Scale to measure medical, nursing and midwifery students' engagement in an e-learning histology course / Escala para medir la participación de estudiantes de medicina, enfermería y obstetricia en un curso de histología e-learning

SUMMARY: E-learning courses become increasingly important and relevant in medicine and health sciences over the last decade. However, there are few teaching experiences of e-learning histology courses published in the literature worldwide. Moreover, most of these studies focus on the didactic aspects of the course without exploring student participation. The study presented below aimed to validate a scale to measure student participation in an e-learning histology course. We provide evidence of validity of the instrument based on its internal structure for use with medical, nursing, and midwifery students. The participants in this study were a group of 426 Chilean medical, nursing and midwifery students from a public university who completed the questionnaire in two consecutive semesters (2020-2021). Data from the first group of students were used to perform an exploratory factor analysis (EFA), while data from the second group of participants were used to perform a confirmatory factor analysis (CFA). The three factors identified according to the CFA were: "Habits of online," "Motivation for online learning," and "Interaction of online". After eliminating one of the initial items of the instrument, the scale showed acceptable psychometric properties suggesting that it is a useful instrument to measure students' perception of their participation in e-learning histology courses. The factors identified through the validation of the instrument provide relevant information for teachers and curriculum developers to create and implement different ways of encouraging student participation in e- learning histology courses to support online learning.

Los cursos e-learning han tomado mayor importancia y relevancia durante la ultima década en carreras de medicina y ciencias de la salud. No obstante, existen escasas experiencias docentes de cursos de histologia e-learning publicadas en la literatura mundial. Además, la mayoría de estos estudios se centran en los aspectos didácticos del curso sin explorar la participación de los estudiantes. El estudio que presentamos a continuación tuvo por objetivo validar una escala para medir la participación de los estudiantes en un curso de histología e-learning. Aportamos evidencia de validez del instrumento basada en su estructura interna para su uso con estudiantes de medicina, enfermería y obstetricia. Los participantes de este estudio fueron un grupo de 426 estudiantes chilenos de medicina, enfermería y obstetricia de una universidad pública quienes completaron el cuestionario en dos semestres consecutivos (año 2020-2021). Los datos del primer grupo de estudiantes se utilizaron para realizar un análisis factorial exploratorio (AFE), mientras que los datos del segundo grupo de participantes se utilizaron para realizar un análisis factorial confirmatorio (AFC). Los tres factores identificados según el AFC fueron: "Hábitos de los estudiantes en línea", "Motivación por el aprendizaje en línea", "Interacción de los estudiantes en línea". Luego de la eliminación de uno de los ítems iniciales del instrumento, la escala mostró propiedades psicométricas aceptables sugiriendo que es un instrumento útil para medir la percepción de los estudiantes sobre su participación en cursos de histología en formato e-learning. Los factores identificados mediante la validación del instrumento entregan información relevante para que los profesores y curriculistas desarrollen e implementen diferentes formas de estimular la participación de los estudiantes en cursos de histología e- learning y así apoyar el aprendizaje en formato online.

Adaptación e implementación del modelo de prevención de consumo de sustancias Planet Youth en Chile / Adaptation and implementation of the Planet Youth substance use prevention model in Chile

Resumen El consumo de sustancias en adolescentes es altamente prevalente en varias regiones del mundo, y especialmente en Chile, siendo su prevención un importante desafío para la salud pública. Este artículo describe el modelo islandés de prevención del consumo de sustancias en adolescentes "Planet Youth", su adaptación y factibilidad de implementación en Chile, como primera experiencia en Latinoamérica. Este modelo comunitario está enfocado en la prevención ambiental y en la promoción de la salud de niños, niñas y adolescentes, basado en un diagnóstico local y oportuno de factores protectores y de riesgo, con colaboración de la autoridad local y la academia. Seis comunas de la región metropolitana en colaboración con la Universidad de Chile y el Icelandic Centre for Social Research and Analysis inician su implementación en 2018. Se tradujo y adaptó la encuesta islandesa que fue aplicada a 7354 estudiantes de 2° medio, cuyos resultados se retroalimentaron a colegios y municipalidades para trabajar en la modificación de los principales factores de riesgo y protección. En 2020, el proceso ha requerido algunas adaptaciones debido a la pandemia por COVID-19. Se discute acerca de factores socioculturales relevantes en la adaptación de estrategias basadas en evidencia internacional que se transfieren a un país diferente. La implementación del modelo Planet Youth es factible en Chile y ofrece una importante oportunidad para prevenir el consumo de sustancias en jóvenes de manera efectiva en Latinoamérica.

