Performance in Kahoot! activities as predictive of exam performance.

BACKGROUND: Game-based learning (GBL) is effective for increasing participation, creativity, and student motivation. However, the discriminative value of GBL for knowledge acquisition has not yet been proven. The aim of this study is to assess the value of Kahoot! as a discriminative tool for formative assessment in medical education in two different subjects. METHODS: A prospective experimental study was conducted on a sample of 173 students enrolled in neuroanatomy (2021-2022). One hundred twenty-five students individually completed the Kahoot! prior to the final exam. In addition, students enrolled in human histology during two academic courses were included in the study. The control group course (2018-2019) received a traditional teaching methodology (N = 211), while Kahoot! was implemented during 2020-2021 (N = 200). All students completed similar final exams for neuroanatomy and human histology based on theory tests and image exams. RESULTS: The correlation between the Kahoot score and the final grade was analyzed for all students enrolled in neuroanatomy who completed both exercises. The correlation between the Kahoot exercise and the theory test, image exam and final grade was significantly positive in all cases (r = 0.334 p < 0.001, r = 0.278 p = 0.002 and r = 0.355 p < 0.001, respectively). Moreover, students who completed the Kahoot! exercise obtained significantly higher grades in all parts of the exam. Regarding human histology, the theory tests, image exams and final grades were significantly higher when using Kahoot! versus the "traditional" methodology (p < 0.001, p < 0.001 and p = 0.014, respectively). CONCLUSIONS: Our study demonstrates for the first time that Kahoot! can be used to improve and predict the final grade in medical education subjects.

Aesthetic and functional rehabilitation of child using mock-up combined with stratified technique.

BACKGROUND: The loss of the vertical dimension of occlusion in children with quickly progressing early childhood caries hinders the aesthetic rehabilitation of primary incisors. Minimally invasive restorations using chemical-mechanical caries removal methods preserve sound dental tissue and maintains the health of the pulp. This is the treatment of choice for children and allows crown reconstruction of the primary incisors without the need for endodontic treatment. The resources employed in the rehabilitation process range from biological restorations to direct and indirect crowns with or without the aid of a celluloid matrix. CASE REPORT: The aim of this study was to describe a case of maxillary incisor rehabilitation in a female patient aged two years five months using a mock-up combined with the stratified technique and Planas' direct tracks. After a 26-month follow-up period only a little fracture of the reconstructed incisor had occurred. CLINICAL IMPLICATIONS: In the case described, neuro-occlusal and functional rehabilitation enabled the establishment of satisfactory aesthetics in the primary incisors.

Expression of cre recombinase as a reporter of signal transduction in mammalian cells.

BACKGROUND: Cell-based reporter assays, which rely on a reporter gene under the control of a regulated promoter, are widely used to screen chemical libraries for novel receptor ligands. Here, we describe a reporter system that is based on ligand-induced DNA recombination to express the reporter gene. This system converts a transient activation of a signal transduction pathway into an amplified, constitutive and heritable expression of the reporter gene. RESULTS: We constructed gene fusions of Cre recombinase and mammalian promoters regulated by calcium, nuclear receptors or cyclic AMP. Reporter systems, comprising a Cre gene fusion and a loxP/reporter gene, were used to study the kinetics and dose responses to compounds that activate or inhibit the corresponding signal transduction pathway. We compared these reporters with conventional reporter systems in which the reporter gene is under the direct control of the responsive promoter. Reporter gene expression of the Cre reporters was greater than that of conventional reporters and could be measured more than a week after adding the stimulus. For all pathways studied here, the dose responses of the Cre reporters are nearly identical to those of conventional reporter systems. CONCLUSIONS: We have shown that Cre recombinase can be regulated by a variety of signal transduction pathways. It should therefore be possible to use receptor ligands to induce phenotypic conversion of mammalian cells for use in a variety of applications. One such application is high-throughput screening, and we developed loxP/luciferase reporter genes that provide an amplified and sustained luminescent response.

Selection of estrogen receptor beta- and thyroid hormone receptor beta-specific coactivator-mimetic peptides using recombinant peptide libraries.

