Crisis no epilépticas psicógenas: Semiología en una cohorte de pacientes de una unidad de epilepsia de referencia nacional en Lima, Perú / Non-epileptic psychogenic seizures: semiology in a patient's cohort from a national reference epilepsy unit in Lima, Peru

RESUMEN Objetivo : Describir la semiología de crisis no epilépticas psicógenas (CNEP) en pacientes diagnosticados mediante videoelectroencefalograma (VEEG) en un centro nacional de epilepsia. Material y métodos : Estudio observacional, descriptivo y retrospectivo que incluyó a pacientes mayores de 14 años, ingresados a monitoreo de telemetría en el Hospital Nacional Edgardo Rebagliati Martins en Lima, Perú, entre el 1 de enero de 2017 y el 31 de diciembre de 2022, y definitivamente diagnosticados con CNEP mediante VEEG. Resultados : La mayoría de los 26 pacientes (20 mujeres y 6 varones) presentó pérdida de postura con caída (92 %), así como una instauración gradual (88 %) y cursaron con algún grado de alteración de conciencia o responsividad durante el evento (73 %). Los signos motores más prevalentes fueron movimientos asincrónicos de tronco y/o extremidades (73 %), fluctuación en la actividad motora (73 %), temblor global o en extremidades (54 %) y cierre palpebral forzado (50 %). Las manifestaciones clínicas no motoras fueron, en su mayoría, síntomas subjetivos (34 %). La mayoría (73 %) presentó CNEP motoras (73 %), en comparación con otras manifestaciones no motoras (12 %) y mixtas (15 %). Conclusiones : Los eventos clínicos descritos fueron de larga duración e instauración gradual y mostraron alteraciones de conciencia/responsividad. Los signos clínicos motores más frecuentes fueron movimientos asincrónicos de tronco y/o extremidades, fluctuación motora, temblor y cierre palpebral forzado. Los hallazgos no motores fueron, en su mayoría, síntomas subjetivos. La mayoría de los pacientes presentaron CNEP motoras.

ABSTRACT Objective : To describe the semiology of Psychogenic Non-Epileptic Seizures (PNES) in patients diagnosed by video-electroencephalogram (VEEG) in a national epilepsy center. Methods : An observational, descriptive, and retrospective study of patients older than 14 years, admitted for telemetry monitoring at the Epilepsy Unit of the National Hospital Edgardo Rebagliati Martins in Lima, Peru, between January 1st, 2017, and December 31, 2022. A definitive diagnosis of PNES was reached through VEEG. Results : Twenty of 26 studied patients were female and 6 male. Most patients experienced loss of posture with falls (92%), gradual onset (88%), some degree of altered consciousness or responsiveness during the event (73%). The most prevalent motor signs included asynchronous movements of the trunk and/or extremities (73%), fluctuation in motor activity (73%), global or limb tremors (54%), and forced eyelid closure (50%). Non-motor signs were predominantly subjective symptoms (34%). Most of the patients presented motor PNES (73%) compared to non-motor (12%) and mixed (15%). Conclusions : The described clinical events had a prolonged duration, gradual onset, and altered levels of consciousness/responsiveness. The most frequent clinical motor signs were asynchronous movements of the trunk and/or extremities, motor fluctuation, tremors, and forced eyelid closure. Non-motor findings were, primarily, subjective symptoms. Most of the patients presented motor PNES.

Somatosensory Auras in Epilepsy: A Narrative Review of the Literature.

An aura is a subjective experience felt in the initial phase of a seizure. Studying auras is relevant as they can be warning signs for people with epilepsy. The incidence of aura tends to be underestimated due to misdiagnosis or underrecognition by patients unless it progresses to motor features. Also, auras are associated with seizure remission after epilepsy surgery and are an important prognostic factor, guiding the resection site and improving surgical outcomes. Somatosensory auras (SSAs) are characterized by abnormal sensations on one or more body parts that may spread to other parts following a somatotopic pattern. The occurrence of SSAs among individuals with epilepsy can range from 1.42% to 80%. The upper extremities are more commonly affected in SSAs, followed by the lower extremities and the face. The most common type of somatosensory aura is paresthetic, followed by painful and thermal auras. In the primary somatosensory auras, sensations occur more commonly contralaterally, while the secondary somatosensory auras can be ipsilateral or bilateral. Despite the high localizing features of somatosensory areas, cortical stimulation studies have shown overlapping sensations originating in the insula and the supplementary sensorimotor area.