The prevalence of substance use is high among adolescents in several region around the world, specifically in Chile, and its prevention is an important public health challenge. We describe the adaptation and the feasibility to implement the Icelandic model of substance use prevention in adolescents "Planet Youth" in Chile as first experience in Latin America. This community prevention model focuses on the environment, culture and the promotion of health in adolescents, informed by local risk and protective factors. Implementation requires collaboration between academia and municipal authorities. Six municipalities of the Metropolitan Region, the University of Chile and the Icelandic Centre for Social Research and Analysis collaborated in the implementation of the Planet Youth model since 2018 in Chile. A substance use survey was translated, adapted, and applied to 7354 tenth grade students. The results were informed to schools and municipalities in order to work on modifications of the main risk and protective factors in their own community. In 2020, the prevention process has required some adaptation due to COVID-19 pandemic. We discuss sociocultural factors in the adaptation of this international prevention model transferred to Latin America. The implementation of the Planet Youth model is feasible in Chile and offers an opportunity to effectively prevent the substance use behaviors of adolescents in Latin America.

Efecto metabólico de la metformina en adolescentes obesas con riesgo de diabetes mellitus tipo 2 / Metabolic effect of metformin in obese adolescents at risk of diabetes mellitus type 2

En adultos, se ha demostrado que la metformina favorece la reducción de peso y previene el desarrollo de Diabetes Mellitus tipo 2 (DM2). Sin embargo, aún no se han determinado estos efectos en población adolescente con riesgo de DM2. Objetivo: Analizar el impacto antropométrico y metabólico de la metformina en adolescentes obesas con riesgo de DM2. Pacientes y Método: Estudio randomizado, doble ciego, en que participaron 19 adolescentes obesas con riesgo de DM2 distribuidas aleatoriamente en dos grupos. Ambos fueron sometidos a un período de tratamiento (3 meses) con cambios en estilo de vida y farmacoterapia (dosis diaria de metformina 500 mg de liberación prolongada o placebo, respectivamente), continuado por un período de seguimiento (3 meses). Se compararon las variaciones en antropometría (peso, IMC, circunferencia cintura, presión arterial) y perfil metabólico (glicemia, HOMA, perfil lipídico, GOT y GPT) entre ellos al finalizar ambos períodos. Resultados: El grupo tratado con metformina mostró reducción significativa del peso e IMC. La disminución de IMC fue significativamente mayor que la del grupo que recibió placebo. Ningún grupo demostró mejora en el perfil de riesgo metabólico. Conclusión: La terapia con metformina, combinada con intervención en el estilo de vida, reduce el peso e IMC en adolescentes obesas con riesgo de DM2 en comparación con pacientes que reciben intervención en estilo de vida y placebo.

In adults, metformin promotes weight loss and prevents the development of type 2 diabetes mellitus (DM2). However, these effects have not been demonstrated in adolescents at risk for DM2. Objective: To analyze the anthropometric and metabolic impact of metformin in obese adolescents at risk for DM2. Patients and Methods: A double-blind, placebo-controlled study was conducted in 19 obese female adolescents at risk for DM2. A structured lifestyle intervention with nutritional and exercise education and motivational support was assessed over 3 month with an additional follow up period of 3 months. Subjects were randomized to 500 mg/ daily of extended release metformin or placebo. Anthropometric (weight, BMI, waist circumference, blood pressure) and metabolic profiles (glycemia, HOMA, lipid profile, AST, ALT) were compared between both groups at the end of both periods. Results: Metformin treated group showed a significant reduction in weight and body mass index (BMI) compared with placebo group. No improvement in the metabolic risk profile was showed in any group. Conclusion: In this study, metformin therapy in combination with a lifestyle intervention helps to reduce weight and BMI in obese adolescent females at risk for DM2, compared to lifestyle and placebo intervention.

