Pertinencia de la atención de la salud mental de conductores para lograr que sean competitivos

Fundamento: Cuidar la salud mental de los conductores de vehículos, es indispensable para que estos sean competitivos y para prevenir accidentes de tránsito, debido a que una de las causas de los accidentes, es la deficiente salud mental de los conductores. Objetivo: Determinar la pertinencia de la atención en salud mental de conductores de vehículos para evitar accidentes y para que sean competitivos. Métodos: La muestra fue de 219 conductores y cobradores de transporte terrestre en Trujillo, La Libertad, Perú; que contestaron el Test de Bienestar General-5, anteriormente aplicado en el Perú por otros investigadores, conformado por 5 preguntas compuestas. La prueba de Hipótesis nula (Ho) y alterna (Ha); se plantearon con una respecto al puntaje decisorio de 54,75 puntos. Resultados: Para las preguntas 2 y 4 se aprobó la hipótesis alterna con la indicación de que es pertinente la atención de salud mental para conductores para que puedan estar relajados; descansen bien e inicien el día sintiéndose sosegados. Para las preguntas 1, 3 y 5 se aceptó la hipótesis nula. Conclusiones: se percibe que los promedios más bajos se corresponden con las preguntas 2 y 4, entonces es pertinente la atención en salud mental para que los conductores de transporte público, puedan recibir asistencia psicológica para sentirse relajados y descansados. Para las demás preguntas se acepta la hipótesis nula.

Foundation: Taking care of the mental health of vehicle drivers is essential for them to be competitive and to prevent traffic accidents because one of the causes of accidents is the poor mental health of drivers. Objective: Determine the relevance of mental health care for vehicle drivers to avoid accidents and to make them competitive. Methods: The sample was 219 drivers and collectors of land transportation in Trujillo, La Libertad, Peru; who answered the General Well-being Test-5, previously applied in Peru by other researchers, made up of 5 composite questions. The null (Ho) and alternate (Ha) hypothesis test; were raised with a respect to the decisive score of 54.75 points. Results: For questions 2 and 4, the alternative hypothesis was approved with the indication that mental health care for drivers is pertinent so that they can be relaxed; also so that they rest well and start the day feeling well rested. For questions 1, 3 and 5, the null hypothesis was accepted. Conclusions: It is perceived that the lowest averages correspond to questions 2 and 4, then mental health care is pertinent for public transport drivers, so that they can receive psychological assistance to feel relaxed and rested. For the other questions, the null hypothesis is accepted.

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

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

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

Análise do perfil epidemiológico dos exames citopatológico do colo do útero em Altamira no período de 2014 a 2020: dados a partir do SISCAN / Analysis of the epidemiological profile of cervical cytopathological exams in Altamira in the period from 2014 to 2020: data from SISCAN / Análisis del perfil epidemiológico de los exámenes citopatológicos de cérvix en Altamira en el periodo de 2014 a 2020: datos del SISCAN

OBJETIVO: Este trabalho aborda sobre características referente aos exames citopatológicos do colo do útero em Altamira, coletado no Sistema de Informação do Câncer, dentro do período de 2014 a 2020. Observou-se também a qualidade da interpretação dos principais resultados encontrados, sobre a técnica de coleta e qualidade de exames. O objetivo é analisar o perfil epidemiológico dos exames citopatológicos do colo do útero do município. MÉTODO: A metodologia realizada foi estudo quantitativo, de corte transversal, epidemiológico, descritiva e analítico. RESULTADOS: Verificou- se um crescimento anual na taxa de cobertura do exame do preventivo no período de 2014 a 2019, que está ligado à implementação do Plano de Desenvolvimento Regional Sustentável do Xingu, e que esse crescimento mostra uma diferença estatística significativa entre a taxa de cobertura de Altamira, Pará, Brasil. Observou-se presença de falhas no preenchimento da ficha de notificação é referente ao campo da escolaridade das pacientes que não apresentam registro. Quanto a faixa etária mais frequente que realizam o exame do preventivo está entre 25 a 34 anos e as lesões intraepiteliais do colo uterino mais frequentes são: a de baixo grau que corresponde à população jovem (<34 anos) e de alto grau entre 25 a 44 anos.

OBJECTIVE: This paper deals with characteristics related to cytopathological examinations of the cervix in Altamira, collected in the Cancer Information System, within the period from 2014 to 2020. It was also observed the quality of interpretation of the main results found, on the technique collection and quality of exams. The objective is to analyze the epidemiological profile of cytopathological tests of the cervix in the city. METHOD: The methodology used was a quantitative, cross- sectional, epidemiological study, descriptive and analytical approach. RESULTS: As a result, there was an annual growth in the coverage rate of the preventive exam in the period from 2014 to 2019, which is linked to the implementation of the Xingu Sustainable Regional Development Plan, and that this growth shows a significant statistical difference between the coverage rate of Altamira, Pará, Brazil. It was observed the presence of failures in completing the notification form referring to the field of education of patients who do not have a record. As for the most frequent age group that undergoes the preventive examination, it is between 25 and 34 years old and the most frequent intraepithelial lesions of the uterine cervix are: low-grade, which corresponds to the young population (<34 years) and high-grade, between 25 and 34 years old. 44 years.

OBJETIVO: En este trabajo se abordan las características relacionadas con los exámenes citopatológicos de cérvix en Altamira, recogidos en el Sistema de Información del Cáncer, en el periodo comprendido entre 2014 y 2020. También se observó la calidad de interpretación de los principales resultados encontrados, sobre la técnica de recolección y calidad de los exámenes. El objetivo es analizar el perfil epidemiológico de los exámenes citopatológicos de cuello uterino en la ciudad. MÉTODO: La metodología utilizada fue un estudio cuantitativo, transversal, epidemiológico, de abordaje descriptivo y analítico. RESULTADOS: Como resultado, se observó un crecimiento anual de la tasa de cobertura del examen preventivo en el período de 2014 a 2019, que está vinculado a la implementación del Plan de Desarrollo Regional Sostenible Xingu, y que este crecimiento muestra una diferencia estadística significativa entre la tasa de cobertura de Altamira, Pará, Brasil. Se observó la presencia de fallas en el llenado del formulario de notificación referente al campo de la educación de los pacientes que no tienen un registro. En cuanto al grupo de edad más frecuente que se somete al examen preventivo, es entre 25 y 34 años y las lesiones intraepiteliales del cuello uterino más frecuentes son: de bajo grado, que corresponde a la población joven (<34 años) y de alto grado, entre 25 y 44 años.

