Can we screen for heart disease in children at public health centres? A multicentre observational study of screening for heart disease with a risk of sudden death in children.

Sudden cardiac death in children is a rare event, but of great social significance. Generally, it is related to heart disease with a risk of sudden cardiac death (SCD), which may occur with cardiovascular symptoms and/or electrocardiographic markers; thus, a primary care paediatrician (PCP) could detect them. Therefore, we proposed a study that assesses how to put into practice and conduct a cardiovascular assessment within the routine healthy-child check-ups at six and twelve years of age; that reflects cardiovascular signs and symptoms, as well as the electrocardiographic alterations that children with a risk of SCD in the selected population present; and that assesses the PCP's skill at electrocardiogram (ECG) interpretation. In collaboration with PCPs, primary care nurses, and paediatric cardiologists, an observational, descriptive, multicentre, cross-sectional study was carried out in the Balearic Islands (Spain), from April 2021 to January 2022, inclusive. The PCPs gathered patient data through forms (medical record, electrocardiogram, and physical examination) and sent them to the investigator, together with the informed consent document and electrocardiogram. The investigator passed the electrocardiogram on to the paediatric cardiologists for reading, in an identical form to those the paediatricians had filled in. The variables were collected, and a descriptive analysis performed. Three paediatric cardiologists, twelve PCPs, and nine nurses from seven public health centres took part. They collected the data from 641 patients, but 233 patients did not participate (in 81.11% due to the PCP's workload). Therefore, the study coverage was around 64%, representing the quotient of the total number of patients who participated, divided by the total number of patients who were eligible for the study. We detected 30 patients with electrocardiographic alterations compatible with SCD risk. Nine of these had been examined by a paediatric cardiologist at some time (functional murmur in 8/9), five had reported shortness of breath with exercise, and four had reported a family history of sudden death. The physical examination of all the patients whose ECG was compatible with a risk of SCD was normal. Upon analysing to what extent the ECG results of the PCP and the paediatric cardiologist agreed, the percentage of agreement in the final interpretation (normal/altered) was 91.9%, while Cohen's kappa coefficient was 31.2% (CI 95%: 13.8-48.6%). The sensitivity of the ECG interpretation by the PCP to detect an ECG compatible with a risk of SCD was 29% and the positive predictive value 45%.     Conclusions: This study lays the foundations for future SCD risk screening in children, performed by PCPs. However, previously, it would be important to optimise their training in reading and interpreting paediatric ECGs. What is Known: • In Spain at present, there is a programme in place to detect heart disease with a risk of sudden death [1], but it targets only children who are starting on or are doing a physical activity as a federated sport. Implementing such screening programmes has proven effective in several countries [2]. However, several studies showed that the incidence of sudden cardiac death is no higher in children competing in sport activities than in those who do not do any sport [3]. This poses an ethical conflict, because at present, children who do not do any federated sport are excluded from screening. According to the revised literature, so far, only in two studies did they screen the child population at schools, and in both, they successfully detected patients with heart disease associated to the risk of sudden death [4, 5]. We have found no studies where the screening of these features was included within the routine healthy-child check-ups by primary care paediatricians. What is New: • We did not know whether-in our setting, at present-the primary care paediatrician could perform a screening method within the routine healthy-child check-ups, in order to detect presumably healthy children at risk of sudden cardiac death, as they present one of the SCD risks. In this regard, we proposed our project: to assess how to put into practice and conduct a cardiovascular assessment via SCD risk screening in the healthy child population by primary care paediatricians and appraise primary care paediatricians' skills in identifying the electrocardiographic alterations associated with SCD risk. The ultimate intention of this pilot study was to make it possible, in the future, to design and justify a study aimed at universalising cardiovascular screening and achieving a long-term decrease in sudden cardiac death events in children.

Neuromodulator hydrogen sulfide attenuates sickness behavior induced by lipopolysaccharide.

Sickness behavior reflects a state of altered physiology and central nervous system function that occurs during systemic infection or inflammation, serving as an adaptive response to illness. This study aims to elucidate the role of hydrogen sulfide (H2S) in regulating sickness behavior and neuroinflammatory responses in a rat model of systemic inflammation. Adult male Wistar rats were treated with lipopolysaccharide (LPS) to induce sickness behavior. Intracerebroventricular (i.c.v.) pretreatments included aminooxyacetic acid (AOAA), an inhibitor of H2S synthesis, and sodium sulfide (NaHS), an H2S donor. Behavioral assays were conducted, along with the assessment of astrocyte activation, as indicated by GFAP expression in the hypothalamus. Pretreatment with NaHS mitigated LPS-induced behavioral changes, including hypophagia, social and exploratory deficits, without affecting peripheral cytokine levels, indicating a central modulatory effect. AOAA, conversely, accentuated certain behavioral responses, suggesting a complex role of endogenous H2S in sickness behavior. These findings were reinforced by a lack of effect on plasma interleukin levels but significant reduction in GFAP expression. Our findings support the central role of H2S in modulating neuroinflammation and sickness behavior, highlighting the therapeutic potential of targeting H2S signaling in neuroinflammatory conditions.