Steroid and thyroid hormone receptors are members of the superfamily of nuclear receptors (NR) that participate in developmental and homeostatic mechanisms by changes in the transcription of specific genes. These activities are governed by the receptors' cognate ligands and through interaction with the components of the transcriptional machinery. A number of coactivator molecules of the steroid receptor coactivator (SRC)/nuclear receptor coactivator (NCoA) family interact with activation functions within NRs through a conserved region containing helical domains of a core LXXLL sequence and, thereby, participate in transcriptional regulation. Using a mammalian-two-hybrid assay, we show that the thyroid hormone receptor beta (TRbeta) and estrogen receptor beta (ERbeta) have different LXXLL motif preferences for interactions with SRC-1. Using large random and focused (centered on the LXXLL motif) recombinant peptide diversity libraries, we have obtained novel peptide sequences that interact specifically with ERbeta or with TRbeta in a ligand-dependent manner. Random sequence libraries yielded LXXLL-containing peptides, and sequence analysis of selected clones revealed that the preferred residues within and around the LXXLL motif vary significantly between these two receptors. We compared the receptor binding of library-selected peptides to that of peptides derived from natural coactivators. The affinities of selected peptides for the ligand binding domains of ERbeta and TRbeta were similar to the best natural LXXLL motifs tested, but showed a higher degree of receptor selectivity. These selected peptides also display receptor-selective dominant inhibitory activities when introduced into mammalian cells. Finally, by directed mutations in specific residues, we were able to alter the receptor binding preference of these peptides.

Study of perfusion changes in the optic disc of patients with fibromyalgia syndrome using new colorimetric analysis software.

PURPOSE: We measured the amount of hemoglobin at the optic nerve head of fibromyalgia (FM) patients using new colorimetric analysis software. We also investigated whether perfusion defects of the optic nerve head in patients with FM lead to tissue atrophy and corresponding retinal nerve fiber layer (RNFL) thinning measured by optical coherence tomography (OCT). METHODS: We recruited for this cross-sectional study 118 FM patients and 76 sex- and age-matched healthy controls. All subjects underwent a complete neuro-ophthalmologic examination, which also included visual field testing using the Spark strategy in an Easyfield perimeter, and OCT examinations using the Spectralis. One photograph of the optic disc was obtained using a Cirrus™ Photo 800 multi-modality imager. We analyzed fundus photographs using Laguna ONhE software, a new method that allows hemoglobin levels to be measured at the optic nerve head. We compared hemoglobin percentages in different sectors of the nerve head and RNFL thicknesses between the two groups. RESULTS: Mean hemoglobin percentages and hemoglobin content in all optic nerve head sectors calculated by the Laguna ONhE program were significantly lower in FM patients than in healthy controls, and the main differences were detected in the outer ring, which corresponds with the neuroretinal rim. However, only the differences in the superotemporal RNFL were statistically significant. Correlations between the RNFL thickness and the percentage of hemoglobin in the different sectors were weak. CONCLUSION: Optic disc perfusion was decreased in patients with FM, especially within the neuroretinal rim, without clear involvement in the RNFL.

[Morbidity and mortality of very-low-birth-weight infants as an indicator of the quality of perinatal care]. / Morbimortalidad en recién nacidos de muy bajo peso en el control de la calidad de la asistencia perinatal.

OBJECTIVE: To compare the clinical outcomes of a cohort of very low birth weight (VLBW) infants who received healthcare in our unit from 1994-2000 with all the variables included in the Vermont-Oxford Network (VON) database. METHODS: A historical cohort of 417 VLBW live infants born in our center from 1994-2000 was evaluated. The 80 variables of the VON already prospectively included in the unit's database were used and a further 20 variables were added through retrospective review of medical records. The rates of perinatal risk factors, interventions, and causes of morbidity were analyzed and the periods 1994-1997 and 1998-2000 were compared. We also compared these rates with those reported by the VON. RESULTS: Comparison of the results in both periods showed an increase in the percentage of multiple pregnancies and prenatal corticosteroid exposure, as well as in the early use of surfactant and continuous positive pressure. The incidence of intraventricular hemorrhage decreased, but no differences were observed in other outcomes. Our rates of Cesarean sections and multiple births, as well as the use of prenatal steroids, were higher than those of the VON. The outcomes of infants receiving healthcare in our unit were similar to those of the VON but mortality in infants weighing < 800 g was slightly higher, coinciding with higher rates of late sepsis. CONCLUSION: Morbidity rates in VLWB infants receiving care in our unit decreased during the period studied and compared favorably with those reported by the VON. Alltogether, our results indicate that the quality of care in our perinatal center is good. General use of this methodology would permit comparison of outcomes and quality of care across regions and nations, as well as across Europe, in a recently established network (EuroNeoNet.com).

[A case of punctate inner choroidopathy: differential diagnosis]. / A propósito de un caso de coroidopatía puntata interna: diagnóstico diferencial.

CASE REPORT: We present the case of a 27-year old woman suffering from a chorioretinal inflammatory disease that was diagnosed as punctate inner choroidopathy (PIC) after a complete ophthalmic evaluation. DISCUSSION: PIC must be taken into consideration when evaluating a patient with a white dot syndrome.

