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    Comparison of achievement in anamnesis skills in on-site and online formative Objective Structured Clinical Exam
    (2023)
    Mariana Jadue
    ;
    Pilar Munitiz
    ;
    Luz-María Torres
    ;
    Marcelo Blacutt
    ;
    Soledad Armijo-Rivera
    <jats:p>Introduction: anamnesis is an initial step of the clinical reasoning process, which is taught throughout interviews to real or simulated patients. Its evaluation through OSCEs is widely disseminated, and in the context of a pandemic, the OSCE was adapted to be administered online. Objective: to compare the levels of achievement in anamnesis skills of two cohorts of medical students in formative OSCEs of semiology in on-site and online modality. Methods: using a blueprint established in 2017 and implemented for three years, competencies were identified that could be trained and evaluated online in third-year medical students. Telesimulations were performed with role play for anamnesis ability. Guided by a tutor, each student participated in 10 telesimulated anamnesis with peer roleplay and one anamnesis with a simulated pacientent. All of it in groups of 6 students. A formative TeleOSCE was implemented, evaluating the same skills of the year 2019 in a face-to-face training instance. In 2019 and 2020, 92 and 91 students participated respectively. The students' performance was compared in three identical scenarios. Results: at the cough, acute diarrhea, and knee pain screening scenarios, students in the 2020 cohort performed better than those in the 2019 cohort (p&lt;0,001). Conclusions: for the development of anamnesis skill in third-year medical students, telesimulation-based teaching allows students to demonstrate adequate performance on a practical assessment administered online via TeleOSCE.</jats:p>
    Scopus© Citations 3  7
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    Lupus eritematoso neonatal, caso clínico
    (2023)
    Catalina Montané
    ;
    HOJMAN CANO, LIA PAULA  
    ;
    Trinidad Hasbún Zegpi
    <jats:p>El lupus eritematoso neonatal (LEN) es una patología autoinmune muy infrecuente, que ocurre en neonatos de madres que presentan auto-anticuerpos para antígenos citoplasmáticos del Síndrome de Sjögren. En la mayoría de los casos, la evolución es benigna hacia la resolución espontánea, pero existe un grupo de pacientes que desarrollan compromiso severo del tejido de conducción miocárdico, por lo que su detección oportuna es fundamental. Objetivo: Describir un caso clínico característico de lupus eritematoso neonatal y destacar la importancia del diagnóstico oportuno en madre y neonato. Caso Clínico: Mujer de 33 años, con antecedente de hipertensión arterial, consulta en dermatología por su neonato de 15 días de vida de sexo masculino, quien presenta aparición reciente de placas redondeadas, eritematosas, de bordes solevantados, no descamativas, compatibles con LEN. Se descartó compromiso de conducción miocárdica. En los exámenes del neonato destacaba neutropenia moderada, elevación leve de transaminasas y anticuerpos antiRo y antiLa positivos. En interrogación dirigida, la madre refiere historia personal de síntomas compatibles con enfermedades del tejido conectivo, tales como fatiga, alopecia y xeroftalmia. Se solicitan anticuerpos antinucleares a la madre, quien presenta título de 1/1280 con patrón moteado, anticuerpos anti Ro y La y anticuerpos anti-DNA doble hebra positivos, y Test de Schirmer compatible con ojo seco, por lo que se diagnostica Lupus Eritematoso Sistémico con Síndrome de Sjögren asociado. Se realiza seguimiento al lactante por 5 meses con remisión de los signos cutáneos y normalización de los exámenes de laboratorio. Conclusiones: Si bien, las manifestaciones cutáneas de LEN son transitorias y benignas en el neonato, estas pueden ir acompañadas de complicaciones de riesgo vital que requieren una búsqueda activa y un manejo oportuno por el equipo médico. Un 25% de las madres de hijos con LEN son asintomáticas, o desconocen su diagnóstico de LES previo al parto, por lo que el diagnóstico oportuno de LEN en un neonato permite diagnosticar a las madres asintomáticas, optimizando su seguimiento y manejo.</jats:p>
    Scopus© Citations 1  4
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    Successful treatment of cytomegalovirus retinitis with oral/intravitreal antivirals in HIV-negative patients with lymphoma
    (2022)
    Anastasia Tasiopoulou
    ;
    URZUA SALINAS, CRISTHIAN  
    ;
    Susan Lightman
