Telemedicine for Screening and Follow-Up of Glaucoma: A Descriptive Study.

Introduction: Glaucoma is a leading cause of irreversible blindness. It is a prevalent disease worldwide, affecting ∼70 million people and expected to reach up to 112 million by 2040. Purpose: The aim of this study is to describe the implementation and initial experience of a telemedicine program to monitor glaucoma and glaucoma suspect patients in a large, integrated health care system during the COVID-19 pandemic. Methods: A retrospective chart review of established glaucoma or glaucoma suspect patients who participated in a telemedicine evaluation at the ophthalmic center of a large, Colombian health care system between June 2020 and April 2023 was conducted. Clinical and sociodemographic variables were analyzed. Generated clinical orders for additional testing, surgical procedures, follow-ups, and referrals, as well as changes in medical treatment, were evaluated. Results: A total of 11,034 telemedicine consults were included. The mean ± standard deviation age of this group was 63 ± 17.2 years and 67% were female. Of the patients who attended teleconsults, 49% were glaucoma suspects and 38.5% were followed with a diagnosis of open-angle glaucoma. After the consult, 25% of patients were referred to a glaucoma specialist, 40% had additional testing ordered, and 8% had a surgical procedure ordered, mainly laser iridotomy (409 cases). Almost a third of patients returned for subsequent telemedicine visits after the initial encounter. Despite some technical difficulties, 99.8% of patients attended and completed their scheduled telemedicine appointments. Conclusions: A telemedicine program aimed to monitor established glaucoma patients can be successfully implemented. Established patients within an integrated health care system have high adherence to the virtual model. Further research by health care institutions and government agencies will be key to expand coverage to additional populations. Clinical Trial Registration Number: CEIFUS 1026-24.

Microwave Imaging System Based on Signal Analysis in a Planar Environment for Detection of Abdominal Aortic Aneurysms.

A proof-of-concept of a microwave imaging system for the fast detection of abdominal aortic aneurysms is shown. This experimental technology seeks to overcome the factors hampering the fast screening for these aneurysms with the usual equipment, such as high cost, long-time operation or hazardous exposure to chemical substances. The hardware system is composed of 16 twin antennas mastered by a microcontroller through a switching network, which connects the antennas to the measurement instrument for sequential measurement. The software system is run by a computer, mastering the whole system, automatizing the measurement process and running the signal processing and medical image generation algorithms. Two image generation algorithms are tested: Delay-and-Sum (DAS) and Improved Delay-and-Sum (IDAS). Own-modified versions of these algorithms adapted to the requirements of our system are proposed. The system is carefully calibrated and fine-tuned with known objects placed at known distances. An experimental proof-of-concept is shown with a human torso phantom, including an aorta phantom and an aneurysm phantom placed in different positions. The results show good imaging capabilities with the potential for detecting and locating possible abdominal aortic aneurysms and reporting acceptable errors.

Non-Invasive Microwave-Based Imaging System for Early Detection of Breast Tumours.

This work introduces a microwave-based system able to detect tumours in breast phantoms in a non-invasive way. The data acquisition system is composed of a hardware system which involves high-frequency components (antennas, switches and cables), a microcontroller, a vector network analyser used as measurement instrument and a computer devoted to the control and automation of the operation of the system. Concerning the software system, the computer runs a Python script which is in charge of mastering and automatising all the required stages for the data acquisition, from initialisation of the hardware system to performing and saving the measurements. We also report on the design of the high-performance broadband antenna used to carry out the measurements, as well as on the algorithm employed to build the final medical images, based on an adapted version of the so-called Improved Delay-and-Sum (IDAS) algorithm improved by a Hamming window filter and averaging preprocessing. The calibration and start-up of the system are also described. The experimental validation includes the use of different tumour models with different dielectric properties inside the breast phantom. The results show promising tumour detection capabilities, even when there is low dielectric contrast between the tumoural and healthy tissues, as is the usual case for dense breasts in young women.

Validation of an RF Image System for Real-Time Tracking Neurosurgical Tools.

