Utility of routine non-gated CT chest in detection of subclinical atherosclerotic calcifications of coronary arteries in hospitalised HIV patients.

OBJECTIVES: To evaluate coronary artery calcification (CAC) on routine CT chest in hospitalised HIV patients and to assess individual risk factors. METHODS: Routine CT chests, May 2010-November 2015, of 143 hospitalised HIV-positive patients were reviewed for qualitative assessment of calcification in major coronary arteries by two radiologists. Presence, location and burden of calcification were evaluated on 3 mm axial images of CT chest. Cardiovascular risk factors and HIV lab parameters such as CD4 count, viral load and duration, and status of antiretroviral treatment were collected. Statistical analysis including multivariate logistic regression was performed. RESULTS: Forty-one patients (28.7%) showed CAC, left anterior descending (n = 38, 92.7%), circumflex (n = 18, 43.9%) and Right Coronary Artery (n = 13, 31.7%); mostly mild CAC burden and mostly proximal left coronary arteries with excellent interobserver and intraobserver agreements (K = 0.9, and 1). Age of CAC+ group (53.9 years) was significantly higher than CAC- group (43.4, p < 0.001, minimum age of CAC+, 27 years). No significant difference between two groups in sex, ethnicity and risk factors and HAART status. CAC+ group showed significantly longer HIV duration (12.3 years vs 8.6, p < 0.0344) and higher CD4 cell counts (mean = 355.9 vs 175.3, p = 0.0053) and significantly lower viral load (76 vs 414K, p = 0.02) than CAC- group. On multivariate logistic regression, age, HIV duration and CD4 were significantly associated with CAC+ (p-values < .05). CONCLUSIONS: One-third of hospitalised HIV patients showed subclinical CAC on CT chest. HIV duration and age of patients were independent risk factors for developing CAC. Higher CD4 cell count was strongly associated with CAC+. ADVANCES IN KNOWLEDGE: Routine CT chest with or without contrast performed for non-cardiac indications is helpful in identification of subclinical CAC in HIV patients and radiologists should be encouraged to report CAC.CAC is seen in younger age group in HIV, and awareness of this finding on routine CT chest would help guiding clinicians to assess risk stratification for primary prevention of ischemic heart disease in this population at an earlier stage when compared to normal population.Duration of HIV infection and age of patients were independent risk factors for developing CAC in our study and CD4 count was strongly associated with presence of CAC.

Diseño de un modelo de evaluación mediante la integración de tecnología inmersiva y a distancia / Design of an assessment model by integrating immersive and remote technology

INTRODUCCIÓN: Uno de los principales retos en educación médica se encuentra en ofrecer una evaluación confiable, precisa, objetiva y auténtica. Particularmente la evaluación de competencias interpersonales, la presencia de múltiples evaluadores favorece la percepción de estos principios por parte del estudiante evaluado. El objetivo de esta investigación fue diseñar un modelo de evaluación innovador, que integre como elementos distintivos el uso de tecnología inmersiva, una estandarización de instrumentos de evaluación, integración de múltiples evaluadores y la posibilidad realizar una valoración remota en tiempo real o diferido. MATERIAL Y MÉTODOS: Se realizó un estudio cuantitativo, descriptivo y transversal con una muestra de 51 estudiantes del segundo año de la carrera de medicina de una universidad mexicana. Participaron en la simulación de un caso clínico con un paciente estandarizado, siendo evaluados de forma presencial y remota por 15 profesores de 3 diferentes universidades. Se utilizó estadística descriptiva para valorar las tendencias por cada elemento incluido. RESULTADOS: Los resultados más favorables se encuentran en el momento del inicio del encuentro con una media de 1,364, siendo más alto particularmente en los elementos de formalidad, con media de 1,636 y modales con media de 1,400. El desempeño menos favorable se encontró durante el encuentro, con media de 0,856, siendo de especial interés el demostrado durante la exploración con media de 0,818. DISCUSIÓN: El uso de tecnologías inmersivas permite hacer una evaluación confiable, precisa, objetiva y auténtica a través de la estandarización de instrumentos de evaluación, con la posibilidad de integrar múltiples evaluadores de forma presencial y a distancia. Esta iniciativa permitió una colaboración interinstitucional para el análisis de los estándares del currículo, a través de distintas regiones geográficas y culturas

INTRODUCTION: One of the main challenges in medical education is to offer an assessment that is reliable, accurate, objective, and authentic. Particularly in interpersonal skills, and having multiple observers, it benefits the student's perception of these principles. The aim of this project was to design and implement an assessment model that integrates the distinctive elements of the use of immersive technology, standardisation of evaluation tools, multiple observers, and remote assessment. MATERIAL AND METHODS: A quantitative, descriptive and cross-sectional study was conducted with a sample of 51 second year medical students from a Mexican university. They participated in the simulation of a clinical case with a standardised patient, being assessed by 15 teachers from 3 different universities. Descriptive statistics were used to assess trends for each measurement included in the study. RESULTS: The best results were obtained at the beginning of the medical encounter, with a mean of 1.364. The elements that were particularly high were formality with a mean of 1.636, and manners with 0.856. The least favourable results were obtained during the encounter, the one obtained in the physical examination being of particular interest, with a mean of 0.818. DISCUSSION: The use of immersive technologies helps to provide a reliable, accurate, objective, and authentic evaluation through the standardisation of the evaluation tools, with the possibility of the integration of multi-assessors on site, or remotely. This initiative led to an inter-institutional collaboration for the analysis of curriculum standards across different geographic regions and cultures

