 10 attributed to this method was 9.06 (S = 1.11). We concluded that the Essure® shows a low rate of complications and users showed a high degree of satisfaction. Impact statement What is already known on this subject: There are few international publications on Essure®. When we conducted a search in PubMed for the term 'Essure', we obtained 221 publications. When we added the terms 'Essure and complications', we obtained 20 publications, and when we increased the restriction including 'satisfaction', we obtained seven; thus, the uniqueness of our study. What the results of this study add: We present a 9-year descriptive prospective study that included 1068 patients. The aim of this study was to understand the potential complications of the Essure® device (Bayer, Whippany, NJ), as well as factors that can influence its onset and the patient satisfaction. The device was placed in 1056 of the patients (98.8%); 894 had no pain or mild pain during the insertion and only 12 patients experienced pain greater than menstrual pain. The proportion of patients without pain was greater in the group that took NSAIDs or NSAIDs and BZD and the unmedicated group had the highest rate of severe pain (p=.00). What the implications are of these findings for clinical practice and/or further research: Our study shows a low rate of complications with Essure®, mild and transient in most cases, as well as a high degree satisfaction. Nevertheless, given the few published studies on this device, we believe that long-term follow-up is needed.

Razonamiento clínico inductivo o deductivo: una propuesta cualitativa en kinesiología / nductive or deductive clinical reasoning: a proposal qualitative in kinesiology

Introducción: a través del proceso de razonamiento clínico, los profesionales de la salud evalúan críticamente sus intervenciones, siendo esta habilidad necesaria para reconocer qué factores son relevantes para el usuario, a fin de realizar juicios clínicos apropiados que contribuyan a la condición de salud óptima del paciente. La literatura indica que el proceso en un estudiante puede no ser lineal, siendo necesario retroceder y buscar nuevas soluciones y patrones para determinar una elección terapéutica. Objetivo: describir el proceso de razonamiento clínico realizado en estudiantes de ciclo intermedio de Kinesiología en la Universidad de Concepción. Método: investigación cualitativa y descriptiva. 7 estudiantes de tercer y cuarto año de la Universidad de Concepción participaron en la recolección de datos, siguiendo un proceso de consentimiento informado. Se aplicó un cuestionario sociodemográfico y se analizaron los problemas kinesiológicos de un caso clínico mediante asociación libre. Los registros se obtuvieron con una grabadora y luego se realizó un análisis de contenido utilizando CAQDAS Atlas-ti 7.5.2. Resultados: a partir de la lectura de los documentos grabados, surgieron 335 unidades asociadas al razonamiento clínico de los estudiantes de Kinesiología. Estas unidades se agruparon en 58 códigos y estos a su vez, en 2 categorías: razonamiento deductivo y razonamiento inductivo. Discusión: el análisis del proceso es esencial para identificar qué estrategias buscan los estudiantes para resolver en un caso clínico, qué diferencias y particularidades existen entre los estudiantes, y qué metodologías de enseñanza son las más adecuadas para guiar apropiadamente las decisiones terapéuticas que enfrentarán los profesionales de la salud en forma diaria.(AU)

Introduction: Through the clinical reasoning process, health professionals critically evaluate their interventions, being these skills required to recognize which factors are relevant to the user, in order to make appropriate clinical judgments that contribute to the optimal health condition of the user. The literature shows that the student´s process may not be linear, needing to go back and look for new solutions and patterns to determine a therapeutic choice. Objective: Describe the process of clinical reasoning carried out in Physiotherapy students who study in the intermediate cycle at the University of Concepción. Method: Qualitative and descriptive research. 7 students from third and fourth year at the Universidad de Concepción started the sample collection, following an informed consent process. A socio-demographic questionnaire was applied, and kinesthetic problems of a clinical case were analyzed by free association. Records were obtained with a tape recorder and then a content analysis was performed using CAQDAS Atlas-ti 7.5.2. Results: From the listening of the recorded documents, 335 units emerged associated with the clinical reasoning of the Physiotherapy students. These units were grouped into 58 codes and these in turn, in 2 categories: deductive reasoning and inductive reasoning. Discussion: Analysis of the process is essential to identify which strategies students seek to resolve a case, what differences and particularities exist among students, and which teaching strategies are best suited to adequately guide the therapeutic decisions they will face as health professionals on a daily basis.(AU)