Influence of maternal immune activation on autism-like symptoms and coping strategies in male offspring.

Maternal immune activation (MIA) caused by exposure to pathogens or inflammation during critical periods of gestation increased susceptibility to neurodevelopmental disorders, including autism, in the offspring. In the present work, we aimed to provide characterization of the long-term consequences on anxiety-like behavior and cardiovascular stress response of MIA in the offspring. This study aimed to evaluate the effect of MIA by lipopolysaccharide (LPS) in adult male offspring. In our study, the animals were subjected to a range of behavioral and physiological tests, including the elevated plus maze, social interaction, cat odor response, open field behavior, contextual fear conditioning, and cardiovascular responses during restraint stress. In the offspring of MIA, our study unveiled distinct anxious behaviors. This was evident by fewer entries into the open arms of the maze, diminished anti-thigmotaxis in the open field, and a decrease in social interaction time. Moreover, these rats showed heightened sensitivity to cat odor, exhibited prolonged freezing during fear conditioning, and presented elevated 22 Hz ultrasonic vocalizations. Notably, during restraint stress, these animals manifested an augmented blood pressure response, and this was associated with an increase in c-fos expression in the locus coeruleus compared to the control group. These findings collectively underline the extensive behavioral and physiological alterations stemming from MIA. This study deepens our understanding of the significance of maternal health in predisposing offspring to neurobehavioral deficits and psychiatric disorders.

Litter reduction-induced obesity promotes early depressive-like behavior and elevated prefrontal cortex GFAP expression in male offspring.

AIMS: The present study was developed to investigate how litter reduction-induced obesity promotes early depressive-related behaviors in rodent offspring. MAIN METHODS: We employed a standardized litter size reduction protocol, dividing litters into groups: normal litters (NL), consisting of six males and six females pups and small litters (SL), comprising two males and two females pups. Maternal behavior was monitored during the initial week of lactation. Subsequently, we assessed the pups for weight gain, locomotor activity, social play behavior, and performance in forced swimming test. We further evaluated the weights of retroperitoneal and perigonadal fat tissues, along with the expression of glial fibrillary acidic pprotein (GFAP) in the hippocampus and prefrontal cortex of the offspring. KEY FINDINGS: Our results indicated that litter size reduction led to an increased the maternal behavior. In contrast, offspring from the SL group displayed greater weight gain and increased, retroperitoneal and perigonadal fat. Both male and female rodents in the SL group exhibited decreased social play behavior, and male offspring spent more time immobile during the forced swimming test, suggesting a depressive-like phenotype. Notably, we observed an increase in the GFAP expression in the prefrontal cortex of male rodents, with a trend toward increased expression in the hippocampus. SIGNIFICANCE: Obesity may facilitate the development of early depressive-like behaviors, potentially associated with elevated GFAP expression in the prefrontal cortex.

Barreras para las actividades de investigación en los programas de residencia: estudio de métodos mixtos / Barriers for research activities in residency programs: A mix-methods study

Introducción Las actividades de investigación tienen un impacto positivo en el rendimiento de los médicos residentes. Falta información sobre investigaciones desarrolladas por residentes de países en vías de desarrollo. Nuestro objetivo fue evaluar las barreras y facilitadores para la investigación en programas de residencia en una Facultad de Medicina de América Latina. Métodos Se llevó a cabo un diseño de estudio de metodología mixta. Utilizamos un enfoque de teoría fundamentada para la fase cualitativa, recopilando los datos a través de entrevistas semiestructuradas y grupos focales con profesores y residentes. Para la fase cuantitativa, se administraron encuestas a residentes y profesores. Para evaluar las propiedades psicométricas de las encuestas utilizamos análisis factorial y scree plot (validez); alfa de Cronbach y coeficiente de Correlación Intraclase (confiabilidad). Resultados Se realizaron grupos focales que incluyeron diez profesores y quince residentes, y se identificaron los siguientes dominios: a) facilitadores para la participación de los residentes, b) barreras, c) estrategias para introducir la investigación en el currículo, d) argumentos que respaldan las actividades de investigación durante la residencia, y e) perfil de los residentes motivados en la investigación. Tanto los residentes como el profesorado identificaron la falta de tiempo protegido y la ausencia de tutoría adecuada como las principales barreras. Se encontró una brecha de género relacionada con las publicaciones internacionales (34% vs 66% mujeres/hombres), las mujeres percibieron que las actividades de investigación 'compiten con otras actividades' (OR: 2.04, IC 95% 1.03 a 4.07). Conclusiones Los residentes y profesores de una universidad latinoamericana de alta productividad valoran mucho la investigación. La presencia de brecha de género, la falta de tiempo protegido y de tutorías destacan como las principales barreras. Las estrategias propuestas para mejorar la investigación dentro de los programas de residencia son: establecer un programa de tutoría interdisciplinario entre residentes e investigadores; promover las rotaciones electivas; y premiar propuestas que consideren la equidad de género.

