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Purpose: Currently, there is a paucity of prior investigations and studies examining applications for artificial intelligence (AI) in upper-extremity (UE) surgical education. The purpose of this investigation was to assess the performance of a novel AI tool (ChatGPT) on UE questions on the Orthopaedic In-Training Examination (OITE). We aimed to compare the performance of ChatGPT to the examination performance of hand surgery residents. Methods: We selected questions from the 2020-2022 OITEs that focused on both the hand and UE as well as the shoulder and elbow content domains. These questions were divided into two categories: those with text-only prompts (text-only questions) and those that included supplementary images or videos (media questions). Two authors (B.K.F. and G.S.M.) converted the accompanying media into text-based descriptions. Included questions were inputted into ChatGPT (version 3.5) to generate responses. Each OITE question was entered into ChatGPT three times: (1) open-ended response, which requested a free-text response; (2) multiple-choice responses without asking for justification; and (3) multiple-choice response with justification. We referred to the OITE scoring guide for each year in order to compare the percentage of correct AI responses to correct resident responses. Results: A total of 102 UE OITE questions were included; 59 were text-only questions, and 43 were media-based. ChatGPT correctly answered 46 (45%) of 102 questions using the Multiple Choice No Justification prompt requirement (42% for text-based and 44% for media questions). Compared to ChatGPT, postgraduate year 1 orthopaedic residents achieved an average score of 51% correct. Postgraduate year 5 residents answered 76% of the same questions correctly. Conclusions: ChatGPT answered fewer UE OITE questions correctly compared to hand surgery residents of all training levels. Clinical relevance: Further development of novel AI tools may be necessary if this technology is going to have a role in UE education.

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Pesticides have well-documented negative consequences to control crop pests, and natural predators are alternatives and can provide an ecosystem service as biological control agents. However, there remains considerable uncertainty regarding whether such biological control can be a widely applicable solution, especially given ongoing climatic variation and climate change. Here, we performed a meta-analysis focused on field studies with natural predators to explore broadly whether and how predators might control pests and in turn increase yield. We also contrasted across studies pest suppression by a single and multiple predators and how climate influence biological control. Predators reduced pest populations by 73% on average, and increased crop yield by 25% on average. Surprisingly, the impact of predators did not depend on whether there were many or a single predator species. Precipitation seasonality was a key climatic influence on biological control: as seasonality increased, the impact of predators on pest populations increased. Taken together, the positive contribution of predators in controlling pests and increasing yield, and the consistency of such responses in the face of precipitation variability, suggest that biocontrol has the potential to be an important part of pest management and increasing food supplies as the planet precipitation patterns become increasingly variable.

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OBJECTIVES: The Brazilian Society of Thoracic Surgeons conducted an online survey to determine the number of surgeons that perform adult and paediatric airway surgery and to understand the practice patterns along the country. METHODS: Active members were electronically invited to complete the questionnaire through the REDCapR platform. Invitations were sent from January to April 2020. The survey encompassed 40 questions that explored 4 different topics in the assessment of tracheal diseases: (i) surgeon's demography; (ii) institutional profile, (iii) education and training in laryngo-tracheal surgery and (iv) preoperative and postoperative evaluation. RESULTS: Eighty-nine percentage of the responders declared to perform tracheal surgery with a median of 5 tracheal resection procedures per year [interquartile range (IQR) 3-12]. Interaction with other specialties occurs in 37.3% of cases. Access to technology and devices is highly variable across the country. Resident training in airway surgery consists in traditional lectures in 97% of the cases. Training in animals (15.2%), cadavers (12.1%) and simulators (6.1%) are rare. Preoperatory evaluation encompasses flexible bronchoscopy (97.8%) and/or computed tomography (CT) scan of the airways (90.6%). Swallowing (20.1%) and voice (14.4%) disorders are rarely evaluated. Eighty-nine percentage of the surgeons consider bronchoscopy to be the preoperatory gold-standard exam, followed by CT scan (38.8%) and CT-3D reconstruction (37.4%). CONCLUSIONS: Brazilian surgeons refer that airway resection and reconstruction are part of their current practice, but the total number of procedures per surgeon per year is low. Access to high-end technology and equipment is heterogenous. Training offered to residents in most academic institutions relies on traditional lectures.

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Introducción: La oftalmología es la ciencia de la medicina que se encarga del estudio del sistema visual y el órgano de la visión, así como de sus anexos. Para ello es dotada de un conjunto de tecnologías de avanzada que permite describir las múltiples patologías que tienen los pacientes. En la actualidad se nutre del uso de los dispositivos móviles, fundamentalmente en la gestión del conocimiento, pero no se explotan sus otras dimensiones. Objetivo: Identificar los referentes que fundamentan el uso de la telefonía móvil en el proceso de enseñanza aprendizaje del residente de oftalmología. Métodos: Se realizó una investigación de desarrollo tecnológico en el campo de la educación médica superior. Se utilizaron como métodos teóricos el histórico-lógico, el analítico-sintético y el método sistémico estructural funcional. Resultados: La telefonía móvil constituye una nueva tendencia en la educación superior cubana y en la educación médica como alternativa para desarrollar los procesos de enseñanza aprendizaje, a través de su uso para la socialización, la comunicación entre los estudiantes, y la gestión de la información, como medio de enseñanza aprendizaje y herramienta de trabajo. Conclusiones: Existe una contradicción entre la formación que deben tener los residentes en oftalmología en cuanto al uso de las tecnologías, y la preparación que poseen para su utilización en función de su especialidad. A pesar de que existen varios estudios que demuestran la importancia del uso de la telefonía móvil en la formación de los residentes de oftalmología, como objeto de estudio y herramienta de trabajo, no se ha establecido la vía para incluirla como una de las tecnologías dentro de la residencia de oftalmología en Cuba(AU)