Worked example como método de ensino da ausculta cardíaca pediátrica para estudantes de Medicina / Worked example as a method for teaching pediatric cardiac auscultation to Medical students

Resumo: Introdução: A performance e a acurácia da ausculta cardíaca de médicos recém-formados estão aquém do esperado, o que resulta em excesso de encaminhamentos para o cardiologista, solicitação de exames desnecessários e atraso diagnóstico. O desenvolvimento de metodologias de ensino eficazes é necessário para melhorar a ausculta cardíaca e a capacidade diagnóstica dos médicos recém-graduados. Objetivo: Este estudo teve como objetivo verificar a eficácia do uso da metodologia do worked example, comparada ao ensino tradicional de aulas expositivas da semiologia do aparelho cardiovascular. Método: Participaram do estudo 56 alunos do quarto ano da Universidade Federal de Minas Gerais. Trata-se de um estudo experimental que comparou a eficácia do modelo de ensino baseado na metodologia do worked example com a metodologia tradicional de aula expositiva sobre ausculta cardíaca pediátrica. Os alunos foram randomizados em grupo experimental e grupo de controle, e avaliados em fases distintas - pré-teste, pós-teste imediato e pós-teste tardio. Resultado: A partir da Análise de Variância de Medidas Repetidas, houve efeito significativo em ambos os métodos de treinamento quando se considerou a fase do estudo (p < 0,001). Os dois grupos obtiveram desempenhos semelhantes independentemente do método de treinamento (p = 0,863). Conclusão: A metodologia ativa conhecida como worked example pode ser tão eficaz quanto uma metodologia tradicional no ensino e aprendizagem da ausculta cardíaca pediátrica.

Abstract: Introduction: The cardiac auscultation performance of newly graduated physicians is below expectations, which results in excessive referrals to cardiologists, requests for unnecessary tests and delays in diagnosis. The development of effective teaching methodologies is necessary to improve cardiac auscultation and the diagnostic capacity of newly graduated physicians. Methods: 56 students from the 4th year of Federal University of Minas Gerais, Brazil, participated in an experimental study to compare the effectiveness of the pedagogical model based on the worked example methodology when compared to the traditional methodology of lectures on pediatric cardiac auscultation. The students were randomized into an experimental group and a control group and evaluated in different phases - pre-test, immediate post-test and later post-test. Results: From the Analysis of Variance of Repeated Measures, there was a significant effect observed in both training methods when considering the study phase (p < 0.001). Both groups obtained similar performances regardless of the training method (p = 0.863). Conclusion: This study suggests that an active methodology can be as effective as a traditional methodology in teaching and learning Pediatric Cardiac Auscultation.

Ensino do exame respiratório: o que é história e o que é necessidade? / Teaching the respiratory physical examination: what is history and what is needed?

A semiologia é uma das técnicas mais utilizadas na prática médica há séculos. Ensinada por meio de roteiros sistematizados, estudantes de inúmeras escolas da área de saúde por todo o mundo aprendem as manobras semiológicas como fundamento na avaliação dos pacientes. No entanto, apesar de extremamente difundida, discute-se pouco sobre sua acurácia como manobra diagnóstica. Tendo este ponto em vista, este artigo aborda a precisão das diversas manobras semiológicas do exame físico do aparelho respiratório e a descrição comparativa do seu ensino em diferentes escolas médicas no mundo. Como resultados, tem-se valores de acurácia discordantes, o que pode ser justificado pela qualidade dos estudos ou pelas variáveis analisadas que diferem entre os estudos e propostas de padronização. Em conclusão, a semiologia é a base da avaliação médica, independentemente dos avanços e disponibilidade dos exames de imagens, e cada manobra deve ser ensinada com seu devido valor científico. Conhecer a aplicabilidade e individualizar a prática das etapas do exame respiratório pode ser um caminho possível de adequação aos tempos atuais, sem impor perdas de informações relevantes para o desenvolvimento do raciocínio clínico (AU)

Medical semiology has been one of the most common techniques used in medical practice for centuries. Health science students around the globe learn these techniques through a systematized model as a fundamental skill for patient evaluation. However, though being widespread, little is known about semiology's true accuracy as a diagnostic maneuver. Knowing that, through a literature review, this paper evaluated the precision of the preconized procedures that are used as part of the exam of the respiratory system and the comparative description of its teaching in different medical schools around the world. As a result, disagreement between several papers was found, which can be justified by the poor quality of the studies and the different variables that were studied in each one. However, one thing is still clear: respiratory physical examination continues to be essential in medical practice, independently of the recent advances and availability of imaging exams. Teaching each step should consider available scientific evidence. The knowledge of the applicability and practical individualization of the respiratory examination can be a possible way for the current times without missing relevant information for developing clinical reasoning (AU)

Tuberculosis: el contrapunto del progreso / Tuberculosis: the counterpoint of progress

Resumen A lo largo de la historia, las enfermedades infecciosas han influido directamente en el desarrollo de la humanidad y en este proceso, la tuberculosis ha tenido un rol protagónico. Esta enfermedad mata más seres humanos que cualquier otra de causa infecciosa y, a pesar de esto, continúa siendo una entidad olvidada y un grave problema de salud pública, sobre todo en las naciones más pobres. La trascendencia de la tuberculosis va más allá del ámbito médico y una visión holística de ella nos permite comprender el grado de desarrollo económico y social de un Estado. Si bien Chile mantenía un programa de control históricamente exitoso, las cifras actuales no son auspiciosas y obligan a analizar el problema desde una mirada multidisciplinaria. Es en este marco que planteamos que el médico clínico, para aportar en el control de la enfermedad, debe poner nuevamente en práctica uno de los principios básicos de la Medicina: la semiología.

