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1.
Front Med (Lausanne) ; 11: 1402606, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39109227

RESUMO

Objective: In 2022, several cases of ocular hypertension (OHT) related to EyeCee One preloaded IOLs were reported. The aim of this study was to determine the presurgical and surgical variables associated with this response. Methods and analysis: An analysis was conducted on patients who underwent isolated cataract surgery between September 2022 and December 2022 at the Hospital Universitario del Henares. The influence of potential factors was studied using the Kruskal-Wallis test and multiple regression analysis. Results: A total of 353 cataract surgeries were included in the study. No significant differences between the different IOLs were found related to a change in the IOP on the first postoperative day (p = 0.395), but the change in the IOP after 1 month was higher in the EyeCee One group (p = 0.016). Approximately 6.1% of the patients who received EyeCee One had an IOP increase greater than 10 mmHg, compared to only 0.8% of the patients who received other IOLs. The odds ratio (OR) of experiencing an IOP increase greater than 10 mmHg in the EyeCee One group at the 1-month visit was 7.99 (1.52-41.99). The multiple regression analysis showed that receiving the EyeCee One lens was associated with a 2-mmHg increase in IOP. A previous history of glaucoma or OHT was not associated with greater IOP. Two patients in the EyeCee One group developed severe visual loss. Conclusion: Patients who received the EyeCee One IOL experienced significant increases in IOP at the 1-month visit. A small number of patients might suffer visual loss secondary to the rise in IOP.

3.
Mov Disord ; 39(3): 510-518, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38140802

RESUMO

BACKGROUND: Friedreich's ataxia (FA) is a rare multisystemic disorder which can cause premature death. OBJECTIVES: To investigate predictors of survival in FA. METHODS: Within a prospective registry established by the European Friedreich's Ataxia Consortium for Translational Studies (EFACTS; ClinicalTrials.gov identifier NCT02069509) we enrolled genetically confirmed FA patients at 11 tertiary centers and followed them in yearly intervals. We investigated overall survival applying the Kaplan-Meier method, life tables, and log-rank test. We explored prognostic factors applying Cox proportional hazards regression and subsequently built a risk score which was assessed for discrimination and calibration performance. RESULTS: Between September 2010 and March 2017, we enrolled 631 FA patients. Median age at inclusion was 31 (range, 6-76) years. Until December 2022, 44 patients died and 119 terminated the study for other reasons. The 10-year cumulative survival rate was 87%. In a multivariable analysis, the disability stage (hazard ratio [HR] 1.51, 95% CI 1.08-2.12, P = 0.02), history of arrhythmic disorder (HR 2.93, 95% CI 1.34-6.39, P = 0.007), and diabetes mellitus (HR 2.31, 95% CI 1.05-5.10, P = 0.04) were independent predictors of survival. GAA repeat lengths did not improve the survival model. A risk score built on the previously described factors plus the presence of left ventricular systolic dysfunction at echocardiography enabled identification of four trajectories to prognosticate up to 10-year survival (log-rank test P < 0.001). CONCLUSIONS: Arrhythmias, progressive neurological disability, and diabetes mellitus influence the overall survival in FA. We built a survival prognostic score which identifies patients meriting closer surveillance and who may benefit from early invasive cardiac monitoring and therapy. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.


Assuntos
Diabetes Mellitus , Ataxia de Friedreich , Humanos , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Estudos Prospectivos , Sistema de Registros
4.
Front Med (Lausanne) ; 10: 1308423, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38155664