Introduction Research activities have a positive impact on the performance of residents. However, information on research conducted by residents from developing countries is scarce. Our study sought to identify the barriers and facilitators for developing research in medical residency programs in a Latin-American faculty of medicine. Methods A mixed methodology study design was carried out. We used a grounded theory approach for the qualitative phase, collecting data through semi-structured interviews and focus groups with faculty and residents. For the quantitative phase, surveys were administered to residents and teachers. We used factor analysis and scree plot (validity), Cronbach's alpha, and Intraclass correlation coefficient (reliability) to evaluate the surveys' psychometric properties. Results Focus groups involving ten faculty members and 15 residents were conducted, and the following domains were identified: a) facilitators for resident participation, b) barriers, c) strategies for introducing research into the curriculum, d) arguments supporting research activities throughout medical residency, and e) profile of research-motivated residents. Both residents and faculty members identified a lack of protected time and adequate mentoring as the major barriers. A gender gap was found related to international publications (34% vs. 66% women/men); women perceived that research activities 'compete with other activities' (OR: 2.04, 95% CI 1.03 to 4.07). Conclusions Research is highly valued by both residents and faculty members at a Latin-American university with a strong academic output. Major barriers to promoting research in this context include lack of protected time and effective mentoring, and gender gaps. Strategies proposed to improve research within medical residency programs include: establishing an interdisciplinary mentoring program between residents and researchers, promoting elective rotations, and rewarding proposals that consider gender equity.

Barriers for research activities in residency programs: A mix-methods study.

Introduction: Research activities have a positive impact on the performance of residents. However, information on research conducted by residents from developing countries is scarce. Our study sought to identify the barriers and facilitators for developing research in medical residency programs in a Latin-American faculty of medicine. Methods: A mixed methodology study design was carried out. We used a grounded theory approach for the qualitative phase, collecting data through semi-structured interviews and focus groups with faculty and residents. For the quantitative phase, surveys were administered to residents and teachers. We used factor analysis and scree plot (validity), Cronbach's alpha, and Intraclass correlation coefficient (reliability) to evaluate the surveys' psychometric properties. Results: Focus groups involving ten faculty members and 15 residents were conducted, and the following domains were identified: a) facilitators for resident participation, b) barriers, c) strategies for introducing research into the curriculum, d) arguments supporting research activities throughout medical residency, and e) profile of research-motivated residents. Both residents and faculty members identified a lack of protected time and adequate mentoring as the major barriers. A gender gap was found related to international publications (34% vs. 66% women/men); women perceived that research activities 'compete with other activities' (OR: 2.04, 95% CI 1.03 to 4.07). Conclusions: Research is highly valued by both residents and faculty members at a Latin-American university with a strong academic output. Major barriers to promoting research in this context include lack of protected time and effective mentoring, and gender gaps. Strategies proposed to improve research within medical residency programs include: establishing an interdisciplinary mentoring program between residents and researchers, promoting elective rotations, and rewarding proposals that consider gender equity.

Introducción: Las actividades de investigación tienen un impacto positivo en el rendimiento de los médicos residentes. Falta información sobre investigaciones desarrolladas por residentes de países en vías de desarrollo. Nuestro objetivo fue evaluar las barreras y facilitadores para la investigación en programas de residencia en una Facultad de Medicina de América Latina. Métodos: Se llevó a cabo un diseño de estudio de metodología mixta. Utilizamos un enfoque de teoría fundamentada para la fase cualitativa, recopilando los datos a través de entrevistas semiestructuradas y grupos focales con profesores y residentes. Para la fase cuantitativa, se administraron encuestas a residentes y profesores. Para evaluar las propiedades psicométricas de las encuestas utilizamos análisis factorial y scree plot (validez); alfa de Cronbach y coeficiente de Correlación Intraclase (confiabilidad). Resultados: Se realizaron grupos focales que incluyeron diez profesores y quince residentes, y se identificaron los siguientes dominios: a) facilitadores para la participación de los residentes, b) barreras, c) estrategias para introducir la investigación en el currículo, d) argumentos que respaldan las actividades de investigación durante la residencia, y e) perfil de los residentes motivados en la investigación. Tanto los residentes como el profesorado identificaron la falta de tiempo protegido y la ausencia de tutoría adecuada como las principales barreras. Se encontró una brecha de género relacionada con las publicaciones internacionales (34% vs 66% mujeres/hombres), las mujeres percibieron que las actividades de investigación 'compiten con otras actividades' (OR: 2.04, IC 95% 1.03 a 4.07). Conclusiones: Los residentes y profesores de una universidad latinoamericana de alta productividad valoran mucho la investigación. La presencia de brecha de género, la falta de tiempo protegido y de tutorías destacan como las principales barreras. Las estrategias propuestas para mejorar la investigación dentro de los programas de residencia son: establecer un programa de tutoría interdisciplinario entre residentes e investigadores; promover las rotaciones electivas; y premiar propuestas que consideren la equidad de género.

Perinatal exposure to glyphosate-based herbicides induced neurodevelopmental behaviors impairments and increased oxidative stress in the prefrontal cortex and hippocampus in offspring.