Abstract Along history, infectious diseases have had a direct influence in the development of humanity, with tuberculosis showing a leading role. Despite this disease being the main cause of mortality among infectious diseases, it remains neglected and constitutes a serious public health problem, especially among the poorest countries in the world. Tuberculosis greatest importance goes beyond Medicine, and a holistic view of the disease allows us to comprehend the economic and social development of a nation. Despite a historically successful control program in Chile, current figures are not auspicious and force upon us the need to address this problem with a multidisciplinary approach. The medical physician is required to put again into practice the fundamental principle of Medicine, Semiology to contribute to the control of tuberculosis.

¿Polipnea o taquipnea? Esa es la cuestión / Compliance with the recommendations for physical activity set by the WHO by public bicycle users in a Spanish municipality

RESUMEN Introducción: Polipnea y taquipnea tienen significados diferentes en diversos textos y los estudiantes de Medicina se desorientan al estudiar la Semiología de la disnea. Objetivo: Elucidar la disparidad semántica entre polipnea y taquipnea. Material y Métodos: Se realizó una revisión bibliográfica utilizando los descriptores en ciencias de la salud taquipnea y polipnea. Se realizó una búsqueda en quince textos de Semiología Médica y en otros libros y revistas, impresos y electrónicos, entre ellos, la Revista Española de Cardiología (enero 1997 a diciembre 2020) en Archivos de Bronconeumología(diciembre 1964 a diciembre 2020); y se hizo el análisis etimológico de las palabras estudiadas, en Medigraphic (2012-21). Resultados: Seis de quince textos de Semiología consideran sinónimos polipnea y taquipnea; cuatro, solo emplean polipnea; y dos, taquipnea. Tres distinguen taquipnea como aumento de la frecuencia respiratoria; de polipnea, respiración superficial y rápida; dos definen taquipnea como aumento de la frecuencia respiratoria simple o con disminución de la amplitud (respiración superficial) y polipnea o hiperpnea, como aumento de la profundidad respiratoria con incremento de la frecuencia. En revistas científicas, taquipnea apareció en 192 artículos como respiración rápida y superficial; con igual significado se encontró polipnea, en 27. Según origen, taquipnea significa aceleración del ritmo respiratorio; polipnea, respiración muy frecuente y superficial, sin relación con polýpnóoos: "que sopla con fuerza" e hiperpnea significa incremento de la velocidad y amplitud de los movimientos respiratorios. Conclusiones: Polipnea y taquipnea deben considerarse equivalentes de respiración rápida y superficial; taquipnea simple, si la amplitud respiratoria es normal; e hiperpnea denomina la respiración muy frecuente y profunda.

ABSTRACT Introduction: Polypnea and tachypnea have different meanings in several texts, and medical studentsmay get confusedwith just the study of the semiology of dyspnea. Objective: Toelucidatethe semantic gap between polypnea and tachypnea. Material and Methods: A bibliographic review was conducted usinghealth science descriptors such as tachypnea and polypnea; a search was performed in 15 texts of Medical Semiology and other printed or electronic books and journals, among them, theRevista Española de Cardiología(fromJanuary 1997 to December 2020) andArchivos de Bronconeumología (from December 1964 toDecember 2020); in addition, the etymological analysis of these words was carried out in Medigraphic (2012-2021). Results: Six out of fifteen texts on semiology consider that the termspolypnea and tachypnea are synonymous; fourtexts only use polypnea; and two use the term tachypnea. Three texts distinguish tachypnea as increased respiratory rate, andpolypnea as arapid, shallow breathing; two texts define tachypnea as a simple increase in the respiratory rateor a decrease in the respiratory amplitude (shallow breathing); and polypnea or hyperpnea as the increasein depth and rate of breathing.In scientific journals, the term tachypnea was usedin 192 papersto refer to rapid, shallow breathing; andpolypnea had the same meaning in 27 articles. According to its origin, tachypnea means rapid respiratory rate; Polypnea is presented as very frequent and shallow breathing, unrelated to polýpnoos: "that blows forcefully"; while hyperpneameans an increase in the speed and amplitude of respiratory movements. Conclusions: Polypnea and tachypnea should be considered as equivalents of rapid andshallow breathing; simple tachypneaif the respiratory amplitude is normal; and hyperpnea designs a very frequent and deep breathing.

Psychiatric semiology in postmodernity / La semiología psiquiátrica en la posmodernidad.

This article intends to reflect on the validation of psychiatric semiology and nosography that is taught in clinical psychologists and psychiatrists training programs. The vision of academic psychiatry of our times, strongly influenced by scientific narrative, seeks to consolidate an universal nosography that aims to erase the culture marks. However, the prevalence of certain diagnoses over others is determined by the social context and cultural changes that determine, in turn, the classifying standards of professionals. For this reason, it is important to include the contributions of public intellectuals and cultural theorists for an updated and culturalized semiology of clinical phenomena. We will use the developments of Mark Fisher on Capitalist Realism to rethink the main symptoms of depression.