Introduction: Ophthalmology is the medical science dealing with the study of the visual system and the organ of vision, as well as its annexes. For this purpose, it is equipped with a set of advanced technologies that allow describing the multiple pathologies presented by patients. Nowadays, it is nourished by the use of mobile devices, mainly in knowledge management, but its other dimensions are not exploited. Objective: To identify the references that support the use of mobile telephony in the teaching-learning process of ophthalmology residents. Methods: A technological development research was carried out in the field of higher medical education. As theoretical methods, the historical-logical, the analytical-synthetic, and the systemic-structural-functional methods were used. Results: Mobile telephony is a new trend in Cuban higher education, as well as in medical education, as an alternative to develop teaching-learning processes, through its use for socialization, communication among students, and information management, as a teaching-learning means and a work tool. Conclusions: There is some contradiction between the training that ophthalmology residents should receive with respect to the use of technologies and the preparation that they have for their usage in accordance with their specialty. Although there are several studies that demonstrate the importance of using mobile telephony in the training of ophthalmology residents, as an object for studying and a work tool, there has not been a way to include it as one of the technologies within the ophthalmology residency in Cuba(AU)

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BACKGROUND: The main objective of this study was to describe the relationship between working conditions, sleep and psycho-affective variables and medical errors. METHODS: This was an observational, analytical and cross-sectional study in which 661 medical residents answered questionnaires about working conditions, sleep and psycho-affective variables. Actigraphic sleep parameters and peripheral temperature circadian rhythm were measured in a subgroup of 38 subjects. Bivariate and multivariate predictors of medical errors were assessed. RESULTS: Medical residents reported working 66.2 ± 21.9 weekly hours. The longest continuous shift was of 28.4 ± 10.9 h. They reported sleeping 6.1 ± 1.6 h per day, with a sleep debt of 94 ± 129 min in workdays. A high percentage of them reported symptoms related to psycho-affective disorders. The longest continuous shift duration (OR = 1.03 [95% CI, 1.00-1.05], p = 0.01), working more than six monthly on-call shifts (OR = 1.87 [95% CI, 1.16-3.02], p = 0.01) and sleeping less than six hours per working day (OR = 1.66 [95% CI, 1.10-2.51], p = 0.02) were independently associated with self-reported medical errors. The report of medical errors was associated with an increase in the percentage of diurnal sleep (2.2% [95% CI, 0.1-4.3] vs 14.5% [95% CI, 5.9-23.0]; p = 0.01) in the actigraphic recording. CONCLUSIONS: Medical residents have a high working hour load that affect their sleep opportunities, circadian rhythms and psycho-affective health, which are also related to the report of medical errors. These results highlight the importance of implementing multidimensional strategies to improve medical trainees' sleep and wellbeing, increasing in turn their own and patients' safety.

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BACKGROUND: Induced abortion in Costa Rica is illegal in all cases except to save the life of the pregnant person. Despite severe restrictions to legal abortion, individuals in Costa Rica still induce abortions outside of the formal healthcare system. These individuals and those with spontaneous abortions, also known as miscarriages, occasionally need medical care for complications. In Costa Rica, an estimated 41% of unintended pregnancies end in abortion, yet there is very little published literature exploring the perspectives of healthcare providers on abortion in Costa Rica. METHODS: We interviewed ten obstetrician-gynecologist clinicians and five obstetrician-gynecologist medical residents in San José, Costa Rica about their beliefs and practices related to extra-legal abortion and post-abortion care (PAC) using a Spanish language in-depth semi-structured interview guide. After transcription and translation into English, analysis team pairs used a combination of deductive and inductive coding to identify themes and sub-themes within the data. RESULTS: Obstetrician-gynecologist clinicians and medical residents were aware of the presence of extra-legal abortion, and particularly, medication abortion, in their communities, but less familiar with dosing for induction. They expressed the desire to provide non-judgmental care and support their patients through extra-legal abortion and PAC journeys. Study participants were most familiar with providing care to individuals with spontaneous abortions. When discussing PAC, they often spoke about a policy of reporting individuals who seek PAC following an extra-legal abortion, without commenting on whether or not they followed the guidance. CONCLUSIONS: This study contributes to a gap in research about the knowledge, attitudes, and practices of Costa Rican obstetrician-gynecologist clinicians and medical residents around extra-legal abortion and PAC. The results reveal an opportunity to train these healthcare providers as harm reduction experts, who are able to accurately counsel individuals who are seeking abortion services outside of the healthcare system, and to provide training to improve care for individuals needing PAC.

