Latin America has a high prevalence of Helicobacter pylori infection and associated diseases, including gastric cancer. Antibiotic therapy can eradicate the bacterial infection and decrease ...associated morbidity and mortality. To tailor recommendations for optimal treatments, we summarized published literature and calculated region- and country-specific prevalences of antibiotic resistance.
Searches of PubMed and regional databases for observational studies evaluating H. pylori antibiotic resistance yielded a total of 59 independent studies (56 in adults, 2 in children, and 1 in both groups) published up to October 2013 regarding H. pylori isolates collected between 1988 and 2011. Study-specific prevalences of primary resistance to commonly prescribed antibiotics were summarized using random-effects models. Between-study heterogeneity was assessed by meta-regression. As a sensitivity analysis, we extended our research to studies of patients with prior H. pylori-eradication therapy.
Summary prevalences of antimicrobial primary resistance among adults varied by antibiotic, including 12% for clarithromycin (n=35 studies), 53% for metronidazole (n=34), 4% for amoxicillin (n=28), 6% for tetracycline (n=20), 3% for furazolidone (n=6), 15% for fluoroquinolones (n=5), and 8% for dual clarithromycin and metronidazole (n=10). Resistance prevalence varied significantly by country, but not by year of sample collection. Analyses including studies of patients with prior therapy yielded similar estimates. Pediatric reports were too few to be summarized by meta-analysis.
Resistance to first-line anti-H. pylori antibiotics is high in Latin American populations. In some countries, the empirical use of clarithromycin without susceptibility testing may not be appropriate. These findings stress the need for appropriate surveillance programs, improved antimicrobial regulations, and increased public awareness.
Background
Feedback is a pivotal cornerstone and a challenge in psychomotor training. There are different teaching methodologies; however, some may be less effective.
Methods
A prospective randomized ...controlled trial was conducted in 130 medical students to compare the effectiveness of the video-guided learning (VLG), peer-feedback (PFG) and the expert feedback (EFG) for teaching suturing skills. The program lasted 4 weeks. Students were recorded making 3-simple stitches (pre-assessment and post-assessment). The primary outcome was a global scale (OSATS). The secondary outcomes were performance time, specific rating scale (SRS) and the impact of the intervention (IOI), defined as the variation between the final and initial OSATS and SRS scores.
Results
No significant differences were found between PFG and EFG in post-assessment results of OSATS, SRS scores or in the IOI for OSATS and SRS scores. Post-assessment results of PFG and EFG were significantly superior to VLG in OSATS and SRS scores (19.8 (18.5–21); 16.6 (15.5–17.5)) and (20.3 (19.88–21); 16.8 (16–17.5)) vs (15.7 (15–16); 13.3 (12.5–14)) (
p
< 0.05), respectively. The results of PFG and EFG were significantly superior to VLG in the IOI for OSATS 7 (4.5–9) and 7.4 (4.88–10) vs 3.5 (1.5–6) (
p
< 0.05) and SRS scores 5.4 (3.5–7) and 6.3 (4–8.5) vs 3.1 (1.13–4.88) (
p
< 0.05), respectively.
Conclusion
The video-guided learning methodology without any kind of feedback is not enough for teaching suturing skills compared to expert or peer feedback. The peer feedback methodology appears to be a viable alternative to handling the emerging demands in medical education.
Autoimmune gastritis (AIG) is associated with nutritional deficiencies, autoimmune diseases, and gastric malignancies. The aims of the study were to test the hypothesis that mucocutaneous (MC) ...manifestations occur more often in patients with vs without AIG and to delineate patterns of MC manifestations in AIG.
A single-center, prospective 2:1 case-control study was conducted. Cases were patients with the diagnosis of AIG based on consistent serologic and histologic findings. Controls had a normal gastric biopsy. MC manifestations were independently evaluated by 3 experienced dermatologists. We conducted a multivariable logistic regression model adjusted for age, sex, Helicobacter pylori, tobacco use, and alcohol consumption to estimate the association between AIG (vs no AIG) and MC manifestations (adjusted odds ratio; 95% confidence interval).
We prospectively enrolled 60 cases and 30 controls (mean age 53.5 ± 15.8 vs 53.4 ± 14.5 years; 75% vs 73.3% women). The pooled prevalence of MC immune-mediated diseases was higher in patients with vs without AIG (66.7% vs 23.3%; adjusted odds ratio 12.01 95% confidence interval: 3.51-41.13). In patients with AIG, seropositive vs seronegative anti-intrinsic factor antibodies more often had concomitant immunological diseases with MC manifestations (100% vs 58.5%; P = 0.016). The most common MC immune-mediated diseases in AIG were Sjögren syndrome (n = 5, 8.3%), alopecia areata (n = 5, 8.3%), and vitiligo (n = 4, 6.7%). Nutritional deficiency-related MC findings, mainly xerosis, lingual, and nail disorders, were also more common in AIG.
