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BACKGROUND AND OBJECTIVE: Brain-Machine Interfaces (BMIs) based on a motor imagination paradigm provide an intuitive approach for the exoskeleton control during gait. However, their clinical applicability remains difficulted by accuracy limitations and sensitivity to false activations. A proposed improvement involves integrating the BMI with methods based on detecting Error Related Potentials (ErrP) to self-tune erroneous commands and enhance not only the system accuracy, but also its usability. The aim of the current research is to characterize the ErrP at the beginning of the gait with a lower limb exoskeleton to reduce the false starts in the BMI system. Furthermore, this study is valuable for determining which type of feedback, Tactile, Visual, or Visuo-Tactile, achieves the best performance in evoking and detecting the ErrP. METHODS: The initial phase of the research concentrates on detecting ErrP at the beginning of gait to improve the efficiency of an asynchronous BMI based on motor imagery (BMI-MI) to control a lower limb exoskeleton. Initially, an experimental protocol is designed to evoke ErrP at the start of gait, employing three different stimuli: Tactile, Visual, and Visuo-Tactile. An iterative selection process is then utilized to characterize ErrP in both time and frequency domains and fine-tune various parameters, including electrode distribution, feature combinations, and classifiers. A generic classifier with 6 subjects is employed to configure an ensemble classification system for detecting ErrP and reducing the false starts. RESULTS: The ensembled system configured with the selected parameters yields an average correction of false starts of 72.60 % ± 10.23, highlighting its corrective efficacy. Tactile feedback emerges as the most effective stimulus, outperforming Visual and Visuo-Tactile feedback in both training types. CONCLUSIONS: The results suggest promising prospects for reducing the false starts when integrating ErrP with BMI-MI, employing Tactile feedback. Consequently, the security of the system is enhanced. Subsequent, further research efforts will focus on detecting error potential during movement for gait stop, in order to limit undesired stops.
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The combined impact of high-hydrostatic pressure (HHP) and ultrasound (US) on the cyanidin-3-O-rutinoside (C3R), quercetin-3-O-rutinoside (Q3R), and volatile compounds from fig (Ficus carica) paste was investigated. The HHP increased the content of C3R and Q3R, from 70 to 133 mg/kg fw and 31 to 44 mg/kg fw, respectively. The combination of HHP and US further enhanced the extraction of these bioactive compounds. Specifically, processing fig paste with US for 5 min at 40 °C yielded approximately 250 mg of C3R/kg fw and 45 mg of Q3R/kg fw, after 20 min. More than 25 volatile compounds were identified, with benzaldehyde being the predominant compound, accounting > 75%. Trace amounts of hydroxymethylfurfural (< 0.36 mg/100 g fw) were detected in HHP-processed fig paste. The application of HHP at mild temperatures and short time, combined with US, effectively promotes the content of bioactive compounds present in fig paste without adversely affecting the fruit's volatile compounds. Supplementary Information: The online version contains supplementary material available at 10.1007/s10068-023-01410-1.
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BACKGROUND/OBJECTIVES: Study of retinal structure based on optical coherence tomography (OCT) data can facilitate early diagnosis of relapsing-remitting multiple sclerosis (RRMS). Although artificial intelligence can provide highly reliable diagnoses, the results obtained must be explainable. SUBJECTS/METHODS: The study included 79 recently diagnosed RRMS patients and 69 age matched healthy control subjects. Thickness (Avg) and inter-eye difference (Diff) features are obtained in 4 retinal layers using the posterior pole protocol. Each layer is divided into six analysis zones. The Support Vector Machine plus Recursive Feature Elimination with Leave-One-Out Cross Validation (SVM-RFE-LOOCV) approach is used to find the subset of features that reduces dimensionality and optimises the performance of the classifier. RESULTS: SVM-RFE-LOOCV was used to identify OCT features with greatest capacity for early diagnosis, determining the area of the papillomacular bundle to be the most influential. A correlation was observed between loss of layer thickness and increase in functional disability. There was also greater functional deterioration in patients with greater asymmetry between left and right eyes. The classifier based on the top-ranked features obtained sensitivity = 0.86 and specificity = 0.90. CONCLUSIONS: There was consistency between the features identified as relevant by the SVM-RFE-LOOCV approach and the retinotopic distribution of the retinal nerve fibres and the optic nerve head. This simple method contributes to implementation of an assisted diagnosis system and its accuracy exceeds that achieved with magnetic resonance imaging of the central nervous system, the current gold standard. This paper provides novel insights into RRMS affectation of the neuroretina.