[Photodynamic therapy for treatment of choroidal neovascularization]. / Terapia fotodinámica en neovascularización coroidea.

PURPOSE: To evaluate the efficacy of photodynamic therapy with photodynamic therapy (PDT) in the management of choroidal neovascularization (CNV) in age-related macular degeneration (AMD) and myopia. METHODS: 102 eyes with subfoveal or yuxtafoveal CNV underwent visual acuity (VA) testing, ophthalmic examination, and fluorescein angiography. Retreatment of persistent CNV was done after three months. RESULTS: CNV was caused by AMD in 75.5% of patients, pathologic myopia in 24.5%. Follow up ranged from 9 to 33 months (mean: 15.94 months). 88% of CNV caused by pathologic myopia was classic and 40% was in lesions caused by AMD. CNV survival was shorter in lesions caused by pathologic myopia with a significant difference (p=0.0018). VA improved in 48% of lesions caused by pathologic myopia and in 28.6% of lesions caused by AMD. We did not observe any severe complication caused by PDT. CONCLUSION: PDT is a moderately effective treatment without complications in treating subfoveal CNV.

[Serpiginous choroiditis: clinical course and treatment]. / Coroiditis serpiginosa: evolución clínica y tratamiento.

PURPOSE: To evaluate the clinical evolution and treatment of serpiginous choroiditis in 11 diagnosed patients. METHODS: Retrospective study of 11 cases diagnosed with serpiginous choroiditis in our area, from 1980 to the present. We analyzed age at onset of symptoms, systemic diseases, ophthalmological symptoms at presentation, the location of lesions, initial and final visual acuity, recurrences, treatment régime and development of subretinal neovascularization. A complete ophthalmological examination and fluorescein angiograms were performed in all of them. RESULTS: The mean period of follow-up was 4 years. Average age was 56 years, predominantly in men (10/1). Five patients had known ischemic cardiopathy and systemic hypertension, one patient underwent a kidney transplant. All of them were treated with oral prednisone (1-1.5 mg/kg/daily) in the active stages. Three patients received triple therapy (prednisone, cyclosporine and azathioprine) that did not prevent the recurrences. Five patients developed a subretinal neovascularization, bilateral in three of them. CONCLUSIONS: The serpiginous choroiditis is a rare entity and the visual outcome prognosis is determined by the macular involvement. Men are predominantly affected in our series and corticosteroid treatment is effective in acute inflammatory episodes. Recurrences could not be prevented by triple therapy with immunosuppressive agents in our three patients.

[Photodynamic therapy for choroidal neovascularization not caused by age related macular degeneration or pathologic myopia]. / Terapia fotodinámica en membrana neovascular subretiniana no relacionada con degeneración macular asociada a la edad o miopía patológica.

PURPOSE: To assess the effects of photodynamic therapy (PDT) with verteporfin on visual acuity (VA) and fluorescein angiography, in patients with subfoveal choroidal neovascularization (CNV) not secondary to age related macular degeneration (AMD) or pathologic myopia. METHODS: 113 eyes from 104 patients underwent PDT due to subfoveal CNV from July 2001 to June 2002. In this study only those patients with CNV not related to AMD or pathologic myopia were included. Fluorescein angiography and visual acuity were evaluated. RESULTS: 9 eyes from 8 patients (8.03%) showed distinct causes of CNV: 3 were idiopathic cases, 1 suffered angioid streaks, 1 was secondary to laser photocoagulation due to diabetic retinopathy, 2 had polypoidal choroidal vasculopathy and 2 central serous choroiditis. Regarding VA results, 77.7% improved or mantained the previous VA. Angiography resolution was observed in 55.5% of the cases (80% with just one PDT session). Average follow up was 10.5 months. Systemic or local complications were not observed. CONCLUSION: PDT may be useful in the treatment of different types of CNV due to causes other than AMD or high myopia.

[Dynamic angiography in age related macular degeneration]. / Angiografía dinámica: diagnóstico y tratamiento en la degeneración macular asociada a la edad.

PURPOSE: To evaluate the utility of dynamic angiography with fluorescein and indocyanine green with scanning laser ophthalmoscope (SLO) in exudative age-related macular degeneration. METHOD: We retrospectively studied 95 patients with exudative age-related macular degeneration (ARMD) between April 98 and April 01. RESULTS: We studied 102 eyes of 95 patients with ARMD. Mean age was 75.3 years with a mean follow-up time of 16.8 months. We found an occult or mixed angiographic membrane pattern with fluorescein angiography in 85 eyes (83.3%). Angiography with indocyanine green showed choroidal neovascular membranes in 94 of 102 eyes (92.1%). The most frequent location found was sub-foveal (53.2%). Laser photocoagulation was used in 55 eyes and photodynamic therapy in 5 eyes. In 17 eyes laser treatment failed to close the membrane. CONCLUSION: Dynamic angiography with fluorescein or indocyanine green allowed neovascular membrane identification in more than 90% of the cases of ARMD. Successful treatment was achieved in 42% of cases.