Síndrome de Balint y trombosis de senos venosos cerebrales: reporte de caso / Balint syndrome and cerebral venous sinus thrombosis: Case report

Introducción: El síndrome de Balint es un trastorno neurológico infrecuente, de etiología diversa, cuya presentación incluye la triada clásica de: simultagnosia, ataxia óptica y apraxia oculomotora, síntomas secundarios asociados a lesiones parieto-occipitales, con pronóstico variable según la etiología que se encuentre. A continuación, se reporta un caso secundario a una trombosis de senos venosos. Presentación del caso: Mujer de 66 años que ingresa a urgencias por cefalea aguda asociada a síntomas neurológicos progresivos con compromiso visual. Presentó tensión arterial elevada, simultagnosia, ataxia óptica y apraxia oculomotora. Los estudios imagenológicos reportaron hemorragia subaracnoidea por trombosis de seno sigmoideo izquierdo, por lo que se inició anticoagulación, antihipertensivo, con adecuada evolución del cuadro clínico. Discusión: A pesar de que el síndrome de Balint es un trastorno poco común, de etiología diversa, con escasos reportes a escala global, el caso comentado concordó con las características descritas en la literatura. El abordaje de la paciente en su atención inicial permitió la sospecha diagnóstica oportuna y la indicación de ayudas diagnósticas imagenológicas pertinentes. Tales ayudas soportaron un manejo temprano y la adecuada evolución y resolución del cuadro, en el contexto de la asociación del síndrome a una trombosis de senos venosos cerebrales (una etiología infrecuente). Conclusión: Mediante una historia clínica completa y minuciosa, junto a un adecuado examen neurológico, es posible hacer un acercamiento diagnóstico temprano que permita generar la sospecha del síndrome de Balint y la solicitud temprana de imágenes diagnósticas que orienten en el estudio de su etiología y manejo oportuno, con mejores desenlaces en el paciente.

Introduction: Balint Syndrome is a rare neurological disorder with multiple etiologies. The physical signs include a classic triad (simultagnosia, optic ataxia, and oculomotor apraxia). These symptoms are associated with parieto-occipital lesions, and the prognosis depends on the etiology. This article reports a case secondary to venous sinus thrombosis. Presentation of the case: A 66-year-old woman presented to the emergency room with acute headache associated with progressive neurological symptoms and visual impairment. She had high blood pressure, simultanagnosia, optic ataxia, and oculomotor apraxia. Imaging studies revealed subarachnoid hemorrhage due to thrombosis of the left sigmoid sinus, for which anticoagulation and antihypertensive therapy were started. The patient had a favorable clinical outcome. Discussion: Although Balint syndrome is a rare disorder of diverse etiology with few clinical cases reported globally, the case discussed here was consistent with the characteristics described in the literature. The patient's initial assessment allowed for timely diagnostic suspicion and appropriate imaging studies, which supported early management and the appropriate evolution and resolution of the condition, given the association of the syndrome with an uncommon cause as cerebral venous sinus thrombosis. Conclusion: A complete and thorough medical history, along with a proper neurological exam, can lead to an early diagnostic approach that raises suspicion of Balint's syndrome and prompts timely imaging studies to guide the investigation of its etiology and management, ultimately leading to better outcomes for the patient.

Uso de la ultrasonografía en la evaluación de la retención urinaria en pacientes críticos / Use of ultrasonography in the evaluation of urinary retention in critically ill patients / Utilização da ultrassonografia na avaliação de retenção urinária em pacientes críticos

Objetivo: medir el volumen urinario por medio de la ecografía vesical, realizado por una enfermera en pacientes críticos, después de la retirada de la sonda urinaria permanente y verificar los factores relacionados en la retención urinaria. Método: estudio cuantitativo, observacional y transversal, realizado con 37 pacientes críticos de ambos sexos, mayores de 18 años, con retiro de catéter vesical permanente en las últimas 48 horas. Se utilizó un cuestionario con variables sociodemográficas y clínicas y el examen ecográfico. Se utilizó un cuestionario con variables sociodemográficas y clínicas y el examen ecográfico. Los datos fueron presentados a través de distribución de frecuencias, medidas de centralidad y variabilidad, asociación mediante la prueba exacta de Fisher y, para el análisis, regresión logística binomial múltiple. Resultados: de los 37 pacientes, en su mayoría fue de sexo masculino, con una edad média de 54,9 años. La medición del volumen urinario por ecografía osciló entre 332,3 y 950 ml, y el 40,54% de los pacientes presentó retención urinaria. La retención urinaria se asoció significativamente a la aparición de infección urinaria, estreñimiento intestinal y diuresis por rebosamiento espontáneo. Los pacientes con infección del tracto urinario tenían 7,4 veces más probabilidades de tener retención urinaria. Conclusión: la ecografía vesical fue eficaz para medir el volumen urinario después de retirar el catéter urinario permanente y puede contribuir a la detección de retención urinaria.