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Inteligência Artificial , Esclerose Múltipla Recidivante-Remitente , Tomografia de Coerência Óptica , Humanos , Tomografia de Coerência Óptica/métodos , Feminino , Masculino , Adulto , Esclerose Múltipla Recidivante-Remitente/diagnóstico por imagem , Pessoa de Meia-Idade , Retina/diagnóstico por imagem , Retina/patologia , Máquina de Vetores de Suporte , Estudos de Casos e Controles , Diagnóstico PrecoceRESUMO
BACKGROUND: Childhood trauma is intimately related with suicidal behaviour. Patients who have suffered childhood trauma develop impaired Reflective Functioning (RF), which refers to the capacity to understand ourselves and others in terms of intentional mental states. An improvement in RF has been associated with a reduction in suicidal attempts, but the mediating role of RF between childhood trauma and suicidal behaviour has not been addressed so far. OBJECTIVE: We aim to examine the potential mediating effect of RF among childhood trauma and suicide attempts. METHOD: We included 748 patients who had attempted suicide at least once. They were asked to complete the Reflective Functioning Questionnaire (RFQ-8), the Columbia-Suicide Severity Rating scale (CSSRS), and the Childhood Trauma Questionnaire-Short Form (CTQ-SF). We conducted linear regressions by simple mediating model to examine the role of RF in the indirect association between childhood trauma and the number of suicide attempts. RESULTS: Our results show significant indirect effects through hypo and hypermentalizing between Emotional Abuse (EA) and Sexual Abuse (SA) in childhood and the number of suicide attempts in lifetime. These results indicate that ineffective RF significantly mediates the association between childhood trauma and suicidality. CONCLUSION: This is the first study supporting the mediational role of RF in the relationship between EA and SA, and the number of suicide attempt in lifetime. These findings have important implications for reducing suicide rates and preventing future re-attempts. Further studies analysing this mediating role and focusing efforts on increasing RF-based interventions are required.
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Experiências Adversas da Infância , Testes Psicológicos , Tentativa de Suicídio , Humanos , Autorrelato , Ideação Suicida , Fatores de RiscoRESUMO
Resumen La enfermedad de Parkinson (EP) es una enfermedad multisistémica de naturaleza neurodegenerativa, que clínicamente se caracteriza por presencia de síntomas motores como bradicinesia, rigidez, temblor en reposo e inestabilidad postural. Sin embargo, también pueden estar presentes síntomas no motores que constituyen trastornos del ánimo, trastornos del sueño, disfunción cognitiva o disfunción autonómica. Dentro de las disfunciones autonómicas, los síntomas urinarios se han documentado en los pacientes con enfermedad de Parkinson. Los síntomas urinarios más comunes son la nicturia, urgencia urinaria, aumento de la frecuencia miccional e incontinencia de urgencia. El presente artículo hace una revisión narrativa de la literatura actual sobre los mecanismos fisiopatológicos, manifestaciones clínicas, diagnóstico y tratamiento de la disfunción urinaria en pacientes con enfermedad de Parkinson.
Parkinson's disease (PD) is a neurodegenerative multisystemic diseases, which is clinically characterized by the presence of motor symptoms such as bradykinesia, rigidity, resting tremor, and postural instability. However, non-motor symptoms constituting mood disorders, sleep disorders, cognitive dysfunction, or autonomic dysfunction may also be present. Within autonomic dysfunctions, urinary symptoms have been documented in patients with Parkinson's disease. The most common urinary symptoms are nocturia, urinary urgency, increased urinary frequency, and urge incontinence. This article makes a narrative review of the current literature on the pathophysiological mechanisms, clinical manifestations, diagnosis and treatment of urinary dysfunction in patients with Parkinson's disease.