Situación de la preservación de fertilidad en pacientes con cáncer en nuestro medio: grado de conocimiento, información e implicación de los profesionales / Current situation on fertility preservation in cancer patients in Spain: Level of knowledge, information, and professional involvement

Introducción: Los riesgos de infertilidad en cáncer infantil, en función de la radioterapia, quimioterapia y/o cirugía son bien conocidos. La implicación de los profesionales y los avances en los métodos de preservación son cada vez mayores. Sin embargo, muchos pacientes no reciben información ni realizan ningún método de preservación. Material: Se realiza una encuesta nacional de 22 preguntas a especialistas en hematología y/o oncología infantil para valorar sus conocimientos, la posibilidad de realizar preservación en sus centros y la práctica habitual. Resultados: Respondieron 50 miembros de la Sociedad Española de Hematología y Oncología Pediátrica, que representan 24 de 43 centros. Están representados el 82% de los centros que tratan un mayor número de pacientes. El 78% de los encuestados refiere conocer los efectos sobre la fertilidad de los tratamientos. El 76% admite no conocer ninguna guía sobre fertilidad en niños y adolescentes. En cuanto al momento para informar al paciente y/o su familia solo un 14% opina que debe hacerse en la entrevista del diagnóstico del cáncer. En su práctica clínica el 12% de los encuestados nunca deriva pacientes a las unidades de reproducción humana. Otro 12% solo lo hace si los afectados demuestran interés. El 38% deriva solo a pacientes púberes. El 34% remite a aquellos que vayan a recibir tratamiento altamente gonadotóxico. Conclusiones: Un gran porcentaje de especialistas manifiestan su falta de conocimientos y el valor de guías clínicas al respecto. Existen claras diferencias en preservación entre pacientes púberes y prepúberes. La frecuencia de preservación es baja (AU)

Introduction: The estimated risks of infertility in childhood cancer due to radiation, chemotherapy and surgery are well known. The involvement of professionals and advances in the different methods of preservation are increasing. However, many patients do not receive information or perform any method of preservation. Material: Questionnaires to paediatric onco-haematology institutions throughout Spain. The questionnaire consisted of 22 questions assessing their usual practices and knowledge about fertility preservation. Results: Fifty members of the Spanish Society of Paediatric Haematology and Oncology, representing 24 of 43 centres, responded. These represented 82% of centres that treated higher numbers of patients. The effect of treatment on fertility was known by 78% of those who responded, with 76% admitting not knowing any guideline on fertility in children or adolescents. As for the ideal time and place to inform the patient and/or family, only 14% thought it should be done in the same cancer diagnosis interview. In clinical practice, 12% of those surveyed never referred patients to Human Reproduction Units, another 12% only did so if the patients showed interest, and 38% only refer patients in puberty. Just over one-third (34%) of those referrals were going to receive highly gonadotoxic treatment. Conclusions: There are clear differences between pre-puberty and puberty patients. The frequency with which some method of fertility preservation is performed in patients is low. All respondents believe that the existence of national guidelines on the matter would be of interest (AU)

[Current situation on fertility preservation in cancer patients in Spain: Level of knowledge, information, and professional involvement]. / Situación de la preservación de fertilidad en pacientes con cáncer en nuestro medio: grado de conocimiento, información e implicación de los profesionales.