Este trabajo se propone reflexionar sobre la vigencia de la semiología y nosografía psiquiátrica que suele circular en los ámbitos de formación de psicólogos clínicos y psiquiatras. La visión de la psiquiatría académica de nuestros tiempos, fuertemente influenciada por el discurso cientificista, busca consolidar una nosografía universal que pretende borrar las marcas propias de la cultura. Sin embargo, la prevalencia de ciertos diagnósticos por sobre otros se encuentra determinada por el contexto social y los cambios culturales que determinan, a su vez, las prácticas clasificatorias de los profesionales. Por ello es importante la inclusión de los aportes de pensadores y críticos de la cultura para desarrollar una semiología actualizada y culturalizada de los fenómenos clínicos. Utilizaremos la teoría de Mark Fisher sobre el Realismo Capitalista para repensar en esta línea los principales síntomas de la depresión.

Distribuição da semiologia do adulto nas escolas médicas do Brasil / Distribution of adult semiology in medical schools in Brazil

Resumo: Introdução: A semiologia é a base da prática clínica e seu ensino é essencial no curso de Medicina. Este estudo foi desenvolvido por haver uma lacuna no conhecimento sobre sua distribuição no Brasil. Objetivo: Este estudo teve como objetivo analisar a distribuição da semiologia do adulto nas escolas médicas brasileiras. Método: Trata-se de um estudo transversal descritivo realizado com 226 escolas médicas brasileiras que disponibilizavam a distribuição de semiologia na internet entre as 335 ativas, em dezembro de 2020 (67,5%). As variáveis estudadas foram região geográfica, administração, gratuidade e tempo de existência da escola, carga horária do curso, do internato e de semiologia, e ano(s) ou semestre(s) em que a semiologia era ofertada no currículo. A análise dos dados foi descritiva, e analisaram-se as associações com os testes: t de Student, análise de variância, qui-quadrado de Pearson, U de Mann-Whitney, Kruskal-Wallis e Wilcoxon. Admitiu-se um nível de significância de p < 0,05. Resultado: A semiologia foi mais frequentemente ofertada apenas no quarto semestre (n = 40), seguida por sua oferta em dois semestres: quarto e quinto e terceiro e quarto. Entre as 226 escolas, 142 integravam os conteúdos em módulos ou eixos (62,8%). Entre 117 escolas que forneciam a carga horária de semiologia, mediana foi de 240,0 horas (P25-75 = 165,4 - 338,2), sem diferença estatística por região geográfica, administração, gratuidade e tempo de existência da escola. A mediana da carga teórica de semiologia [77,5 horas (P25-75 = 51,7 - 123,5)] foi menor do que a carga prática [147,0 horas (P25-75 = 64,5 - 180,0)], Z = -3,99, p < 0,01. A mediana da porcentagem da carga horária de semiologia no curso foi de 2,9% (P25-75 = 2,0 - 4,0). Conclusão: A semiologia é mais frequentemente ofertada no quarto semestre, e sua carga horária não difere por características geográficas, de administração e tempo de existência das escolas estudadas.

Abstract: Introduction: Semiology is the basis of clinical practice and its teaching is essential in the medical course. This study was developed to fill a gap in the knowledge about its distribution in Brazil. Objective: To analyze the distribution of adult semiology in Brazilian medical schools. Method: Cross-sectional descriptive study with 226 Brazilian medical schools that provided the distribution of semiology on the Internet among the 335 active schools in December 2020 (67.5%) The variables studied were school geographic region, administration and free tuition, time of existence of the course, course load of the regular course, clerkship and semiology, and year(s) or semester(s) in which semiology was offered in the curriculum. Data analysis was descriptive and the associations were analyzed using: Student's t, Chi-square, Analysis of Variance, Mann-Whitney-U, Kruskal Wallis and Wilcoxon tests. The significance level was set at p < 0.05. Result: Semiology was more frequently offered only in the 4th semester (n = 40), followed by its offer in two semesters, the 4th and 5th and 3rd and 4th. Among the 226 schools, 142 integrated semiology into modules or axes (62.8%). Among the 117 schools that provided the semiology course load, its median was 240.0 hours (P25-75 = 165.4 - 338.2), with no statistical difference by geographic region, type of administration and time of existence of the course. The median of the theoretical course load [77.5 hours (P25-75 = 51.7 - 123.5)] was lower than the practical course load [147.0 hours (P25-75 = 64.5 - 180.0)], Z = - 3,99, p < 0,01. The median of the percentage of semiology course load during the course was 2.9% (P25-75 = 2.0 - 4.0). Conclusion: Semiology is more frequently offered in the 4th semester and its median course load is similar in Brazilian geographic regions and by school administration type and time of existence of the assessed schools.

Comparison of semiology in patients with psychogenic nonepileptic seizures or with epilepsy in Puerto Rico.

PURPOSE: The aims of this study were to develop a descriptive profile of patients with psychogenic nonepileptic seizures (PNES) in Puerto Rico who have been evaluated using an epilepsy monitoring unit. The other aim was to establish comparisons between the clinical manifestation of PNES and events of generalized epilepsy (GE). METHOD: A retrospective study was conducted to evaluate the information of patients who passed through the Epilepsy Unit in Caguas, Puerto Rico. In the first phase, sociodemographic information of 100 patients with PNES was collected. In the second phase, a sample of 51 cases was obtained; 37 cases with a final diagnosis of PNES and 14 cases with the diagnosis of GE. Observations were made with the objective of viewing and comparing the semiology and clinical manifestation presented through video encephalograms (vEEG) in both subsamples. RESULTS: Patients with PNES and epilepsy demonstrated different semiological patterns. Psychogenic nonepileptic seizures is predominant in females (95%). Most patients with epilepsy presented a relatively short seizure (<2 min) compared with patients with PNES (79% vs. 46%). Patients with epilepsy showed a slow return to their baseline manifestation (100% vs. 11%). Specifically, having their eyes closed, extreme asynchronous limb movements, and rigidity were statistically significant. CONCLUSION: These findings provide evidence that the semiology of patients with PNES is different from those displaying an epileptic seizure. This study supports the idea that the semiology of Latino patients with PNES is similar to the characteristics reported in other countries.