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Humanos , Doença de Parkinson/fisiopatologia , Transtornos Urinários/fisiopatologia , Doença de Parkinson/tratamento farmacológico , Transtornos Urinários/diagnóstico , Transtornos Urinários/tratamento farmacológico , Bexiga Urinaria NeurogênicaRESUMO
INTRODUCCIÓN: La corioamnionitis histológica (CH) es causa importante de parto pretérmino y se asocia a resultados neonatales adversos, con secuelas del neurodesarrollo. Ocurre en alrededor de un 20% de embarazos a término y 60% de pretérmino. Este proceso está asociado a varias complicaciones neonatales, entre las más frecuentes: sepsis neonatal temprana, menor edad gestacional y mayor estancia hospitalaria. OBJETIVO: Establecer la asociación de complicaciones neonatales con el diagnóstico de CH en pacientes con parto pretérmino espontáneo en un hospital de alta complejidad. MÉTODOS: Estudio retrospectivo, se incluyeron 160 pacientes con parto pretérmino espontáneo con estudio histopatológico de la placenta según protocolo institucional. Se recolectan las características basales de la gestante y complicaciones neonatales. Se calcula la prevalencia de CH, y se comparan dos grupos (con y sin) la asociación de complicaciones neonatales, distribuidas por edad gestacional y peso neonatal. RESULTADOS: La prevalencia de CH es de 69% (IC95%: 61-76). Al distribuir por edad gestacional se reporta: 87% en 34 (IC 95%: 45 -67). La CH entre las 28 - 34 y > 34 semanas, se asocia a mayor sepsis neonatal temprana (p 2000 g se asocia con sepsis neonatal (p<0.05). CONCLUSIÓN: La prevalencia de CH es alta, principalmente a menor edad gestacional, se asocia a complicaciones neonatales como la sepsis neonatal temprana.
INTRODUCTION: Histological chorioamnionitis (HC) is an important cause of preterm delivery and is associated with adverse neonatal outcomes, with sequelae of neurodevelopment. It occurs in about 20% of full-term and 60% preterm pregnancies. This process is associated with several neonatal complications, among the most frequent: early neonatal sepsis, younger gestational age, and longer hospital stay. OBJECTIVE: To establish the association of neonatal complications with HC diagnosis in patients with spontaneous preterm delivery in a highly complexity hospital in Colombia. RESULTS: The prevalence of HC is 69% (95% CI: 61-76). When distributed by gestational age, it is reported: 87% in 34 (95% CI: 45-67). HC between 28 - 34 and > 34 weeks, is associated with higher early neonatal sepsis (p 2000 g is associated with early neonatal sepsis (p <0.05). CONCLUSION: The prevalence of HC is high, mainly at a lower gestational age, it is associated with neonatal complications such as early neonatal sepsis.
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Humanos , Feminino , Gravidez , Recém-Nascido , Adolescente , Adulto , Adulto Jovem , Corioamnionite/patologia , Corioamnionite/epidemiologia , Complicações Infecciosas na Gravidez/patologia , Complicações Infecciosas na Gravidez/epidemiologia , Resultado da Gravidez , Prevalência , Estudos Retrospectivos , ColômbiaAssuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Parto Obstétrico/métodos , Microbiota/fisiologia , MãesRESUMO
Resumen: En Chile, la Escala de Evaluación del Desarrollo Psicomotor (EEDP) y Test de Desarrollo Psicomotor (TEPSI) son herramientas no actualizadas, que carecen de confiabilidad y validación internacional conocida; por ello se hace necesario analizar el proceso evaluativo desde los actores de salud y educación, Enfermeras y Educadoras de párvulos respectivamente. El objetivo fue develar las vivencias de estos actores sociales, partícipes en el proceso evaluativo del desarrollo psicomotor en menores de tres años, según determinantes sociales. Se trata de un estudio cualitativo exploratorio, basado en la fenomenología de Alfred Schütz, realizado en siete informantes claves, cinco enfermeras y dos educadoras de párvulos, por medio de la entrevista semiestructurada. El análisis se circunscribió a transcripción, codificación, agrupamiento en categorías y síntesis. Se develan las metacategorías: A: Dilemas e incertidumbres por nudos críticos y categorías intermedias: a) Brecha entre políticas públicas y realidad local, no favorece el desarrollo de los niños, b) Instrumentos desactualizados y descontextualizados, c) Mitos y expectativas de los padres frente a la evaluación, d) Instrumentos sin pertinencia social; y B: Expectativas y categorías intermedias: a) Actualización del marco político para un avance continuo y efectivo, b) Incorporación y empoderamiento de los padres en el proceso, c) Capacitación y perfeccionamiento de profesionales. Se concluye que es necesario la actualización de las estrategias evaluativas y disponer de instrumentos validados, actualizados, con pertinencia social y que consideren a los padres