Objective: to measure urinary volume through bladder ultrasound, performed by a nurse in critically ill patients, after removal of the indwelling urinary catheter and to verify the related factors on urinary retention. Method: quantitative, observational and cross-sectional study, carried out with 37 critically ill patients of both sexes, over 18 years of age, with removal of indwelling urinary catheter in the last 48 hours. A questionnaire containing sociodemographic and clinical variables and an ultrasound examination were used. Data were presented through frequency distribution, centrality and variability measures, association using Fisher`s exact test and, for analysis multiple binomial logistic regression analysis. Results: the 37 patients were mostly male, with a mean age of 54.9 years. The measurement of urinary volume by ultrasound ranged from 332.3 to 950 ml, and 40.54% of patients had urinary retention. Urinary retention was significantly associated with the occurrence of urinary tract infection, intestinal constipation and spontaneous overflow diuresis. Patients with urinary tract infection were 7.4 times more likely to have urinary retention. Conclusion: bladder ultrasonography was effective in measuring urinary volume after removal of the indwelling urinary catheter and and may contribute to the detection of urinary retention.

Objetivo: mensurar o volume urinário por meio da ultrassonografia de bexiga, realizada por enfermeiro em pacientes críticos, após a remoção do cateter vesical de demora, e verificar os fatores relacionados na retenção urinária. Método: estudo quantitativo, observacional e transversal, realizado com 37 pacientes críticos de ambos os sexos, idade superior a 18 anos, com retirada de cateter vesical de demora nas últimas 48 horas. Foram utilizados um questionário contendo as variáveis sociodemográficas e clinicas e o exame de ultrassonografia. Os dados foram apresentados por meio da distribuição de frequência, medidas de centralidade e de variabilidade, associação pelo teste exato de Fisher e, para análise a regressão logística binomial múltipla. Resultados: dos 37 pacientes, a maioria era do sexo masculino, com média de idade de 54,9 anos. A mensuração do volume urinário pela ultrassonografia variou de 332,3 a 950 ml, sendo que 40,54% dos pacientes apresentaram retenção urinária. A retenção urinaria apresentou associação significativa para a ocorrência de infecção do trato urinário, constipação intestinal e diurese espontânea por transbordamento. Pacientes com infecção urinária tiveram 7,4 vezes mais chance de apresentar retenção urinária. Conclusão: ultrassonografia de bexiga foi eficaz para mensurar o volume urinário após a remoção do cateter vesical de demora e poderá contribuir na detecção da retenção urinária.

Performance of ChatGPT on the Peruvian National Licensing Medical Examination: Cross-Sectional Study.

BACKGROUND: ChatGPT has shown impressive performance in national medical licensing examinations, such as the United States Medical Licensing Examination (USMLE), even passing it with expert-level performance. However, there is a lack of research on its performance in low-income countries' national licensing medical examinations. In Peru, where almost one out of three examinees fails the national licensing medical examination, ChatGPT has the potential to enhance medical education. OBJECTIVE: We aimed to assess the accuracy of ChatGPT using GPT-3.5 and GPT-4 on the Peruvian National Licensing Medical Examination (Examen Nacional de Medicina [ENAM]). Additionally, we sought to identify factors associated with incorrect answers provided by ChatGPT. METHODS: We used the ENAM 2022 data set, which consisted of 180 multiple-choice questions, to evaluate the performance of ChatGPT. Various prompts were used, and accuracy was evaluated. The performance of ChatGPT was compared to that of a sample of 1025 examinees. Factors such as question type, Peruvian-specific knowledge, discrimination, difficulty, quality of questions, and subject were analyzed to determine their influence on incorrect answers. Questions that received incorrect answers underwent a three-step process involving different prompts to explore the potential impact of adding roles and context on ChatGPT's accuracy. RESULTS: GPT-4 achieved an accuracy of 86% on the ENAM, followed by GPT-3.5 with 77%. The accuracy obtained by the 1025 examinees was 55%. There was a fair agreement (κ=0.38) between GPT-3.5 and GPT-4. Moderate-to-high-difficulty questions were associated with incorrect answers in the crude and adjusted model for GPT-3.5 (odds ratio [OR] 6.6, 95% CI 2.73-15.95) and GPT-4 (OR 33.23, 95% CI 4.3-257.12). After reinputting questions that received incorrect answers, GPT-3.5 went from 41 (100%) to 12 (29%) incorrect answers, and GPT-4 from 25 (100%) to 4 (16%). CONCLUSIONS: Our study found that ChatGPT (GPT-3.5 and GPT-4) can achieve expert-level performance on the ENAM, outperforming most of our examinees. We found fair agreement between both GPT-3.5 and GPT-4. Incorrect answers were associated with the difficulty of questions, which may resemble human performance. Furthermore, by reinputting questions that initially received incorrect answers with different prompts containing additional roles and context, ChatGPT achieved improved accuracy.

Método MasQsano. Detección de enfermedades cardiacas no conocidas en reconocimientos médicos deportivos / MasQsano method. Detection of unknown cardiac diseases in sports medical examinations

El reconocimiento médico deportivo es considerado como un punto de partida para cualquier deportista antes de incorporarse a la actividad física o deportiva. Su objetivo principal es la detección de patologías que pudieran poner en riesgo su vida y aquellas que una vez corregidas pueden potenciar el rendimiento físico. Es por ello por lo que debe realizarse por un equipo de salud multidisciplinario experto en el área. De esta manera, resulta importante revisar la evidencia científica y conocer directamente el estado de salud de un grupo de adultos y niños deportistas, su incidencia de enfermedades cardiovasculares y el rol de la enfermería en su aplicación. Este estudio, evaluó una muestra de 7.340 deportistas con edades comprendidas entre los 3 y 17 años, compuesta de 1.693 femeninos y 5.647 masculinos, a los cuales se les realizó el reconocimiento médico deportivo, de acuerdo con un protocolo registrado y establecido previamente en los clubes deportivos de 2 provincias españolas con el apoyo del personal de enfermería durante el año 2021. De estos, se obtuvo un total de 112 casos de patologías cardiacas, de los cuales el 54% tenía conocimiento de patología cardiaca y el 64% no era conocido. De este grupo de patologías cardíacas no conocidas, el 5,9% de los casos requirió intervención quirúrgica, el 21,1% se encuentra en revisión y el 73% fue dado de alta. El total de casos con patologías cardíacas no conocida representa un 0,70% de la muestra. Así mismo, se determinó el rol fundamental de enfermería en la aplicación de este protocolo.(AU)