Professor Faustino Esposel: Neurology, football and spiritualism / Professor Faustino Esposel: Neurologia, futebol e espiritismo

ABSTRACT Faustino Monteiro Esposel was a renowned neurologist from Rio de Janeiro, born on October 24, 1888. Together with his mentor, Professor Antônio Austregésilo Rodrigues Lima - the founder of modern Brazilian Neurology -, Professor Esposel described one of the rival signs of the Babinski sign, known as the Austregésilo-Esposel sign, in a study published in the renowned journal L'Encéphale in 1912. This article aims to summarize the life story of this illustrious neurologist as well as to highlight his achievements "beyond medicine".

RESUMO Faustino Monteiro Esposel foi um renomado neurologista do Rio de Janeiro, nascido em 24 de outubro de 1888. Junto de seu mentor, o Professor Antônio Austregésilo Rodrigues Lima, considerado o pai da Neurologia brasileira moderna, descreveu um dos sinais sucedâneos do sinal de Babinski, conhecido como sinal de Austregésilo-Esposel, publicado no renomado periódico L'Encéphale em 1912. Este artigo tem como objetivo trazer a história deste ilustre neurologista, destacando também seus feitos "além da medicina".

Differential Semiology Based on Video Electroencephalography Monitoring Between Psychogenic Nonepileptic Seizures and Temporal Lobe Epileptic Seizures.

BACKGROUND: Psychogenic nonepileptic seizures (PNESs) are disruptive changes in behavior without ictal correlate of epileptic activity and high prevalence of psychiatric morbidity. Differential diagnosis is difficult particularly with temporal lobe epilepsy (TLE), which is also associated with high prevalence of psychiatric comorbidity. Although video electroencephalography is the gold standard for differential diagnosis, clinical semiology analysis may help the clinician in general medical practice. OBJECTIVE: In this study, the differential semiology, based on video electroencephalography, between PNESs and TLE seizures was analyzed. METHODS: The video electroencephalography of patients with diagnosis of PNES and TLE were reviewed and compared between groups. Clinical semiology of all episodes recorded by video electroencephalography in each patient was analyzed and classified in accordance with the presence of behavioral arrest, motor hyperkinetic activity, impaired awareness, aura, and automatisms. Chi square test and binary logistic regression were determined. RESULTS: Thirty-two patients with PNES (32 ± 11 y) and 34 with TLE (32 ± 12 y) were included. Female patients were predominant in the PNES group (P < 0.05). Mean time duration of episodes was 6.8 ± 10 minutes in PNES and 1.6 ± 0.8 minutes in TLE (P < 0.05). Impaired awareness (odds ratio = 24.4; 95% confidence interval = 3.79 -157.3, P < 0.01), automatisms (odds ratio = 13.9; 95% confidence interval = 2.1- 90.5, P < 0.01), and shorter duration of the events (odds ratio = 2.261, 95% confidence interval = 1.149 - 4.449, P = 0.018) were found as independent factors for detecting TLE seizures comparing PNESs. CONCLUSION: Clinical semiology analysis may orientate the differential diagnosis in general medical practice, between PNESs and TLE seizures. Further studies comparing PNES semiology with other subtypes of epilepsies may complete these preliminary findings.

Semiology and radiology integration: a new trend in the teaching-learning process / Integração semiologia e radiologia: nova tendência no processo de ensino e aprendizagem

Abstract: Introduction: The development of clinical reasoning to diagnose diseases and order ancillary tests, such as radiology imaging, is based on history-taking and physical examination skills, which are developed during the semiology course. Objective: We aimed to evaluate the results of the innovative integration of two courses in the medical curriculum at our institution: Medical Semiology and Clinical Radiology. Methods: The sample consisted of 184 fifth-semester medical students attending the two courses simultaneously. Extra-class semiology-radiology sessions based on theoretical and practical topics integrating radiological images and semiological signs were conducted, and the results were assessed by applying a semi-structured questionnaire to the participants, in which all 18 items were rated on a scale from 0 (worst) to 10 (best). The normality hypothesis in score distribution was verified by the Kolmogorov-Smirnov test and the Shapiro-Wilk test. The distribution of the 18 scores were summarized by descriptive statistics and compared by Friedman's test, with post-hoc test in pairwise comparisons adjusted by Bonferroni test. Correlations between the scores were determined by Spearman's Rank Correlation Coefficients. Results: The overall mean score for the semiology-radiology sessions was high (8.55). Students were satisfied with the selection of clinical cases (8.46) and found that the semiology-radiology sessions contributed to the development of their clinical reasoning (8.58). Conclusion: Medical schools are facing new challenges in medical education. The innovative concept of Radiology-Semiology integrated teaching modality affects the students' self-perception ability to interpret radiological images and might be an educational strategy trend.