Efecto metabólico de la metformina en adolescentes obesas con riesgo de diabetes mellitus tipo 2 / Metabolic effect of metformin in obese adolescents at risk of diabetes mellitus type 2

In adults, metformin promotes weight loss and prevents the development of type 2 diabetes mellitus (DM2). However, these effects have not been demonstrated in adolescents at risk for DM2. Objective: To analyze the anthropometric and metabolic impact of metformin in obese adolescents at risk for DM2. Patients and Methods: A double-blind, placebo-controlled study was conducted in 19 obese female adolescents at risk for DM2. A structured lifestyle intervention with nutritional and exercise education and motivational support was assessed over 3 month with an additional follow up period of 3 months. Subjects were randomized to 500 mg/ daily of extended release metformin or placebo. Anthropometric (weight, BMI, waist circumference, blood pressure) and metabolic profiles (glycemia, HOMA, lipid profile, AST, ALT) were compared between both groups at the end of both periods. Results: Metformin treated group showed a significant reduction in weight and body mass index (BMI) compared with placebo group. No improvement in the metabolic risk profile was showed in any group. Conclusion: In this study, metformin therapy in combination with a lifestyle intervention helps to reduce weight and BMI in obese adolescent females at risk for DM2, compared to lifestyle and placebo intervention.

En adultos, se ha demostrado que la metformina favorece la reducción de peso y previene el desarrollo de Diabetes Mellitus tipo 2 (DM2). Sin embargo, aún no se han determinado estos efectos en población adolescente con riesgo de DM2. Objetivo: Analizar el impacto antropométrico y metabólico de la metformina en adolescentes obesas con riesgo de DM2. Pacientes y Método: Estudio randomizado, doble ciego, en que participaron 19 adolescentes obesas con riesgo de DM2 distribuidas aleatoriamente en dos grupos. Ambos fueron sometidos a un período de tratamiento (3 meses) con cambios en estilo de vida y farmacoterapia (dosis diaria de metformina 500 mg de liberación prolongada o placebo, respectivamente), continuado por un período de seguimiento (3 meses). Se compararon las variaciones en antropometría (peso, IMC, circunferencia cintura, presión arterial) y perfil metabólico (glicemia, HOMA, perfil lipídico, GOT y GPT) entre ellos al finalizar ambos períodos. Resultados: El grupo tratado con metformina mostró reducción significativa del peso e IMC. La disminución de IMC fue significativamente mayor que la del grupo que recibió placebo. Ningún grupo demostró mejora en el perfil de riesgo metabólico. Conclusión: La terapia con metformina, combinada con intervención en el estilo de vida, reduce el peso e IMC en adolescentes obesas con riesgo de DM2 en comparación con pacientes que reciben intervención en estilo de vida y placebo.

Tuberculosis laríngea diagnosticada en una escolar / Laryngeal tuberculosis diagnosed in a school girl

Tuberculosis is at the present time a worldwide endemic disease. Extrapulmonary tuberculosis is less frequent than the pulmonary form and its diagnosis represents a challenge. Laryngeal tuberculosis accounts for less than 1 percent of extrapulmonary tuberculosis. In this report, we present a case of laryngeal tuberculosis diagnosed in a 12 years old girl at the pediatric department of a general hospital. The patient had a six months history of hoarseness and persistent cough. At the time she was admitted at the hospital she complainted about stridor, odynophagia, weakness and respiratory distress. A cervical mass was the main finding at her physical exam. A laryngeal nodule was shown after practicing a direct laryngoscopy. The biopsy of this lesion revealed presence of a granulomatous inflammatory process compatible with tuberculosis. Besides the samples of sputum taken at her admission for acid -fast bacilli direct examination and culture were positive. We would like to emphasize the delay in diagnosing this case, because of the outpatient clinical study failed in proposing to carry out a direct laryngoscopy in this patient, despite she complainted of hoarseness and persistent cough.