INTRODUCTION: The estimated risks of infertility in childhood cancer due to radiation, chemotherapy and surgery are well known. The involvement of professionals and advances in the different methods of preservation are increasing. However, many patients do not receive information or perform any method of preservation. MATERIAL: Questionnaires to paediatric onco-haematology institutions throughout Spain. The questionnaire consisted of 22 questions assessing their usual practices and knowledge about fertility preservation. RESULTS: Fifty members of the Spanish Society of Paediatric Haematology and Oncology, representing 24 of 43 centres, responded. These represented 82% of centres that treated higher numbers of patients. The effect of treatment on fertility was known by 78% of those who responded, with 76% admitting not knowing any guideline on fertility in children or adolescents. As for the ideal time and place to inform the patient and/or family, only 14% thought it should be done in the same cancer diagnosis interview. In clinical practice, 12% of those surveyed never referred patients to Human Reproduction Units, another 12% only did so if the patients showed interest, and 38% only refer patients in puberty. Just over one-third (34%) of those referrals were going to receive highly gonadotoxic treatment. CONCLUSIONS: There are clear differences between pre-puberty and puberty patients. The frequency with which some method of fertility preservation is performed in patients is low. All respondents believe that the existence of national guidelines on the matter would be of interest.

Parametrization of halogen bonds in the CHARMM general force field: Improved treatment of ligand-protein interactions.

A halogen bond is a highly directional, non-covalent interaction between a halogen atom and another electronegative atom. It arises due to the formation of a small region of positive electrostatic potential opposite the covalent bond to the halogen, called the 'sigma hole.' Empirical force fields in which the electrostatic interactions are represented by atom-centered point charges cannot capture this effect because halogen atoms usually carry a negative charge and therefore interact unfavorably with other electronegative atoms. A strategy to overcome this problem is to attach a positively charged virtual particle to the halogen. In this work, we extend the additive CHARMM General Force Field (CGenFF) to include such interactions in model systems of phenyl-X, with X being Cl, Br or I including di- and trihalogenated species. The charges, Lennard-Jones parameters, and halogen-virtual particle distances were optimized to reproduce the orientation dependence of quantum mechanical interaction energies with water, acetone, and N-methylacetamide as well as experimental pure liquid properties and relative hydration free energies with respect to benzene. The resulting parameters were validated in molecular dynamics simulations on small-molecule crystals and on solvated protein-ligand complexes containing halogenated compounds. The inclusion of positive virtual sites leads to better agreement across experimental observables, including preservation of ligand binding poses as a direct result of the improved representation of halogen bonding.

[Definitive contraception with Essure device: Single institutional experience on 517 procedures]. / Anticoncepción definitiva con Essure: experiencia unicéntrica de 517 procedimientos.

OBJECTIVES: To analyse the outcomes of patients undergoing Essure sterilization in a single institution, interns of complications and technique failure. PATIENTS AND METHODS: Retrospective descriptive study of 517 patients underwent definitive contraception with Essure device in outpatient hysteroscopy office without anesthesia and controlled at 3 months with abdominal radiography, ultrasonography and hysterosalpingography in selected cases. RESULTS: The success rates of the insertion of Essure was 96.8%, similar to data reported in the literature with 3.7% of vagal reactions, as most prevalent complication. 7 (1.35%) unintended pregnancies were observed. CONCLUSIONS: Essure is a permanent birth control device, with high rate of successful insertion and a low rate of complications. Unintended pregnancies in our study are high and we must change the protocols of placement and monitoring, considering hysterosalpingography as a routine control test.

Mallas en la cirugía del prolapso genital / Meshes for genital prolapse surgery

El objetivo de esta revisión es analizar la información científica disponible sobre la utilización de las mallas en la cirugía del prolapso genital, evaluando eficacia, efectos adversos y complicaciones. La utilización de mallas en la reparación del compartimento anterior se asocia con mejores resultados anatómicos que las técnicas clásicas, mientras que no hay datos suficientes que avalen su utilización en el compartimento posterior. En el compartimento apical, la colposacropexia abdominal ha demostrado tener tasas de recurrencia menores que los procedimientos por vía vaginal, ya sea mediante técnicas clásicas o mediante el uso de mallas. Las mallas se asocian con efectos adversos a corto y a largo plazo, que pueden implicar la necesidad de nuevos procedimientos quirúrgicos.