[A case of primary toxoplasmosis in an immunocompetent patient]. / Toxoplasmosis primaria en paciente inmunocompetente.

CASE REPORT: A case of an immunocompetent patient presenting primary systemic toxoplasma infection involving the eye (condition seen in less than 3% of primary infections). The patient showed reactivation of this primary focus two years later. DISCUSSION: Diagnosis of toxoplasm retinitis is based on a typical lesion consisting in an area of active retinitis adjacent to an inactive corioretinal scar. Differential diagnosis must consider other causes of retinal coroiditis in primary infection cases: sarcoidosis, tuberculosis, syphilis as well as viral and fungal infections. Ocular toxoplasmosis was confirmed by serum tests.

[Benefit of scanning laser ophthalmoscopy for detecting retinal nerve fiber layer defects in patients with intraocular hypertension]. / Utilidad de la oftalmoscopia láser de barrido en la detección de defectos en la capa de fibras nerviosas retinianas en pacientes con hipertensión ocular.

PURPOSE: To compare the ability to identify RNFL alterations between standard images and SLO images in a group of patients suffering from ocular hypertension. METHODS: We evaluated RNFL in sixty patients with ocular hypertension and with normal perimetry, by using standard photography and SLO. Two different independent observers evaluated the images on two different ocassions. RESULTS: We studied 118 eyes, twelve eyes were rejected because of the low quality of the images. Four cases of diffuse atrophy and five patients with wedge shaped defects were observed using both methods. Statistical analysis showed no differences between both exploration techniques or between observers. CONCLUSIONS: RNFL study with SLO seems to be at least as reliable as standard photography as a method to evaluate RNFL defects. SLO has also proved to be much easier, and faster than traditional methods.

[Study of infectious keratitis in corneal graft]. / Estudio de la queratitis infecciosa en el injerto corneal.

PURPOSE: This retrospective study was conducted to identify the associated risk factors and microbiologic spectrum in infectious keratitis (IK) after penetrating keratoplasty (PK). METHODS: Medical records of 246 PK (corneal grafts for a 17-year period, 1980-1997) were reviewed to identify IK. Criterion for inclusion was IK in PK and positive corneal culture or smear Gram stain. PK indications, interval PK-IK, risk associations microbiologic study, complications, and final corneal graft clarity were reviewed. RESULTS: The incidence reported was 4.8%, 12 cases of IK identified in 246 PK performed. The most common PK diagnosis was herpes simplex keratopathy. Potential risk factors have been categorized in :1- Local ocular (graft discompensation, therapeutic contact lens, suture-related), 2- Topical medication (corticosteroids and antibiotics) and 3- Systemic causes (diabetes mellitus). Time interval between PK-IK was 27.1+/-25.7 months (25% occurred within 12 months PK and suture complications were the main cause; 75% later than 12 months and corneal oedema and therapeutic contact lens the main late causes). Microbial spectrum: 66.6% cases were bacterial, Gram (+) organisms were predominantly involved (Streptococcus and Staphylococci) and the remaining cases were fungal (Candida). There was one case of infectious crystalline keratopathy due to Streptococcus Mitis. The prevalence of complications like evisceration and failure clear graft were 75%. CONCLUSIONS: IK after PK is an uncommon (4.8%) but serious complication. It proves a major later form incidence, associated to graft discompensation and contact lens use. Gram (+) bacterial organism and fungi (Candida) were predominantly involved.

[Conjunctival flaps in corneal perforations]. / Recubrimientos conjuntivales en perforaciones corneales.

PURPOSE: To evaluate conjunctival flaps as an emergency surgical treatment of corneal perforations. METHODS: We revised a sequence of 15 patients who are yielded to total conjunctival flap and 3 patients yielded to partial conjunctival flap. They were made between 1980-1998. RESULTS: Diagnostic to surgery included chronic ulcerative keratitis (2), bullous keratopathy (2), central ulcers (6), chemical burned (2), failed graft (3) and others (3). Seven flaps finished off keratoplasty, tree flaps retractions occurred and one eye needed evisceration. The rest of the pathology were controlled with the conjunctival flap. CONCLUSIONS: Conjunctival flaps are underused and should show consideration for determining corneal pathology where medical treatment is not being effective.