La tuberculosis (TBC) es en la actualidad una endemia a nivel mundial. La tuberculosis extrapulmonar, menos frecuente que la forma pulmonar constituye un desafío diagnóstico. La forma laríngea representa menos del 1 por ciento de las tuberculosis extrapulmonares. En esta publicación, presentamos un caso de tuberculosis laríngea diagnosticada en una escolar de nuestro servicio de pediatría hospital Dr. Gustavo Fricke, cuyos síntomas cardinales fueron disfonía y tos presentes durante 6 meses previo al diagnóstico. Al momento de ingreso al servicio se había agregado compromiso del estado general, odinofagia estridor y dificultad respiratoria. Al examen físico destacaba la presencia de masa cervical. El diagnóstico se realizó mediante laringoscopia directa que evidenció nódulo en cuerda vocal derecha cuya biopsia reveló presencia de proceso inflamatorio crónico granulomatoso compatible con TBC. Las baciloscopías y cultivo de Koch de expectoración, realizados al momento del ingreso, resultaron positivos. Cabe destacar el retraso diagnóstico del caso, debido a que nunca se planteó realizar laringoscopia durante el estudio ambulatorio, pese a la presencia de disfonía y tos persistente.

Demencia por déficit de vitamina B12. Caso clínico / Dementia caused by vitamin B12 deficiency. Clinical case

Cyanocobalamin (vitamin B12) deficiency can cause polyneuropathy, myelopathy, blindness, confusion, psychosis and dementia. Nonetheless, its deficiency as the sole cause of dementia is infrequent. We report a 59 years old man with a 6 months history of progressive loss of memory, disorientation, apathy, paranoid delusions, gait difficulties with falls, and urinary incontinence. He had suffered a similar episode 3 years before, with a complete remission. On examination there was frontal type dementia with Korsakoff syndrome, a decrease in propioception and ataxic gait. Cerebrospinal fluid examination showed a protein of 0.42 g/L. Brain computed tomography showed sequelae of a frontal left trauma. Brain single photon computed tomography (SPECT) was normal. Complete blood count showed a macrocytic anemia with a hematocrit 29 per cent and a mean corpuscular volume of 117 micron3. Plasma vitamin B12 levels were undetectable, erythrocyte folate levels were 3.9 ng/ml and plasma folate was normal. The myelogram showed megaloblastosis and the gastric biopsy showed atrophic gastritis. Treatment with parenteral B12 vitamin and folic acid reverted the symptoms, with normalization of the neuropsychological tests and reintegration to work.

Trauma penetrante abdominal / Penetrating abdominal trauma

Durante 18 meses se atendió a 66 pacientes que habían sufrido una herida penetrante de abdomen en el Hospital Dr. Gustavo Fricke de Viña del Mar, siendo posible el análisis de los datos en 63 casos. El manejo de estos enfermos incluyó la laparotomía precoz entodos los casos con herida de bala, inestabilidad hemodinámica o evisceración, y la observación quirúrgica de las heridas por arma blanca, seguida de laparotomía en aquellos casos en que la evidencia clínica o de laboratorio orientó hacia una complicación intraperitoneal

Fluorosis dental: recuento de streptoccus mutans en escolares provenientes de la Primera Región de Chile: estudio longitudinal / Dental fluorosis: a longitudinal quantification of streptococcus mutans in school age children from Mamiña, Chile