A radio frequency (RF)-based system for surgical navigation is presented. Surgical navigation technologies are widely used nowadays for aiding the surgical team with many interventions. However, the currently available options still pose considerable limitations, such as line-of-sight occlusion prevention or restricted materials and equipment allowance. In this work, we suggest a different approach based on a microwave broadband antenna system. We combine techniques from microwave medical imaging, which can overcome the current limitations in surgical navigation technologies, and we propose methods to develop RF-based systems for real-time tracking neurosurgical tools. The design of the RF system to perform the measurements is shown and discussed, and two methods (Multiply and Sum and Delay Multiply and Sum) for building the medical images are analyzed. From these measurements, a surgical tool's position tracking system is developed and experimentally assessed in an emulated surgical scenario. The reported results are coherent with other approaches found in the literature, while overcoming their main practical limitations. The discussion of the results discloses some hints on the validity of the system, the optimal configurations depending on the requirements, and the possibilities for future enhancements.

Impact of Gestational COVID-19 on Neonatal Outcomes: Is Vertical Infection Possible?

BACKGROUND: The vertical transmission of severe acute respiratory coronavirus-2 (SARS-CoV-2) remains highly debated. Here, we evaluated SARS-CoV-2-transmission in newborns with intrauterine conditions. METHODS: This was a prospective, observational and multicentric study involving 13 Spanish hospitals included in the GEStational and NEOnatal-COVID cohort. Pregnant women with microbiologically confirmed SARS-CoV-2 infection during any trimester of pregnancy or delivery and their newborns were included from March to November 2020. Demographic, clinical and microbiological data were also obtained. Viral loads were analyzed in different maternal and newborn biological samples (placenta, breast milk and maternal blood; urine, meconium and newborn blood). RESULTS: A total of 177 newborns exposed to SARS-CoV-2 were included. Newborns were tested by reverse transcriptase-polymerase chain reaction using nasopharyngeal swabs within the first 24-48 hours of life and at 14 days of life. In total 5.1% were considered to have SARS-CoV-2 infection in the neonatal period, with 1.7% considered intrauterine and 3.4% intrapartum or early postnatal transmission cases. There were no differences in the demographic and clinical characteristics of the pregnant women and their newborns' susceptibility to infections in their perinatal history or background. CONCLUSIONS: Intrauterine transmission of SARS-CoV-2 is possible, although rare, with early postnatal transmission occurring more frequently. Most infected newborns remained asymptomatic or had mild symptoms that evolved well during follow-up. We did not find any maternal characteristics predisposing infants to neonatal infection. All infected newborn mothers had acute infection at delivery.Although there was no presence of SARS-CoV2 in cord blood or breast milk samples, SARS-CoV-2 viral load was detected in urine and meconium samples from infected newborns.

Assessing Medical Students' Knowledge of the Deaf Culture and Community in Puerto Rico: A Descriptive Study.

BACKGROUND: Effective communication between health care professionals and Deaf and Hard of Hearing (D&HH) patients remains a challenge. Literature regarding health professionals' knowledge of the D&HH community and their barriers toward health care access is limited in Puerto Rico and suggests a need for research. Therefore, this descriptive study aims to evaluate future physician's knowledge about the Deaf culture and community in a student cohort at San Juan Bautista School of Medicine (SJBSM), with the objective of guiding our results toward improving our curriculum. METHODS: Medical students answered a survey to evaluate their knowledge of D&HH patients. The survey consisted of 3 parts testing awareness, exposure, and knowledge of the Deaf community. Responses from the Knowledge section were graded using an answer key, and correct answers were added to create an overall continuous sum score per participant, with higher scores meaning higher knowledge. Participants were also asked to write in possible issues deaf patients may face when hospitalized, apart from communication problems. All data were recorded and used for descriptive analysis. RESULTS: 158 (68%) medical students participated. 63% reported exposure to D&HH people, and 80% were aware of the Deaf culture. 21% of students answered to have attended an American Sign Language (ASL) class, and 86% expressed interest in taking an ASL class. The overall percentage of correct answers from all the medical groups evaluated was 39%, with increasing percent knowledge as medical student year increased. The most frequently listed problem by respondents that deaf patients may face when hospitalized was dealing with an emergency in the hospital, such as the fire alarm. CONCLUSION: Students from clinical years (MSIII & MSIV) showed a better understanding of the Deaf culture than students in pre-clinical years (MSI & MSII). Nevertheless, the knowledge was limited in all groups. The information generated is not only valuable for our school but the healthcare community as well. The literature related to Deaf culture, particularly in the medical setting in Puerto Rico, is limited. Therefore, there exists a need to continue investigating ways to improve medical students' education of the Deaf culture and community.