The sports medical examination is considered a starting point for any athlete before taking up physical or sporting activity. Its main objective is to detect pathologies that could put your life at risk and those that, once corrected, can enhance physical performance. This is why it must be carried out by a multidisciplinary health team with expertise in the area. In this way, it is important to review the scientific evidence and learn directly about the health status of a group of adult and child athletes, their incidence of cardiovascular diseases and the role of nursing in their application. This study evaluated a sample of 7340 athletes aged between 3 and 17 years, composed of 1693 females and 5647 males, who underwent a sports medical examination, according to a registered and previously established protocol in sports clubs in 2 Spanish provinces with the support of nursing staff during the year 2021. Of these, a total of 112 cases of cardiac pathologies were obtained, of which 54% were known to have a cardiac pathology and 64% were unknown. Of this group of unknown cardiac pathologies, 5.9% of the cases required surgical intervention, 21.1% are under review and 73% were discharged. The total number of cases with unknown cardiac pathologies represents 0.70% of the sample. The fundamental role of nursing in the application of this protocol was also determined.(AU)

Aproximación teórica a las incoherencias grafo-corporales en los procesos de recogida de muestras en pericia caligráfica / Theoretical approach to grapho-corporal inconsistencies in the processes of sample collection in handwriting expertise / Abordagem teórica das inconsistências grafo-corporais nos processos de coleta de amostras em perícias de caligrafia

La recogida de muestras indubitadas al momento de elaborar un cuerpo de escritura a una persona, es un proceso de suma importancia en la pericia caligráfica. Existen parámetros por los que se rigen los peritos calígrafos al confeccionar dicho cuerpo de escritura, que se centran de forma general en la posición del escribiente, la velocidad escritural, la espontaneidad, cantidad de muestras, entre otros. Sin embargo, el escribiente puede intentar alterarlo o manipularlo de diferentes formas, normalmente intentando dificultar la labor pericial. Así, existen diversos elementos que indican a un experto en grafística que se está intentando modificar la escritura o firma durante este proceso desde el punto de vista técnico. En este sentido, el objetivo de este estudio es resaltar la importancia de recopilar un cuerpo de escritura con todas las garantías para que pueda tratarse como un documento incuestionable, además de destacar la relevancia de que el perito tenga la capacidad de confirmar la sinceridad del escribiente, tanto mediante el análisis de su escritura (grafología) como a través del análisis de su comunicación no verbal en el momento de escribirlo. Se ha utilizado una metodología cualitativa, usando la técnica de información documental, mediante la recopilación de información para su estudio y análisis, así como de monografías, manuales de estudio y artículos científicos.

The collection of indubitable samples when a corpus of handwriting is taken from a person is an extremely important process in handwriting expertise. There are parameters by which handwriting experts are governed when making such a writing corpus, which generally focus on the position of the scribe, writing speed, spontaneity, number of samples, among others. However, the scribe may try to alter or manipulate it in different ways, usually in an attempt to hinder the expert's work. Thus, there are several elements that indicate to a handwriting expert that an attempt is being made to modify the handwriting or signature during this process from a technical point of view. In this sense, the aim of this study is to highlight the importance of compiling a handwriting corpus with all the guarantees that it can be treated as an unquestionable document, as well as highlighting the importance of the expert having the ability to confirm the scribe's sincerity, both through the analysis of their handwriting (graphology) and through the analysis of their non-verbal communication at the time of writing. A qualitative methodology has been used, using the documentary information technique, by means of the collection of information for study and analysis, as well as monographs, study manuals and scientific articles.

A coleta de provas indubitáveis quando um corpo de caligrafia é retirado de uma pessoa é um processo extremamente importante na perícia de caligrafia. Existem parâmetros pelos quais os peritos em caligrafia são regidos ao fazer esse corpo de escrita, que geralmente se concentram na posição do escriba, na velocidade da escrita, na espontaneidade, no número de amostras, entre outros. No entanto, o escrevente pode tentar alterá-lo ou manipulá-lo de diversas formas, geralmente na tentativa de dificultar o trabalho do perito. Assim, existem vários elementos que indicam ao perito em caligrafia que, do ponto de vista técnico, está havendo uma tentativa de modificar a caligrafia ou a assinatura durante esse processo. Nesse sentido, o objetivo deste estudo é destacar a importância de se compilar um corpo de caligrafia com todas as garantias de que possa ser tratado como um documento inquestionável, bem como destacar a importância de o perito ter a capacidade de confirmar a sinceridade do escrevente, tanto por meio da análise de sua caligrafia (grafologia) quanto por meio da análise de sua comunicação não verbal no momento da escrita. Foi utilizada uma metodologia qualitativa, com a técnica de informação documental, por meio da coleta de informações para estudo e análise, bem como de monografias, manuais de estudo e artigos científicos.

Success of ChatGPT, an AI language model, in taking the French language version of the European Board of Ophthalmology examination: A novel approach to medical knowledge assessment.

PURPOSE: The purpose of this study was to evaluate the performance of ChatGPT, a cutting-edge artificial intelligence (AI) language model developed by OpenAI, in successfully completing the French language version of the European Board of Ophthalmology (EBO) examination and to assess its potential role in medical education and knowledge assessment. METHODS: ChatGPT, based on the GPT-4 architecture, was exposed to a series of EBO examination questions in French, covering various aspects of ophthalmology. The AI's performance was evaluated by comparing its responses with the correct answers provided by ophthalmology experts. Additionally, the study assessed the time taken by ChatGPT to answer each question as a measure of efficiency. RESULTS: ChatGPT achieved a 91% success rate on the EBO examination, demonstrating a high level of competency in ophthalmology knowledge and application. The AI provided correct answers across all question categories, indicating a strong understanding of basic sciences, clinical knowledge, and clinical management. The AI model also answered the questions rapidly, taking only a fraction of the time needed by human test-takers. CONCLUSION: ChatGPT's performance on the French language version of the EBO examination demonstrates its potential to be a valuable tool in medical education and knowledge assessment. Further research is needed to explore optimal ways to implement AI language models in medical education and to address the associated ethical and practical concerns.