Resumo: Introdução: O desenvolvimento do raciocínio clínico para diagnosticar doenças e solicitar exames complementares, como os radiológicos, baseia-se na história e no exame físico, desenvolvidos durante o curso de Semiologia. Objetivo: Nosso objetivo foi avaliar os resultados da integração inovadora de duas disciplinas no currículo médico em nossa instituição: Semiologia Médica e Radiologia Clínica. Métodos: A amostra foi composta por 184 estudantes de Medicina do quinto semestre que participaram das duas disciplinas simultaneamente. Realizaram-se sessões extraclasse de semiologia e radiologia, baseadas em tópicos teóricos e práticos, integrando imagens radiológicas com sinais semiológicos. Avaliaram-se os resultados por meio da aplicação de um questionário semiestruturado aos participantes, no qual todos os 18 itens foram classificados em uma escala de 0 (pior) a 10 (melhor). A hipótese de normalidade na distribuição dos escores foi verificada pelos testes de Kolmorov-Smirnov e Shapiro-Wilk. As 18 distribuições de pontuação foram resumidas por estatística descritiva e comparadas pelo teste de Friedman, com teste post hoc em comparações pareadas ajustadas por Bonferroni. As correlações entre as pontuações foram determinadas pelos coeficientes de correlação de classificação de Spearman. Resultados: O escore médio geral para as sessões de semiologia e radiologia foi alto (8,55). Os estudantes ficaram satisfeitos com a seleção de casos clínicos (8,46) e descobriram que as sessões de semiologia-radiologia contribuíram para o desenvolvimento de seu raciocínio clínico (8,58). Conclusão: As escolas médicas enfrentam novos desafios na educação médica. O conceito inovador da modalidade de ensino integrado de radiologia-semiologia afeta a capacidade de autopercepção dos alunos para interpretar imagens radiológicas e pode ser uma tendência de estratégia educacional.

Abdominal Palpation Does Not Modify the Number of Bowel Sounds in Healthy Volunteers and Gastrointestinal Outpatients.

BACKGROUND: The effect of abdominal palpation on bowel sounds is controversial. The authors developed an auscultation apparatus to count bowel sounds and determined whether abdominal palpation modifies the number of bowel sounds in healthy volunteers and gastrointestinal outpatients. METHODS: Four medical students developed an auscultation apparatus by attaching a Littmann stethoscope to an electret condenser microphone. The students examined 20 healthy volunteers and 20 gastrointestinal outpatients between March and June 2018. Abdominal auscultation lasting 4 minutes (1-minute each quadrant) was performed before and after abdominal palpation with registration of sound tracings. The software Audacity was used to count the bowel sounds. The effect of palpation on bowel sounds was analyzed using Generalized Estimating Equations. RESULTS: The volunteers were predominantly young (mean ± SD, 21 ± 2 years) and men (70%), whereas the outpatients were older (60 ± 11 years) and women (80%). The apparatus was able to generate sound tracings with good quality from all participants. In the comparison before/after palpation, the number of bowel sounds did not differ either in volunteers (mean ± SD, 12.6 ± 4.7 and 11.6 ± 3.5; P = 0.482) or in patients (15.6 ± 7.5 and 15.8 ± 7.9; P = 0.714). In the analysis of all participants, the difference before-after palpation was not statistically significant (mean ± SD, 14.1 ± 6.3 and 13.7 ± 6.4, respectively; P = 0.550; mean difference = 0.4; 95% CI -1.2 to 2.0) and did not depend on the group studied. CONCLUSIONS: Using an apparatus devised by medical students, the authors found that abdominal palpation did not modify the number of bowel sounds in healthy volunteers and gastrointestinal outpatients.

Descripción de la prueba semiológica de Compresión y flexión del pulgar, para el diagnóstico de Rizartrosis. Estudio de Cohorte Transversal / Description of thumb compression and flexion test for the diagnosis of rhizarthrosis. Cross sectional Cohort Study