Resumo: No Chile, as Escala de Avaliação do Desenvolvimento Psicomotor (EEDP) e Teste de Desenvolvimento Psicomotor (TEPSI) não são ferramentas atualizadas, que carecem de confiabilidade e validação internacionalmente conhecidas, por essa razão, é necessário analisar o processo de avaliação dos atores de saúde e educação, enfermeiros e educadoras de creches, respectivamente. Lo objetivo foi revelar as experiências dos atores sociais participantes, enfermeiros e educadoras de creches, no processo de avaliação do desenvolvimento psicomotor em crianças menores de 3 anos, segundo os determinantes sociais. Foi realizado um estudo qualitativo exploratório baseado na fenomenologia de Alfred Schütz, realizado em 7 informantes-chave, 5 enfermeiros e 2 educadoras de creches, por meio de entrevista semiestruturado. A análise foi limitada à transcrição; codificação; agrupamento em categorias e síntese. Dilemas e incertezas de nós críticos e categorias intermediárias: a) lacuna entre política pública e da realidade local, não favorece o desenvolvimento das crianças, b) instrumentos desatualizados e, c) Mitos descontextualizadas e expectativas dos metacategorias são revelados os pais na frente da avaliação, d) Instrumentos sem relevância social; e B: Expectativas e categorias intermediárias: a) Atualização do arcabouço político para o progresso contínuo e efetivo, b) Incorporação e empoderamento dos pais no processo, c) Treinamento e aperfeiçoamento dos profissionais. É necessário atualizar as estratégias de avaliação e validar instrumentos atualizados e de relevância social que considerem os pais
Abstract: In Chile, the Psychomotor Development Evaluation Scale (EEDP in Spanish) and the Psychomotor Development Test (TEPSI in Spanish) are outdated tools that lack international reliability and validation. It is necessary to analyze the evaluation process from the point of view of the health and education professionals, that is, nurses and early childhood educators. The purpose was to reveal the experiences of these actors in the evaluation process of psychomotor development in children under three years of age, according to social determinants. This is a qualitative exploratory study based on the Alfred Schütz phenomenology, carried out in seven key informants, five nurses and two educators, through semi-structured interviews. The analysis was limited to transcription, coding, grouping into categories and synthesis. The meta categories revealed are: A: Dilemmas and uncertainties by critical nodes and intermediate categories: a) The gap between public policies and local reality does not favor the development of children, b) Outdated and decontextualized instruments, c) Myths and expectations of the parents regarding the evaluation, d) Instruments without social relevance; and B: Expectations and intermediate categories: a) Political framework update for continuous and effective progress, b) Parents incorporation and empowerment in the process, c) Professionals training and improvement. It was concluded that it is necessary to update the evaluation strategies and have validated, updated and socially relevant instruments that include the parents
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Objetivo: El objetivo de este estudio fue evaluar la frecuencia con que las raíces de premolares y molares superiores se encuentran dentro del seno maxilar. Conocer la relación entre dichas estructuras es importante para planificar los procedimientos endodónticos y quirúrgicos a ser realizados en esa región. Materiales y métodos: Se realizó el análisis cualitativo dinámico de 82 tomografías computadas de haz cónico (CBCT) unilaterales, analizándose 738 raíces correspondientes a premolares y molares de una sola hemiarcada superior. Se utilizó sala con iluminación controlada y la observación fue realizada por un solo examinador. El criterio de inclusión requería que la cortical inferior del seno maxilar debía ser visible para poder establecer la relación. Se utilizaron los tres planos tomográficos de visualización, permitiendo ajustes de brillo y contraste. La escala de clasificación de cada raíz consideró su relación como: dentro o fuera del seno maxilar. Los datos obtenidos fueron sometidos a las pruebas de Chi-cuadrado y Test Exacto de Fisher. Resultados: el primer premolar superior mostró una proyección