Propuesta de intervención educativa para la prevención de la conducta suicida en adolescentes en la ciudad de Manizales (Colombia) / Educational intervention proposal for the prevention of suicidal behaviour in adolescents in Manizales city (Colombia)

Resumen El objetivo de este estudio fue realizar una intervención educativa para la prevención de la conducta suicida en adolescentes entre los grados 6° a 8° de un colegio de la ciudad de Manizales, en el departamento de Caldas, Colombia. Se realizó un estudio cuasi experimental, que contó con una población de 103 participantes. Se cuantificaron en la población variables demográficas. Adicionalmente se aplicaron la escala de Riesgo Suicida de Plutchik, la encuesta mito o realidad, escala de Asertividad de Rathus, y escala de autoestima de Rosenberg. Seguidamente se realizó una intervención educativa en 8 sesiones, con los estudiantes participantes divididos en 4 grupos. Un mes después se aplicaron nuevamente los cuestionarios mencionados. En la aplicación de los cuestionarios, antes de la intervención educativa, se encontró un 42,7% de riesgo suicida, en mayor proporción 56,9% de autoestima baja, en mayor proporción 68,9% de asertividad confrontativa, y 2,9 en el cuestionario sobre mitos alrededor del suicido. Después de esta intervención se encontró: factor de riesgo suicida de 6,8%, en mayor proporción autoestima alta en 45,1%, en mayor proporción 44,7% presentaron asertividad confrontativa, y 4,5 en el cuestionario sobre mitos. La prueba t para grupos apareados mostró en todos los casos un aprendizaje significativo (p< 0.001). Como conclusión, la investigación resaltó la importancia de que los jóvenes reconocieran y fortalecieran las habilidades sociales, tengan comunicación asertiva y destrezas intelectuales con el fin de reducir el riesgo suicida en la población estudiantil.

Abstract Objective: To assess the effect of an educational intervention to prevent suicidal behavior in teenagers of grades 6th to 8th at a school in Manizales, Colombia. Materials and methods: Quasi-experimental study (n = 103), that collected demo-graphic variables, the Plutchik Suicide Risk Scale, the Myth or Reality Survey, the Rathus Assertiveness Scale, and the Rosenberg Self-Esteem Scale. Participants were divided into five groups and an educational intervention lasting 8 sessions was given to them. A month later, the same questionnaires were administered. Results: Before the educational intervention, suicidal risk was identified in 42.7% of the sample, low self-esteem in 56.9%, confrontational assertiveness in 68.9%, and 2,9 on the myths around suicide questionnaire. After the intervention, the suicide risk factor fell to 6.8%, high self-esteem was found in 45.1%, a greater proportion of patients, 44.7% showed confrontational assertiveness, and the score on the myths questionnaire rose to 4.5. The t-test for paired groups showed significant learning in all cases (p < 0.001). Conclusions: The study highlighted the importance recognizing and strengthening social skills, having assertive communication and intellectual skills in order to reduce suicidal risk in young students.

[Effects of a 'theory of mind' cognitive development pilot programme in three children with autism: emotional component]. / Efectos de un programa piloto de desarrollo cognitivo 'teoria de la mente' en tres niños con autismo: componente emocional.

