Evidence-Based Learning Strategies in Medicine Using AI.

Unlabelled: Large language models (LLMs), like ChatGPT, are transforming the landscape of medical education. They offer a vast range of applications, such as tutoring (personalized learning), patient simulation, generation of examination questions, and streamlined access to information. The rapid advancement of medical knowledge and the need for personalized learning underscore the relevance and timeliness of exploring innovative strategies for integrating artificial intelligence (AI) into medical education. In this paper, we propose coupling evidence-based learning strategies, such as active recall and memory cues, with AI to optimize learning. These strategies include the generation of tests, mnemonics, and visual cues.

Genetic parameters of colostrum and calf serum antibodies in Swedish dairy cattle.

BACKGROUND: A sufficient IgG content in the colostrum is essential for the newborn calf, as it provides passive immunity which substantially affects the probability of survival during rearing. Failure of passive transfer (FPT) occurs when a calf does not absorb enough antibodies from the colostrum and is defined by an IgG concentration in calf serum lower than 10 g/L. Apart from delayed access to colostrum, FPT can be due to a low production of IgG in the mother or poor IgG absorption by the calf. The aim of this study was to estimate the genetic background of antibody levels and indicator traits for antibodies in the colostrum and calf serum, and their correlation with milk production. RESULTS: Colostrum data were available for 1340 dairy cows with at least one calving and calf serum data were available for 886 calves from these cows. Indicator traits for antibody concentrations were estimated using refractometry (a digital Brix refractometer for colostrum and an optical refractometer for serum), and enzyme-linked immunosorbent assays (ELISA) were used to determine the levels of total IgG and natural antibodies (NAb) of various antibody isotypes in the colostrum and calf serum. Colostrum traits had heritabilities ranging from 0.16 to 0.31 with repeatabilities ranging from 0.21 to 0.55. Brix percentages had positive genetic correlations with all colostrum antibody traits including total IgG (0.68). Calf serum antibody concentrations had heritabilities ranging from 0.25 to 0.59, with a significant maternal effect accounting for 17 to 27% of the variance. When later in life calves produced their first lactation, the lactation average somatic cell score was found to be negatively correlated with NAb levels in calf serum. CONCLUSIONS: Our results suggest that antibody levels in the colostrum and calf serum can be increased by means of selection.

Vesicular Stomatitis Virus Isolated from a Bovine Brain Sample in Costa Rica.

The genome of Vesicular stomatitis (New Jersey) virus was obtained by high-throughput sequencing after the nucleic acid was extracted from the supernatant of Vero E6 cells inoculated with a sample of a bovine brain with nervous signs. The sample was negative for rabies by direct Immunofluorescence and bovine spongiform encephalopathy by histopathology.

Rabies in Costa Rica - Next Steps Towards Controlling Bat-Borne Rabies After its Elimination in Dogs.

Rabies is an acute, progressive encephalitis caused by a lyssavirus, with the highest case fatality of any conventional infectious disease. More than 17 different lyssaviruses have been described, but rabies virus is the most widely distributed and important member of the genus. Globally, tens of thousands of human fatalities still occur each year. Although all mammals are susceptible, most human fatalities are caused by the bites of rabid dogs, within lesser developed countries. A global plan envisions the elimination of human rabies cases caused via dogs by the year 2030. The combination of prophylaxis of exposed humans and mass vaccination of dogs is an essential strategy for such success. Regionally, the Americas are well on the way to meet this goal. As one example of achievement, Costa Rica, a small country within Central America, reported the last autochthonous case of human rabies transmitted by a dog at the end of the 1970s. Today, rabies virus transmitted by the common vampire bat, Desmodus rotundus, as well as other wildlife, remains a major concern for humans, livestock, and other animals throughout the region. This review summarizes the historical occurrence of dog rabies and its elimination in Costa Rica, describes the current occurrence of the disease with a particular focus upon affected livestock, discusses the ecology of the vampire bat as the primary reservoir relevant to management, details the clinical characteristics of recent human rabies cases, and provides suggestions for resolution of global challenges posed by this zoonosis within a One Health context.

Effects of using mobile augmented reality for simple interest computation in a financial mathematics course.