Background: High fluorine concentrations in drinking water are associated with a decrease in the amount of salivary S mutants. Taking into account that clinical dental fluorosis can appear with 1.5 ppm of fluorine in the drinking water, fluorine concentration in Mami-a is 2.4 ppm. Aim: To quantify salivary S mutans in school age children from Mami-a, a zone with a high fluorine content in the drinking water, during one year. Material and methods: During 1997 and 1998, dental health was assessed and salivary samples were obtained from 51 children (27 male) aged 10 ñ 2 years to quantify S mutans. Results: Most children studied had more than 105 salivary S mutans colony forming units. No changes in the rates of infection or dental health characteristics were observed during the observation year. Conclusions: High fluorine content in the drinking water did not have an effect on salivary S mutans infection in this population

Recuento de Streptococci mutans en la saliva de mujeres embarazadas de la región metropolitana: estudio transversal / Counting of salivary streptococci mutans in pregnant women of the metropolitan region of Chile

Background: Salivary Streptococci mutans contamination is considered the main microbiological risk factor for the initiation of caries. Aim: To assess the oral health of pregnant women, counting Salivary Streptococci mutants. Patients and methods: One hundred seventy four pregnant women, in the first, second and third trimester of pregnancy, aged 27 ñ 5 years old, consulting at a public primary health center, were studied. Puerperal women that had their delivery two months before, were studied as a control group. Salivary samples were obtained and Streptococci mutans colonies were counted using quantitative and semiquantitative methods. Results: There was a good concordance between both counting methods. No differences in Streptococci mutans counts were observed among the three groups of pregnant women, but the latter as a group had higher counts than puerperal women. Women with more than 5 caries had also higher counts. Conclusions: Semiquantitative Streptococci mutans counts are easy, rapid and non invasive and have a good concordance with quantitative counts in saliva

Distinct grooming patterns induced by intracerebroventricular injection of CRH, TRH and LHRH in male rats

This paper reports the effects on grooming, related behaviors and levels of anxiety induced by the hypophysiotropic peptides corticotropin-releasing hormone (CRH, 1 mug, 0.2 nmol, icv), thyrotropin-releasing hormone (TRH, 100 mug, 275 nmol, icv) and luteinizing hormone-releasing hormone (LHRH, 1.5 mug, 1.3 nmol, icv) administered into the lateral ventricle of the brain (icv) of adult male rats of a Holtzman-derived colony (N = 15, each group). CRH induced an increase in total grooming scores, whereas LHRH, TRH and vehicle had no effect. CRH strongly increased face and head grooming and induced head shakes. The time spent in rearing and gnawing was significantly decreased. In the plus-maze, CRH reduced the time of exploration in the open arm. TRH increased face grooming and induced body shakes. LHRH had no effect on grooming or rearing behavior. No body or head shakes were observed after LHRH administration. Scoring of individual grooming elements demonstrated differences in action of the three peptides. Although both CRH and TRH increased face grooming, only CRH induced head grooming. Furthermore, CRH induced predominantly head shakes while TRH increased body shake activity. In contrast, CRH was anxiogenic and TRH appeared to induce stereotyped behavior. From the characterization of grooming elements and related responses, we conclude that each hypophysiotropic peptide induces a specific behavioral pattern.

Escritura descriptiva en demencia de tipo Alzheimer / Written discourse in dementia of Alzheimer type

En un grupo de pacientes con demencia de tipo Alzheimer se estudia el discurso escrito, pidiéndoles describir una escena completa. A medida que la demencia es más severa aparecen trastornos del contenido, defectos linguísticos y mecánicos. Los defectos mecánicos se refieren a agrafias apráxicas, reduplicaciones y defectos visuoespaciales, que se observan en las demencias más severas. Los defectos linguísticos de la escritura son más frecuentes que los trastornos del lenguaje oral; en los pacientes más avanzados se hace difícil su evaluación por los defectos mecánicos. Con respecto al contenido destaca la paulatina reducción en el número de ideas atingentes, pero también el aumento de ideas secundarias y la aparición de ideas no atingentes