INTRODUCTION: Theory of mind is defined as the capacity to predict, understand and act when faced with other people's behaviour, their knowledge, their intentions, their emotions and their beliefs. It is proposed as a feasible alternative for establishing a programme adapted to the characteristics of children diagnosed with autism spectrum disorder. CASE REPORTS: The effect of a 'theory of mind' cognitive development pilot programme on the emotional skills of three children with autism spectrum disorder is reported. Case 1: 9-year-old boy, with scarce emotional identification and expression, as well as difficulties to hold fluent and coherent conversations. Case 2: 10-year-old boy, with mechanical, not very fluent language, and difficulties to start and maintain a conversation. Case 3: 8-year-old girl who presents deficits in the non-verbal communicative behaviours used in social interaction and difficulties to adapt to situations other than everyday ones. In the three cases there is an improvement in the emotional capacities following implementation of the programme; moreover, their parents, teachers or therapists perceived positive changes in the children's adaptive skills. CONCLUSIONS: The methodological and structural aspects of the cognitive development programme were well-suited to the children with autism who took part in the research study. Due to the preliminary nature of this study, it is suggested that future research should utilise a larger sample and a double-blind design with randomised case-controls that allow the findings to be generalised.

TITLE: Efectos de un programa piloto de desarrollo cognitivo 'teoria de la mente' en tres niños con autismo: componente emocional.Introduccion. La teoria de la mente se define como la capacidad para predecir, comprender y actuar frente a la conducta de otras personas, sus conocimientos, sus intenciones, sus emociones y sus creencias. Se plantea como una alternativa viable para establecer un programa adaptado a las caracteristicas de los niños diagnosticados con trastorno del espectro autista. Casos clinicos. Se describe el efecto de un programa piloto de desarrollo cognitivo 'teoria de la mente' en las habilidades emocionales de tres niños con trastorno del espectro autista. Caso 1: niño de 9 años, con escasa identificacion y expresion emocional, asi como dificultades para mantener conversaciones fluidas y coherentes. Caso 2: niño de 10 años, con lenguaje mecanico, poco fluido, y dificultades para iniciar y mantener una conversacion. Caso 3: niña de 8 años que presenta deficits en las conductas comunicativas no verbales usadas en la interaccion social y dificultades para adaptarse a situaciones no cotidianas. En los tres casos se presenta mejoria de las capacidades emocionales posterior a la implementacion del programa; ademas, los padres, docentes o terapeutas percibieron cambios positivos en las habilidades adaptativas de los niños. Conclusiones. Los aspectos metodologicos y estructurales del programa de desarrollo cognitivo fueron adecuados para los niños con autismo participantes de la investigacion. Debido al caracter preliminar del estudio, se sugiere para futuras investigaciones una muestra mayor y un diseño doble ciego con aleatorizacion caso/control que permitan la generalizacion de los resultados.

Valoración de la rotación de lentes intraoculares tóricos con OPD Scan III y su repercusión en medidas de calidad visual en pacientes con cirugía de catarata por facoemulsificación / Evaluation of toric intraocular lenses axis rotation with OPD Scan III and its effect on visual quality measurements in cataract phacoemulsifi cation patients

El buen desempeño de los LIOs (Lentes Intraoculares) tipo tóricos, se basa en que la rotación del implante sea mínima y en la adecuada selección preoperatoria de los pacientes. En este estudio, se describió el comportamientos de estos LIOs en nuestra población, por medio de la medición de diferentes parámetros de calidad visual aportados por el OPD Scan III, teniendo en cuenta la técnica quirúrgica y demarcación de un solo cirujano. Aunque la muestra no fue lo suficientemente grande para permitir resultados estadísticamente significativos, estos demuestran una relación directamente proporcional de la rotación con las aberrometrías de alto orden e inversamente proporcional con las agudezas visuales, a pesar de que la rotación máxima fue sólo de 15 grados. Se sugiere continuar este estudio con otro de tipo analítico e incluyendo LIO multifocales para la medición de descentramiento y su repercusión sobre parámetros de calidad visual medidos con el OPD Scan III.