Glyphosate is the organophosphate pesticide most widely used in the world. Recent studies correlate exposure to glyphosate and the emergence of neurodevelopmental disorders. Therefore, it was objective to propose a rat model of perinatal exposure to glyphosate-based herbicides (GBH) to study associated neurodevelopmental disorders. Behavioral aspects and brain pathways were assessed in the prepubertal phase. For this, maternal treatment occurred throughout the entire gestation period (from GD0) until weaning on postnatal day 22 (PND 22). Control group received oral gavage with 5 mL/kg of saline per day and GBH group received oral gavage with 50 mg/kg of GBH per day (n = 10 per group). Maternal behavior was evaluated in PND 2-6. Offspring were evaluated for quantification of ultrasonic vocalizations (PND 5); homing behavior test (PND 13); and hole board, social play behavior, open field, and object recognition tests (PND 28-32). Prefrontal cortex and hippocampus of the offspring were processed to evaluate oxidative stress. Maternal exposure to GBH impaired early social communication, olfactory discrimination, social play behavior, and the exploration of objects, in addition to increasing repetitive and stereotyped movements. GBH also increased oxidative stress. Therefore, perinatal GBH exposure induced behavioral and oxidative stress impairments in rats associated with neurodevelopmental disorders. The manifestations found in the offspring are in accordance with symptoms of autism spectrum disorder.

Design, synthesis, and biological evaluation of new thalidomide-donepezil hybrids as neuroprotective agents targeting cholinesterases and neuroinflammation.

A new series of eight multifunctional thalidomide-donepezil hybrids were synthesized based on the multi-target-directed ligand strategy and evaluated as potential neuroprotective, cholinesterase inhibitors and anti-neuroinflammatory agents against neurodegenerative diseases. A molecular hybridization approach was used for structural design by combining the N-benzylpiperidine pharmacophore of donepezil and the isoindoline-1,3-dione fragment from the thalidomide structure. The most promising compound, PQM-189 (3g), showed good AChE inhibitory activity with an IC50 value of 3.15 µM, which was predicted by docking studies as interacting with the enzyme in the same orientation observed in the AChE-donepezil complex and a similar profile of interaction. Additionally, compound 3g significantly decreased iNOS and IL-1ß levels by 43% and 39%, respectively, after 24 h of incubation with lipopolysaccharide. In vivo data confirmed the ability of 3g to prevent locomotor impairment and changes in feeding behavior elicited by lipopolysaccharide. Moreover, the PAMPA assay evidenced adequate blood-brain barrier and gastrointestinal tract permeabilities with an Fa value of 69.8%. Altogether, these biological data suggest that compound 3g can treat the inflammatory process and oxidative stress resulting from the overexpression of iNOS and therefore the increase in reactive nitrogen species, and regulate the release of pro-inflammatory cytokines such as IL-1ß. In this regard, compound PQM-189 (3g) was revealed to be a promising neuroprotective and anti-neuroinflammatory agent with an innovative thalidomide-donepezil-based hybrid molecular architecture.

Curcumin attenuates LPS-induced sickness behavior and fever in rats by modulating Nrf2 activity.

Lipopolysaccharide (LPS) is a potent inducer of inflammation, triggering behavioral changes and fever. The present study aimed to evaluate whether pretreatment with curcumin prevents the behavioral changes and fever induced by LPS through the modulation of nuclear factor-erythroid 2 related factor 2 (Nrf2). Male Wistar rats received either vehicle or LPS and after 2 h, the behavioral responses were assessed through open field test (OFT), social interaction test, forced swim test (FST), and food intake assessment. The febrile response was assessed by telemetry after vehicle or LPS injection to evaluate the effect of curcumin on the thermoregulatory response during the immunological challenge. The pretreatment with curcumin at doses of 50 and 100 mg/kg prevented the reduction of distance traveled on OFT, increased the immobility time of FST, impaired social withdrawal, decreased food intake, and induced fever. In addition, at these doses, it was possible to observe a significant decrease in the plasma levels of cytokines and an increase in Nrf2 translocation to the cell nucleus during the immunological challenge. Our data provide further evidence of curcumin's ability to prevent LPS-induced sickness behavior and fever possibly by a mechanism related to the modulation of Nrf2 translocation.

Maternal overweight induced by reduced litter size impairs the behavioral neurodevelopment of offspring.

AIMS: We assessed the influence of maternal overweight on the behavioral neurodevelopment of male and female offspring in prepubertal age by reducing the litter size. MAIN METHODS: To reduce litter size in Wistar rats, the offspring of generation 0 (G0) were culled for 12 pups (6 males and 6 females: normal litter, NL-G1) or 4 pups (2 males and 2 females: small litter, SL-G1). In G1 dams, overweight was characterized, maternal behavior and locomotor activity were assessed. At G2, we quantified the ultrasonic vocalizations in post-natal day 5 (PND5); we evaluated olfactory discrimination in the homing behavior test on PND13; and in PND28-32 (prepubertal age), we performed the following tests: social play behavior, hole board, object recognition, and open field. At the end of the experiments, hippocampus and prefrontal cortex were dissected to quantify the synaptophysin by western blotting. KEY FINDINGS: Our data demonstrated that a reduction in litter size was able to induce maternal overweight without altering the parameters related to overweight in the offspring. The SL-G2 offspring showed deficits in early social communication, olfactory discrimination, social play behavior, and the exploration of objects, in addition to increasing repetitive and stereotyped movements. There were also changes in the synaptophysin levels in the hippocampus and prefrontal cortex of the offspring from reduced litter dams. In conclusion, maternal overweight caused by litter reduction impairs behavioral neurodevelopment, inducing autism-like symptoms in the offspring. SIGNIFICANCE: This study alerts the public about the negative consequences of maternal overweight in the descendants.