[Place of breast self-examination in screening strategies. French College of Gynecologists and Obstetricians (CNGOF) recommendations for clinical practice]. / Recommandations pour la pratique clinique du CNGOF. Place de l'auto-examen des seins dans les stratégies de dépistage.

OBJECTIVES: Breast cancer is the most common female cancer in the world. In France, over 60,000 new cases are currently diagnosed, and 12,000 deaths are attributed to it annually. Numerous studies have shown that the risk of metastatic disease increases with tumor volume. In this context, it is useful to assess whether the regular practice of breast self-examination (BSE) has an impact on the number of cancers diagnosed, their stage, the treatments used and mortality. DESIGN: the CNGOF's Commission de Sénologie (CS), composed by 17 experts and 3 invited members, drew up these recommendations. No funding was provided for the development of these recommendations. The CS respected and followed the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method to assess the quality of the evidence on which the recommendations were based. METHODS: The CS studied 16 questions concerning BSE, individualizing four groups of women (general population, women aged over 75, high-risk women, and women previously treated for breast cancer). For each situation, it was determined whether the practice of BSE compared with abstention from this examination led to the detection of more breast cancers and/or recurrences and/or reduced treatment and/or increased survival. RESULTS: BSE should not be recommended for women in the general population, who otherwise benefit from a clinical breast examination (by the attending physician or gynecologist) from the age of 25, and from organized screening from 50 to 74 (strong recommendation). However, in the absence of data on the role of BSE in patients aged over 75, those at high risk of breast cancer and those previously treated for breast cancer, the CS was unable to issue recommendations. Thus, if women in these latter categories wish to undergo BSE, they must be given rigorous training in the technique, and information on the benefits and risks observed in the general population. Finally, the CS invites all women who detect a change or abnormality in their breasts to consult a healthcare professional without delay. CONCLUSION: BSE is not recommended for women in the general population. No recommendation can be established for women aged over 75, those at high risk of breast cancer and those previously treated for breast cancer.

Patologías Oftalmológicas en lactantes menores de 6 meses en un servicio de oftalmopediatría de un hospital de referencia

Introducción: Las afecciones oftalmológicas en niños menores de 6 meses pueden producir alteraciones visuales e incluso la ceguera total. Objetivos: Describir la frecuencia y los tipos de patologías oftalmológicas en lactantes menores de 6 meses en un servicio de oftalmopediatría de un hospital infantil. Materiales y Métodos: estudio observacional, descriptivo, retrospectivo. Se revisó la base de datos del servicio de oftalmopediatría. Por muestreo de casos consecutivos fueron incluidos lactantes con edad ≤6 meses, que consultaron en el periodo de marzo a septiembre del 2022, en cuyas fichas figuraban el número telefónico. Variables: edad, sexo, motivo de consulta, antecedentes perinatales y de patologías oftalmológicas, resultado del examen oftalmológico y tratamiento. Los datos fueron analizados en SPSS con estadísticas descriptivas. El comité de ética aprobó el protocolo con consentimiento de los padres. Resultados: Ingresaron 137 lactantes con edad 2,9 ± 1,8 meses, peso de nacimiento 2995 ± 621, edad gestacional 38 ± 2,1 semanas, 53% varones, 31% para control, el 83%, con antecedente de patología ocular. Presentaron patología ocular el 32% (44/137), 59% (26/44) de origen congénito y 41%(18/44) adquiridas. El 18% (8/44) de las alteraciones oculares recibieron tratamiento quirúrgico. Conclusión: El 32% de los lactantes atendidos en el servicio de oftalmopediatria presentaron patologías oculares, de las cuales el 59% fueron congénitas, las dos más frecuentes la catarata congénita y la obstrucción del conducto nasolagrimal.

Introduction: Ophthalmological conditions in children under 6 months can cause visual disturbances and even total blindness. Objectives: To describe the frequency and types of ophthalmological pathologies in infants under 6 months of age in a pediatric ophthalmology service at a children's hospital. Materials and Methods: this was an observational, descriptive and retrospective study. The database of the ophthalmopediatric service was reviewed. By sampling consecutive cases, infants aged ≤6 months, who consulted from March to September 2022 and whose records included the telephone number were included. Variables: age, sex, chief complaint, perinatal history and ophthalmological pathologies, result of ophthalmological examination and treatment. Data were analyzed in SPSS with descriptive statistics. The ethics committee approved the protocol and parental consent was obtained. Results: 137 infants, aged 2.9 ± 1.8 months, birth weight 2995 ± 621, gestational age 38 ± 2.1 weeks, of which 53% were male were selected for this study. 31% presented for a routine follow-up, 83% had a history of ocular pathology. 32% (44/137) presented ocular pathology, 59% (26/44) congenital and 41% (18/44) acquired. 18% (8/44) of the ocular alterations received surgical treatment. Conclusions: 32% of the infants seen in the ophthalmopediatric service presented ocular pathologies, of which 59% were congenital, the two most frequent being congenital cataracts and nasolacrimal duct obstruction.

[Diagnostic criteria, epidemiology and assessment of patients with functional neurological disorders]. / Définitions, épidémiologie et démarche diagnostique clinique dans les troubles neurologiques fonctionnels.

