Metformin as a prophylactic treatment of gestational diabetes in pregnant patients with pregestational insulin resistance: A randomized study.

AIM: We aimed to assess the use of metformin (MTF) in the prevention of gestational diabetes mellitus (GDM) in patients with pregestational insulin resistance (PIR). METHODS: A double blind, multicenter, randomized trial was carried out in patients with a history of PIR and pregestational MTF treatment. Groups were allocated either to MTF 1700 mg/day or placebo. Patients were recruited between 12+0 and 15+6 gestational weeks, and treatment was extended until week 36. A multiple logistic regression analysis was applied to determine the relation between the use of metformin and the development of GDM. RESULTS: One hundred and forty one patients were randomized (68 patients in the MTF group and 73 in the placebo group). A total of 30 patients withdrew from the study during follow-up. Administration of MTF was not associated with a decrease in the incidence of GDM as compared to placebo (37.5% vs 25.4%, respectively; P = 0.2). Moreover, MTF administration was associated with a significant increase in drug intolerance as compared to placebo (14.3% vs 1.8%, respectively; P = 0.02). CONCLUSION: The use of MTF is not effective in prevention of GDM in populations with PIR. The use of MTF shows a significantly higher frequency of drug intolerance than placebo.

[Objective structured clinical evaluation to assess clinical skills of international medical graduates]. / Experiencia con el empleo del examen OSCE en el ciclo de evaluación de competencias clínicas de médicos que revalidan su título.

BACKGROUND: Our institution adopted the Objective Structured Clinical Evaluation (OSCE) format to assess clinical skills of International Medical Graduates (IMGs) aiming to practice in Chile. The OSCE has clear advantages over oral exams due to its objective and structured nature. AIM: To report our experience with OSCE. MATERIAL AND METHODS: A team consisting of clinical specialists and medical educators with expertise in clinical simulation organized this OSCE cycle. IMGs were required to pass four clinical examinations (Internal Medicine, Surgery, Pediatrics and Obstetrics & Gynecology) where their respective general medical competences were evaluated. The latter were carefully selected from those issued by the Chilean Medical Evaluation policy-making body (EUNACOM). Each OSCE consisted of ten stations. Initially conceived to last five minutes each, they were afterwards expanded to seven minutes, after it was realized that most candidates had never been exposed to an OSCE examination before. A post-hoc analysis according to qualitative and psychometric quality criteria followed each OSCE. RESULTS: The proportion of candidates passing the first two examinations of the cycle, were 65 and 75% respectively and reached 100% in the last ones. Lack of IMG familiarity with the OSCE system initially hampered their full expression of competencies. Extending the stations' duration to seven minutes subsequently rectified this situation, as well as potential adverse impacts on the validity of results. CONCLUSIONS: This evaluative process, which entails important consequences for the community and the IMGs, requires a meticulous and coordinated planning and post-hoc quality control.

Descripción de la aplicación de screening universal para SARS-CoV-2 en mujeres embarazadas que ingresan para interrupción en Hospital de Carabineros - Santiago de Chile / Description of the application of a universal screening for SARS-CoV-2 in pregnant women admitted for interruption of pregnancy at Carabineros Hospital- Santiago de Chile