RESUMO

Background: There are environmental factors that may contribute to the onset of myopia. This study aims to evaluate the children's lifestyle changes before and after the COVID-19 lockdown and how they can influence their vision. Methods: The same questionnaire was administered to children aged between 5 and 7 in Spain every year in September before (2017-2019) and after the COVID-19 lockdown (2020-2021). All the children also passed a vision exam consisting of the measurement of visual acuity (VA) and determination of objective and subjective refraction. Children were classified as myopes, pre-myopes, or hyperopes. The cut-off points to define the refractive error were established according to the value of the spherical equivalent (SE): hyperopia (SE > +0,75D), myopia (SE ≤ -0,5D), or pre-myopia (-0.5D < SE ≥ +0.75D). Data analysis is performed with the SPSS 27.0 software (SPSS Inc., Chicago, Illinois). Results: In the pre-COVID period, the pre-myopes were the ones who spent the longest time outdoors, and after the COVID lockdown, there were no differences between groups. There neither were any differences in the time spent doing near-work activities between the groups in both periods (p > 0.05). Regarding the spherical equivalent, in the pre-COVID period, the mean value was 0.75 ± 2.09D and after the COVID lockdown, it was 0.47 ± 1.88D (p < 0.001). Conclusion: Pre-myopes spent more time outdoors than myopes in the pre-COVID period, while myopes spent more time using digital devices. All these differences do not exist after the COVID lockdown, with a general increase in the time spent outdoors and a decrease in the use of digital devices. Further studies are needed to know if these lifestyle changes remain and how they influence the onset of myopia.

5.
Plant Dis ; 2023 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-38035786

RESUMO

Banana (Musa spp.) is the most economically important crop in Ecuador, with exports representing 35% of the agricultural GDP of the country. It covers 230,000 hectares, mostly concentrated in three coastal provinces, Guayas, Los Ríos, and El Oro. Between July and September 2022, disease symptomatic banana cv. Williams plants were observed in commercial plantations located in two parishes in the province of Guayas (Naranjito and Lorenzo de Garaicoa) and one parish in the province of Santo Domingo de los Tsáchilas (La Concordia), with an incidence that ranged from 5% to 15%. Symptoms included soft rot of the pseudostem and rhizome decay, characterized by a fetid odor. Three symptomatic pseudostems from each location were collected, washed with running water to remove any debris, and dried with absorbent paper. From the lesion of each pseudostem, seven pieces of 2 cm² were taken, surface-sterilized, and macerated in 9 ml of sterile peptone water (0.1% w/v). The macerate was diluted three fold in sterile water, plated on nutrient agar, and incubated at 30°C for 24 h. Eight randomly picked colonies, with convex elevation and creamy white color, were isolated on nutrient agar. Each of the bacterial isolates was biochemically profiled by the Biolog system (Biolog Inc., USA) and identified as Pectobacterium. Three isolates, one from each parish (FP220416, FP220694, and FP220904), were selected for testing Koch's postulates and further identification. Sequences from fragments of the 16S, dnaA, gapA and gyrB genes were obtained from these isolates, following the protocols used by Dobhal et al. (2020) and Boluk et al. (2020), showing 98.1-99.0%, 98.2%, 99.7-99.8%, and 98.4-98.9% identitity, respectively, with sequences from the P. brasiliense type strain LMG_21371 (Acc. number JQOE00000000). The obtained sequences were deposited in GenBank with the following accession numbers: OR392417, OR371545,OR371546, OR727281, OR727282, and OR739074-OR739080. Using BEAST v.1.10.4 (Suchard et al.,2018), a bayesian multilocus phylogenetic tree was built with multiple sequence alignments of dnaA, gapA, ang gyrB from 22 P. brasiliense isolates and 2 P. aquaticum isolates used as outgroup. The phylogenetic analysis showed that the Ecuadorian isolates cluster with P. brasiliense BF20, isolated from Opuntia ficus-indica in México and are closely related with the type strain. Pathogenicity tests were conducted through syringe infiltration with 1 ml of 1 × 10^8 CFU ml-1 bacterial suspensions. Each of the three characterized isolates were inoculated into the pseudostems of five healthy 4-month-old banana plants of the Williams cultivar. Negative control plants were infiltrated with sterile distilled water. The plants were incubated at 25°C and 74% relative humidity. Black lesions started to appear 11 days after inoculation and 5 weeks after inoculation plants showed clear symptoms of soft rot of the pseudostem, including fetid odor associated with plant tissue decomposition. Control plants remained symptom-free. Bacteria were re-isolated only from symptomatic pseudostems and identified as P. brasiliense with specific primers Pb1F and Pb1R. Soft rot of banana caused by different enterobacteria including Dickeya zeae, Erwinia carotovora, and Erwinia chrysanthemi hasve been previously reported (Jingxin et al. 2022, Arun et al. 2012, Loganathan, et al. 2019). This is the first report of P. brasiliense causing soft rot of banana in Ecuador, the biggest exporter of the fruit in the world.