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Introducción: los residentes y posgrados son un eslabón central en los servicios hospitalarios. El síndrome de Burnout se define como el agotamiento físico y emocional resultado de la exposición crónica al estrés en el ámbito laboral. El Maslach Burnout Inventory (MBI-HSS) es un instrumento diseñado y validado para evaluarlo. El objetivo de este estudio es determinar la prevalencia del síndrome de Burnout en nuestro servicio y compararla entre los estudiantes de distintas generaciones para luego poner en marcha mecanismos que permitan realizar seguimiento, detección temprana e identificación de factores modificables. Material y método: estudio transversal, descriptivo, observacional, desarrollado en abril de 2021 a través de la realización del test MBI-HSS para el diagnóstico de situación. Este estudio continuará con una segunda etapa que consta de la aplicación del test cada cuatro meses, la cual no desarrollaremos en el presente trabajo. La población objetivo la constituyen todos los residentes y posgrados de la especialidad de Neonatología en un centro hospitalario de tercer nivel. Se aplicó el cuestionario MBI-HSS y un cuestionario general para caracterizar a la población. Resultados: se incluyeron un total de 22 participantes, de los cuales 13 presentaron puntajes altos de agotamiento emocional, 9 obtuvieron un valor alterado de despersonalización y 9 presentaron puntajes bajos de realización personal. Seis participantes (27%) presentaron puntajes alterados para las tres variables. Conclusiones: se evidenció una alta prevalencia de Burnout, el 27% en la población total. Se encontraron diferencias estadísticamente significativas para los ítems despersonalización y realización personal entre los distintos años de la especialidad, con mayor puntaje de despersonalización y menor puntaje de realización personal en los de segundo y tercer año. Esto constituye un elemento de alarma que exige la modificación inmediata del funcionamiento y de las actividades.

Introduction: Residents and postgraduates are a fundamental part of hospital services. Burnout Syndrome is defined as physical and emotional exhaustion resulting from chronic exposure to stress in the workplace. The Maslach Burnout Inventory (MBI-HSS) is an instrument designed and validated to evaluate it. The objective of this study is to determine the prevalence of Burnout Syndrome in our service and to compare it among students of different generations to then implement mechanisms that allow monitoring, early detection and identification of modifiable factors. Materials and methods: Cross-sectional, descriptive, observational study carried out in April 2021 through the Maslach Burnout Inventory - Human Services Survey (MBI-HSS) test to carry out a diagnosis of the situation. This study will continue with a 2nd stage consisting of the application of the test every 4 months, which we will not develop in this work. The target population is all residents and postgraduates in the neonatology specialty at a tertiary level hospital. The MBI-HSS questionnaire and a general questionnaire were applied to characterize the population. Results: A total of 22 participants were included, of which 13 presented high scores of emotional exhaustion, 9 obtained an altered value of depersonalization and 9 presented low scores of personal fulfillment. Six participants, 27%, presented altered scores for the three variables. Conclusions: A high prevalence of Burnout was evidenced, being 27% in the total population. Statistically significant differences were found for the items "depersonalization" and "personal fulfillment" between the different years of the specialty, with higher depersonalization scores and lower personal fulfillment scores in the second and third years. This constitutes an alarm element, which requires immediate modification of the operation and activities.

Introdução: Residentes e pós-graduandos constituem um elo central nos serviços hospitalares. A Síndrome de Burnout é definida como exaustão física e emocional resultante da exposição crônica ao estresse no ambiente de trabalho. O Maslach Burnout Inventory (MBI-HSS) é um instrumento elaborado e validado para avaliá-lo. Objetivo: O objetivo deste estudo é determinar a prevalência da Síndrome de Burnout no Serviço de Neonatologia do Centro Hospitalario Pereira Rossel e compará-la entre estudantes de diferentes gerações para então implementar mecanismos que permitam monitoramento, detecção precoce e identificação de fatores modificáveis. Materiais e métodos: Estudo transversal, descritivo, observacional realizado em abril de 2021 por meio do teste Maslach Burnout Inventory - Human Services Survey (MBI-HSS) para diagnóstico da situação. Este estudo continuará com uma 2ª etapa que consiste na aplicação do teste a cada 4 meses, que não desenvolveremos neste trabalho. A população-alvo são todos os residentes e pós-graduandos da especialidade de neonatologia de um hospital de nível terciário. O questionário MBI-HSS e um questionário geral foram aplicados para caracterizar a população. Resultados: Foram incluídos 22 participantes, dos quais 13 apresentaram escores elevados de exaustão emocional, 9 obtiveram valor alterado de despersonalização e 9 apresentaram escores baixos de realização pessoal. Seis participantes, 27%, apresentaram escores alterados nas três variáveis. Conclusões: Evidenciou-se uma alta prevalência de Burnout de 27% na população total. Foram encontradas diferenças estatisticamente significativas nos itens "despersonalização" e "realização pessoal" entre os diferentes anos da especialidade, com maiores pontuações de despersonalização e menores pontuações de realização pessoal no segundo e terceiro anos. Isto constitui um elemento de alarme, que requer modificação imediata do funcionamento e das atividades.

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Introducción: la depresión es un trastorno cada vez más prevalente alrededor del mundo. Los médicos generales son los profesionales de la salud más consultados por pacientes deprimidos. Más del 70% de los pacientes con depresión son vistos por médicos generales y no por especialistas en Psiquiatría. Según estudios realizados en Buenos Aires, más del 25% de los pacientes internados en Servicios de Clínica Médica en hospitales generales presenta depresión. Estos pacientes suelen ser atendidos y seguidos por médicos en formación, sean residentes o concurrentes de Clínica Médica. El objetivo del trabajo fue analizar el conocimiento sobre los inhibidores selectivos de la recaptura de serotonina (ISRS) que tienen los médicos residentes y concurrentes de Clínica Médica de 5 hospitales de la Ciudad Autónoma de Buenos Aires (CABA) y describir el tratamiento de un paciente depresivo por ellos. Material y métodos: se realizó un estudio descriptivo de corte transversal con un muestreo de tipo no probabilístico. Se utilizó como instrumento de medición un cuestionario semiestructurado organizado en dos secciones, una de datos demográficos que permiten caracterizar la muestra. La otra, de 15 ítems, explora los conocimientos sobre los ISRS y el tratamiento de la depresión. Dicho cuestionario fue revisado por 4 expertos. El instrumento es anónimo. Se aplicó a 59 médicos en formación en Clínica Médica, residentes y concurrentes, de 5 hospitales de la CABA, que participaron de forma voluntaria, durante el período agosto-septiembre de 2022. Resultados: la mayoría de los médicos en formación en Clínica Médica no tratan cuadros depresivos y, ante un paciente deprimido, solicitan la evaluación por un especialista en Salud Mental. Solo un 6,8% lo medica con un antidepresivo. Más del 75% de la muestra refiere recordar los conocimientos que tiene sobre de los ISRS de la cursada de Farmacología y un 13,6 de la cursada de Psiquiatría en la Facultad de Medicina. Conclusión: se observa un conocimiento deficitario sobre los ISRS en médicos residentes y concurrentes de Clínica Médica. Se considera necesario reforzar la formación sobre depresión y manejo de antidepresivos durante la residencia/concurrencia de Clínica Médica. (AU)