[Topical versus contact anaesthesia in conventional trabeculectomy. Prospective randomised study]. / Anestesia tópica versus anestesia de contacto en la trabeculectomía convencional. Estudio prospectivo aleatorizado.

PURPOSE: To compare the pain rates, comfort levels and safety between conventional topical anaesthesia and the application of a long lasting lidocaine soaked film or contact anaesthesia. METHODS: Fifty patients undergoing conventional trabeculectomy with or without Mitomycin-C were included. One half received topical anaesthesia and the other half contact anaesthesia in a random fashion. Pain and discomfort rates before, during and after surgery were evaluated on a scale from 0 to 5, also, surgeon subjective stress and complications observed were included in the clinical protocol. RESULTS: Significant differences were found between both groups regarding pain rates, during and after surgery, and surgeon stress level. Sedation and change of anesthesic method were required more frequently by the patients included in the topical anaesthesia group. CONCLUSIONS: Topical anaesthesia provides sufficient level of anaesthesia for performing a trabeculectomy. Nevertheless pain rate differences between contact and conventional topical anaesthesia were patent during and after surgery. Contact anaesthesia appears to be a valid and practical alternative in a wide range of patients undergoing glaucoma surgery.

[Idiopathic polypoidal choroidal vasculopathy]. / Vasculopatía coroidea polipoidal idiopática.

PURPOSE: To evaluate the incidence, clinical features and evolution of polypoidal choroidal vasculopathy (PCV) in our population. METHODS: Retrospective study of patients diagnosed with exudative and/or hemorrhagic maculopathy including age-related macular degeneration in the last two years and who have undergone a complete ophthalmologic exploration and videoangiography with fluorescein and indocyanine green. RESULTS: 250 patients were included in the study, 8 patients (3.2%) had clinical and angiographic criteria of PCV. The mean age was 68 years-old, 62.5% were men and 85.7% were caucasian. Ninety percent of cases presented clinically as a predominantly hemorrhagic macular detachment. The initial clinical diagnosis before indocyanine green angiography was exudative age-related macular degeneration in 90% of cases. The mean visual acuity was 0.2 at baseline and after follow-up. Laser treatment was performed in 4 eyes, achieving good anatomic and visual acuity results in 2 of them; both eyes of one patient were treated by photodynamic therapy with poor angiographic and functional outcome. CONCLUSIONS: Polypoidal choroidal vasculopathy is a clinical entity which is relatively frequent among patients previously diagnosed with exudative maculopathy. Indocyanine green angiography increases the number of correct diagnoses. Treatment must be individualized depending on the location of the lesions and the severity of the disease.

Sección de Perinatología. Servicio de Pediatría del Hospital Universitario Cruces / Perinatology section: pediatrics department of the Hospital Universitario Cruces

En este artículo se presenta la organización, la actividad asistencial, docente y de investigación y los índices de calidad de la Sección de Perinarología del Hospital Universitario Cruces (HU Cruces). Se trata de un proceso multidisciplinar que tiene como principal objetívo contribuir a mantener y, si es posible, mejorar la calidad de la atención sanitaria del recién nacido (RN) y su madre, contando con la implicación y participación de todo e! personal sanitario de la Sección y en coordinación con otras áreas asistenciales (Unidad de Medicina Perinatal, Unidad de Medicina Fetal y Unidad Neonatal) y especialistas. Se describirá nuestra actual Cartera de Servicios y las estrategias de mejora para favorecer la información prenatal, la asistencia especializada a partos de riesgo y e! control posnatal, tanto de los RN aparentemente sanos, como de los que requieran una adaptación especial o un control multidisciplinar postnatal, promocionando y favoreciendo la inseparabilidad de la madre y su hijo de manera segura y la lactancia materna (LM) (AU)

This paper presents the Organization, the Quality Indexes and the Health Care, Teaching and Research activities of the Perinatology Section at Cruces University Hospital. The paper holds a multidisciplinary perspective and its main objective is to help to maintain and, if possible, improve newborns and mothers' health care quality, relying on the participation of all the health care workers in the Section and on the coordination with other care areas (Unit of Perinatal Medicine, Fetal Medicine Unit and Neonatal Unit) and specialists. Our current service portfolio will be presented together with suggestions of improvement strategies leading to the following objectives: prenatal information improvement, specialized care for risk births, postnatal control, related both to apparently healthy newborns and to those requiring special adaptation or a multidisciplinary postnatal control, and the encouragement of safe mother-child inseparability and breastfeeding (AU)