6.
Sensors (Basel) ; 23(2)2023 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-36679591

RESUMO

Structural Health Monitoring (SHM) systems allow three types of diagnostic tasks to be performed, namely damage identification, loads monitoring, and damage prognosis. Only if all three tasks are correctly fulfilled can the useful remaining life of a structure be estimated credibly. This paper deals with the second task and aimed to extend state-of-the-art in load identification, by demonstrating that it is feasible to achieve it through the analysis of response signals captured with high-speed three-dimensional Digital Image Correlation (HS 3D-DIC). The efficacy of the proposed procedure is demonstrated experimentally on a frame structure under broadband vibration excitation. Full-field vibration displacement signals are captured with the use of two high-speed cameras and processed with 3D-DIC. Loads are identified with two different algorithms based on inverting the Frequency Response Function (FRF) matrix and modal filtration (MF). The paper discusses both methods providing their theoretical background and experimental performance.


Assuntos
Algoritmos , Imageamento Tridimensional , Imageamento Tridimensional/métodos , Vibração , Eletrocardiografia
9.
ARS med. (Santiago, En línea) ; 47(4): 59-68, dic. 26, 2022.
Artigo em Espanhol | LILACS | ID: biblio-1451669

RESUMO

Introducción: el uso de técnicas de imagenología es habitual e incluso indispensable en algunos procesos diagnósticos. Sin embargo, su indicación en mujeres embarazadas y en período de lactancia es controvertida. Objetivo: presentar una revisión narrativa sobre los riesgos asociados al uso de imágenes con radiación y medio de contraste en embarazo y periodo de lactancia, con énfasis en las recomendaciones y aplicaciones clínicas que el médico tratante debe tener presente al momento de su indicación. Métodos: se realizó una revisión bibliográfica de la literatura relevante sobre los riesgos y consideraciones especiales del uso de medios de contraste en el embarazo y lactancia. Resultados: los riesgos de la radiación ionizante sobre el feto varían de acuerdo al estadio del embarazo, por lo que la indicación del estudio debe ponderar los riesgos y beneficios. En las dosis clínicas en embarazo y lactancia, el uso de contraste yodado como basados en gadolinio no tienen efectos deletéreos en la salud de la madre ni la del feto. Sin embargo, las sociedades internacionales recomiendan limitar su uso. Conclusión: si bien la indicación de estudios de imagen que utilizan radiación ionizante en el embarazo y lactancia es seguro, el médico clínico debe conocer los posibles riesgos de la radiación ionizante en este grupo de pacientes. Respecto a los medios de contraste, el único efecto adverso reportado es la disfunción tiroidea transitoria en hijos de madres que recibieron medios de contraste yodado.


Introduction: the use of imaging techniques is essential in some diagnostic processes. However, its indication in pregnant and lac-tating women is controversial. Objective: To present a narrative review of the risks associated with using images with radiation and contrast media in pregnancy and lactation. Emphasis will be put on the recommendations and clinical applications that the physician must consider before its indication. Methods: a bibliographic review of the relevant literature on the risks and special considerations of contrast media in pregnancy and lactation was performed. Results: the risks of ionising radiation on the fetus vary according to the stage of pregnancy, so the indication of the study must balance the risks and benefits. The use of iodinated and gadolinium-based con-trast agents in clinical doses in pregnancy and lactation has no effects on the health of the mother or the fetus. However, international societies recommend limiting its use. Conclusion: Although the indication for imaging studies using ionising radiation in pregnancy and lactation is safe, the clinician must be aware of the possible risks of ionising radiation in this group of patients. The only adverse effect reported is transient thyroid dysfunction in children of mothers who received iodinated contrast media.


