Medicina Clinica最新文献

Point-of-care ultrasound (POCUS) has become an essential diagnostic and procedural adjunct in infectious disease practice, providing real-time bedside evaluation that improves patient outcomes. Despite its clinical relevance, broad implementation faces educational challenges, including limited access to hands-on training, inconsistent curricular integration, and lack of standardized certification pathways across all stages of medical education. This review frames POCUS education as a longitudinal, progressive pathway starting with foundational exposure in undergraduate medical curricula and advancing through competency-based postgraduate training, continuing professional development, and formal credentialing. Key educational frameworks such as G.O.O.S.E. and I-AIM structure the acquisition of both technical imaging skills and clinical integration, fostering critical ultrasound competence. Various stakeholders contribute to this continuum: medical schools form the foundational base; private sector programs fill training gaps using innovative educational approaches including immersive workshops, simulation, blended learning, and small-group pathology-focused sessions; and scientific societies provide leadership by defining standards, supporting collaborative research, and advocating for formalized training and certification. These innovative training modalities enable flexible, practical skill acquisition tailored to evolving clinical needs and diverse practice environments, accelerating learners' progression toward competent, autonomous ultrasound use. Such approaches are especially valuable in resource-limited settings or where traditional academic resources are constrained. Sustained multisectoral collaboration among academic institutions, private educators, scientific societies, and regulatory bodies is vital to ensure accessible, effective, and equitable POCUS training worldwide. By outlining this comprehensive educational roadmap and recognizing ongoing innovations, this review aims to guide the integration of POCUS into infectious disease care, ultimately improving global patient outcomes.

Introduction: Transgender people show incongruence between the sex assigned at birth and the gender they identify with. Puberty generates hormonal changes that induce physical changes, with the development of secondary sexual character, which cause great discomfort in the transgender individual. It is also a vital time when there is an increase in the rate of growth. The drug GnRHa stops puberty, slowing down the changes in the body and allowing the adolescent time to consider their gender identity. However, an expected side effect of these drugs is that growth velocity is affected.

Objective: To determine the growth velocity of adolescents and transgender children undergoing pubertal blocking therapies.

Material and methods: We conducted a longitudinal study using anthropometric and laboratory measurements every 6months, collected 1year before and 2years after blockade, to assess whether growth velocity and height are affected by pubertal blockade. The comparison was made using the standard deviations of the variables according to age, using the Wilcoxon signed-rank test in paired groups and the U-Mann Whitney test in independent groups. To obtain the data, we reviewed the medical records of the participants in our study.

Results: Fifty-five transgender adolescents initiating pubertal blocking with a median age of 11.8years are studied. It is observed that height measured in standard deviations (SD) and growth velocity, measured in centimetres and SD, decrease in accordance with increasing time in pubertal block. When comparing transgender boys and girls, transgender girls show a greater decrease in height SD. These differences are statistically significant for pre-blocking, 6 and 12months of BP therapy (P=.036, P=.005 and P=.042 respectively). In addition, it was also observed that growth velocity was more affected in trans girls than in boys, although these differences were not statistically significant.

Conclusions: Height and growth velocity are decreased when puberty is blocked. This decrease is more striking in transgender girls than in transgender boys.