The good performance of toric intraocular lens is based on implant minimal rotation and appropriate preoperative patient selection. In this study, we described the results of these IOLs in our population, by measuring different visual quality parameters provided by the OPD Scan III, considering the surgical technique and demarcation of a single surgeon. Although the sample was not large enough to allow statistically signifi cant results, these show a directly proportional relationship of the rotation with high order aberrations and inversely proportional to visual acuity, even though the maximum rotation was only 15 degrees. This study should continue with analytical studies including multifocal IOLs to describe descentration and its impact on visual quality parameters measured with the OPD Scan III.

Increases in cycling performance in response to caffeine ingestion are repeatable.

The primary aim of this study was to determine the repeatability of caffeine's ergogenic effects on cycling performance. It was hypothesized that improvements in performance would be similar when caffeine was ingested on 2 separate days. Nine endurance-trained men and women (mean age and maximal oxygen uptake, 27.4 ± 5.9 years and 57.5 ± 3.9 mL kg⁻¹ min⁻¹) initially completed 2 familiarization trials. During 3 subsequent sessions separated by at least 48 hours, the subjects completed a 10-km cycling time trial preceded by ingestion of a drink containing caffeine (5 mg/kg) or placebo. Treatments were ingested using a randomized, single-blind, crossover design, and the subjects were deceived as to the specific content of all drinks. During exercise, heart rate, rating of perceived exertion, and time were recorded every 1.6 km. Repeated-measures analysis of variance was used to compare the differences in variables across distance and treatment. In both caffeine trials, caffeine increased (P = .02) cycling performance by 1.6% and 1.9% vs placebo (16.98 ± 0.96 and 16.92 ± 0.97 minutes with caffeine vs 17.25 ± 0.96 minutes in placebo), and 7 of 9 subjects revealed improved performance. The mean performance improvement in the caffeine trials was similar (P = .35; -0.27 and -0.32 minutes, respectively) across days. Heart rate during exercise was higher (P b .001) with caffeine vs placebo, although the rating of perceived exertion was similar (P = .65). Data reveal that caffeine's ergogenic effects on cycling performance are repeatable across days, yet some individuals did not exhibit improved performance with caffeine.

Effect of caffeine on RPE and perceptions of pain, arousal, and pleasure/displeasure during a cycling time trial in endurance trained and active men.

Caffeine has been reported to alter perceptions of exertion, muscle pain, and mood, yet the majority of existing data were obtained in resting volunteers or during steady-state exercise. The primary aim of this study was to examine the effects of caffeine on rating of perceived exertion (RPE) and perceptions of leg pain, arousal, and pleasure/displeasure during a simulated cycling time trial. Endurance-trained (n=8, VO(2)max=57.5±3.9 mL/kg/min) and active (n=8, VO(2)max=46.5±6.3 mL/kg/min) men initially completed two familiarization trials separated by at least 48 h. Over the next three trials, they completed a 10 km time trial preceded by ingestion of drinks containing caffeine (5 mg/kg ingested on 2 separate days) or placebo. Treatments were ingested using a single-blind, crossover design, and participants were deceived as to the content of all drinks. During exercise, RPE (6-20 scale), leg pain (0-10 scale), arousal (Felt Arousal Scale), and pleasure/displeasure (Feeling Scale) were recorded using various categorical scales. Repeated measures analysis of variance was used to assess differences in all variables across time and treatments, with fitness level used as a between-subjects variable. Pleasure/displeasure was altered (p<0.05, partial eta-squared (η(2))=0.23) with caffeine compared to placebo, although leg pain, RPE, and arousal were similar (p>0.05) across treatments. Caffeine increased (p<0.05, η(2)=0.27) cycling performance by 0.3-2.0% versus placebo, with no effect (p>0.05) of fitness level. Only in trained men; however, was there a significant caffeine-mediated improvement in cycling performance, which was consequent with diminished mood in trained and improved mood in active individuals.