This is the first comparative study specifically designed to evaluate MC manifestations in AIG. We demonstrated that AIG is more frequently associated with both immune- and nutritional deficiency-related MC manifestations, which might have both diagnostic and therapeutic clinical implications.
Non-alcoholic fatty liver disease (NAFLD) diagnosis requires a liver biopsy, which is inapplicable to large populations. Alternatively, NAFLD can be detected indirectly by non-invasive methods such ...as Fatty Liver Index (FLI) and Lipid Accumulation Product (LAP). Thus, the prevalence of NAFLD and its association with lifestyle habits (e.g., physical activity) can be studied within populations. This study aimed to (i) estimate the prevalence of NAFLD by FLI and LAP in the adult Chilean population and (ii) determine the association between the presence of NAFLD and physical activity levels.
We analyzed the National Health Survey of Chile 2016-2017. Individuals meeting these criteria were included: 21-75 years old; absence of hepatitis B/C, HIV, acquired immunodeficiency syndrome, syphilis, chancre, and gonorrhea; alcohol consumption <20 g/day for women, or <30 g/day for men. NAFLD was detected by FLI (considers circulating triglycerides, circulating gamma-glutamyl-transferase, body mass index, and waist circumference) and LAP (considers circulating triglycerides, and waist circumference). The Global Physical Activity Questionnaire was used to estimate physical activity levels. Logistic regression was used to determine the association between NAFLD presence and physical activity, adjusted by age, sex, body mass index, and education.
We included 2,774 participants, representative of 10,599,094 9,831,644–11,366,544 adults. NAFLD prevalence 95%CI was 39.4% 36.2–42.8 by FLI, and 27.2% 24.2–30.4 by LAP. Prevalence progressively increased with higher body mass indexes. Compared to participants in the 1st-quartile of physical activity, those in the 3rd-quartile or 4th-quartile had lower odds of having NAFLD by FLI or LAP, respectively.
The prevalence of NAFLD in Chile surpasses global estimates. The excess body weight among adults in Chile may explain this phenomenon. Notably, physical activity seems relevant to prevent NAFLD, independently of excess body weight. Focused public health interventions are urgently required in Chile.
FONDECYT 1191183 to F.B. and 11180361 to R.F.-V.
Feedback processes are crucial for learning, guiding improvement, and enhancing performance. In workplace-based learning settings, diverse teaching and assessment activities are advocated to be ...designed and implemented, generating feedback that students use, with proper guidance, to close the gap between current and desired performance levels. Since productive feedback processes rely on observed information regarding a student's performance, it is imperative to establish structured feedback activities within undergraduate workplace-based learning settings. However, these settings are characterized by their unpredictable nature, which can either promote learning or present challenges in offering structured learning opportunities for students. This scoping review maps literature on how feedback processes are organised in undergraduate clinical workplace-based learning settings, providing insight into the design and use of feedback.
A scoping review was conducted. Studies were identified from seven databases and ten relevant journals in medical education. The screening process was performed independently in duplicate with the support of the StArt program. Data were organized in a data chart and analyzed using thematic analysis. The feedback loop with a sociocultural perspective was used as a theoretical framework.
The search yielded 4,877 papers, and 61 were included in the review. Two themes were identified in the qualitative analysis: (1) The organization of the feedback processes in workplace-based learning settings, and (2) Sociocultural factors influencing the organization of feedback processes. The literature describes multiple teaching and assessment activities that generate feedback information. Most papers described experiences and perceptions of diverse teaching and assessment feedback activities. Few studies described how feedback processes improve performance. Sociocultural factors such as establishing a feedback culture, enabling stable and trustworthy relationships, and enhancing student feedback agency are crucial for productive feedback processes.
This review identified concrete ideas regarding how feedback could be organized within the clinical workplace to promote feedback processes. The feedback encounter should be organized to allow follow-up of the feedback, i.e., working on required learning and performance goals at the next occasion. The educational programs should design feedback processes by appropriately planning subsequent tasks and activities. More insight is needed in designing a full-loop feedback process, in which specific attention is needed in effective feedforward practices.