Functional neurological disorders (FND) are symptoms that can affect a variety of functions including motor, sensory and cognitive. These symptoms are genuinely experienced by the patient and are related to a functional disorder rather than a structural one. There is little epidemiological data on these disorders, but their frequency is well established in clinical practice, it is the second most frequent reason for consultation in Neurology. Despite of the frequency of the disorder, general practitioners and specialists are insufficiently trained in the disease, and patients often suffer from stigmatization and/or unnecessary investigations. It is therefore important to be aware of the diagnostic approach to FND, which mostly relies on positive clinical signs. Psychiatric evaluation can help with the characterization of predisposing, precipitating and perpetuating factors of the symptoms (according to the 3P biopsychosocial model related to FND), and guide their management. Finally, diagnosis explanation is a crucial step in the management of the disease, which can in itself have a therapeutic effect, and allow the patient to adhere to the treatments.

Rol enfermero en la prevención de muerte súbita del deportista y detección de enfermedades no conocidas / The nursing role in the prevention of sudden death in sports and detection of unknown diseases

Objetivo: identificar alteraciones cardiacas en deportistas de entre 3 a 17 años de las provincias de Granada y Almería (España). Método: estudio descriptivo transversal en 7.340 deportistas de clubes deportivos de Granada y Almería en el año 2021. Se les realizó un reconocimiento médico deportivo (RMD) obligatorio para la competición, llevado a cabo por un equipo multidisciplinar (Medicina, Enfermería, Fisioterapia) y acorde a las directrices de la European Society of Cardiology. Tras finalizar el RMD, el personal de Enfermería llevó a cabo una intervención educativa, facilitando consejos sobre la práctica deportiva y realizando el seguimiento de quienes requirieron una valoración por especialistas.Resultados: un 50% de la muestra (7.340) practicaba fútbol. Fueron detectados 52 deportistas con patologías cardiacas no conocidas (0,69%), que sumados a los 60 de quienes ya se conocía que tenían patologías cardiacas ascienden a un 1,5%. De las 52 personas de nueva detección, su edad media fue de 10,8, el 71,4% era hombre y el deporte más practicado fue el fútbol (67,3%). La patología cardiaca más frecuente detectada fue la inversión de la onda T (42,3%). Conclusiones: existe una baja prevalencia de enfermedades cardiacas, representando el 1,5% de la muestra. El RMD aplicado en población infantil y adolescente deportista es efectivo para detectar patología cardiaca. El personal de Enfermería tiene un papel relevante en los RMD para ayudar en la detección de patologías cardiacas y en la prevención de la muerte súbita del deportista, abarcando desde lo educativo, la supervisión del equipamiento, la valoración y el asesoramiento necesario a los deportistas.(AU)

Objectives: to detect cardiac alterations in 3-to-17-year-old sportsmen from the provinces of Granada and Almería (Spain).Method: a descriptive cross-sectional study conducted in 7,340 sportsmen from sports clubs of Granada and Almería in 2021. A sports medical examination (SME) was conducted, which was compulsory for the competition, by a multidisciplinary team (Medicine, Nursing, Physiotherapy) and according to the guidelines by the European Society of Cardiology. After completing the SME, the Nursing team conducted an educational intervention, providing advice about the sports practice and conducting follow-up for those who required assessment by specialists.Results: of the sample, 50% (7,340) played football. Fifty-two (52) sportsmen with not-known cardiac conditions were detected (0.69%); added to the 60 with already known cardiac conditions, they amounted to 1.5%. The mean age of the 52 persons with new detection was 10.8; 71.4% were male and the most practiced sport was football (67.3%). The most frequently detected cardiac condition was T-wave inversion (42.3%).Conclusions: there is a low prevalence of cardiac conditions, representing 1.5% of the sample. The SME applied in the population of child and adolescent athletes is effective in order to detect cardiac conditions. The Nursing staff plays a relevant role in SMEs to help detect cardiac conditions and in the prevention of sudden deaths in sports, including the educational aspect, equipment supervision, and the required assessment and counselling provided to sportsmen.(AU)

An umbrella review exploring the effect of radiotherapy for head and neck cancer patients on the frequency of jaws osteoradionecrosis.

OBJECTIVE: Efforts have been made to reduce epidemiological indicators of osteoradionecrosis in patients with head and neck cancer over recent years. This umbrella review aims to synthesize the information of the systematic reviews/meta-analyses investigating the effect of radiotherapy in patients with head and neck cancer on the frequency of osteoradionecrosis and to identify and analyze the gaps in current scientific literature. MATERIAL AND METHODS: A systematic review of systematic reviews with and without meta-analysis of intervention studies was conducted. Qualitative analysis of the reviews and their quality evaluation were performed. RESULTS: A total of 152 articles were obtained, and ten of them were selected for the final analysis, where six were systematic reviews and four were meta-analysis. According to the guide Assessing the Methodological Quality of Systematic Reviews (Amstar), eight articles included were of high quality and two of medium quality. These descriptive systematic reviews/meta-analyses included a total of 25 randomized clinical trials, showing that radiotherapy has positive effects on the frequency of osteoradionecrosis. Even though a reduction in the incidence of osteoradionecrosis was observed back in the history, in systematic reviews with meta-analysis, overall effect estimators were not significant. CONCLUSIONS: Differential findings are not enough to demonstrate that there is a significant reduction in the frequency of osteoradionecrosis in patients with head and neck cancer treated by radiation. Possible explanations are related to factors such as the type of studies analyzed, indicator of irradiated complication considered, and specific variables included in the analysis. Many systematic reviews did not address publication bias and did identify gaps in knowledge that require further clarification.