Anxiety-like behavior and neuroendocrine changes in offspring resulting from gestational post-traumatic stress disorder.

Exposure to stressful environmental events during the perinatal period can increase vulnerability to psychopathologies that cause neuroendocrine changes associated with deficits in emotional behavior that can appear early in life. Post-traumatic stress disorder (PTSD) is a frequent, chronic, and disabling disorder that negatively impacts the emotional, social, and cognitive behaviors of affected individuals. Thus, we induced PTSD in pregnant rats by applying inescapable footshocks and then investigated the behavioral parameters similar to anxiety in offspring at prepubertal age, in addition to the plasma levels of maternal and offspring corticosterone and expression of glucocorticoid receptors (GR) in the offspring's hippocampus. With the dams, maternal behavior, open field, and object recognition tests were performed. With the male and female offspring, we performed the following: quantification of ultrasonic vocalizations, elevated plus-maze test, evaluation of exploratory activity in the open field, and hole board test, as well as plasma corticosterone measurements and Western blotting for GR. Our results showed that gestational PTSD affected maternal behavior, led to anxiety-like symptoms, increased corticosterone levels, and increased GR expression in the offspring's hippocampus. Therefore, our data can contribute to the understanding of the onset of early (childhood and juvenile/pre-pubertal phases) anxiety owing to exposure to a traumatic event during the gestation period.

Neonatal overnutrition programming impairs cholecystokinin effects in adultmale rats.

Overfeeding and rapid weight gain during early life are risk factors for the development of obesity in adulthood. This metabolic malprogramming may be mediated by endocrine disturbances during critical periods of development. Cholecystokinin (CCK) acts on the central nervous system by elevating thermogenesis and the activity of anorectic neurons, modulating overall energy balance. Therefore, we tested the hypothesis that postnatal overfeeding impaired CCK effects. Pups were raised in either a litter of three (neonatal overnutrition/small litter group) or 12 (controls/normal litter group) pups per dam to study the effects of postnatal overfeeding on the central and peripheral CCK systems in adulthood. Rats raised in small litters became overweight during lactation and remained overweight as adults, with increased adiposity and plasma levels of lipids, glucose, insulin, and leptin. Neonatally over-nourished rats showed attenuation of gastric emptying and anorexigenic response to CCK, suggesting that offspring from the SL group may present CCK resistance as adult male rats. Consistent with this idea, overweight rats displayed impaired central response in c-Fos immunoreactivity on the nucleus tractus solitarius, area postrema, paraventricular nucleus, central amygdala, arcuate nucleus, and dorsomedial hypothalamus in response to peripheral CCK at adulthood. The small litter group of adult male rats also exhibited reduced norepinephrine- and CCK-stimulated thermogenesis. Unresponsiveness to the effects of CCK may contribute to overweight and metabolic dysfunctions observed in postnatally over-nourished adult rats. Thus, the involvement of an impaired CCK system, among other neurohormonal failures, may contribute to the development of obesity.

Percepción del ambiente educacional en estudiantes de pregrado de la carrera de Kinesiología: metodología mixta / Educational environment perception in Physiotherapy undergraduate students: Mixed methodology

ANTECEDENTES Y OBJETIVOS: El ambiente educacional (AE) ha cobrado relevancia en las últimas décadas debido al impacto que produce en el proceso de aprendizaje, vida social y futuro laboral de los estudiantes. El objetivo de este proyecto es medir la percepción del AE en estudiantes de pregrado de la carrera de Kinesiología de la Pontificia Universidad Católica de Chile. MÉTODOS: Se utilizó metodología mixta. Componente cuantitativo: se aplicó el cuestionario Dundee Ready Education Environment Measure (DREEM) del 1.er al 4.° año. Componente cualitativo: con base en el análisis de preguntas abiertas. Se describen los ítems, dominios y puntaje global del DREEM mediante promedios y desviación estándar. Análisis estadísticos con t de Student para muestras independientes y ANOVA (más de 2 cohortes). Los datos cuantitativos fueron analizados usando el software SPSS y los datos cualitativos (teoría fundada) mediante software Atlas.ti®. Por último, se procedió a la triangulación de la información de ambas fuentes. RESULTADOS: Un total de 295 de un universo de estudiantes de 362 contestaron los cuestionarios (81%). El promedio global del cuestionario DREEM fue de 135,74 ± 19,15, lo que revela un AE «más positivo que negativo». La mayor fortaleza fue la percepción de la calidad de los docentes (73%) y el dominio con más baja percepción fue la atmósfera (63%). Los datos cualitativos permitieron complementar y enriquecer los resultados. No se encontraron diferencias significativas en la percepción del AE entre hombres y mujeres. CONCLUSIONES: La medición del AE permitió identificar las principales fortalezas y aspectos por mejorar, lo cual servirá de base para un futuro plan de mejoramiento, autoevaluación y proceso de acreditación