Introduction. Children with autism spectrum disorder (ASD) have difficulties adapting to stressful situations, such as the COVID-19 pandemic. Objective. To assess the impact of the first year of the ...pandemic on feeding difficulties in children with ASD. Population and methods. The caregivers of children and adolescents with non-syndromic ASD (age: 2-18 years) from a neurodevelopment unit were invited to participate. Participants completed a questionnaire and the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) online before and during the first year of the pandemic. A priority score (product between the average frequency and the problem) for each BPFAS item was estimated. Results. Among the caregivers, 56.6% (86/152) completed the survey (mother: 74.4%); children's median age was 6.3 years (p25-p75: 4.7-8.2); 80.2% of children were males; 58.1% continued with their therapy during the pandemic; and 61.6% had behavioral problems before the pandemic. During the first year of the pandemic, children had greater behavioral problems (34.9%) and feeding difficulties (61.6%); however, 31.4% of caregivers referred improvements in feeding. There were no significant differences in the BPFAS scores before and during the pandemic. The following items obtained the highest priority scores: gets up from table during meal, does not try new food, does not eat vegetables, does not eat fruits. Conclusions. A high frequency of feeding difficulties was noted during the first year of the pandemic. No differences were observed in feeding characteristics before and during the pandemic.
En este número de la Revista ARS Médica, queremos compartir la alegría de celebrar los 50 años de Educación Médica en la UC. En marzo del año 1971 comenzó a funcionar la oficina de Educación Médica ...UC y en agosto de ese mismo año, se publicó el primer número del Boletín del Hospital Clínico de la Universidad Católica de Chile que más tarde se transformaría en la actual Revista ARS Médica. Ambas iniciativas representaron hitos muy importantes en la formación médica y de profesionales en salud. A lo largo de 50 años de educación médica en la UC hemos ido aprendiendo de profesionales clínicos, estudiantes, docentes y expertos de diversas partes del mundo cómo mejorar la formación de nuestros profesionales para que sirvan mejor a sus comunidades.
Objectives
Persistent olfactory dysfunction (OD) after 6 months caused by SARS‐CoV‐2 infection has been reported with a variable prevalence worldwide. This study aimed to determine the prevalence of ...long‐term OD and identify predisposing factors.
Methods
A prospective cohort study was conducted on 100 adults with COVID‐19. Olfactory function was assessed with the University of Pennsylvania Smell Identification Test and a symptom survey at the onset of disease and 30 days later. Patients with persistent quantitative OD at the second assessment were reevaluated after 1 year. Demographic variables, symptoms, and the degree of smell loss were analyzed.
Results
Participants included 100 patients. The mean age was 42.2 ± 15.6 years, 55 (55%) were female, and 56 (56%) were outpatients. Baseline smell loss was identified in 75/100 (75%) patients, decreasing to 39/95 (40%) after 1 month, and persisting in 29 patients after 1 year. Phantosmia at baseline was the only risk factor identified for persistent OD after 1 year (relative risk 2.51; 95% confidence interval 1.53–4.12; p < 0.001). Regardless of the outcome in smell function, a significant decline in olfaction was associated with the presence of phantosmia at 1 month (β = −12.39; 95% CI −19.82 to −4.95; p < 0.01).
Conclusions
SARS‐CoV‐2 (2019–2020 variants) produced a highly frequent OD that persisted in 29% of the patients after 1 year. The presence of phantosmia at baseline and 1 month was associated with a worse evolution, but phantosmia may interfere with the performance in an identification smell test. A longer follow‐up is required in these patients.
Level of Evidence
2 Laryngoscope, 132:2445–2452, 2022
Olfactory dysfunction following COVID‐19 persisted in 29% of the patients after 1 year of infection. Phantosmia at baseline and 1 month were associated with a worse evolution, but their presence may represent ongoing regeneration. Longer follow‐up is required in these patients.
Background and Aims
Nodular gastropathy (NG) is an inflammatory condition of the gastric mucosa characterized by the endoscopic detection of multiple millimeter protrusions. A strong association ...between NG and
Helicobacter pylori
and a possible role of NG as a risk factor for undifferentiated gastric cancer have been described. The aim of this study was to characterize the pathogenic and inflammatory profile of patients with NG.
Methods
Adult patients referred for upper gastrointestinal endoscopy were prospectively enrolled in this study.
H. pylori
infection status was determined by rapid urease test. Biopsies were stained with hematoxylin–eosin. Sydney and OLGA scores were used to assess gastritis characteristics and gastric cancer risk. PCR analysis was performed to determine bacterial load and virulence factors CagA (and its EPIYA motifs) and VacA alleles. Finally, gastric mucosa cytokine gene expression (IL-8, IL-1β, and TNF-α) was determined by real-time RT-PCR.
Results
Forty-eight patients, mean age of 36 years, were recruited. All NG patients were infected by
H. pylori.
OLGA score was similar in both groups (NG patients and non-NG patients). NG patients had higher bacterial load in the gastric corpus (
p
= 0.01) and significantly less pro-inflammatory cytokine levels than non-NG infected patients (
p
= 0.01).
Conclusions
In our study, NG is not associated with preneoplastic lesions. An increase in bacterial load without a concomitant increase in mucosal inflammatory cytokine responses in
H. pylori
-infected subjects with NG may represent a general dampening of immune responses or an additional mechanism of
H. pylori
active immune evasion.
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