INTRODUCCIÓN Y OBJETIVOS: El Síndrome Respiratorio Agudo Grave Coronavirus 2 (SARSCoV-2) es una enfermedad altamente contagiosa y que puede ser transmitida por pacientes asintomáticos. Por esto surge el interés de poder determinar la prevalencia de la infección por SARS-Cov-2 en pacientes embarazadas que ingresan para interrupción de la gestación. MÉTODOS: Se realizó un análisis descriptivo, retrospectivo en el Servicio de Obstetricia y Ginecología de Hospital de Carabineros de Chile entre el 15 de mayo y el 30 junio del 2020. Se incluyeron todas las mujeres embarazadas que ingresaron para interrupción de la gestación, a las que se les realizó el examen PCR SARS-CoV-2; y una encuesta de signos y síntomas sugerentes de la enfermedad. RESULTADOS: Se realizaron 73 interrupciones de la gestación, con toma de PCR a 72 mujeres; de estas pacientes 65 (90.3%) fueron negativas, 5 (6.9%) positivas y 2 (2.8%) indeterminadas; los resultados indeterminados fueron considerados como positivos, por lo que la prevalencia de positividad fue de 9,5%. De estas pacientes, sólo 1 de ellas tenía síntomas sugerentes de la enfermedad, todas las demás (6) eran pacientes asintomáticas, y se mantuvieron así durante toda la hospitalización. CONCLUSIÓN: La realización del examen PCR para SARS-CoV-2 a todas las embarazadas que ingresan a un servicio de Ginecología y Obstetricia ayuda a identificar a las pacientes asintomáticas contagiadas con el virus. Ya que la consulta por presencia de signos y síntomas no permite identificar los casos positivos, es necesario considerar la realización de este examen en los protocolos de ingreso hospitalario a lo largo de nuestro país.

INTRODUCTION AND OBJECTIVES: Severe Acute Respiratory Syndrome Coronavirus (SARSCoV-2) is a highly contagious disease that can be transmitted by asymptomatic patients. Therefore, is of interest to determine the prevalence of SARS-Cov-2 infection in pregnant patients entering for interruption. METHODS: A descriptive, retrospective analysis was performed in the Obstetrics and Gynecology Service of the Hospital de Carabineros de Chile between May 15 and June 30, 2020. Pregnant women who entered for interruption of their pregnancy and who were given the SARS-CoV-2 PCR exam were included. A survey of signs and symptoms suggestive of the disease was applied. RESULTS: There were 73 pregnancy interruptions, 72 of them were tested by SARS-CoV-2 PCR exam. Among these patients, 65 (90.3%) resulted negative, 5 (6.9%), were positive and 2 (2.8%) were indeterminate; indeterminate results were considered positive, so the prevalence of positivity was 9.5%. Of these patients only 1 had symptoms suggestive of the disease, all the others (6) were asymptomatic, and remained so throughout the hospitalization. CONCLUSION: Conducting the PCR test for SARS-CoV-2 for all pregnant women entering a Gynecology and Obstetrics service helps to identify asymptomatic patients infected with the virus. As a survey of signs and symptoms cannot identify positive patiens, it is necessary to consider conducting universal screeing in hospital admission protocols throughout our country.

Experiencia con el empleo del examen OSCE en el ciclo de evaluación de competencias clínicas de médicos que revalidan su título / Objective structured clinical evaluation to assess clinical skills of international medical graduates

Background: Our institution adopted the Objective Structured Clinical Evaluation (OSCE) format to assess clinical skills of International Medical Graduates (IMGs) aiming to practice in Chile. The OSCE has clear advantages over oral exams due to its objective and structured nature. Aim: To report our experience with OSCE. Material and Methods: A team consisting of clinical specialists and medical educators with expertise in clinical simulation organized this OSCE cycle. IMGs were required to pass four clinical examinations (Internal Medicine, Surgery, Pediatrics and Obstetrics & Gynecology) where their respective general medical competences were evaluated. The latter were carefully selected from those issued by the Chilean Medical Evaluation policy-making body (EUNACOM). Each OSCE consisted of ten stations. Initially conceived to last five minutes each, they were afterwards expanded to seven minutes, after it was realized that most candidates had never been exposed to an OSCE examination before. A post-hoc analysis according to qualitative and psychometric quality criteria followed each OSCE. Results: The proportion of candidates passing the first two examinations of the cycle, were 65 and 75% respectively and reached 100% in the last ones. Lack of IMG familiarity with the OSCE system initially hampered their full expression of competencies. Extending the stations' duration to seven minutes subsequently rectified this situation, as well as potential adverse impacts on the validity of results. Conclusions: This evaluative process, which entails important consequences for the community and the IMGs, requires a meticulous and coordinated planning and post-hoc quality control.