hacia el interior del seno maxilar significativamente menor que las otras piezas dentarias posteriores (p>0.05), observándose su raíz vestibular sin proyección. La raíz palatina del primer premolar superior mostró la mayor incidencia dentro del seno maxilar, con un 39,02% del total de las raíces analizadas (p<0,05). El segundo molar superior mostró considerable proximidad con el seno maxilar, pero con menor incidencia con relación a la raíz palatina del primer molar. Conclusión: los procedimientos endodónticos o quirúrgicos a realizarse en cercanía al seno maxilar deben considerar siempre la relación raíz/seno, para evitar maniobras que lo invadan. La raíz palatina del primer molar superior mostró la mayor incidencia dentro del seno maxilar, con un 39,02% (AU)
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Humanos , Masculino , Feminino , Adulto , Raiz Dentária/diagnóstico por imagem , Dente Pré-Molar , Tomografia Computadorizada de Feixe Cônico , Seio Maxilar/diagnóstico por imagem , Dente Molar , Raiz Dentária/anatomia & histologia , Distribuição de Qui-Quadrado , Estudos Retrospectivos , Estudo Observacional , Seio Maxilar/anatomia & histologiaRESUMO
Resumen El impacto de la intervención Módulo Ambientes Seguros contra los accidentes domésticos que sufren niños durante la primera infancia fue evaluado a través de visitas domiciliarias en las cuales se valoró el nivel de riesgo de accidentes domésticos y la calidad del contexto inmediato de desarrollo temprano de los niños, antes y después de la intervención, en dos grupos. Se conformó un grupo intervención de 29 cuidadoras y un grupo control de 18 participantes que fueron seleccionadas según su disponibilidad para ser visitadas en sus hogares y para participar en la intervención. Los resultados mostraron que la intervención mejoró la calidad del contexto inmediato del desarrollo temprano de los niños en su dimensión interacción, y disminuyó la conducta de dejar solos a los niños en casa. Al finalizar, las participantes manifestaron un alto grado de satisfacción con la intervención Módulo Ambientes Seguros.
The Safe Environment Intervention Module for the prevention of domestic accidents in early childhood was assessed using home visits to test its effects on the level of risk of domestic accidents, as well as the quality of the immediate context of early child development. The intervention was developed in four sessions in which 29 caregivers participated. They self-reported their satisfaction at the end of the intervention. A control group with 18 caregivers was formed according to their availability. The results showed that the intervention improves the quality of the immediate context of early child development in their interactive dimensions, and reduces the behaviour of leaving children alone at home. Participants were highly satisfied with the Safe Environment Intervention Module.
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Humanos , Feminino , Acidentes Domésticos , Meio Ambiente , Gestão da Qualidade Total , Prevenção de AcidentesRESUMO
Background: There are differences in the educational context in Health Sciences, between clinical and non-clinical teachers. Therefore, the didactic and reflexive peculiarities of both educational scenarios should be analyzed. Aim: To describe the conditions of the educational context in Health Sciences for the practice of the teaching role in a Chilean university. Material and Methods: Qualitative study, performed according to Grounded Theory of Strauss and Corbin. Thirty one teachers from six health sciences programs were selected according to Patton's maximum variation criterion and contacted personally, after an informed consent process. Semi-structured interviews and focus group were performed, analyzed by open coding, using the constant comparison method, with the Atlas-ti 7.5.2 software. Results: Six conditions of the educational context that can support the teaching role in these careers emerged. Namely, a clinical field suited for patient attention and teaching, classrooms designed for the new educational models, number of students in the classrooms and clinical settings, insertion programs for teachers' training, teachers' coordination and economic resources of the program. Conclusions: Health Sciences programs are developed in a complex educational context, having to articulate diverse elements to train professionals. Therefore, it is fundamental to understand the conditions of the educational context that can favor the practice of the teaching role, thus generating improvements in teaching-learning process.