Assuntos
Radiação , Aleitamento Materno , Gravidez , Meios de Contraste , Radiação Ionizante , Diagnóstico , Feto
10.
Sci Rep ; 12(1): 19173, 2022 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-36357508

RESUMO

We explored whether disease severity of Friedreich ataxia can be predicted using data from clinical examinations. From the database of the European Friedreich Ataxia Consortium for Translational Studies (EFACTS) data from up to five examinations of 602 patients with genetically confirmed FRDA was included. Clinical instruments and important symptoms of FRDA were identified as targets for prediction, while variables such as genetics, age of disease onset and first symptom of the disease were used as predictors. We used modelling techniques including generalised linear models, support-vector-machines and decision trees. The scale for rating and assessment of ataxia (SARA) and the activities of daily living (ADL) could be predicted with predictive errors quantified by root-mean-squared-errors (RMSE) of 6.49 and 5.83, respectively. Also, we were able to achieve reasonable performance for loss of ambulation (ROC-AUC score of 0.83). However, predictions for the SCA functional assessment (SCAFI) and presence of cardiological symptoms were difficult. In conclusion, we demonstrate that some clinical features of FRDA can be predicted with reasonable error; being a first step towards future clinical applications of predictive modelling. In contrast, targets where predictions were difficult raise the question whether there are yet unknown variables driving the clinical phenotype of FRDA.


Assuntos
Ataxia de Friedreich , Humanos , Ataxia de Friedreich/diagnóstico , Ataxia de Friedreich/genética , Atividades Cotidianas , Progressão da Doença , Índice de Gravidade de Doença , Ataxia
11.
Hist Cienc Saude Manguinhos ; 29(3): 769-788, 2022.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-36074362

RESUMO

In 1895, Nicolás Sáenz proposed to the Chilean government to purchase a collection of "Inca" objects brought from Lima. This acquisition was approved in 1897. Despite the difficulties caused by the War of the Pacific, the Museo Nacional de Historia Natural (Chile) continued to acquire Peruvian antiquities, following a tradition of comparative studies of material culture. Within the framework of social evolutionism, these antiquities were a measure of civilization, a reference from which to evaluate the material culture of the pre-Hispanic peoples of Chile. This article analyzes the acquisition of the Sáenz collection as the culmination of a process of transition towards an archeology that focused on the new post-war territorial acquisitions in the Pacific.


En 1895, Nicolás Sáenz propuso al gobierno chileno la venta de una colección de objetos "incaicos" traídos desde Lima; adquisición aprobada en 1897. Pese a las dificultades ocasionadas por la Guerra del Pacífico, el Museo Nacional (Chile) continuó adquiriendo antigüedades peruanas, siguiendo una tradición de estudios comparados de cultura material. Dentro del marco del evolucionismo social, estas antigüedades servían como medida de civilización, con la cual contrastar la cultura material de los pueblos prehispánicos de Chile. Este artículo analiza la adquisición de la colección Sáenz, como un punto cúlmine de un proceso de tránsito hacia a una arqueología enfocada en las nuevas adquisiciones territoriales post guerra del Pacífico.


