No sonographer, no radiologist: New system for automatic prenatal detection of fetal biometry, fetal presentation, and placental location.

Ultrasound imaging is a vital component of high-quality Obstetric care. In rural and under-resourced communities, the scarcity of ultrasound imaging results in a considerable gap in the healthcare of pregnant mothers. To increase access to ultrasound in these communities, we developed a new automated diagnostic framework operated without an experienced sonographer or interpreting provider for assessment of fetal biometric measurements, fetal presentation, and placental position. This approach involves the use of a standardized volume sweep imaging (VSI) protocol based solely on external body landmarks to obtain imaging without an experienced sonographer and application of a deep learning algorithm (U-Net) for diagnostic assessment without a radiologist. Obstetric VSI ultrasound examinations were performed in Peru by an ultrasound operator with no previous ultrasound experience who underwent 8 hours of training on a standard protocol. The U-Net was trained to automatically segment the fetal head and placental location from the VSI ultrasound acquisitions to subsequently evaluate fetal biometry, fetal presentation, and placental position. In comparison to diagnostic interpretation of VSI acquisitions by a specialist, the U-Net model showed 100% agreement for fetal presentation (Cohen's κ 1 (p<0.0001)) and 76.7% agreement for placental location (Cohen's κ 0.59 (p<0.0001)). This corresponded to 100% sensitivity and specificity for fetal presentation and 87.5% sensitivity and 85.7% specificity for anterior placental location. The method also achieved a low relative error of 5.6% for biparietal diameter and 7.9% for head circumference. Biometry measurements corresponded to estimated gestational age within 2 weeks of those assigned by standard of care examination with up to 89% accuracy. This system could be deployed in rural and underserved areas to provide vital information about a pregnancy without a trained sonographer or interpreting provider. The resulting increased access to ultrasound imaging and diagnosis could improve disparities in healthcare delivery in under-resourced areas.

Motoric Cognitive Risk Syndrome: Prevalence and Cognitive Performance. A cross-sectional study.

Background: Motoric Cognitive Risk Syndrome (MCR) is a predementia stage where slow gait speed and subjective memory complaints are present. The purpose of this study was to estimate the prevalence of MCR and assess its relationship with sociodemographic factors and chronic conditions. Methods: This is a secondary analysis of the SABE Colombia study conducted in 2015. The analytic sample consisted of 17·577 participants. After determining MCR prevalence, logistic regression was performed to examine the correlates of MCR. Findings: The prevalence of MCR was 10·71 %. The median age was 71 years and women composed 74·63 % of the MCR group. After adjusting for confounding variables MCR was associated with increasing age (OR 1·69, CI 1·43 - 1·92), no or low education (OR 1·99, CI 1·67- 2·37), MMSE (OR 0·93, CI 0·91 - 0·95) and chronic conditions such as mental disorders (OR 1·36, CI 1·11-1·67), history of myocardial infarction (OR 1·24, CI 1·04 - 1·47), hypertension (OR 1·23, CI 1·08 - 1·40) and diabetes (OR 1.18, CI 1.01 - 1.37). Interpretation: This study found a prevalence of 10·71 % of MCR in Colombian older adults. Additionally, MCR was associated with chronic conditions and sociodemographic factors identified in prior studies. These results increase the awareness of a novel predementia stage whose identification can be performed by clinicians in the outpatient clinic, minimizing the cost of a full neuropsychologic evaluation performed in a memory clinic. Funding: Funded by the Administrative Department of Science, Technology and Innovation (Colciencias) and the Ministry of Health and Social Protection of Colombia.

Faculty and student perception of innovative evaluation strategies in a medical programme basic area / Percepción de docentes y estudiantes sobre estrategias innovadoras de evaluación en el área básica de un programa de medicina

ABSTRACT Objective: To understand the on-line knowledge examination, the Interdisciplinary Evaluation and Feedback Seminar (SERI in Spanish) and the Objective Structured Clinical Examination (OSCE) as innovative evaluation strategies, based on the perceptions of faculty and students of an medical programme basic area. Materials and methods: Qualitative, microethnographic research. Five focus groups and seven in-depth interviews were conducted with faculty members and students who gave their informed consent and their permission for recording. The data were analysed using open axial coding and emerging categories. Triangulation of sources, authors and techniques was used, and a final report was prepared before returning the information. Results: The strategies studied have strengths and weaknesses; on-line examination is well accepted by the students but there is a lack coordination. Greater faculty training in the use of the platform is required, and it is important to establish mechanisms to avoid potential fraud. SERI favours feedback but there is a need to reduce the risk of affecting self-esteem and to find ways to improve knowledge assessment. OSCE comes closer to the correlation between basic training and clinical practice, but organisation and physical space for stations need to be improved. Conclusions: Innovative evaluation strategies must be the focus of constant review in terms of their structure and implementation in order to strengthen comprehensive student training.