Introduction: depression is an increasingly common disorder around the world. General practitioners are the most frequently consulted health professionals by depressed patients. More than 70% of all depressed patients receive treatment by general practitioners and not by psychiatric specialists. According to studies conducted in Buenos Aires, more than 25% of all patients admitted to the Clinical Services in public hospitals present depression. These patients are usually under the care and follow-up of clinical trainee physicians, residents, or interns.This study aimed to analyze the knowledge about selective serotonin reuptake inhibitors (SSRIs) of clinical trainee residents and interns in five hospitals in the Ciudad Autónoma de Buenos Aires (CABA) and to describe their treatment of a depressive patient. Material and methods: we conducted a descriptive cross-sectional study with a non-probabilistic sampling. We used a semi-structured questionnaire arranged into two sections as a measuring tool. One, with demographic data to describe the sample. The other, with 15 items, explores respondents' knowledge of SSRIs and the treatment of depression. Four experts reviewed the questionnaire, which was anonymous. We applied it to 59 clinical medical trainees, residents, and interns from five CABA hospitals who volunteered to participate during August-September 2022. Results: most clinical trainees do not treat depressive conditions and, when confronted with a depressed patient, request an assessment by a Mental Health specialist. Only 6.8% medicate the patient with an antidepressant. More than 75% of the sample reported remembering their knowledge of SSRIs from the Pharmacology course and 13.6% from the Psychiatry course at the School of Medicine. Conclusion: there is a deficient knowledge about SSRIs in trainee residents and interns of Clínica Médica. We believe it is necessary to reinforce training on depression and management of antidepressants during residency/internship practice in Clínica Médica. (AU)

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Introducción: la simultaneidad de actividades entre las exigencias académicas y el adiestramiento médico durante las residencias provoca un elevado riesgo de desarrollar un desgaste profesional (o síndrome de burnout [SB]) en los médicos residentes. El objetivo fue identificar los factores psicosociales y socio- demográficos asociados al SB en médicos residentes. Materiales y métodos: estudio transversal y correlacional. Participaron 47 médicos residentes de un hospital público. Se aplicaron la Escala de Desgaste Ocupacional (EDO), el Inventario Multifásico de la Personalidad Minnesota-2 Forma Reestructurada (MMPI2-Rf) y un cuestionario sociodemográfico. Los datos se analizaron mediante la prueba de correlación no paramétrica de Spearman. Resultados: el 25.6 % de los participantes mostró burnout alto, y el 51 %, un agotamiento emocional alto. Respecto a los factores de personalidad y sociodemográficos asociados, solo mostraron relación significativa (p < 0.05) la escala de impulsividad (r = 0.341, p = 0.019) y las horas de ejercicio en la semana (r = −0.414, p = 0.004). Al segmentar por sexo, solo en los hombres del estudio existió una relación entre SB y psicoticismo (r = 0.468, p = 0.018), la disminución de la actividad física (r = −0.620, p = 0.001) y primeros años de residencia (r = −0.396, p = 0.050). Conclusiones: el alto agotamiento emocional de los residentes está asociado con problemas en el manejo de impulsos, distorsiones de la realidad (debido al psicoticismo), pertenecer a los primeros años de residencia y falta de ejercicio físico. Se requiere especial atención a la salud física y mental de estos profesionales

Introduction: The simultaneity of activities between academic demands and medical training during residencies is a high risk of developing burnout syndrome (BS) among resident physicians, which decreases their quality of life. This study aimed to identify the psychosocial and sociodemographic factors associated with BS among resident physicians from a public hospital. Materials and methods: This cross-sectional and correlational study involved 47 resident physicians. The Occupational Burnout Scale (EDO), the Minnesota Multiphasic Personality Inventory-2 Restructured Form, and a sociodemographic questionnaire were applied. The data were analyzed by using nonparametric Spearman's correlation test. Results: We found that 25.6% of the participants had a high level of burnout, while 51% showed a high level of emotional exhaustion. Regarding personality and sociodemographic factors associated with BS, only the impulsivity scale (r = 0.341; p = 0.019) and the hours of exercise performed in a week (r = −0.414; p = 0.004) showed a significant relationship (p < 0.05). When segmented by sex, a relationship between BS and psychoticism (r = 0.468; p = 0.018), decreased physical activity (r = −0.620; p = 0.001), and first years of residence (r = −0.396; p = 0.050) were noted only in men. Conclusions: A high level of emotional exhaustion was evidenced among the medical residents in relation to the development of their activities, which were associated with problems in the management of impulses, distortions of reality (due to psychoticism), belonging to the first years of residency, and the lack of physical exercise. Hence, special attention must be given to the physical and mental health of medical residents