Factores que facilitan la adopción de tecnología educativa en escuelas de medicina / Factors that enable the adoption of educational technology in medical schools

INTRODUCCIÓN: La incorporación de tecnología educativa puede aportar numerosos beneficios en el aprendizaje, no obstante frecuentemente se realiza sin reflexionar sobre la capacidad de la institución educativa para adoptar estos cambios. Esto ocasiona que los proyectos se queden inconclusos, desperdicio de recursos económicos y profesores desmotivados. El objetivo de esta investigación fue diseñar y validar un modelo que integre los factores que facilitan la adopción de tecnología educativa en escuelas de medicina. MATERIAL Y MÉTODOS: El método empleado es cuantitativo y descriptivo. Se contó con una muestra de 15 profesores de ciencias de la salud para estudiar la validez del modelo, en el que se les pidió que catalogaran el nivel en que se encontraba la organización a la que están adscritos. Se estimó la consistencia interna del instrumento con análisis de ítem. Se utilizó estadística descriptiva para valorar las tendencias por cada uno de los factores propuestos. RESULTADOS: Los reactivos resultaron homogéneos y válidos. En el análisis ítem, se obtuvo un coeficiente de alfa de Cronbach de 0,938. Las respuestas más favorables se obtuvieron en el factor de planeación organizacional con una media de 3,23. DISCUSIÓN: Se cataloga la escuela en estudio en un nivel de inicio, aunque en algunos criterios alcanza el nivel de vinculado. Para estar preparada para nuevos retos en adopción de tecnología educativa necesita incrementar la presencia institucional en foros nacionales mediante la difusión de sus propuestas de innovación, así como la vinculación con pares para la propuesta de proyectos interinstitucionales

INTRODUCTION: Although the incorporation of technology brings numerous benefits into learning, this is usually done without considering the capacity of the institution to deal with these changes. This leads to unfinished projects, wasted resources, and unmotivated teachers. The objective of this study was to design and validate a model that integrates the factors that enable the adoption of educational technology into schools of medicine. MATERIAL AND METHODS: The methodology employed is quantitative and descriptive. A sample of 15 health science faculties participated in order to study the model's validity, using a questionnaire in which they were asked to catalogue the level of their organisation. The internal consistency of the tool was studied using item analysis. Descriptive statistics were used to assess trends by each factor. RESULTS: The items are homogeneous and valid. In item analysis, a Cronbach alpha coefficient of 0.938 was obtained. The most favourable responses were obtained in the organisational planning factor with an average of 3.23. DISCUSSION: The institution where the study was conducted is catalogued at a Start level, although in some factors it reaches the Connected level. In order for it to be prepared for the new challenges in educational technology adoption, the organisation needs to increase institutional presence on national forums through the dissemination of its innovation proposals, as well as the relationship with their peers for the proposal of inter-institutional projects

Radiogenomics and IR.

Radiogenomics involves the integration of mineable data from imaging phenotypes with genomic and clinical data to establish predictive models using machine learning. As a noninvasive surrogate for a tumor's in vivo genetic profile, radiogenomics may potentially provide data for patient treatment stratification. Radiogenomics may also supersede the shortcomings associated with genomic research, such as the limited availability of high-quality tissue and restricted sampling of tumoral subpopulations. Interventional radiologists are well suited to circumvent these obstacles through advancements in image-guided tissue biopsies and intraprocedural imaging. Comprehensive understanding of the radiogenomic process is crucial for interventional radiologists to contribute to this evolving field.

Cross-sectional imaging following surgical interventions for stress urinary incontinence in females.

Stress urinary incontinence (SUI) is a condition in which the weakness of the pelvic floor muscles causes unintentional loss of urine. For patients who are unable to achieve symptomatic improvement from lifestyle modification and pharmacotherapy, surgical placement of the pelvic slings or the use of urethral bulking agents has been shown to provide tremendous symptomatic improvement. Learning to recognize the pelvic slings and to identify their complications on imaging is invaluable; however, this is challenging because of the change in the local anatomy after surgical placement of the sling. In this paper, we present CT and MR imaging to demonstrate the surgical and non-surgical treatments of female SUI and their complications. Through this pictorial essay, our goal is to familiarize radiologists with recognizing the various forms of treatment for SUIs, the relevant pelvic anatomy, and complications that may occur secondary to the surgical placement of the pelvic slings.