RESUMEN Objetivo: comprender las estrategias innovadoras de evaluación: examen de conocimientos en la plataforma virtual, Seminario de Evaluación y Retroalimentación Interdisciplinar (SERI) y Examen de Conocimientos por Objetivos Estructurado (ECOE), desde las percepciones de docentes y estudiantes del área básica de un programa de medicina. Materiales y métodos: investigación cualitativa, microetnográfica. Se realizaron cinco grupos focales y siete entrevistas en profundidad a docentes y estudiantes, con grabación autorizada y consentimiento informado; se analizó la información mediante codificación abierta y axial, y generación de categorías emergentes. Se utilizó triangulación de fuentes, autores y técnicas, se elaboró informe final, previa devolución de información. Resultados: las estrategias investigadas tienen fortalezas y debilidades, el examen en plataforma es bien recibido por estudiantes pero le falta coordinación. Se necesita mayor capacitación de docentes en el uso de la plataforma, y es importante establecer mecanismos para evitar posibles fraudes. El SERI favorece la retroalimentación, pero se requiere que disminuya el riesgo de vulnerar la autoestima y permita una mejor valoración de conocimientos. El ECOE los acerca a la correlación básico-clínica, pero falta organización y espacio para las estaciones. Conclusiones: las estrategias innovadoras de evaluación deben someterse a una constante revisión desde su estructura y ejecución, fortaleciendo así la formación integral de los estudiantes.

Gender and Health in Spanish Nurses / Gênero e Saúde em Enfermeiras Espanholas / Género y Salud en Enfermeras Españolas

Abstract gender exercises a powerful effect on determining health status: it may limit different rates of exposure to certain risks, different patterns in the quest for treatment or differential impacts of the social economic determinants of health. The object of this study has been to discover the relationships between gender and health in a special group of the Spanish population, male/female nurses. Spanish male (n = 98) and female (n = 98) nurses completed measures of gender norms, and health behavior variables. The analysis of correlations between health variables and gender norms indicates that registering a higher score in gender norms correlates with lower scores in physical and mental health and lifestyles. The logistical regression equations (self-perceived health, mental health and the number of illnesses suffered) identify differences between male and female nurses, with the only common variable being the level of perceived stress.

Resumo O gênero exerce um efeito poderoso na determinação do estado de saúde. Ele pode limitar diferentes níveis de exposição a certos riscos, diferentes padrões na busca por tratamento ou diferentes impactos de determinantes socioeconômicos na saúde. Este estudo teve por objetivo descobrir as relações entre gênero e saúde em um grupo especial da população espanhola, enfermeiros e enfermeiras. Enfermeiros (n = 98) e enfermeiras (n = 98) completaram medidas de normas de gênero e comportamentos de saúde. A análise das correlações entre variáveis de saúde e normas de gênero indicaram que um alto escore nas normas de gênero se correlaciona com baixos escores de saúde física/mental e estilos de vida. As equações de regressão logística (saúde auto percebida, saúde mental e número de dolências) identificaram diferenças entre enfermeiros e enfermeiras; estresse percebido foi a única variável em comum.

Resumen el género ejerce un efecto poderoso en la determinación del estado de salud y puede limitar diferentes niveles de exposición a ciertos riesgos, diferentes patrones en la búsqueda por tratamiento o diferentes impactos de determinantes socioeconómicos en la salud. El objetivo de este estudio fue descubrir las relaciones entre género y salud en un grupo especial de la población española, enfermeros y enfermeras. Enfermeros (n = 98) y enfermeras (n = 98) completaron medidas de normas de género y comportamientos de salud. El análisis de las correlaciones entre variables de salud y de género indicaron que un alto escore en las normas de género se correlaciona con bajos escores de salud física/mental y estilos de vida. Las ecuaciones de regresión logística (salud autopercibida, salud mental y número de dolencias) identificaron diferencias entre enfermeros y enfermeras; estrés percibido ha sido la única variable en común.