Introdução: a simultaneidade de atividades entre as demandas acadêmicas e ao mesmo tempo a formação médica durante as residências acarreta alto risco de desenvolvimento da Síndrome de Burnout (SB) nos médicos residentes, diminuindo sua qualidade de vida. O objetivo da pesquisa foi identificar os fatores psicossociais e sociodemográficos associados à SB em médicos residentes. Materiais e métodos: estudo transversal e correlacional. Participaram 47 médicos residentes de um hospital público. Aplicou-se a Escala de Desgaste Ocupacional (EDO), o Inventário Multifásico da Personalidade Minnesota-2 Forma Reestruturada (MMPI2-Rf) e adicionalmente um questionário sociodemográfico. Os dados foram analisados por meio do teste de correlação não paramétrica de Spearman. Resultados: 25,6% dos participantes apresentaram alto burnout e 51% alto nível de exaustão emocional. Em relação aos fatores de personalidade e sociodemográficos associados à SB, apenas a escala de impulsividade (r = 0,341; p = 0,019) e as horas de exercício por semana (r = −0,414; p = 0.004) apresentaram relação significativa (p < 0,05). Quando segmentado por sexo, apenas nos homens do estudo houve relação entre SB e psicoticismo (r = 0,468; p = 0,018), diminuição da atividade física (r = −0,620; p = 0,001) e primeiros anos de residência (r = −0,396; p = 0,050). Conclusões: destaca-se o elevado desgaste emocional vivenciado pelos residentes no desenvolvimento das suas atividades, que se associa a problemas na gestão dos impulsos, distorções da realidade (devido ao psicoticismo), estar nos primeiros anos de residência e falta de exercício físico. É necessária atenção especial à saúde física e mental desses profissionais

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Background: Residents usually cover night and weekend shifts issuing the preliminary reading of radiological studies in university hospitals. This is essential to strengthening decision-making skills when facing complex cases independently. However, there should be a balance between patient safety and academic experience since some concern has been expressed about the accuracy of the interpretations generated by trainees. This work aims to evaluate and characterize the discrepancies in preliminary reports issued by radiology residents. Material and methods: Radiologists filled out a questionnaire to evaluate preliminary reports of trainees considering diagnosis, findings description, clinical approach changes, and critical findings. Analysis was performed considering modality, imaging type, body part, and resident academic year. A Chi-square test with a significance level α of 0.05 was used to make group comparisons. Results: A total of 9072 studies were reviewed. Major and minor overall discrepancy rates were 1.7% and 8.3%, respectively. Minor discrepancy rate, findings description, and critical findings identification improved with increasing academic year, both overall and by modality. Discrepancy rates were lower for CT than MR and neuroimaging than for body-imaging studies. The highest major and minor discrepancy rates as abdomen/pelvis CT and lumbar-spine MR, respectively. Two percent of reports presented discrepancies that could generate a medical approach change. Conclusion: Discrepancy rates are low and comparable with those reported in the literature. These rates tend to improve as the resident's academic year increases. Our results suggest that radiology residents' coverage of night shifts and weekends is a practice that benefits the educational process without negatively impacting patient safety.

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The secretome of different cell types has been applied on in vitro and in vivo assays, indicating considerable therapeutic potential. However, the choice of the ideal cell type and culture conditions for obtaining the best set of soluble factors, as well as the assays to assess specific effects, remain subjects of vigorous debate. In this study, we used mass spectrometry to characterize the secretomes of ventricle derived-cardiac resident stromal cells (vCRSC) and human dermal fibroblasts (HDFs) and evaluate them in an effort to understand the niche specificity of biological responses toward different cellular behaviors, such as cell proliferation, adhesion, migration, and differentiation. It was interesting to note that the HDF and vCRSC secretomes were both able to induce proliferation and cardiac differentiation of H9c2 cells, as well as to increase the adhesion activity of H9c2 cells and human umbilical vein endothelial cells. Analysis of the secretome composition showed that the vCRSCs derived from different donors secreted a similar set of proteins. Despite the differences, almost half of the proteins identified in conditioned medium were common to both HDF and vCRSC. Consequently, a high number of common biological processes were identified in the secretomes of the two cell types, which could help to explain the similar results observed in the in vitro assays. We show that soluble factors secreted by both HDF and vCRSC are able to promote proliferation and differentiation of cardiomyoblasts in vitro. Our study indicates the possible use of vCRSC or HDF secretomes in acellular therapies for regenerative medicine.

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Pesticide usage has contributed to increasing food production; it has also caused them to be found in ecosystems inducing adverse effects on biota. Fish are the most abundant and diverse vertebrates in the world and are of great importance both economically and ecologically. Some fishes are indicators of the environmental quality of aquatic ecosystems and provide insight as to how pollutants might influence public health. The tilapias species can be considered biomonitors because they present little displacement representing the contamination level of a site. This study aimed at three goals: (1) to determine the concentration of 20 pesticides in tilapia muscle in the Ayuquila-Armería basin, (2) to describe the spatiotemporal variation of analytes and (3) to evaluate the risk of consuming contaminated fish. The presence of 11 pesticides was determined. Ametrine, glyphosate and malathion concentrations showed significant differences by season. The risk assessment showed that the consumption of tilapia muscle from the Ayuquila-Armería basin does not represent a risk for the population. Diazinon concentrations were relatively low compared to the other pesticides concentrations, but its toxic characteristics were the ones that most negatively influenced the risk assessment. The results obtained are relevant from the social and economic points of view.