BACKGROUND AND OBJECTIVES: The educational environment (EE) has become relevant in the past decades, due to the impact it has on the learning process, social life, and future professional work of the students. The aim of this study is to measure the perception of the EE in undergraduate students of the Kinesiology course in the Pontificia Universidad Católica de Chile. METHODS: Mix methodology was used. Quantitative component: the DREEM (Dundee Ready Education Environment Measure) questionnaire was completed by 1st to 4th year students. Qualitative field: based on open question analysis. The items, domains and overall score of the DREEM are described by the mean and standard deviation. Statistical analysis was performed using the Student-t test for independent samples and ANOVA (more than 2 cohorts). The quantitative data was analysed using SPSS software, and the qualitative data (grounded theory) by Atlas.ti® software. The information from both sources was triangulated. RESULTS: A total of 295 students out of 362 completed the questionnaires (81%). The overall mean of the DREEM questionnaire was 135.74±19.15, revealing a «more positive than negative» EE. The major strength was the perception of the teacher quality (73%), and the domain with the lowest perception was the atmosphere (63%). The qualitative data was used to complement and enrich the results. No significant difference was found in the perception of EE between men and women. CONCLUSIONS: EE measurement was able to identify the main strengths and aspects to improve. This could serve as the basis for a future improvement plan, self-evaluation, and accreditation process

Metabolic syndrome accentuates post-traumatic stress disorder-like symptoms and glial activation.

The relationship between individuals with post-traumatic stress disorder (PTSD) and the development of metabolic syndrome (MS) is well understood, but the relationship between individuals with preexisting MS and the development of PTSD is not yet known. Therefore, we evaluated the course of PTSD development in preexisting MS rats and we quantified the glial fibrillary acidic protein (GFAP) and ionized the calcium binding adaptor molecule 1 (Iba-1) in the cortex and hippocampus of the experimental animals. Male Wistar rats were divided into two groups: control or 10 % fructose for 5 weeks. After 5 weeks of MS induction, a group of animals was used to characterize MS. In another group, after 5 weeks of MS induction, animals were exposed to or not exposed to inescapable footshocks, followed by social isolation. After 14 days of a retention interval, the animals were re-exposed to the inescapable footshocks box, and the freezing time was evaluated. Over the following days, the animals were tested using the open field, social interaction and forced swimming tests, respectively. In another group of animals, after induction of MS and PTSD as previously described, elevated plus maze and object recognition tests were performed. Our results demonstrate that fructose solution for 5 weeks was able to induce MS, and animals with MS had more pronounced PTSD-like symptoms and a greater increase in GFAP and Iba-1 in the hippocampus and prefrontal cortex. In conclusion, MS accentuated PTSD-like symptoms that may be related to increased glial activation. This study helps reveal factors that may predispose individuals to the development of PTSD, such as metabolic disorders.

Efecto de la cáscara o pulpa de Solanum Tuberosum sobre el peso de órganos y estrés oxidativo hepático en ratas obesas / Effect of Solanum Tuberosum peel or pulp on organ weight and hepatic oxidative stress in obese rats

RESUMEN Con el objetivo de determinar el efecto del consumo de harina de cáscara o harina de pulpa de dos variedades de Solanum tuberosum (papa Yungay y papa Canchán) sobre la acumulación de tejido adiposo, peso de órganos y estrés oxidativo en hígado de ratas realizamos un estudio experimental en 24 ratas Holtzman obesas, divididos en cuatro grupos y, sometidas a dietas que contenían 10% de harina de las dos variedades de papa. Los grupos fueron T1: cáscara Yungay, T2: pulpa Yungay; T3: cáscara Canchán; y T4: pulpa Canchán. Al finalizar, se sacrificaron todos los animales para registrar los pesos de órganos y tejido adiposo, y extraer muestras para determinar la actividad enzimática de superóxido dismutasa y catalasa en el hígado. El grupo de ratas obesas que consumió pulpa de variedad Yungay tuvo menor estrés oxidativo en el hígado; además, independientemente de la parte de tubérculo consumido, esta variedad redujo el peso de los riñones.

ABSTRACT This study aimed to determine the effect of the consumption of peel flour or pulp flour from two varieties of Solanum tuberosum (Yungay potato and Canchán potato) on the accumulation of adipose tissue, organ weight, and oxidative stress in the liver of rats. We carried out an experimental study in 24 obese Holtzman rats, divided into four groups and subjected to diets containing 10% flour from both varieties of potato. The groups were T1: Yungay peel; T2: Yungay pulp; T3: Canchán peel; and T4: Canchán pulp. When the study was completed, all the animals were slaughtered to record the weights of organs and adipose tissue and to extract samples to determine the enzyme activity of superoxide dismutase and catalase in the liver. The group of obese rats that consumed the pulp of the Yungay variety had less oxidative stress in the liver. Also, regardless of the tuber part consumed, this variety reduced the weight of the kidneys.