Understanding the concept of simple interest is essential in financial mathematics because it establishes the basis to comprehend complex conceptualizations. Nevertheless, students often have problems learning about simple interest. This paper aims to introduce a prototype called "simple interest computation with mobile augmented reality" (SICMAR) and evaluate its effects on students in a financial mathematics course. The research design comprises four stages: (i) planning; (ii) hypotheses development; (iii) software development; and (iv) design of data collection instruments. The planning stage explains the problems that students confront to learn about simple interest. In the second stage, we present the twelve hypotheses tested in the study. The stage of software development discusses the logic implemented for SICMAR functionality. In the last stage, we design two surveys and two practice tests to assess students. The pre-test survey uses the attention, relevance, confidence, and satisfaction (ARCS) model to assess students' motivation in a traditional learning setting. The post-test survey assesses motivation, technology usage with the technology acceptance model (TAM), and prototype quality when students use SICMAR. Also, students solve practice exercises to assess their achievement. One hundred three undergraduates participated in both sessions of the study. The findings revealed the direct positive impact of SICMAR on students' achievement and motivation. Moreover, students expressed their interest in using the prototype because of its quality. In summary, students consider SICMAR as a valuable complementary tool to learn simple interest topics.

Decreased availability of nitric oxide and hydrogen sulfide is a hallmark of COVID-19.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is involved in a global outbreak affecting millions of people who manifest a variety of symptoms. Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 is increasingly associated with cardiovascular complications requiring hospitalizations; however, the mechanisms underlying these complications remain unknown. Nitric oxide (NO) and hydrogen sulfide (H2S) are gasotransmitters that regulate key cardiovascular functions. METHODS: Blood samples were obtained from 68 COVID-19 patients and 33 controls and NO and H2S metabolites were assessed. H2S and NO levels were compared between cases and controls in the entire study population and subgroups based on race. The availability of gasotransmitters was examined based on severity and outcome of COVID-19 infection. The performance of H2S and NO levels in predicting COVID-19 infection was also analyzed. Multivariable regression analysis was performed to identify the effects of traditional determinants of gasotransmitters on NO and H2S levels in the patients with COVID-19 infection. RESULTS: Significantly reduced NO and H2S levels were observed in both Caucasian and African American COVID-19 patients compared to healthy controls. COVID-19 patients who died had significantly higher NO and H2S levels compared to COVID-19 patients who survived. Receiver-operating characteristic analysis of NO and H2S metabolites in the study population showed free sulfide levels to be highly predictive of COVID-19 infection based on reduced availability. Traditional determinants of gasotransmitters, namely age, race, sex, diabetes, and hypertension had no effect on NO and H2S levels in COVID-19 patients. CONCLUSION: These observations provide the first insight into the role of NO and H2S in COVID-19 infection, where their low availability may be a result of reduced synthesis secondary to endotheliitis, or increased consumption from scavenging of reactive oxygen species.

Diagnóstico tomográfico tuberculosis adrenal y addison - altura / Tomographic Diagnosis Of Adrenal Tuberculosis And Addison - Height

Reportamos el caso de un varón de 23 años, natural y residente de la altura, con hiperpigmentación. astenia, fatiga, náuseas, vómitos, pérdida de peso, dolor abdominal, hiporexia e hipotensión, con dosaje de cortisol disminuido y ACTH elevado. Radiografía de tórax normal, baciloscopia en esputo y en orina negativo. Antígeno TB LAM negativo. En la tomografía computarizada de abdomen con contraste se visualiza incremento de dimensiones y pequeñas calcificaciones en ambas adrenales sugerentes de infiltración granulomatosa de tipo específico. En zonas endémicas de tuberculosis como en el Perú, ante la ausencia de la biopsia adrenal, se puede recurrir en forma precoz, como alternativa diagnóstica a la tomografía para descartar el compromiso adrenal. En conclusión, el presente reporte a descrito como la tomografía puede ser usado como un método diagnostico alternativo en hospitales donde no es factible realizar la biopsia en forma rápida.

We report the case of a 23-year-old male, natural and resident of height, with hyperpigmentation. Asthenia, fatigue, nausea, vomiting, weight loss, abdominal pain, hiporexia and hypotension, with decreased cortisol dosage and elevated ACTH. Normal chest X-Ray, smear in sputum and negative urine. Negative TB-LAM Antigen. In contrasted abdomen computed tomography, an increase in dimensions and small calcifications is shown in both adrenals suggestive of specific type granulomatous infiltration. In endemic areas of tuberculosis as in Peru, in the absence of the adrenal biopsy, it can be used early, as a diagnostic alternative to the tomography to rule out the adrenal commitment. In conclusion, this report described as the tomography can be used as an alternative diagnostic method in hospitals where it is not feasible to perform the biopsy in a rapid manner.

Genome-wide association study identifies loci influencing natural antibody titers in milk of Dutch Holstein-Friesian cattle.