Assuntos
Arqueologia , Governo , Chile , Hispânico ou Latino , Humanos , Peru
12.
Hist. ciênc. saúde-Manguinhos ; 29(3): 769-788, jul.-set. 2022. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1405023

RESUMO

Resumen En 1895, Nicolás Sáenz propuso al gobierno chileno la venta de una colección de objetos "incaicos" traídos desde Lima; adquisición aprobada en 1897. Pese a las dificultades ocasionadas por la Guerra del Pacífico, el Museo Nacional (Chile) continuó adquiriendo antigüedades peruanas, siguiendo una tradición de estudios comparados de cultura material. Dentro del marco del evolucionismo social, estas antigüedades servían como medida de civilización, con la cual contrastar la cultura material de los pueblos prehispánicos de Chile. Este artículo analiza la adquisición de la colección Sáenz, como un punto cúlmine de un proceso de tránsito hacia a una arqueología enfocada en las nuevas adquisiciones territoriales post guerra del Pacífico.


Abstract In 1895, Nicolás Sáenz proposed to the Chilean government to purchase a collection of "Inca" objects brought from Lima. This acquisition was approved in 1897. Despite the difficulties caused by the War of the Pacific, the Museo Nacional de Historia Natural (Chile) continued to acquire Peruvian antiquities, following a tradition of comparative studies of material culture. Within the framework of social evolutionism, these antiquities were a measure of civilization, a reference from which to evaluate the material culture of the pre-Hispanic peoples of Chile. This article analyzes the acquisition of the Sáenz collection as the culmination of a process of transition towards an archeology that focused on the new post-war territorial acquisitions in the Pacific.


Assuntos
Arqueologia , Coleção , Antropologia Cultural , Museus , Chile , História do Século XIX
13.
Sensors (Basel) ; 22(14)2022 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-35890786

RESUMO

The digital transformation of the defence sector is not exempt from innovative requirements and challenges, with the lack of availability of reliable, unbiased and consistent data for training automatisms (machine learning algorithms, decision-making, what-if recreation of operational conditions, support the human understanding of the hybrid operational picture, personnel training/education, etc.) being one of the most relevant gaps. In the context of cyber defence, the state-of-the-art provides a plethora of data network collections that tend to lack presenting the information of all communication layers (physical to application). They are synthetically generated in scenarios far from the singularities of cyber defence operations. None of these data network collections took into consideration usage profiles and specific environments directly related to acquiring a cyber situational awareness, typically missing the relationship between incidents registered at the hardware/software level and their impact on the military mission assets and objectives, which consequently bypasses the entire chain of dependencies between strategic, operational, tactical and technical domains. In order to contribute to the mitigation of these gaps, this paper introduces CYSAS-S3, a novel dataset designed and created as a result of a joint research action that explores the principal needs for datasets by cyber defence centres, resulting in the generation of a collection of samples that correlate the impact of selected Advanced Persistent Threats (APT) with each phase of their cyber kill chain, regarding mission-level operations and goals.


Assuntos
Conscientização , Software , Algoritmos , Comunicação , Humanos , Aprendizado de Máquina
14.
J Clin Med ; 11(13)2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35807117

RESUMO

Background: Due to the importance of choroidal thickness in the development of myopia, this study examined the effect of MiSight contact lenses (CLs) on the choroidal thickness of myopic children and the differences between responders and non-responders to the treatment with these CLs. Methods: A total of 41 myopic children were fitted with MiSight CLs and 33 with single-vision spectacles. They were followed up for two years. Subfoveal choroidal thickness and choroidal thickness 1 and 3 mm temporal and nasal to the fovea were measured by OCT at baseline and one and two years after the treatment. Differences in all the choroidal thickness parameters were assessed in each group over time. Patients from the MiSight group were classified based on a specific range of changes in axial length at the end of the second year of treatment as "responders" (AL change < 0.22 mm/per year) and "non-responders", and the choroidal thickness of both groups was analyzed. Results: The subfoveal choroidal thickness of the MiSight and single-vision spectacle groups did not show any changes over time. Wearing MiSight CLs induced relative choroidal thickening in the responder group in the first year of treatment. Conclusion: Choroidal thickness might work as a predictor of the effectiveness of MiSight in myopia treatment.