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BACKGROUND: Several classification systems have been developed to support orthopedic surgeons regarding diagnostic, treatment, or prognostic outcomes of distal radius fracture (DRF). However, the best classification system for this fracture remains controversial. We aimed to identify the reliability of three different DRF classifications among orthopedists in training (medical residents). METHODS: Orthopedic residents (n = 22) evaluated thirty cases of DRF in anteroposterior and lateral projections in three different periods (0, 6, 12 months). Each radiography was sorted with three different classifications: Frykman, AO/OTA, and Jupiter-Fernandez. All assessments were blinded to the investigators. The inter- and intra-observer reliability was evaluated using the Cohen's kappa coefficient. An additional analysis was performed for a simpler sub-classification of the AO/OTA (27, 9, or 3 groups). RESULTS: Inter-observer agreement for AO/OTA, Frykman, and Jupiter-Fernandez classifications was slight (k = 0.15), fair (k = 0.31), and fair (k = 0.30), respectively. Intra-observer agreement showed similar results: AO/OTA, k = 0.14; Frykman, k = 0.28; and Jupiter-Fernandez, k = 0.28. When the AO/OTA classification was simplified (9 or 3 descriptions), the inter-observer agreement improved from slight (k = 0.16) to fair (k = 0.21 and k = 0.30, respectively). A similar improvement from slight (k = 0.14) to fair (k = 0.32 and k = 0.21) was detected for intra-observer agreement. CONCLUSIONS: The more complex the DRF classification system, the more complex is to reach reliable inter- and intra-observer agreements between orthopedic trainees. Senior residents did not necessarily show greater kappa values in DRF classifications.

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Fundamento: No se conoce cómo aceptan los residentes de Histología la inclusión de un sistema de videoconferencias sobre la estructura microscópica del cuerpo humano en su estrategia de autoaprendizaje. Objetivo: Explorar en profundidad la experiencia de los residentes de Histología de la Universidad de Ciencias Médicas de Sancti Spíritus que utilizaron un sistema de videoconferencias para su formación profesional. Metodología: Estudio cualitativo en el que se realizó una entrevista a profundidad con los especialistas y residentes de Histología que han utilizado el sistema de videoconferencias en la Universidad de Ciencias Médicas de Sancti Spíritus. Se transcribieron las entrevistas, se codificaron y se seleccionaron los principales temas abordados. Resultados: Se entrevistaron 5 usuarios del sistema de videoconferencias; de la entrevista surgieron 5 temas: 1) Como los residentes insertan las videoconferencias en su estrategia de autoaprendizaje, 2) Preferencia de las videoconferencias sobre los libros de texto, 3) Aciertos y desaciertos de las videoconferencias, 4) ¿Qué aportan las videoconferencias a la formación del residente, ventajas y desventajas? y 5) Sugerencias para mejorar las videoconferencias. Conclusiones: Un sistema de videoconferencias sobre la estructura microscópica del cuerpo humano puede ocupar un papel protagónico en la estrategia de aprendizaje de residentes de Histología. La preferencia que muestran los residentes por las videoconferencias sobre otros medios didácticos puede estar asociada a la capacidad de la multimedia para disminuir la carga cognitiva y facilitar el aprendizaje cuando se siguen los principios de Mayer al elaborar estos medios. La presencia de imágenes digitales en estas videoconferencias fue clave para su aceptación.

Background: It is not known how Histology residents accept the inclusion of a videoconferencing system on the microscopic structure of the human body in their self-learning strategy. Objective: To explore to depth the experience of Histology residents at the Sancti Spíritus University of Medical Sciences who used a videoconferencing system for their professional training. Methodology: Qualitative study with in-depth interview was conducted with Histology specialists and residents who have used the videoconferencing system at the Sancti Spíritus University of Medical Sciences. The interviews were transcribed, coded and the main topics addressed were selected. Results: 5 users of the videoconferencing system were interviewed; 5 themes emerged from the interview: 1) How residents insert videoconferences into their self-learning strategy, 2) Preference for videoconferences over textbooks, 3) Successes and failures of videoconferences, 4) What do videoconferences contribute to the training of the resident, advantages and disadvantages?, 5) Suggestions to improve videoconferences. Conclusions: A videoconferencing system on the microscopic structure of the human body can play a leading role in the learning strategy of Histology residents. The preference shown by residents for videoconferencing over other teaching media may be associated with the ability of multimedia to reduce cognitive load and facilitate learning when Mayer's principles are followed to developing these media. The presence of digital images in these videoconferences was essential to their acceptance.

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Resumen Introducción: Hasta donde se tiene conocimiento, la investigación que se presenta constituye el primer trabajo multicéntrico en México que estudia el desarrollo de la aptitud clínica en unidades formadoras de cardiólogos. Objetivo: Determinar el grado de desarrollo de la aptitud clínica en residentes de cardiología en tres unidades médicas de alta especialidad. Métodos: Diseño transversal multicéntrico. Se analizaron todos los estudiantes del ciclo académico 2019-2020. Se construyó un instrumento que evaluó la aptitud clínica a partir de ocho indicadores y 170 ítems; la validez conceptual/de contenido y la confiabilidad fueron valoradas por cinco cardiólogos con experiencia docente y en investigación educativa. Resultados: Por indicador y año de residencia se observaron diferencias estadísticas significativas en la sede CMN20Nov; en HCSXXI e INCICh se observaron diferencias estadísticamente significativas en uno de ocho indicadores. Se estimaron diferencias entre residentes R1 (n = 41) de las tres sedes por indicador, con significación estadística en tres de ocho indicadores. El resultado fue semejante al comparar R2 (n = 35) y R3 (n = 43). Conclusiones: El grado de desarrollo de la aptitud clínica se puede considerar medio en las tres sedes académicas, probablemente debido a que el instrumento exploró situaciones clínicas problematizadas que exigieron del residente la reflexión crítica de su experiencia clínica.

