Medicina-buenos Aires最新文献

Hidradenitis suppurativa and psoriasis are chronic inflammatory systemic dermatoses. The immune system plays a fundamental role in their pathogenesis, as each involves an immunological imbalance and the participation of numerous cytokines, including interleukin-17. The coexistence of these conditions can significantly impair quality of life, thus requiring integrated and targeted therapeutic approaches. We report the case of a 47-year-old woman diagnosed with hidradenitis suppurativa who developed psoriasis lesions over time. After receiving multiple therapeutic regimens without response, she began treatment with secukinumab, with excellent outcomes for both entities.

We present a case of a 60-year-old woman with a history of poorly controlled type 2 diabetes who came to the emergency room with severe headache, nausea, and vomiting that had been ongoing for one week. Her vision was progressing with decreased visual acuity and diplopia. A MRI of the brain and sellar region was ordered, which revealed a lesion occupying the sphenoid sinus. Biochemical parameters included leukocytosis, hyperglycemia, central hypothyroidism and hypogonadism. Considering these findings, an interdisciplinary approach was undertaken to initiate a diagnostic and therapeutic algorithm. A fungal infection was suspected, and the patient was admitted to the Otolaryngology Department for endoscopic nasal surgery. Fungal-like tissue with abundant hyphae and localized inflammation was found. Aspergillus flavus was isolated from the culture, and the patient completed medical treatment with voriconazole. Invasive aspergillosis of the sphenoid sinus is a very rare entity, generally associated with immunocompromised patients. It requires a high level of suspicion and timely treatment. Due to its clinical and imaging characteristics, it remains a challenge for the medical specialties involved in its study, such as clinical medicine, otolaryngology, images, and endocrinology.

In recent years, artificial intelligence has rapidly transitioned from a theoretical promise to a practical ally in medical education. Among its most accessible tools, chatbots powered by large language models stand out for their ability to simulate clinical scenarios, facilitate autonomous learning, and personalize feedback. In this article, we examine the pedagogical value and challenges of integrating chatbots into both undergraduate and postgraduate medical training. Beyond a narrative review of the literature, we describe three original implementations developed in academic and clinical settings: (1) chatbots simulating virtual patients to enhance interviewing and communication skills, (2) a virtual assistant for teaching respiratory physiology, and (3) a decision-support tool to guide critical care drug titration. Finally, we propose a research agenda aimed at evaluating the impact of these technologies on clinical reasoning, student motivation, and the overall quality of medical education.

Randomized controlled clinical trials (RCTs) are a fundamental tool for evaluating various intervention strategies. Their design is a critical aspect that defines the validity of their conclusions. Of the numerous factors to be considered, the endpoint is of primary importance. It represents the effect of the intervention on the outcome of the clinical entity considered. Mortality, from any cause or disease-specific, complications of a certain severity, and hospitalizations, are clinically unquestionable. When the statistical method is time to event (Cox model), only the first episode is considered. If this is hospitalization and the subsequent, more significant event is death, it will not be considered. Furthermore, the Cox model does not allow for the inclusion of repeated episodes. However, why is it necessary to include multiple components in the endpoint? The objective is for the trial to achieve sufficient power, avoiding false negatives. In the case of rare diseases, the number of patients can be increased or the observation period extended, with the resulting complications and economic implications. The win ratio (WR) method circumvents these drawbacks, as it prioritizes events in a hierarchical order within a combined outcome, also allowing for the computation of repeated episodes. With the WR, it is also possible to include some surrogate for major complications. This manuscript analyzes the clinical interpretation of the effect of a pharmacological intervention expressed by the WR in a fictitious RCT, describing the conceptual mechanics of the statistical procedure.

Introduction: The objective of this study was to investigate the impact of a blended learning strategy, utilizing the Xuexitong online educational platform, on cardiac rehabilitation (CR) for patients with coronary heart disease (CHD) following hospital discharge Materials and methods: Seventy CHD patients discharged from Hebei University Affiliated Hospital between July 2022 and January 2023 were randomly divided into blended and conventional education groups. Both received routine CR education before discharge. Post - discharge, the conventional group got education and supervision via WeChat, and the blended group used Xuexitong for blended education. The study compared risk factor control, cardiovascular events, quality of life, and CR compliance between the two groups pre - and post - intervention.