Transiluminación negativa en patología testicular / Negative transillumination in testicular pathology

Los tumores testiculares representan el 1-2% de las neoplasias masculinas, siendo el más frecuente el seminoma. En pacientes con aparición de una masa o dolor testicular subagudo, es importante hacer una anamnesis exhaustiva y una exploración física. Hemos de apoyarnos en dos técnicas exploratorias para poder hacer un diagnóstico diferencial adecuado y detectar patología testicular urgente: transiluminación y ecografía testicular. El tratamiento incluye una orquiectomía y, según el estadio tumoral, quimioterapia.(AU)

Testicular tumors account for 1% to 2% of male neoplasms, the most common being seminoma. In patients who consult due to the presence of a mass or subacute testicular pain, it is important to undertake a thorough history and physical examination. We must rely on two exploratory techniques to be able to perform a suitable differential diagnosis and detect urgent testicular pathology: transillumination and testicular ultrasound. Treatment includes performing an orchiectomy and depends on tumor stage and chemotherapy.(AU)

Sex differences on anxiety and depression in older adults and their relationship with cognitive impairment / Diferencias por sexo en ansiedad y depresión en personas adultas mayores y su relación con el deterioro cognitivo

Introduction Subjective memory complaints (SMCs) in elderly adults could express cognitive decline in the future. A consensus has been reached about how these SMC relate to mood variables, but further research is required to determine which socio-demographic, cognitive, functional and occupational factors will act as predictors in elderly adults. Objetivo To analyze, through a descriptive observational study, the relationship between anxiety/depression and sex, age and occupation, with cognitive/functional performance in 367 older adults with SMC, but without objective cognitive impairment in a primary healthcare center. Methods The cognitive variables were measured by applying the Spanish version of Mini-Mental State Examination (MEC-35) and Set-test for verbal fluency. To measure functional level, the Barthel index and Lawton and Brody scales were employed. Physical occupational status and mental occupational status were measured based on three levels, low, medium and high, according to the American Occupational Therapy Association. Results Low educational and occupational physical and mental levels were related to anxiety and depression. In addition, differences by sex were found on anxiety and depression related to different factors. In men, anxiety was related to higher cognitive level, and in women to higher functional performance in IADLs. On the contrary, depression in men was related to lower cognitive level and higher performance in ADLs. Conclusions It is important to maintain a sex-gender perspective on the study of anxiety and depression in elderly, taking into account social roles and the traints of the work environment, in order to avoid cognitive and functional impairment (AU)

Introducción Las quejas subjetivas de memoria (SMC) en adultos mayores podrían expresar un daño cognitivo en el futuro. Existe consenso sobre la relación de estas SMC con variables del estado de ánimo pero se necesita más investigación para determinar qué factores sociodemográficos, cognitivos, funcionales y ocupacionales serían los predictores en los adultos mayores. Objetivo Analizar la relación entre ansiedad y depresión con el sexo, edad y ocupación, así como con el desempeño cognitivo y funcional en 367 adultos mayores con SMC en un centro de atención primaria. Métodos Las variables cognitivas se midieron mediante la version Española del Mini-Mental State Examination (MEC-35) y Set-Test para la fluidez verbal. Para medir el nivel funcional se utilizaron el índice de Barthel y la escala de Lawton y Brody. El estado ocupacional físico y mental fueron medidos en base a tres niveles (bajo, medio y alto) según la American Occupational Therapy Association. Resultados Los niveles educativos y ocupacionales físicos y mentales bajos se relacionaron con ansiedad y depresión. Además, se encuentran diferencias por sexo en los factores relacionados con la ansiedad y depresión. En los hombres, la ansiedad se relacionó con un mayor nivel cognitivo y en las mujeres con mayor desempeño funcional en las actividades instrumentales de la vida diaria (AIVD). Por el contrario, la depresión en los hombres se relacionó con menor nivel cognitivo y un mayor desempeño en las actividades básicas de la vida diaria (ABVD). Conclusiones Es importante mantener la perspectiva sexo-género en el análisis de la ansiedad y depresión en personas mayores, teniendo presentes los roles sociales y características del entorno laboral, para evitar el deterioro cognitivo y funcional (AU)

Adherencias del capuchón del clítoris al glande: una condición poco estudiada y poco examinada / Clitoral hood adhesions to the glans penis: an understudied and under-examined condition

INTRODUCCIÓN: El clítoris es una de las estructuras vulvares menos examinadas, pese a su relevancia en la vida sexual y sus importantes relaciones anatómicas. Las adherencias del capuchón del clítoris han sido descritas y clasificadas según la exposición del glande, siendo relacionadas con trastornos del deseo sexual. La inervación del clítoris depende de raíces de S3-S4, siendo posible que síntomas frecuentes del piso pélvico tengan relación con esta condición. Realizamos un análisis retrospectivo de pacientes de policlínico de piso pélvico entre noviembre de 2021 y abril de 2022. Se incluyeron 100 pacientes con adherencias al ingreso. RESULTADOS: Promedio de edad 45,8 ± 15,5 años. Las adherencias fueron el 19% leves, el 62% moderadas y el 18% graves. Los principales síntomas eran mal vaciado vesical (38%), dolor (28%), disfunción sexual (39%) y síntomas irritativos vesicales (43%); solo una paciente fue asintomática. El área visible promedio del clítoris era de 20,7 ± 13,7 mm2. CONCLUSIONES: Las adherencias del capuchón del clítoris son un hallazgo común, muchas veces no diagnosticadas, por lo que su evaluación debe ser parte de la exploración física. Pueden asociarse a sintomatología de piso pélvico.

INTRODUCTION: The clitoris is one of the least examined vulvar structures despite its relevance in sexual life and important anatomical relationships. Clitoral hood adhesions have been described in the literature, classified based on glans exposure, and related to sexual desire disorders. The innervation of the clitoris depends on the roots of S3-S4, and frequent pelvic floor symptoms may be associated with this condition. We retrospectively analyzed the clinical record of patients admitted to a pelvic floor clinic between November 2021 and April 2022. One hundred patients with adhesions at the time of admission were registered. RESULTS: Average 45.8 ± 15.5 years. Clitoral hood adhesions were mild (19%), moderated (62%), or severe (18%). The main symptoms were voiding dysfunction symptoms (38%), pain (28%), sexual dysfunction (39%), and irritative bladder symptoms (43%); only one patient was asymptomatic. The visible area of the clitoris was 20.7 ± 13.7 mm2. CONCLUSIONS: Adhesions of the clitoral hood are often undiagnosed, and its analysis should be part of the physical exam. Clitoral hood adhesions could be associated with pelvic floor symptoms.