Natural antibodies (NAb) are produced without any antigenic stimulation as a part of the innate immune system and provide a first line of defense against pathogens. Hence, they may be a useful trait when estimating an animal's potential immune competence and in selection for disease resistance. The aim of this study was to identify genomic regions associated with different NAb traits in milk and potentially describe candidate genes. Milk samples from 1,695 first-lactation Holstein Friesian cows with titer measurements for keyhole limpet hemocyanin, lipopolysaccharide, lipoteichoic acid, and peptidoglycan-binding total NAb and isotypes IgG1, IgM, and IgA were used. Genome-wide association study analyses were performed using imputed 777K SNP genotypes, accounting for relationships using pedigree information. Functional enrichment analysis was performed on the significantly associated genomic regions to look for candidate genes. For IgM NAb, significant associations (false discovery rate <0.05) were found on Bos taurus autosome (BTA) 17, 18, and 21 with candidate genes related to immunoglobulin structure and early B cell development. For IgG1, associations were found on BTA3, and we confirmed a quantitative trait loci on BTA21 previously reported for IgG NAb in serum. Our results provide new insights into the regulation of milk NAb that will help unravel the complex relationship between milk immunoglobulins and disease resistance in dairy cattle.

Desarrollo de la capacidad para la regulación en salud en México.

La Academia Nacional de Medicina es un espacio esencial para discutir la ciencia de la regulación en salud y posicionar su impacto en la salud y la economía. Enmarcada dentro de la función rectora de la autoridad sanitaria, la regulación en salud es la acción de proteger a la población de los peligros sanitarios involuntarios contra los cuales el individuo no puede protegerse; es una función esencial de la salud pública, componente institucional del sistema de salud y, por ende, vinculada a sus reformas y a la cobertura universal. La regulación tiene sustento en un cuerpo teórico epidemiológico, organizacional, legal, sociológico y económico. Tiene un cuerpo metodológico que sustenta su proceso en el análisis de riesgos y se traduce en normas, implementaciones, cumplimiento, monitoreo y evaluación de la regulación. Tiene una arquitectura profesional, financiera, organizacional, legal y de gobernanza. Dada su acción universal tiene un impacto generalizado en la población y un sustancial efecto económico, influyendo en al menos 17 % del comercio internacional regional. La salud a través de sus autoridades regulatorias debe ser parte del dialogo comercial internacional.The National Academy of Medicine is an essential space to discuss regulatory science in health, and to position its impact on health and economy. Framed within the stewardship role of the health authority, health regulation is the action of protecting the population against involuntary health hazards against which the individual cannot protect him/herself. It is an essential function of public health, an institutional component of the health system and, therefore, linked to its reforms and to universal coverage. Regulation has its support on an epidemiological, organizational, legal, sociological and economic theoretical body. It has a methodological body that supports its regulatory process based on risk analysis and that is translated into regulations, implementations, compliance, monitoring and evaluation of the regulation. It has a professional, financial, organizational, legal and governance architecture. Given its universal action, it has a widespread impact on the population and a substantial economic effect, influencing on at least 17% of regional international trade. Health through its regulatory authorities should be an early part of international trade discussions.

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) delivered via a modified perfusion system for peritoneal carcinomatosis of colorectal origin.

BACKGROUND AND PURPOSE: The long-term survival of patients with peritoneal carcinomatosis of colorectal origin has been achieved with cytoreductive surgery, which removes all macroscopic implants, combined with hyperthermic intraperitoneal chemotherapy (HIPEC). The current technology for administering intraperitoneal heated chemotherapy is expensive and, for some institutions, unaffordable. We conducted this study to assess the temperature stability provided by a modified, inexpensive system, to offer a simple and low cost alternative to the standard HIPEC delivery equipment. METHODS: Ten patients with histologically diagnosed peritoneal metastases of adenocarcinoma or pseudomyxoma peritonei underwent cytoreductive surgery and received HIPEC with 5-fluorouracil for 90 min, delivered via our modified system. The temperature was recorded from two probes: one in the inflow catheter and one in the outflow catheter. The intra-abdominal temperature was monitored meticulously to maintain it at between 41 and 42 °C. RESULTS: All patients underwent cytoreductive surgery and HIPEC using our modified delivery system. Temperature stability was achieved in all patients, with a mean of 41.4°. There were no thermal injuries associated with any of the ten perfusions. The mean hospital stay was 15 days and the median survival was 30 months. CONCLUSION: Analysis of this data demonstrates that the uniform delivery of HIPEC at 41° with this modified system is feasible and safe. The outcome of the patients treated with cytoreductive surgery and HIPEC with this modified system compares favorably to other published series. Its low cost and simple design will give more patients with peritoneal carcinomatosis access to this treatment.

Colitis induces enteric neurogenesis through a 5-HT4-dependent mechanism.