[Effect of Solanum Tuberosum peel or pulp on organ weight and hepatic oxidative stress in obese rats]. / Efecto de la cáscara o pulpa de Solanum Tuberosum sobre el peso de órganos y estrés oxidativo hepático en ratas obesas.

This study aimed to determine the effect of the consumption of peel flour or pulp flour from two varieties of Solanum tuberosum (Yungay potato and Canchán potato) on the accumulation of adipose tissue, organ weight, and oxidative stress in the liver of rats. We carried out an experimental study in 24 obese Holtzman rats, divided into four groups and subjected to diets containing 10% flour from both varieties of potato. The groups were T1: Yungay peel; T2: Yungay pulp; T3: Canchán peel; and T4: Canchán pulp. When the study was completed, all the animals were slaughtered to record the weights of organs and adipose tissue and to extract samples to determine the enzyme activity of superoxide dismutase and catalase in the liver. The group of obese rats that consumed the pulp of the Yungay variety had less oxidative stress in the liver. Also, regardless of the tuber part consumed, this variety reduced the weight of the kidneys.

Con el objetivo de determinar el efecto del consumo de harina de cáscara o harina de pulpa de dos variedades de Solanum tuberosum (papa Yungay y papa Canchán) sobre la acumulación de tejido adiposo, peso de órganos y estrés oxidativo en hígado de ratas realizamos un estudio experimental en 24 ratas Holtzman obesas, divididos en cuatro grupos y, sometidas a dietas que contenían 10% de harina de las dos variedades de papa. Los grupos fueron T1: cáscara Yungay, T2: pulpa Yungay; T3: cáscara Canchán; y T4: pulpa Canchán. Al finalizar, se sacrificaron todos los animales para registrar los pesos de órganos y tejido adiposo, y extraer muestras para determinar la actividad enzimática de superóxido dismutasa y catalasa en el hígado. El grupo de ratas obesas que consumió pulpa de variedad Yungay tuvo menor estrés oxidativo en el hígado; además, independientemente de la parte de tubérculo consumido, esta variedad redujo el peso de los riñones.

Bloqueo del elevador de la espina (ESP) para analgesia posoperatoria en mastectomía radical total: reporte de caso / Erector spinae plane (ESP) block for postoperative analgesia in total radical mastectomy: case report

Abstract Case report: A 50-year-old female patient with an 8-year history of amass in the right breast which has undergone rapid progressive growth, involving the entire breast, over the past 7 months, diagnosed as a phyllodes tumor. Simple right mastectomy with axillary lymph node dissection and pectoralis major fascia resection were performed under general anesthesia. Ultrasound-guided erector spinae plane block was performed for postoperative analgesia, with excellent response up to 18hours following the procedure, and no need for additional opioids. There were no adverse effects or complications associated with the block. Conclusions: Ultrasound-guided erector spinae block is a fast and safe procedure that may be used as a valuable adjunct to ensure postoperative analgesia in radical mastectomy cases, which pose a challenge in terms of pain control. Moreover, it offers an advantage in terms of reduced opioid requirement in these patients.

Resumen Caso clínico: Se presenta el caso de una paciente de 50 años con cuadro clínico de 8 años de evolución de masa en mama derecha la cual en los últimos 7 meses muestra un crecimiento rápido y progresivo que ocupa toda la mama, hacen diagnóstico de tumor phylloides. Realizan mastectomía derecha simple más vaciamiento ganglionar axilary resección de fascia pectoral mayor bajo anestesia general. Se efectúa bloqueo del elevador de la espina guiado por ultrasonido con fines analgésicos en el posoperatorio, obteniéndose una excelente respuesta hasta 18 horas posterior al procedimiento, sin necesidad de consumo de opioides, no se registraron efectos adversos o complicaciones relacionadas con el bloqueo. Conclusiones: El bloqueo del elevador de la espina ecoguiado es un procedimiento rápido y seguro que puede ser una herramienta valiosa para asegurar la analgesia posoperatoria en mastectomías radicales que generan un desafío en control del dolor, además de la ventaja de disminución de consumo de opioides en estas pacientes.