Results: After intervention, the blended education group had a higher risk factor control rate (blood pressure 91.4%, LDL cholesterol 91.4%, glycemia 88.6%) than the conventional group (60%, 68.6%, 51.4% respectively, p<0.01). Cardiovascular events occurred in 5 (14.3%) in the blended group and 15 (43%) in the conventional group, with a relative risk of 0.33 (0.14-0.82). The blended group's quality of life (81 (76-85)) was higher than the conventional group's (62 (58-66), P<0.001). Also, the blended group's CR compliance (19 (17-20)) was higher than the conventional group's (15 (13-16)) during the intervention (P<0.001).

Conclusion: Applying a blended patient education strategy based on Xuexitong for patients with CHD after discharge can effectively control risk factors, reduce adverse cardiovascular events, improve quality of life, and enhance CR compliance.

Introduction: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that causes atrophy and paralysis of skeletal muscles, including respiratory muscles. The development of ventilatory failure determines the prognosis. The primary outcome was to determine which common clinical variables can be predictors of daytime hypercapnia and develop a risk model of ventilatory failure. Secondary outcome was to determinate the survival rate of high-risk patients with and without hypercapnia.

Materials and methods: Retrospective study. Patients with ALS without mechanical ventilation were selected and followed from June 2015 to May 2024. They underwent arterial blood carbon dioxide measurement and classified into two groups: hypercapnic (pCO2 ≥45 mmHg) and normocapnic (pCO2 <45 mmHg). Different predictive models for hypercapnia were constructed.

Results: An association between orthopnea (p=0.0001), dyspnea (p=0.02) and FVC <50% (p=0.04) was found. The predictive model constructed with the following variables: orthopnea, dyspnea and ALSFRS-R score ≤21, presented a good performance on the detection hypercapnia risk. A score > 23 points had a sensitivity of 80.6% and a specificity of 72.8% for detecting patients at high risk of hypercapnia. Normocapnic patients at high risk who start mechanical ventilation before developing hypercapnia improve their survival rate by 6 months (p=0.17).

Discussion: The risk score includes easily obtained clinical variables and is effective in detecting patients at risk for hypercapnia. Initiating mechanical ventilation in at-risk patients who have not yet developed hypercapnia has a clinically significant impact on survival.

Introduction: Retinoblastoma is an embryonal origin neoplasm of the developing retina. It represents the most frequent ocular cancer in childhood. The presentation can be unilateral, bilateral or trilateral. In patients with bilateral retinoblastoma, germline variants in the RB1 gene are observed in approximately 90%, while in unilateral retinoblastoma in 10-25% of cases. Molecular study is essential for familial genetic counseling.

Materials and methods: Sixty patients with retinoblastoma who consulted Garrahan Hospital between 2018-2022 were evaluated. For the study of single nucleotide variants, PCR amplification and Sanger sequencing of the RB1 gene was performed. Multiplex Ligationdependent Probe Amplification was used to detect copy number alterations.

Results: Of the 60 patients, 22 single nucleotide variants and 6 heterozygous deletions were detected in bilateral retinoblastoma (n:32). In 2 patients with unilateral retinoblastoma (n:28) alterations were observed, being in one case a single nucleotide variant and in the other a deletion of the whole gene. Family segregation and genetic counseling were performed when feasible.

Discussion: This study allowed us to describe the genetic variants of the RB1 gene in Argentine pediatric patients with retinoblastoma. The distribution and types of variants observed in this patient group are similar to those described in other populations. Currently, next-generation sequencing is in the process of being incorporated in order to describe variants with higher throughput technology.

Introduction: Entrustable professional activities (EPA) were developed to connect competencies with clinical practice and make them operational. These are tasks that can be entrusted to a trainee once he/she has obtained adequate competence to perform them, without supervision. By definition, residencies are the ideal setting for their implementation. However, one of the main challenges lies in the design and incorporation of EPA into current training programs. Through a collaborative effort between the Medical Education Department at Medicine University and Hospital de Clínicas, a pathway has been initiated for the design and incorporation of EPA. The objective of this study is to describe the process of developing professional profiles and EPA's titles for the 39 residency programs at Hospital de Clínicas.

Materials and methods: A team was formed between the Medical Education Department and Hospital de Clínicas. Using an eight-step procedure, professional profile and EPA for 39 residency programs were written and validated.

Results: Professional profiles for 39 specialties and 655 titles for EPA, were written and published to incorporate them into residency programs, as a standard for their accreditation.

Discussion: This work compiles the experience and communicates the progress towards the implementation of EPA for health residencies, in order to promote competency-based education and to improve the quality of postgraduate training programs.