    <jats:title>Abstract</jats:title><jats:sec> <jats:title>Objectives</jats:title> <jats:p>To report patients with systemic lymphoma and cytomegalovirus (CMV) retinitis, treated with a combination of oral and intravitreal antiviral agents on an outpatient basis.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>Retrospective cases series. Information was gathered from the database of the Uveitis clinics at Moorfields Eye Hospital, United Kingdom from December 2014 to December 2018. The inclusion criteria comprised the diagnosis of systemic lymphoma, associated with a diagnosis of CMV retinitis. Exclusion criteria were alternative ocular diagnosis, human immunodeficiency virus (HIV), primary intraocular lymphoma, or other causes of immunosuppression.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>All seven subjects had been under oncologist care for systemic lymphoma. CMV retinitis presented with a median of 61 months after the systemic lymphoma diagnosis. Five patients underwent a vitreous biopsy, and four of them returned PCR positive for CMV and the fifth patient had PCR positive in a blood sample. All patients were treated with oral Valganciclovir, with an induction dose of 900 mg every 12 h for up to 3 weeks until disease resolution and a maintenance dose thereafter. All but one received additional intravitreal Foscarnet injections, with a dose of 2.4 mg /0.1 ml.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The management of patients with systemic lymphoma and CMV retinitis with oral and intravitreal antiviral agents, resulted in effective disease control.</jats:p> </jats:sec>
      1Scopus© Citations 6
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    Analysis of REM sleep without atonia in 22q11.2 deletion syndrome determined by domiciliary polysomnography: a cross sectional study
    (2021)
    Jorge Mauro
    ;
    Mario Diaz
    ;
    Teresa Córdova
    ;
    Katiuska Villanueva
    ;
    Tania Cáceres
    <jats:title>Abstract</jats:title> <jats:sec> <jats:title>Study Objectives</jats:title> <jats:p>Our aim is to evaluate the presence of REM sleep without atonia (RWA), the objective hallmark of REM sleep Behaviour Disorder (RBD), as prodromal marker of Parkinson’s disease (PD), in an adult cohort of 22q11.2 deletion syndrome (22qDS).</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Sleep quality was assessed by means of Pittsburgh quality scale index (PSQI), and RBD symptoms by means of RBD questionnaire-Hong-Kong (RBDQ-HK). Attended domiciliary video-Polysomnography (v-PSG) were performed in 26 adults (18–51 years, 14 females) 22qDS patients. Electromyogram during REM sleep was analyzed by means of SINBAR procedure at 3-second time resolution (miniepochs).</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>An overall poor sleep quality was observed in the cohort and high RBDQ-HK score in 7 of the 26 patients, two additional patients with positive dream enactment reported by close relatives had low score of RBDQ-HK. Nevertheless, SINBAR RWA scores were lower than cut-off threshold for RWA (mean 5.5%, range 0–12.2%). TST and the percentage of light sleep (N1) were increased, with preserved proportions of N2 and N3. Participants reported poor quality of sleep (mean PSQI &amp;gt; 5), with prolonged sleep latency in the v-PSG. No subjects exhibit evident dream enactment episodes during recording sessions.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>RWA was absent in the studied cohort of 22qDS adult volunteers according to validated polysomnographic criteria. High RBDQ-HK scores do not correlate with v-PSG results among 22qDS individuals.</jats:p> </jats:sec>
    Scopus© Citations 5  2
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    Lyme borreliosis presenting as severe back pain after Shinrin-Yoku (forest bathing) in southern Germany
    (2021)
    WEITZEL, THOMAS  
    ;
    Inia Perez
    ;
    PORTE TORRE, LORENA ISABEL  
    <jats:p>Since Lyme borreliosis is endemic in the Northern Hemisphere, it is usually not in the spotlight of travel medicine. However, borreliosis is a relevant problem and diagnostic challenge in travelers from the Southern Hemisphere returning from trips to Europe and North America.</jats:p>
    Scopus© Citations 2  18
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    Quiste pilonidal del ombligo: presentación de dos casos
    (2021)
    Juan Hepp
    ;
    Horacio Rios Rivas
    ;
    Juan Hepp Valenzuela
    ;
    Paulina Fuenzalida Soffia
    <jats:p>Introducción: El quiste pilonidal del ombligo (QPO) es una entidad muy infrecuente y por eso no es reconocida precozmente. El objetivo de este manuscrito es dar a conocer esta patología. Reporte de casos: Presentamos dos pacientes referidos por un proceso inflamatorio del ombligo, con descarga de mal olor. El primer paciente, luego de dos meses de tratamiento local sin resolución, es intervenido resecando la lesión umbilical, comprobando en ese momento la existencia de contenido piloso en el quiste. En el segundo paciente se plantea el diagnóstico durante la anamnesis y se confirma con el examen físico. En ambos casos se efectuó una resección parcial del ombligo incluyendo la lesión pilonidal. La biopsia confirmo el diagnóstico. El resultado postoperatorio ha sido satisfactorio y sin recaídas. Discusión y conclusión: hay escasa literatura relacionada con el QPO. Se proponen el tratamiento conservador y la opción de resección quirúrgica del quiste. En nuestra limitada experiencia se procedió a resecar la lesión y recomendar la depilación de la región periumbilical. No podemos descartar la alternativa de manejo conservador en futuros casos, antes de proponer la cirugía.</jats:p>
      15