Tromboembolismo pulmonar de alto riesgo e isquemia cerebral aguda: presentación de caso / High-risk pulmonary thromboembolism in patients with acute cerebral ischemia: case report

La presentación de tromboembolismo pulmonar de alto riesgo en paciente con evento isquémico cerebral agudo, a pesar de ser infrecuente, implica alto riesgo de morbimortalidad y un reto para el clínico respecto a su manejo. La trombolisis como manejo inicial está contraindicada dado el riesgo incrementado de sangrado intracraneal, por tal motivo deben plantearse otras terapias alternativas de reperfusión. Presentamos el caso de una paciente de 45 años con cuadro clínico de seis meses de evolución dado por cefalea en quien se diagnosticó aneurisma del segmento cavernoso de la arteria carótida interna izquierda, sometiéndose a embolización y presentando migración de múltiples trombos desde posición proximal de stent, con trombolisis fallida y desarrollo de isquemia hemisférica ipsilateral; quien posteriormente presenta tromboembolismo pulmonar de alto riesgo, manejado mediante tromboaspiración y trombolisis farmacológica selectiva guiada por catéter e implantación de filtro de vena cava inferior. La trombolisis farmacológica selectiva guiada por catéter constituye la estrategia de reperfusión con la mejor relación riesgo/beneficio en el contexto de isquemia cerebral aguda y tromboembolismo pulmonar de alto riesgo. Asimismo, es posible utilizar otras alternativas para disminuir el riesgo de recurrencia, tales como los filtros venosos y la compresión neumática intermitente..(AU)

The presence of high risk pulmonary thromboembolism in a patient with an acute cerebral ischemic event, although infrequent, poses a high risk of morbimortality and a challenge in its handling. The Thrombolysis as a first treatment is contraindicated given the risk of high intracranial bleeding. For this reason, it is important to propose alternative reperfusion treatments. We present the case of a 45 years old patient with a clinical picture of a six months follow up of headaches that was diagnosed with an aneurism of the cavernous segment of the internal left carotid artery, subjected to embolization and presenting migration of multiple thrombi from stent proximal end, with failed thrombolysis and the development of ipsilateral hemispheric ischemia; who later presents high risk pulmonary thromboembolism, handled through thromboaspiration and selective pharmacological thrombolysis guided by a catheter and the implementation of a filter in the inferior vena cava. The selective pharmacological thrombolysis guided by catheter makes up the strategy of reperfusion with the best risk/benefit rate in the context of acute cerebral ischemia and high risk pulmonary thromboembolism. Likewise, it is possible to use other treatments to lower the risk of recurrence, such as venous filters and intermittent pneumatic compression..(AU)

What makes a medical school socially accountable in Latin America? A report from a Latin American panel based on a qualitative approach.

BACKGROUND: Latin America is a region with huge health inequalities and a tremendous growth in the number of medical schools during the last decades. The role of the medical schools in reducing health inequality has not been systematically explored. METHODS: A qualitative framework method was used to explore the meaning, barriers, and facilitators of the concept of the social accountability of medical schools in Latin America. Twenty nine Latin American academic leaders from seven countries participated in an expert panel discussion. The Atlas ti.7 software was used to analyze the information. RESULTS: Social accountability was identified as a core dimension of the mission of medical schools. The panel identified a gradient of three dimensions associated with social accountability. First, a formative dimension related to student selection, curricular structure and community based learning initiatives. Second, a societal dimension associated with institutional mission, community partnerships, and social research projects. Third, a political dimension related with involvement in health policies and primary care engagement. Lack of accreditation standards was identified as a main barrier to improve social accountability. CONCLUSIONS: Latin American leaders consider that medical schools should develop specific formative, societal, and political initiatives in order to be socially accountable.

Evaluation of Radiology Teachers' Performance and Identification of the "Best Teachers" in a Residency Program: Mixed Methodology and Pilot Study of the MEDUC-RX32 Questionnaire.

RATIONALE AND OBJECTIVES: Radiology teachers are well trained in their specialty; however, when working in academic institutions, faculty development and promotion through the education pathway tends to be based on their teaching knowledge and skills. The aim of this study is to assess psychometric properties of the Medicina Universidad Católica-Radiology 32 items (MEDUC-RX32), an instrument designed to evaluate the performance of postgraduate radiology teachers and to identify the best teachers. MATERIALS AND METHODS: Mixed methodology was used, including qualitative and quantitative phases. The psychometric properties of the MEDUC-RX32 survey were performed by factor analysis (validity), Cronbach alpha coefficient, and G coefficient (reliability). The residents assessed their teachers and simultaneously voted for the "best teacher," which was used as a gold standard for the receiver operating characteristic curves construction comparing their votes with the global score. RESULTS: A total of 28 residents answered 164 surveys. The global score was 6.23 ± 0.8 (scale from 1 to 7). The factor analysis showed six domains of the resident's perception: (1) tutorial teaching, feedback, and independent learning; (2) communication and teamwork; (3) learning objectives; (4) respectful behavior; (5) radiological report; and (6) teaching and care support. The tutor's strengths were related with respectful behavior and teamwork. The instrument is highly reliable with a Cronbach alpha of 0.937 and a G coefficient of 0.831 (with a minimum of 8 residents). The MEDUC-RX32 instrument has a sensitivity of 91.7% and specificity of 83.3% to identify tutors as best teachers with at least one vote with an area under the receiver operating characteristic curve of 0.931 with a cutoff of 5.94. CONCLUSIONS: The MEDC-RX32 instrument is a multidimensional, valid, and highly reliable method to evaluate radiology teachers, identifying teachers with excellence in tutorial teaching in a postgraduate radiology program.