BACKGROUND: The intestine is known to contain enteric neuronal progenitors, but their precise identity and the mechanisms that activate them remain unknown. Based on the evidence for the neurogenic role of serotonin (5-HT) in the postnatal gut and the observation of enteric neuronal hyperplasia in inflammatory bowel disease, we hypothesized that colitis induces a neurogenic response through 5-HT4 receptor signaling. METHODS: We examined the effects of 5-HT4 agonism on colonic neurogenesis and gliogenesis in vitro and in vivo in adult mice using dextran sodium sulfate to experimentally induce colitis. RESULTS: In vitro, 5-HT4 agonism led to increased neuronal proliferation and density. Induction of experimental colitis in vivo similarly resulted in increased numbers of myenteric neurons, and this was inhibited by 5-HT4 antagonism. Interestingly, both in vitro and in vivo, 5-HT4 signaling increased glial cell proliferation but did not increase glial cell numbers, leading us to hypothesize that glia may give rise to neurons. After induction of colitis in normal, Nestin-GFP and Sox2-GFP transgenic mice, it was revealed that multiple glial markers (Sox2, Nestin, and CD49b) became strongly expressed by enteric neurons. Immunoselected enteric glia were found to give rise to neurons in culture, and this was inhibited in the presence of 5-HT4 blockade. Finally, isolated glia gave rise to a neuronal network upon transplantation into aganglionic embryonic avian hindgut. CONCLUSIONS: These results show that colitis promotes enteric neurogenesis in the adult colon through a serotonin-dependent mechanism that drives glial cells to transdifferentiate into neurons.

Arsenic in Mexican children exposed to contaminated well water.

This cross-sectional study measures the arsenic level in school children exposed to contaminated well water in a rural area in México. Arsenic was measured in hair by hydride generation atomic absorption spectrophotometry. Overall, 110 children were included (average 10 years-old). Among 55 exposed children, mean arsenic level on hair was 1.3 mg/kg (range <0.006-5.9). All unexposed children had undetectable arsenic levels. The high level of arsenic in water was associated to the level in hair. However, exposed children drank less well water at school or at home than unexposed children, suggesting that the use of contaminated water to cook beans, broths or soups may be the source of arsenic exposure.

Fine-scale predictions of distributions of Chagas disease vectors in the state of Guanajuato, Mexico.

One of the most daunting challenges for Chagas disease surveillance and control in Mexico is the lack of community level data on vector distributions. Although many states now have assembled representative domestic triatomine collections, only two triatomine specimens had been collected and reported previously from the state of Guanajuato. Field personnel from the state's Secretaría de Salud conducted health promotion activities in 43 of the 46 counties in the state and received donations of a total of 2,522 triatomine specimens between 1998 and 2002. All specimens were identified, and live insects examined for Trypanosoma cruzi. In an effort to develop fine-scale distributional data for Guanajuato, collection localities were georeferenced and ecological niches were modeled for each species by using evolutionary-computing approaches. Five species were collected: Triatoma mexicana (Herrich-Schaeffer), Triatoma longipennis (Usinger), Triatoma pallidipennis (Stål), Triatoma barberi (Usinger), and Triatoma dimidiata (Latreille) from 201 communities located at elevations of 870-2,200 m. Based on collection success, T. mexicana had the broadest dispersion, although niche mapping indicates that T. barberi represents the greatest risk for transmission of Chagas disease in the state. T. dimidiata was represented in collections by a single adult collected from one village outside the predicted area for all species. For humans, an estimated 3,755,380 individuals are at risk for vector transmission in the state, with an incidence of 3,500 new cases per year; overall seroprevalences of 2.6% indicate that 97,640 individuals are infected with T. cruzi at present, including 29,300 chronic cases.

Morinda citrifolia (Noni) y sus posibles efectos como planta medicinal / Morinda citrifolia (Noni) and its possible effects as a medicinal plant

Morinda citrifolia es un arbusto de alrededor de 6 m de altura, de hojas opuestas, de la familia Rubiaceae, que, por lo general, se desarrolla en climas húmedos y templados. Su fruto, se produce durante todo el año y ha sido ampliamente utilizado en la medicina por sus poderes curativos; se considera la "fruta sagrada que regenera el cuerpo". Actúa como antiinflamatorio, analgésico, mejora el sistema inmunológico, la circulación, etc. Se consume el jugo, extraído del fruto. Aún no se conocen los mecanismos según los que funciona, pero se sabe que contiene compuestos como Escopoletina, Damna- canthal y la Norepinefrina, los cuales se cree son los que le confieren algunas de sus propiedades curativas.