Multimedia educativa: Examen Físico del Aparato Cardiovascular

Introducción: La formación de estudiantes de las Ciencias Médicas se inició como algo netamente presencial; al pasar el tiempo las invenciones fueron formando parte de la práctica médica y educativa, donde la educación digital tomó un puesto relevante. Objetivo: Diseñar un software educativo para la enseñanza y aprendizaje de las características del examen físico del aparato cardiovascular. Métodos: Se realizó un estudio de innovación y desarrollo tecnológico con el diseño de una multimedia, usando la plataforma Chreasoft, para el estudio del examen físico del aparato cardiovascular en la Filial de Ciencias Médicas Nuevitas durante el curso 2020 - 2021. El universo de aplicación del software se conformó por los 33 estudiantes de 3er. año de la carrera de medicina. Resultados: Durante el diagnóstico inicial, tres estudiantes resultaron evaluados de mal. En la evaluación final, luego de utilizar el software, predominó el uso de bibliografía digital e impresa; además se evidenció un incremento en el nivel de información de los estudiantes, ya que la mayoría obtuvo calificación de bien; se destacó el nivel de satisfacción en la categoría de alto tras el uso del software educativo por los estudiantes. Conclusiones: La multimedia Examen Físico del Aparato Cardiovascular constituye, en nuestro medio, un aporte al proceso de enseñanza aprendizaje y tributa al modo de actuación del futuro egresado, mediante la formación de valores, interactividad con el contenido, retroalimentación, evaluación y el desarrollo de habilidades, como el trabajo independiente y la autopreparación.

Introduction: The training of medical sciences students began as something involving purely face-to-face activities; but as time passed, the inventions became part of the medical and educational practice where digital education reached a relevant position. Objective: To design an educational software for the teaching and learning of the characteristics of the physical examination of the cardiovascular system. Methods: A study of innovation and technological development was carried out with the design of a multimedia, using the Chreasoft platform for the study of the physical examination of the cardiovascular system at the Subsidiary of Medical Sciences Nuevitas during the 2020 - 2021 academic year. The universe of application of the software was made up of the 33 students in the 3rd year of medical studies. Results: During the initial diagnosis, three students were evaluated as poor. In the final evaluation, after using the software, the use of digital and printed bibliography predominated. In addition, an increase in the level of information among students was evidenced since most of them were evaluated as good; after the use of the educational software the high level of satisfaction expressed by the students was highlighted. Conclusions: The multimedia Physical Examination of the Cardiovascular System constitutes, in our field, a contribution to the teaching-learning process and contributes to the way of acting of the future graduate through the formation of values, interactivity with the content, feedback, evaluation and development of skills, independent work, and self-preparation.

[Pelvic exam in gynecology and obstetrics: Guidelines for clinical practice]. / Examen pelvien en gynécologie et obstétrique : recommandations pour la pratique clinique.

OBJECTIVE: To provide guidelines for the pelvic clinical exam in gynecology and obstetrics. MATERIAL AND METHODS: A multidisciplinary experts consensus committee of 45 experts was formed, including representatives of patients' associations and users of the health system. The entire guidelines process was conducted independently of any funding. The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS: The committee studied 40 questions within 4 fields for symptomatic or asymptomatic women (emergency conditions, gynecological consultation, gynecological diseases, obstetrics, and pregnancy). Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® methodology. RESULTS: The experts' synthesis work and the application of the GRADE method resulted in 27 recommendations. Among the formalized recommendations, 17 present a strong agreement, 7 a weak agreement and 3 an expert consensus agreement. Thirteen questions resulted in an absence of recommendation due to lack of evidence in the literature. CONCLUSIONS: The need to perform clinical examination in gynecological and obstetrics patients was specified in 27 pre-defined situations based on scientific evidence. More research is required to investigate the benefit in other cases.

Effects of an easy neuroanatomy book with schematics on student learning / Efectos de un libro sencillo de neuroanatomía con esquemas sobre el aprendizaje de los estudiantes

SUMMARY: Numerous students perceive neuroanatomy as a particularly difficult subject due to its overwhelming complexity. Therefore, a neuroanatomy book that concentrates on easy-to-read stories with schematics rather than exhaustive details has been published. This study evaluates the effect of a trial of the new neuroanatomy book on student learning. From the book, a printout on the brainstem and cranial nerve was extracted. Medical students read the printout, and subsequently were examined on their knowledge of and interest in neuroanatomy. Students who read the extract answered examination questions relatively well and were more interested in neuroanatomy. The printout seemed to enhance the knowledge and concentration of the students. After grasping the fundamental information in the book, students are expected to be able to learn advanced concepts comfortably and confidently. In addition, the book with its concise and simple content is suitable not only for short- duration neuroanatomy courses but also for self-learning.

Muchos estudiantes perciben la neuroanatomía como un tema particularmente difícil debido a su abrumadora complejidad. Por lo tanto, se ha publicado un libro de neuroanatomía que se concentra en historias fáciles de leer con esquemas en lugar de detalles exhaustivos. Este estudio evalúa el efecto de una prueba del nuevo libro de neuroanatomía en el aprendizaje de los estudiantes. Del libro, se extrajo una impresión sobre el tronco encefálico y los nervios craneales. Los estudiantes de medicina leyeron la copia impresa y, posteriormente, se les examinó su conocimiento e interés por la neuroanatomía. Los estudiantes que leyeron el extracto respondieron relativamente bien a las preguntas del examen y estaban más interesados en la neuroanatomía. La impresión parecía mejorar el conocimiento y la concentración de los estudiantes. Después de comprender la información fundamental del libro, se espera que los estudiantes puedan aprender conceptos avanzados con comodidad y confianza. Además, el libro con su contenido conciso y simple es adecuado no solo para cursos de neuroanatomía de corta duración, sino también, para el autoaprendizaje.