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Humanos , Ensino , Universidades , Docentes de Medicina/normas , Chile , Pesquisa Qualitativa , Docentes de Medicina/estatística & dados numéricosRESUMO
Se presenta un paciente masculino, de 67 años, residente en la provincia de La Rioja, quien concurre al Servicio de Neumonología del Hospital Vera Barros. Ex fumador importante (60 p/y hasta hace 5 años), trabajó en curtiembre y con forrajes. Consultó por disnea de esfuerzo grado III en la escala modificada del Medical Researh Council (mMRC) y tos seca de 3 o 4 años de evolución. Estos síntomas se agudizaban 3 o 4 veces al año y requerían medicación que no podía precisar
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Enfisema Pulmonar , Fibrose PulmonarRESUMO
Abstract Solid-state fermentation can be used to produce feeds for ruminants, which can provide an enriched population of yeasts to improve ruminal fermentation. Fermentation of apple bagasse was performed to obtain a yeast-rich product, with the objective of isolating, identifying, and characterizing yeast strains and testing their capability to enhance in vitro ruminal fermentation of fibrous feeds. Yeasts were isolated from apple bagasse fermented under in vitro conditions, using rumen liquor obtained from cannulated cows and alfalfa as a fibrous substrate. A total of 16 new yeast strains were isolated and identified by biochemical and molecular methods. The strains were designated Levazot, followed by the isolate number. Their fermentative capacity was assessed using an in vitro gas production method. Strain Levazot 15 (Candida norvegensis) showed the greatest increase in gas production (p < 0.05) compared with the yeast-free control and positively affected in vitro ruminal fermentation parameters of alfalfa and oat straw. Based on these results, it was concluded that the Levazot 15 yeast strain could be potentially used as an additive for ruminants consuming high-fiber diets. However, further studies of effects of these additives on rumen digestion, metabolism, and productive performance of ruminants are required.
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Animais , Leveduras/isolamento & purificação , Leveduras/classificação , Celulose , Malus , Aditivos Alimentares , Ração Animal/microbiologia , Filogenia , Leveduras/genética , Leveduras/metabolismo , Ruminantes , FermentaçãoRESUMO
Background: Educational environment has an important effect on the quality of learning and student satisfaction in medicine. Most of previous studies have been conducted using questionnaires that assess the phenomenon considering overall dimensions, without paying attention to the specific manifestations of this topic, especially those aspects that are related to the protagonists of the learning process: teachers and students. Aim: To describe factors that affect the educational environment in the preclinical Medical formation, according to Medical teachers in Concepción, Chile. Material and Methods: Qualitative study, using the Grounded theory method. Semi-structured interviews were performed to 10 medical teachers in Concepcion, Chile. They were selected by theoretical sampling. Data were analyzed using open coding. Results: Four emerging categories about the factors that affect the learning environment were identified: Personal factors of students, academic factors of students, personal factors of teachers and academic factors of teachers. Conclusions: According to interviewed teachers, both personal factors in teachers and students that promote a positive learning environment are related with an attitude oriented towards others and communication skills. Academic factors are related with the responsible exercise of student and teacher roles and with the promotion of participation in the educational process.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Estudantes de Medicina/psicologia , Educação de Graduação em Medicina/normas , Professores Escolares/psicologia , Meio Social , Fatores de Tempo , Chile , Entrevistas como Assunto , Pesquisa Qualitativa , Aprendizagem , MotivaçãoRESUMO
Introduction: Malignant cranial base neoplasm constitutes a heterogeneous group of lesions with common seat in this localization. In the last years endonasal endoscopic approach has been more used. Methods: It was carried out a descriptive retrospective study of the database of the Service of Neurosurgery of "Hermanos Ameijeiras" Hospital between September 2009 and September 2015 with the objective of determining the results of endoscopic treatment to these lesions. Results: They were treated a total of 12 patients with wicked lesions of the cranial base inside. Six of them corresponded to anterior cranial base: 5 carcinomas (2 indiferenciate carcinoma, 2 carcinomas of scamous cells and 1 adenocarcinoma) and a metastases of renal carcinoma. Other six corresponded to cordoma (3 patients) and hematopoyetic neoplasm (2 plasmocitomas and 1 linfoma). The age average was of 51,1 years with a masculine-feminine relationship of 1,1:1. Conclusions: Surgical resection according to oncological principles can be used with endoscopic technics that in fact are associate with less morbility, better vision, betercompartiments access, nasolacrimal system and medial canthal tendon, absence of facial scar, craniectomy and brain retraction.