Permanent neonatal diabetes by a new mutation in KCNJ11: unsuccessful switch to sulfonylurea

Permanent neonatal diabetes (PNDM) can result from activating heterozygous mutations in KCNJ11 gene, encoding the Kir6.2 subunit of the pancreatic ATP-sensitive potassium channels (KATP). Sulfonylureas promote KATP closure and stimulate insulin secretion, being an alternative therapy in PNDM, instead of insulin. Male, 20 years old, diagnosed with diabetes at 3 months of age. The genetic study identified a novel heterozygous mutation in exon 1 of the KCNJ11 gene – KCNJ11:c1001G>7 (p.Gly334Val) – and confirmed the diagnosis of PNDM. Therefore it was attempted to switch from insulin therapy to sulfonylurea. During glibenclamide institution C-peptide levels increased, however the suboptimal glycemic control lead us to restart an intensive insulin scheme. This new variant of KCNJ11 mutation had a phenotypic lack of response to sulfonylurea therapy. Age, prior poor metabolic control and functional change of KATP channel induced by this specific mutation may explain the observed unsuccessful switch to sulfonylurea. Interestingly, C-peptide levels raise during glibenclamide administration support some degree of improvement in insulin secretory capacity induced by the treatment. Understanding the response to sulfonylurea is crucial as successful treatment may be life-changing in these patients.

Permanent neonatal diabetes by a new mutation in KCNJ11: unsuccessful switch to sulfonylurea.

Permanent neonatal diabetes (PNDM) can result from activating heterozygous mutations in KCNJ11 gene, encoding the Kir6.2 subunit of the pancreatic ATP-sensitive potassium channels (KATP). Sulfonylureas promote KATP closure and stimulate insulin secretion, being an alternative therapy in PNDM, instead of insulin. Male, 20 years old, diagnosed with diabetes at 3 months of age. The genetic study identified a novel heterozygous mutation in exon 1 of the KCNJ11 gene - KCNJ11:c1001G>7 (p.Gly334Val) - and confirmed the diagnosis of PNDM. Therefore it was attempted to switch from insulin therapy to sulfonylurea. During glibenclamide institution C-peptide levels increased, however the suboptimal glycemic control lead us to restart an intensive insulin scheme. This new variant of KCNJ11 mutation had a phenotypic lack of response to sulfonylurea therapy. Age, prior poor metabolic control and functional change of KATP channel induced by this specific mutation may explain the observed unsuccessful switch to sulfonylurea. Interestingly, C-peptide levels raise during glibenclamide administration support some degree of improvement in insulin secretory capacity induced by the treatment. Understanding the response to sulfonylurea is crucial as successful treatment may be life-changing in these patients.

Diagnóstico ecosonográfico y seguimiento neurológico de porencefalia congénita / Echosonographyc diagnostic and neurological continuation of congenital porencephaly

Se presenta un caso de porencefalia congénita diagnosticado por ultrasonido en la semana 35 del embarazo en una paciente epiléptica. La tomografía axial computarizada confirmó el diagnóstico ecográfico. El examen neurológico neonatal sólo reveló hipotonía de miembros inferiores. Al año de edad la paciente presenta retardo psico-motor, retardo en la adquisición del lenguaje. Electroencefalograma anormal, asimétrico, especifico, sin tendencia paroxística, con tendencia focal. actualmente, 16 meses de edad con hemiplejia izquierda (camina con apoyo)

Ecosonografía, control neurólogico / Ultrasonography, neurological control

Evaluamos y seguimos desde el punto de vista clínico neurológico y ecosonográfico a una muestra de 50 niños con peso inferior a 1.500 gramos al nacer, egresados de la Maternidad "Concepción Palacios". La evaluación clínica neurológica la realizamos siguiendo los patrones del examen neonatal y desarrollo psicomotor de Mme. Saint Anne Dargassies y el estudio ecosonográfico con aparato Dataline General Eletric de tiempo real con transductor lineal de 3,5 Mhz y un Aloka con transductor linieal de 3,5 Mhz. La incidencia de secuelas mayores fue del 12%. Ecosonográficamente tuvimos 30% de HIV y 14% dilataciones ventrículares. En nuestro estudio encontramos al igual que otros autores que a medida que es mayor el grado de severidad de la hemorragia, mayor es la incidencia de secuelas graves. Asimismo obtuvimos que la evolución de los niños con hemorragia sin dilatación no fue muy diferente a los normales ecosonográficamente, así como no la hubo entre los niños con hemorragia ventricular acompañada de dilatación y los que presentaron dilatación sin hemorragia