Regulation of luteinizing hormone-releasing hormone and luteinizing hormone secretion by hypothalamic amino acids

1. The present review discusses the proposed roles of the amino acids glutamate and GABA in the central regulation of luteinizing hormone-releasing hormone (LHRH) and in luteinizing hormone (LH) secretion. 2. Descriptions of the mechanisms of action of these neurotransmitters have focused on two diencephalic areas, namely, the preoptic-anterior hypothalamic area where the cell bodies of LHRH neurons are located, and the medial basal hypothalamus which contains the nerve endings of the LHRH system. Increasing endogenous GABA concentration by drugs, GABA agonists, or blockade of glutamatergic neurotransmission by selective antagonists in rats and non-human primates prevents ovulation and pulsatile LH release, and blunts the LH surges induced by estrogen or an estrogen-progesterone combination. In contrast, glutamate and different glutamate agonists such as NMDA, AMPA and kainate, can increase LHRH/LH secretion. 3. The simultaneous enhancement of glutamatergic activity and a decrease of GABAergic tone may positively influence the maturation of the pituitary-gonadal system in rats and non-human primates. Administration of glutamate receptor agonists has been shown to significantly advance the onset of puberty. Conversely, glutamate antagonists or increased endogenous GABA levels may delay the onset of puberty. The physiological regulation of LHRH/LH secretion may thus involve a GABA-glutamate interaction and a cooperative action of the various types of ionotropic glutamate receptors. 4. The inhibitory actions of GABA on LH release and ovulation may be exerted at the level of afferent nerve terminals that regulate LHRH secretion. A likely candidate is noradrenaline, as suggested by the synaptic connections between noradrenergic nerve terminals and GABAergic interneurons in the preoptic area. Recent experiments have provided complementary evidence for the physiological balance between inhibitory and excitatory transmission resulting in modulation of the action of noradrenaline to evoke LHRH release.

Amnesias hipocampicas y mamilo-talamicas. / Hippocampal and mamillo-thalamic amnesias

Se presentan 4 pacientes con sindromes amnesicos: un caso postencefalitico, un caso de amnesia global transitoria, un ictus amnesico y un sindrome de Korsakoff nutricio-alcoholico. Se senala la asociacion entre la nocion de enfermedad y la ausencia de fabulaciones en las amnesias hipocampicas (postencefaliticas, ammnesia global transitoria y el ictus amnesico) y entre la anosognosia y la presencia de fabulaciones en el sindrome de Korsakoff nutricio-alcoholico, en que existen lesiones de cuerpos mamilares y de nucleos dorsomediales del talamo. Se senala que la relacion funcional entre anosognosia y fabulaciones tambien puede observarse en otros defectos neurologicos

Apraxias constructivas y otras alteraciones del dibujo. Parte II. / Constructive apraxia and other disturbances of drawing. Part II

Se analizan 22 casos que mostraban ausencia de programacion en la copia del dibujo Se concluye que este defecto se asocia a demencia severa, apraxia ideomotora y afasia mixta severa; en el ultimo caso la asociacion seria solo casual. Las lesiones que determinan este defectos son silvianas (100%) e izquierdas (95% de los casos)

Agnosia visual asociativa: un sindrome de desconexion. / Associative visual agnosia: a disconection syndrome

Se presenta un caso de infarto en el territorio de la arteria cerebral izquierda, con hemianopsia homonima derecha, negligencia espacial unilateral, mal manejo de las relaciones espaciales, moderado defecto perceptual visual y una desconexion viso-tactil y viso-verbal. La desconexion viso-verbal corresponderia a lo que clasicamente se ha llamado agnosia visual asociativa. Para explicarnos estos defectos se supone que debe existir una lesion adicional entre areas visuales y somestesicas del hemisferio derecho, que no se visualiza en la escanografia cerebral. Se hace hincapie en la necesidad de buscar en forma dirigida los sindromes de desconexion