Introducción: Las neoplasias malignas de la base craneal constituyen un grupo heterogéneo de lesiones con asiento común en esta localización. En los últimos años el abordaje endonasal endoscópico ha cobrado mayor auge. Métodos: Se realizó un estudio retrospectivo descriptivo de la base de datos del Servicio de Neurocirugía del Hospital "Hermanos Ameijeiras" durante el período comprendido entre septiembre de 2009 y septiembre de 2015 con el objetivo de determinar los resultados del tratamiento endonasal endoscópico a estas lesiones. Resultados: Fueron tratados un total de 12 pacientes con lesiones malignas de la base craneal, 6 de la base craneal anterior dentro de los cuales 5 correspondieron a carcinomas (2 carcinomas indiferenciados, 2 carcinomas de células escamosas y 1 adenocarcinoma) y una metástasis de carcinoma renal. De los 6 de fosa posterior 3 presentaron cordomas y 3 lesiones hematopoyéticas (2 plasmocitomas y 1 linfoma). El promedio de edad fue de 51,1 años con una relación masculino-femenino de 1,1:1. Conclusiones: La resección quirúrgica acorde a los principios oncológicos se puede realizar utilizando las técnicas endoscópicas que incluso se asocian a menor morbilidad, mayor visión, mejor acceso a determinados compartimentos, preservación del sistema nasolacrimal, del tendón cantal medial, ausencia de cicatriz facial, de craneotomía y de retracción cerebral.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Endoscopia/métodos , Procedimentos Neurocirúrgicos/métodos , Neoplasias da Base do Crânio/cirurgia , Base do Crânio/cirurgia , Neoplasias dos Seios Paranasais/cirurgia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
INTRODUCCIÓN: Entre 15-20% de los embarazos gemelares monocoriales biamnióticos se complican con el síndrome de transfusión feto/fetal el cual se asocia con mortalidad superior a 90% y morbilidad significativa en el 50% del gemelo sobreviviente. La técnica láser que coagula la superficie de la placa coriónica entre los principales canales a lo largo del ecuador (técnica de Solomon), se ha sugerido para disminuir la recurrencia, prevenir complicaciones secundarias sin incrementar resultados adversos. Métodos: REVISIÓN de la literatura existente en las bases de datos MEDLINE, EBSCO, OVID, PROQUEST, COCHRANE, Lilacs, SciELO, desde el año 2000 al 2015. Se incluyeron los artículos de revisión e investigaciones originales que compararon la técnica estándar de fotocoagulación secuencial con láser y la técnica de Solomon, el resultado primario fue la reducción de la incidencia Secuencia Anemia Policitemia, recurrencia del síndrome de transfusión feto/fetal, mortalidad perinatal y morbilidad neonatal severa. RESULTADOS: Se encontraron 200 artículos, se seleccionaron seis: 1 ensayo clínico y su análisis secundario, 2 estudios de cohorte retrospectivos, 1 revisión sistemática y un estudio que compara los resultados del neurodesarrollo. Los estudios sugieren una mejoría en la sobrevida de algunos de los fetos con la técnica Solomon, menor recurrencia del síndrome de transfusión feto/fetal y Secuencia Anemia Policitemia, sin la presencia de eventos adversos. CONCLUSIÓN: La técnica de Solomon mejora la sobrevida de algunos gemelos, sin embargo no puede concluirse que haya mejoría en la mortalidad pues los estudios no tienen el suficiente poder para determinarlo.
INTRODUCTION: Between 15 to 20% of monochorionic diamniotic twin pregnancies are complicated by the twin-twin transfusion syndrome. It has a mortality greater than 90% and a significant morbidity, 50% in the surviving twin. The Solomon technique (laser photocoagulation of the main vascular channels of the chorio-nic plate surface along the entire vascular equator) has been suggested to reduce the recurrence, and pre-vent secondary complications without increasing adverse results. METHODS: Systematic review of electronic searches of the literature from 2000 to 2015 (MEDLINE, EBSCO, OVID, PROQUEST, COCHRANE, Lilacs, and SciELO). We included review articles and original investigations comparing the standard photocoagulation technique with laser ablation against the Solomon technique. The primary results were reduction of Anemia Polycythemia Sequence incidence, twin-twin transfusion syndrome recurrence, perinatal mortality and severe neonatal morbidity. RESULTS: Of 200 articles, we selected six: one clinical essay and its secondary analysis, two retrospective cohort studies, one systematic review and a study comparing neurodeve-lopmental outcomes. The studies suggested a survival improvement in some fetuses using the Solomon technique, less twin-twin transfusion syndrome recurrence and Anemia Polycythemia Sequence without the presence of adverse effects. CONCLUSION: Solomon technique improves the survival of some twins, although we cannot conclude there is mortality improvement, because the studies do not have enough power to determine that.
Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Fotocoagulação a Laser/métodos , Transfusão Feto-Fetal/cirurgia , Policitemia/etiologia , Síndrome , Gêmeos , Resultado da Gravidez , Resultado do Tratamento , Transfusão Feto-Fetal/complicações , Fetoscopia , Anemia/etiologia , FotocoagulaçãoRESUMO
Background: Motivation is an essential aspect in the training process of medical students. The association that motivation can have with learning self-regulation is of utmost importance for the design of curriculum, teaching methods and evaluation. Aim: To describe the motivational aspects of self-directed learning among medical students from a traditional Chilean University. Material and Methods: A qualitative, descriptive study based on grounded theory of Strauss and Corbin. Twenty 4th and 5th year medical students were selected using a maximum variation sampling technique. After obtaining an informed consent, semi-structured interviews and field notes were carried out. Data were analyzed to the level of open coding through Atlas-ti 7.5.2. Results: From the student point of view, personal motivational aspects are linked to the search for information, constant updating, the perception of the physician-patient relationship and interest in subject matters. From the scope of teachers, a main issue is related to their ability to motivate students to develop independent study skills. Conclusions: Personal motivational aspects facilitate the development of independent study skills, specifically in the search of information. The role of teachers is crucial in promoting these skills and the perception of medical students from their learning process.
Assuntos
Humanos , Estudantes de Medicina/psicologia , Educação de Graduação em Medicina , Aprendizagem , Motivação , Chile , Pesquisa QualitativaRESUMO
Plasmocytomas constitute a group of malignant neoplasm arise from clonal plasmatic cells being solitary extramedular form infrequent. Here we report three patients with solitary anterior and middle cranial base plasmocytoma. The importance of these tumors in differential diagnoses of cranial base lesions and the role of endoscopic endonasal biopsy before deciding definitive clinical approach was emphasized.
Los plasmocitomas constituyen neoplasias malignas de las células plasmáticas clónales. La forma extramedular solitaria en la base craneal es infrecuente. Se reportan tres pacientes con plasmocitoma solitario de la base craneal anterior y media. Se enfatiza en la importancia de esta afección en el diagnóstico diferencial de las lesiones de base de cráneo así como la biopsia endonasal endoscópica antes de decidir el tratamiento definitivo.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Plasmocitoma , Crânio , Base do Crânio , NeoplasiasRESUMO
In Chile the only requirement to study medicine is to obtain an academic achievement score over a certain cutoff value. However, the literature states that this type of selection is insufficient, since the medical profession requires cognitive and non-cognitive skills. These abilities are associated with better adaptation and academic success, as well as less dropping out. Therefore, those skills should be considered in the selection process to assure that the education goals are met. The aim of this study was to review the existing literature regarding the selection and evaluation criteria for students who are applying to medical schools. It was evident that Chilean medical schools need to establish appropriate criteria to ensure a more inclusive and fair admission. They need to design a system of admission with solid evidence of validity and reliability, complementary to the current form of student selection. This system should be considered common to all schools of medicine and, in turn, consider the sensibilities of the particular mission of each school, since academic, cognitive, inter- and intrapersonal aspects may vary among them.
Assuntos
Humanos , Cognição , Critérios de Admissão Escolar , Estudantes de Medicina/estatística & dados numéricos , Chile , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Avaliação Educacional/estatística & dados numéricos , Estudantes de Medicina/psicologiaRESUMO
Background: Stress may affect the sense of wellbeing and academic achievement of university students. Aim: To assess the relationship of academic engagement and burnout with academic achievement among first year medical students. Material and Methods: The Utrecht Work Engagement Scale-Student and Maslach Burnout Inventory Student Survey (MBI-SS) were applied to 277 first year medical students of four universities. Their results were correlated with the grades obtained in the different courses. Results: Moderately high engagement and low burnout levels were detected. There was a high level of satisfaction with studies and a moderate exhaustion level. Academic achievement was associated with the degree of engagement with studies but not with burnout. Conglomerate analysis detected a group of students with high levels of wellbeing, characterized by high levels of academic engagement and low burnout. Other group had moderate levels of engagement and lack of personal fulfilment. Other group, identified as extenuated, had high levels of personal exhaustion and depersonalization. Finally the disassociated group had a low academic engagement, low emotional exhaustion, high levels of depersonalization and lack of personal fulfillment. Conclusions: Academic achievement is associated with the level of engagement with studies but not with burnout.