Introducción El dolor del pulgar secundario a la artrosis de la articulación trapecio-metacarpiana es una condición común, especialmente en mujeres llegando a causar niveles altos de incapacidad en algunos pacientes. El diagnóstico de rizartrosis se basa en el dolor localizado, la inflamación e inestabilidad en la exploración física además de la valoración radiológica. Existen en la actualidad varias pruebas semiológicas que podemos utilizar en el diagnóstico de la rizartrosis sintomática, una de ellas es la prueba de Grind o molienda, que es considerada el patrón de oro. El presente estudio tiene como objetivo describir y evaluar la prueba de Compresión y flexión del pulgar ideada para el diagnóstico de rizartrosis. Materiales y Métodos Se realizó un estudio de corte transversal en el periodo de enero del 2007 a mayo del 2013, Se evaluaron 230 pacientes que acudieron a consulta con síntomas sugestivos de rizartrosis a quienes se les practico simultáneamente la prueba de Grind y la prueba de compresión y flexión para la confirmación del diagnóstico. Resultados De los 230 pacientes que acudieron a consulta, el 87.8% (202) eran mujeres con una edad promedio de 60 años (32 a 86 años). El 14.8% de los pacientes presentaron una afectación bilateral. El 47.8% tenían comorbilidades presentes entre las que se encuentran síndrome de túnel carpiano en el 67.3%, dedo en gatillo 11.8%, entre otras. El índice de concordancia PABAK entre los dos signos semiológicos fue de 0.948, indicando un nivel de acuerdo excelente entre ambos. El 100% de los pacientes fueron diagnosticados por la prueba de flexión y compresión. Discusión producto de obtener una prueba positiva en la totalidad de los pacientes evaluados con la prueba de compresión y flexión, consideramos puede ser una opción que complemente la pesquisa clínica en el paciente con rizartrosis, es necesario entonces estudios posteriores para validar dicha prueba y poder obtener su sensibilidad y especificidad.

Background Thumb pain secondary to osteoarthritis of the trapezium-metacarpal joint is a common condition, especially in women, and causing high levels of disability in some patients. The diagnosis of rhizarthrosis is based on localised pain, inflammation, and instability on physical examination, in addition to radiographic evaluation. There are currently several semiological tests that can be used in the diagnosis of symptomatic rhizarthrosis, one of which is the Grind or grinding test, which is considered the gold standard. The present study aims to describe and evaluate the thumb compression and flexion test designed for the diagnosis of rhizarthrosis. Methods A cross-sectional study was carried out during the period from January 2007 to May 2013. The study included a total of 230 patients that came to the clinic with symptoms suggestive of rhizarthrosis, and on whom the Grind test, the compression test, and flexion were simultaneously performed to confirm the diagnosis. Results Of the 230 patients who attended the clinic, 87.8% (202) were women with a mean age of 60 years (32 to 86 years). A bilateral involvement was observed in 14.8% of the patients. Just under half (47.8%) currently had co-morbidities that included, among others, carpal tunnel syndrome (67.3%) and trigger finger (11.8%). The prevalence-adjusted and bias-adjusted kappa (PABAK) concordance index between the two semiological signs was 0.948, indicating an excellent level of agreement between both. All (100%) of the patients were diagnosed by the flexion and compression test. Discussion Due to obtaining a positive test in all the patients evaluated with the compression and flexion test, it should be considered as a complementary test in the clinical evaluation of patients with rhizarthrosis. Further studies are necessary to validate this test in order to establish its sensitivity and specificity.

Desarrollo del aprendizaje basado en problemas a través de casos clínicos en semiología para estudiantes de enfermería

El presente artículo tiene como objetivo principal presentar los resultados de la implementación del aprendizaje basado en problemas (ABP) como estrategia didáctica de integración de los conocimientos teóricos mediante la práctica en la asignatura de Semiología en el programa de formación en Enfermería de la Universidad del Magdalena. La investigación se realizó con base en una metodología mixta e introducción de elementos de participación-acción y mediando casos clínicos para el desarrollo de las habilidades del estudiante en la valoración sistemática del paciente. Se realizó un trabajo de índole cuasiexperimental sobre una muestra de 21 estudiantes de cuarto y quinto semestre, basado en el diseño de cinco casos clínicos. Posteriormente y mediante la aplicación de una encuesta tipo Likert de escala 1 a 7 en conocimientos, habilidades y actitudes, con un total de 54 ítems, se determinaron el acuerdo, la aceptación y la tendencia actitudinal respecto al uso de dicha estrategia didáctica con base en ABP como alternativa de cambio. Los resultados permitieron evidenciar el acuerdo pleno de los estudiantes con los criterios esperados por el ABP, así como la comprobación de su plena disposición respecto a la metodología implementada. En general, el grupo evidenció comprender el aporte de la orientación diferencial que provee el uso del ABP mediante los casos clínicos propuestos en el aula para el desarrollo de la asignatura de Semiología.

Our main objective is to introduce the results of the implementation of the problem-based learning method (ABP in Spanish) as a didactic strategy to integrate theorical knowledge and practice in the course of Semiology in the Nursery program of Madgalena University. Re- search was based in a mixed methodology, with an introduction of elements of participative-action and through the management of cli- nical cases for the development of students' skills in the assessment of patients. We carried out a quasi-experimental work on a sample of 21 students of fourth and fifth semester, based on the design of five clinical cases. After that, we applied a Likert-based survey with a scale of 1 to 7 in knowledge, abilities, and attitudes, with a total of 54 items. We determined the agreement, acceptance and attitude trend regar- ding the use of the didactic strategy based in ABP as an alternative for change. Results allowed us to evidence how the students agreed with the expected criteria of ABP, as well as to prove their willingness to use the implemented methodology. In general, the group showed that they understood the contribution to differential orientation provided by the usage of ABP through the clinical cases proposed in the class- room to carry out the course of Semiology.