Abstract Introduction: To the best of our knowledge, the research herein presented is the first multicenter study in Mexico to analyze the development of clinical aptitude in medical units that train cardiologists. Objective: To determine the degree of development of clinical aptitude in cardiology residents at three High Specialty Medical Units. Methods: Multicenter, cross-sectional design. All students of the 2019-2020 academic year were included in the study. An instrument was constructed that evaluated clinical aptitude based on eight indicators and 170 items; conceptual/content validity and reliability were assessed by five cardiologists with teaching and educational research experience. Results: By indicator and year of residence, significant statistical differences were observed in the CMN20Nov academic site. At HCSXXI and INCICh, statistically significant differences were observed in one of eight indicators. Differences between R1 residents (n = 41) of all three academic sites were estimated by indicator, with statistical significance being recorded in three of eight indicators. Between R2 (n = 35) and between R3 residents (n = 43), the result was similar. Conclusions: The degree of clinical aptitude development can be considered intermediate in all three academic sites, probably because the instrument explored problematized clinical situations that required the residents to critically reflect on their clinical experience.

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This study compares clinical practice and objections to controversial ethical issues among 836 Brazilian resident physicians according to levels of religiousness/spirituality. Residents with low religiousness/spirituality (s/r) believed less in the influence of spirituality on clinical practice, were less comfortable addressing this issue, tended to listen less carefully and try to change the subject more than other groups. Residents with high spirituality and low religiousness (S/r) inquired more about religious/spiritual issues, while those with high religiousness/spirituality (S/R) were more supportive and reported fewer barriers to addressing these issues. Concerning ethical issues (e.g., physician-assisted suicide, withdrawal of life support, abortion), S/R had more objections than others.

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Mycobacterium tuberculosis, the causal agent of one of the most devastating infectious diseases worldwide, can evade or modulate the host immune response and remain dormant for many years. In this review, we focus on identifying the local immune response induced in vivo by M. tuberculosis in the lungs of patients with active tuberculosis by analyzing data from untouched cells from bronchoalveolar lavage fluid (BALF) or exhaled breath condensate (EBC) samples. The most abundant resident cells in patients with active tuberculosis are macrophages and lymphocytes, which facilitate the recruitment of neutrophils. The cellular response is characterized by an inflammatory state and oxidative stress produced mainly by macrophages and T lymphocytes. In the alveolar microenvironment, the levels of cytokines such as interleukins (IL), chemokines, and matrix metalloproteinases (MMP) are increased compared with healthy patients. The production of cytokines such as interferon (IFN)-γ and IL-17 and specific immunoglobulin (Ig) A and G against M. tuberculosis indicate that the adaptive immune response is induced despite the presence of a chronic infection. The role of epithelial cells, the processing and presentation of antigens by macrophages and dendritic cells, as well as the role of tissue-resident memory T cells (Trm) for in situ vaccination remains to be understood.

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Introducción: El desempeño asistencial del residente de gastroenterología en cuanto al diagnóstico y tratamiento de pacientes con enfermedades digestivas condiciona su pertinencia profesional en la salud pública. Objetivo: Profundizar en el proceso de formación del residente de gastroenterología. Métodos: Se realizaron un análisis epistemológico y un diagnóstico fáctico del proceso de formación del residente de gastroenterología en cuanto a la atención a pacientes con neoplasias digestivas, en el Hospital General Docente Dr. Juan Bruno Zayas de Santiago de Cuba, durante el bienio 2017-2018, a partir de la observación del desempeño asistencial, la aplicación de una encuesta a residentes y de entrevistas a especialistas de esa rama en la provincia. Resultados: Existieron inconsistencias en esta formación como resultado de una visible polarización médico-instrumental de la práctica en la asistencia, orientada hacia la endoscopia digestiva diagnóstica y terapéutica en detrimento de lo preventivo. Conclusiones: Pudo confirmarse que no se había sistematizado lo suficiente la dimensión de asistencia a pacientes con neoplasias digestivas a partir de la integración formativa de la prevención, el diagnóstico y la terapéutica en la praxis endoscópica de ese profesional.

Introduction: The heath care performance of the gastroenterology resident conditions his professional pertinence in the public health as for the diagnosis and treatment of patients with digestive diseases. Objective: To deepen in the training process of the gastroenterology resident. Method: An epistemologic analysis and factic diagnosis of the training process of the gastroenterology resident regarding the care to patients with digestive neoplasm in Juan Bruno Zayas Teaching General Hospital from Santiago de Cuba during the biennium from the observation of the health care performance, the survey to residents and interviews to specialists of this branch in the province. Results: There were inconsistencies in this training as a result of a visible polarization doctor-tools of practice in the care, orientated to the endoscopic and therapeutic digestive endoscopy contrary to the preventive procedure. Conclusion: It could be confirmed that the care dimension had not been sufficiently systematized while giving care to patients with digestive neoplasm taking into account the training integration of prevention, diagnosis and therapeutics in the endoscopic praxis of this professional.