15.
Ecology ; 103(10): e3783, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35668026

RESUMO

Documenting and understanding long-term biodiversity change is limited by the availability of historical data, particularly from periods preceding major anthropogenic changes associated with the Industrial Revolution. We mined the information of a standardized historical survey developed in 628 localities across Spain between 1574 and 1582 (Relaciones Topográficas de Felipe II) with the goal of producing a general characterization of Spanish settlements, including, though not limited to, natural resources. From this survey, we were able to gather 7309 records for 75 wild plant taxa, 89 wild animal taxa, and 60 crop and domestic animal taxa. These data can be used to reconstruct historical land use and habitat cover, and model historical distributions of many species, including emblematic ones such as wolf and bear, which can establish reference distributions to assess range and niche expansion, contraction, and shifts. Data are provided under a Creative Commons Attribution Non Commercial (CC-BY-NC) 4.0 License. Please cite this data paper when the data are used in publications. The authors are open to collaborate in projects based on this dataset.


Assuntos
Biodiversidade , Ecossistema , Animais , Animais Selvagens , Conservação dos Recursos Naturais , Espanha
16.
Rev. med. Chile ; 150(6): 821-827, jun. 2022. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-1424124

RESUMO

The accelerated scientific, technological, and social advances in recent years have posed new challenges for professional training institutions, where universities play a leading role. Medical schools have not been oblivious to this process. This is how Pontificia Universidad Católica de Chile implemented in 2015 a curricular reform derived from the joint work of academics, students and graduates. For this purpose, a model consisting of stages was followed, including the identification of the problem, general assessment of needs, definition of purpose and learning objectives. We worked with surveys, focus groups and committees of academics and students to identify and map content within the mesh, review terminal learning objectives while creating and reviewing courses for the vertically and horizontally integrated delivery of content and competencies. The first cohort of the new curriculum entered in 2015, consisting of 126 students. The implementation required constant follow-up and monitoring, establishing changes and adjustments according to educational needs and unforeseen conditions such as the COVID-19 pandemic. The implementation process of the new curriculum has been positive, adjusting to the defined strategic planning and responding to unexpected events.


Assuntos
Humanos , Estudantes de Medicina , Educação de Graduação em Medicina , Faculdades de Medicina , Currículo , Pandemias
17.
Case Rep Orthop ; 2022: 8898876, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35280347

RESUMO

We present a case of nondiagnosed comminuted stress fracture of the base of the proximal phalanx associated with flexor digitalis longus rupture in a teenage athlete. To our knowledge, there is no description in the literature of such a combination of injuries due to delayed diagnosis and incorrect treatment, including injections in the metatarsophalangeal joint of the second toe. The present article focuses on the importance of clinical suspicion of this rare lesion to achieve early diagnosis and avoid surgical treatment. Finally, the surgical technique used to treat this uncommon injury in the chronic phase, which yielded an excellent outcome in this teenage athlete, is described.

18.
J Optom ; 15(1): 78-87, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-33750678

RESUMO

PURPOSE: To investigate which baseline factors are predictive for success in controlling myopia progression in a group of children wearing MiSight Contact Lens (CLs). METHODS: Myopic patients (n=41) fitted with MiSight CLs and followed up two years were included in this study. Bivariate analysis, a logistic regression analysis (LG) and a decision tree (DT) approach were used to screen for the factors influencing the success of the treatment. To assess the response, axial length (AL) changes were considered as main variable. Patients were classified based on a specific range of change of axial length at the end of each year of treatment as "responders" (R) (AL change <0.11mm/per year) and "non-responders" (NR) (AL change ≥0.11mm/per year). RESULTS: Of a total of forty-one Caucasian patients treated with MiSight CLs, 21 and 16 were considered responders in the first and the second year of follow-up, respectively. LG analysis showed that the only factor associated with smaller axial length growth was more time spent outdoors (p=0.0079) in the first year of treatment. The decision tree analysis showed that in the responding group spending more than 3 and 4h outdoors per week was associated with the best response in the first year and in the second year of treatment respectively. CONCLUSIONS: The LR and the DT approach of this pilot study identifies time spent outdoors as a main factor in controlling axial eye growth in children treated with MiSight CLs.