Este artigo tem como objetivo principal apresentar os resultados da implantação da aprendizagem baseada em problemas (ABP) como estratégia didática de integração dos conhecimentos teóricos mediante a prática na disciplina de Semiologia, no programa de Enfermagem da Universidad del Magdalena, Colômbia. Esta pesquisa foi realizada com base em uma metodologia mista e em uma introdução de elementos de participação-ação e mediando casos clínicos para desenvolver habilidades do estudante na avaliação sistemática do paciente. Foi realizado um trabalho de índole quase-experimental com uma amostra de 21 estudantes de quarto e quinto período, baseado no desenho de cinco casos clínicos. Em seguida, mediante a aplicação de um questionário tipo Likert de escala de 1 a 7 em conhecimentos, habilidades e atitudes, com um total de 54 itens, foram determinados o acordo, a aceitação e a tendência atitudinal a respeito do uso dessa estratégia didática com base na ABP, como alternativa de mudança. Os resultados permitiram evidenciar o acordo pleno dos estudantes com os critérios esperados pela ABP, bem como a comprovação de sua plena disposição quanto a metodologia implantada. Em geral, o grupo evidenciou compreender a contribuição da orientado diferencial que fornece o uso da ABP mediante casos clínicos propostos na sala de aula para desenvolver a disciplina de Semiologia.

Adult-onset psychogenic nonepileptic seizures: A multicenter international study.

PURPOSE: The aim of this multicenter international cross-cultural study was to compare clinical variables in a large sample of people with adult-onset psychogenic nonepileptic seizures (PNES). METHODS: In this retrospective study, we evaluated persons with documented PNES, who were older than 16 years of age at the onset, from four countries (i.e., Iran, Brazil, Venezuela, and Argentina) regarding their age, gender, PNES semiology, and possible predisposing factors. RESULTS: We included 389 patients (244 from Iran, 66 from Brazil, 51 from Venezuela, and 28 from Argentina). Age at diagnosis was 32 ±â€¯9 years (range: 17-64 years), and age at the onset of seizures was 27 ±â€¯8 years (range: 17-49 years). There was a female predominance in all countries. The demographic characteristics and factors associated with PNES were similar among the countries. However, there were significant semiological differences among the countries. CONCLUSION: This study corroborates the notion that PNES share more similarities than differences cross-culturally and across international borders. However, the background determined by cultural, ethnic, and religious differences may influence the semiology of PNES. Further cross-cultural studies involving more than two continents may advance our understanding of PNES.

La actualización del método clínico / Updating on the clinical method

En la actualidad existe desarrollo de la tecnociencia aplicada a la medicina con tendencia a relegar a un segundo plano el método clínico. Las diferentes escuelas de medicina del mundo, incluyendo la cubana, han comenzado una modernización del método clínico, el cual está basado en un método científico, por lo que es importante centrar su enseñanza en aspectos eminentemente prácticos, además de usar adecuadamente los exámenes complementarios para ratificar el diagnóstico, pronóstico y tratamiento del enfermo. El objetivo de esta investigación es aunar criterios sobre la enseñanza y aplicación del método clínico, para ello se hacen algunas reflexiones sobre su utilidad práctica, los programas actuales de su enseñanza y los textos en los que se basa. La conceptualización del método clínico es fruto de la Escuela Cubana de Clínica, donde los internistas han tenido una función importante en los últimos 50 años. Los especialistas de esta área del conocimiento, junto a todos los médicos asistenciales que están en la necesidad de utilizar este método para el manejo de sus enfermos, están llamados a continuar con la tarea de mantener y transmitir la esencia misma de la clínica, en medio de un ambiente inestable y cambiante(AU)

At present, due to the development of techno science applied to medicine, there is a tendency to overshadow the clinical method. Different medical schools in the world, including the Cuban school, have begun the modernization of the clinical method, which is based on the scientific method. Therefore, it is important to focus teaching on the eminently practical aspects, in addition to properly using complementary tests to confirm the patient´s diagnosis, prognosis and treatment. The objective of this research is to combine criteria on the teaching and use of the clinical method. Some reflections arise from its practical convenience, current syllabus and the texts on which it is based. The conceptualization of the clinical method is the result of the Cuban School of Clinic, where internists have played important role in the last 50 years. The specialists of this area of knowledge, together with all the medical assistants who need to use this method for treating their patients, are called to continue with the task of maintaining and transmitting the very essence of the clinic, in the midst of unstable and changing circumstances(AU)

DEPDC5 mutation and familial focal epilepsy with variable foci: genotype and phenotype of a family.

Familial focal epilepsy with variable foci is a relatively rare autosomal disease with an unclear incidence, which is characterized by focal seizures arising from different cortical regions in different family members. We describe three members of a two-generation Argentine family with familial focal epilepsy with variable foci syndrome and a DEPDC5 gene mutation. The mean onset age was nine years old. The father experienced episodes with occipital semiology and both siblings exhibited frontal lobe seizures. Their neurological examination and neuroimaging studies were normal. All three patients are currently seizure-free, in spite of initially experiencing frequent seizures. Complete exome sequencing revealed a new DEPDC5 gene mutation (NM_001242896: c.4718T>C; p.L1573P). This study of a family with clinical characteristics that met all the criteria for familial focal epilepsy with variable foci demonstrates the usefulness of exome sequencing as a diagnostic tool. [Published with video sequence on www.epilepticdisorders.com].