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Background: During the COVID-19 containment, a decrease in physical activity, vigorous physical exercise and an increase in sedentary lifestyle were documented. Objective: To describe the physical activity, biochemical and somatometric profile of Rehabilitación resident physicians during the COVID-19 pandemic and to determine the correlations between these variables. Material and methods: A cross-sectional, analytical study of medical residents was carried out. Clinical, somatometric and biochemical data were taken. The average number of steps for one day was recorded. Correlations between these variables were sought. A p < 0.05 was considered significant. Results: 57 residents were recruited. The median number of steps was 3,187 (36 - 6,338) in men and 4,935 (2,139 - 7,731) in women. The median waist circumference was normal in women and men (77.5 (67.4 - 87.6) cm and 90 (74.5 - 105) cm); the waist/hip ratio remained within normal limits (0.84 (0.77 - 0.91) and 0.91 (0.78 - 1.04)) and the percentage of fat was high in both sexes (35.42 ± 7.41% and 29.82 ± 8.67). Significant correlations were found between the number of steps and serum triglycerides (-0.34), BMI (-0.49), waist circumference (-0.44), and fat percentage (-0.55). Conclusions: The physical activity of medical residents in the COVID-19 contingency was low. The percentage of fat was found to be increased in both sexes. Total cholesterol was found in the upper limits of normality. Significant correlations were found between the number of steps and serum triglycerides, BMI, waist circumference, and body fat percentage.

Introducción: Durante la contengencia por COVID-19 se documentó disminucion de la actividad fisica, del ejercicio físico vigoroso e incremento del sedentarismo. Objetivo: Describir la actividad física, perfil bioquímico y somatométrico de médicos residentes durante la pandemia COVID-19 y determinar las correlaciones entre estas variables. Métodos: Se realizó un estudio transversal, analítico de médicos residentes. Se tomaron datos clínicos, somatométricos y bioquímicos; se registró el número de pasos promedio de un día. Se buscaron correlaciones entre estas variables. Se considero significativo una p<0.05. Resultados: Se reclutaron 57 residentes. La mediana del número de pasos fue de 3187 (36 - 6338) en hombres y 4935 (2139 - 7731) en mujeres. La mediana de la circunferencia de cintura fue normal en mujeres y hombres (77.5 (67.4 - 87.6) cm y 90 (74.5 - 105) cm); el índice cintura/cadera se mantuvo en valores límites de la normalidad (0.84 (0.77 - 0.91) y 0.91 (0.78 - 1.04)) y el porcentaje de grasa fue elevado en ambos sexos (35.42±7.41% y 29.82±8.67). Se encontraron correlaciones significativas entre el número de pasos y triglicéridos séricos (-0.34), el IMC (-0.49), circunferencia de cintura (-0.44) y porcentaje de grasa (-0.55). Conclusiones: La actividad física de médicos residentes en la contingencia COVID-19 fue baja. El porcentaje de grasa se encontró incrementado en ambos sexos. El colesterol total se encontró en límites superiores de normalidad. Se encontraron correlaciones significativas entre el número de pasos y triglicéridos séricos, IMC, circunferencia de cintura y porcentaje de grasa corporal.

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BACKGROUND: Resident involvement in the operating room is a vital component of their medical education. Laparoscopic cholecystectomy (LC) represents the paradigmatic minimally invasive training procedure, both due to its prevalence and its different forms of complexity. We aim to evaluate whether the supervised participation of residents as operative surgeons in LC of different degrees of complexity affects postoperative outcomes in a university hospital. METHODS: This is a retrospective, single-center study that included all consecutive adult (> 18 years old) patients operated for a LC between January 1, 2012 and December 31, 2017. Each surgical procedure was recorded according to the level of complexity that we established in three types of categorization (level 1: elective surgery; level 2: cholecystitis; level 3: biliary instrumentation). Patients were clinically monitored at an outpatient clinic 7 and 30-day postoperative. Postoperative outcomes of patients operated by supervised residents (SR) and trained surgeons (TS) were compared. Postoperative complications were graded according to the Clavien-Dindo classification of surgical complications. RESULTS: A total of 2331 patients underwent LC during the study period, of whom 1573 patients (67.5%) were operated by SR and 758 patients (32.5%) by TS. There were no significant differences among age, sex, and BMI between patients operated in both groups, with the exception of ASA (P = 0.0001). Intraoperative cholangiography was performed in 100% of the patients, without bile duct injuries. There were no deaths in the 30 postoperative days. The overall complication rate was 5.70% (133 patients), with no significant differences when comparing LC performed by SR and TS (5.09 vs. 6.99%; P = 0.063). The severity rates of complications were similar in both groups (P = 0.379). Patient readmission showed a statistical difference comparing SR vs TS (0.76% vs. 2.2%; P = 0.010). The postoperative complications rate according to the complexity level of LC was not significant in level 1 and 2 for both groups. However in complexity level 3 the TS group experienced a greater rate of complications compared to the SR group (18.12% vs. 9.38%; P = 0.058). In the multivariate analysis, the participation of the residents as operating surgeons was not independently associated with an increased risk of complications (OR 1.22, 95% CI 0.84-1.77; P = 0.275), neither other risk factors like age ≥ 65 years, BMI, complexity level 2-3, or ASA ≥ 3-4. The association of another surgical procedure with the LC was an independent factor of morbidity (OR 3.85, 95% CI 2.54-5.85; P = 0.000). CONCLUSION: Resident involvement in LC with different degrees of complexity did not affect postoperative outcomes. The participation of a resident as operating surgeon is not an independent risk factor and may be considered ethical, safe, and reliable whenever implemented in the background of a residency-training program with continuous supervision and national accreditation. The sum of other procedures not related to a LC should be taken as a risk factor of morbidity.

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