Assuntos
Lentes de Contato Hidrofílicas , Miopia , Comprimento Axial do Olho , Criança , Progressão da Doença , Humanos , Miopia/diagnóstico , Miopia/terapia , Projetos Piloto , Refração Ocular , Espanha
19.
Rev Med Chil ; 150(6): 821-827, 2022 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-37906916

RESUMO

The accelerated scientific, technological, and social advances in recent years have posed new challenges for professional training institutions, where universities play a leading role. Medical schools have not been oblivious to this process. This is how Pontificia Universidad Católica de Chile implemented in 2015 a curricular reform derived from the joint work of academics, students and graduates. For this purpose, a model consisting of stages was followed, including the identification of the problem, general assessment of needs, definition of purpose and learning objectives. We worked with surveys, focus groups and committees of academics and students to identify and map content within the mesh, review terminal learning objectives while creating and reviewing courses for the vertically and horizontally integrated delivery of content and competencies. The first cohort of the new curriculum entered in 2015, consisting of 126 students. The implementation required constant follow-up and monitoring, establishing changes and adjustments according to educational needs and unforeseen conditions such as the COVID-19 pandemic. The implementation process of the new curriculum has been positive, adjusting to the defined strategic planning and responding to unexpected events.


Assuntos
Educação de Graduação em Medicina , Estudantes de Medicina , Humanos , Faculdades de Medicina , Pandemias , Currículo
20.
Neurol Sci ; 43(1): 633-641, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33914193

RESUMO

OBJECTIVES: To explore different neurological manifestations with suspicion of being associated to serum glutamate decarboxylase antibodies (GAD-Abs) in order to better characterize anti-GAD neurological syndromes. METHODS: Observational retrospective study including all patients for whom GAD65-Abs titers in serum were requested by the Neurology Department at La Paz University Hospital between 2015 and 2019. GAD-Abs were measured by ELISA. Demographic data, neurological symptoms, comorbidity with diabetes mellitus (DM) or with another autoimmune disease, and GAD-Abs titers were studied. Stiff-person syndrome, ataxia, encephalitis, and epilepsy were considered typical anti-GAD neurological syndromes and were compared to other atypical manifestations. RESULTS: A total of 173 patients (51.7% men, mean age 51.62) were included. A progressive increase in requests of serum GAD-Abs has occurred over the last 5 years, especially in patients with atypical neurological manifestations. GAD-Abs were found in the serum of 22 patients (12.7%); of those, 15 (68.18%) suffered a typical anti-GAD syndrome. Presence of DM or another organ-specific autoimmune disease was predictive of GAD-AB seropositivity (p < 0.001). 6.6% of requested patients with an atypical syndrome had GAD-Abs, but serum levels were significantly lower than those found in patients with a typical syndrome (706.67 vs 1430.23 UI/mL; Mann-Whitney U, p = 0.034), and were finally diagnosed with another neurological disease. CONCLUSION: Serum GAD-Abs were infrequently found in patients with clinical phenotypes other than those classically described as anti-GAD disorders, and with very low titers. In typical anti-GAD syndromes, there is a high comorbidity with DM and with other autoimmune diseases, and high serum GAD-Abs levels are usually present.


Assuntos
Autoanticorpos/sangue , Doenças do Sistema Nervoso , Ataxia , Doenças Autoimunes , Comorbidade , Diabetes Mellitus , Encefalite , Epilepsia , Feminino , Glutamato Descarboxilase/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/epidemiologia , Estudos Retrospectivos , Rigidez Muscular Espasmódica
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