Use of Eye-Tracking Technology by Medical Students Taking the Objective Structured Clinical Examination: Descriptive Study

Background: The objective structured clinical examination (OSCE) is a test used throughout Spain to evaluate the clinical competencies, decision making, problem solving, and other skills of sixth-year medical students. Objective: The main goal of this study is to explore the possible applications and utility of portable eye-tracking systems in the setting of the OSCE, particularly questions associated with attention and engagement. Methods: We used a portable Tobii Glasses 2 eye tracker, which allows real-time monitoring of where the students were looking and records the voice and ambient sounds. We then performed a qualitative and a quantitative analysis of the fields of vision and gaze points attracting attention as well as the visual itinerary. Results: Eye-tracking technology was used in the OSCE with no major issues. This portable system was of the greatest value in the patient simulators and mannequin stations, where interaction with the simulated patient or areas of interest in the mannequin can be quantified. This technology proved useful to better identify the areas of interest in the medical images provided. Conclusions: Portable eye trackers offer the opportunity to improve the objective evaluation of candidates and the self-evaluation of the stations used as well as medical simulations by examiners. We suggest that this technology has enough resolution to identify where a student is looking at and could be useful for developing new approaches for evaluating specific aspects of clinical competencies

Treatment of hepatitis delta and HIV infection

Hepatitis delta virus (HDV) is a defective agent that only infects individuals with hepatitis B virus (HBV). Around 5–10% of chronic hepatitis B patients worldwide are superinfected with HDV, which means 15–25 million people. Hepatitis delta is the most severe of all chronic viral hepatitis, leading to cirrhosis, liver cancer and/or transplantation in most patients. Despite it, many HDV patients remain undiagnosed. The only treatment available until recently was peginterferon alfa, with poor results and significant side effects. The recent approval of bulevirtide, a lipopeptide that blocks HBV/HDV entry, has revolutionized the field. Another drug, lonafarnib, already approved to treat progeria, is expected to be available soon as HDV therapy. Since there is no cell reservoir for the HDV RNA genome, hypothetically viral clearance could be achieved if complete blocking of viral replication occurs for a minimum time frame. This is what happens in hepatitis C using direct-acting antivirals, with the achievement of cure in nearly all treated patients. We envision the cure of hepatitis delta using combination antiviral therapy. Given that sexual and parenteral transmission routes are the most frequent for the acquisition of HBV and HDV, shared with HIV infection and HBV/HDV and HIV coinfection. The clinical outcome of hepatitis delta is worst in the HIV setting, with more frequent liver complications. Since most persons infected with HIV are on regular health care follow-up, we propose that HIV-HDV patients should be prioritized for moving forward new and potentially curative treatments for hepatitis delta

Dermatoses in Latin American immigrants seen in a tertiary hospital

Europe, and in particular Spain, has become the destination of a considerable number of immigrants, 50% come from Latin America. The purpose of this study was to describe the cases of dermatoses seen in the immigrant Latin American population and compare them with those found in the control Spanish population. Over a year all the visits of economic immigrants seen in the Dermatology Section of the Hospital General Universitario de Alicante were prospectively recorded. During the study period 706 Latin American patients were seen. The most frequent dermatoses were eczema (18.2%), acne (6.5%) and non-genital viral warts (6.3%). The comparative study of dermatoses adjusted for age and sex, found a greater frequency of eczema, alopecia, melasma, herpes simplex, pilar keratosis, xerosis, and scabies (p < 0.01) in the Latin American population. On the other hand, melanocytic nevi and melanoma were less frequent in these patients (p < 0.05). We may say that the skin type and socio-sanitary conditions of the Latin American immigrant population lead to a greater frequency of eczema, melasma and scabies. In addition, the skin type and younger age favour a lower frequency of skin tumours

Tinea nigra palmaris: a clinical case in a rural Ethiopian hospital

Tinea nigra is an infrequent, superficial fungal infection, mainly caused by Hortaea werneckii, which is still underreported in Ethiopia. An asymptomatic 62-year-old male patient sought a rural hospital of Ethiopia, showing dark plaques on the palms of both hands. A superficial mycosis was suspected and a direct light microscopic mycological examination from skin scrapings revealed short brownish hyphae. To our knowledge, this is the first case of tinea nigra from the Ethiopian highlands. This may be due to the actual rarity of the condition or to underreportin

Malaria importada en población pediátrica de Alicante, España (1994-2019)

Introduction: In recent years there has been an increase in imported malaria among children in whom it is a potentially serious and fatal disease.Objective: To describe the incidence and the clinical and epidemiological characteristics of malaria in children diagnosed in Alicante, Spain, over a 26-year period.Materials and methods: We conducted an observational retrospective study of malaria in children aged under 15 years diagnosed at the Alicante General University Hospital from 1994 to 2019.Results: Twenty-four cases were registered over the study period. The frequency of cases increased from 2 over the first five years to 11 in the last five years. The median age of the children was 6 years (interquartile range: 3-8); 91.6% came from sub-Saharan Africa. Over half (n=15, 62.5%) were children born in Spain to immigrant parents visiting friends and relatives (VFR); just one (6.7%) had received antimalarial chemoprophylaxis. The most frequent clinical signs were fever (86.9%), hepatosplenomegaly (70.8%), and anemia (70.8%). Plasmodium falciparum was the most frequently identified species (83.3%, n=20). The most common treatment was oral piperaquine/dihydroartemisinin (41.6%, n=10) with favorable outcomes in all cases.Conclusions: Imported childhood malaria shows an increasing incidence and a nonspecific clinical presentation. Professional awareness of this disease and a high degree of clinical suspicion are needed for the early initiation of treatment. Pre-travel preventive measures should be promoted when appropriate.Introducción. En los últimos años ha aumentado la malaria importada en niños, en quienes la enfermedad es potencialmente grave y mortal.Objetivo. Describir la incidencia y características clínico-epidemiológicas de niños con diagnóstico de conmalaria en Alicante, España, en los últimos años.Materiales y métodos. Se hizo un estudio observacional y retrospectivo de los casos de malaria en menores de 15 años, diagnosticados en el Hospital General Universitario de Alicante desde 1994 hasta 2019.Resultados. Se registraron 24 casos. El número de casos pasó de dos en el primer quinquenio a 11 en el último. La mediana de edad fue de 6 años (rango intercuartílico: 3 a 8). El 91,6 % procedía de África subsahariana. Los niños nacidos en España de padres inmigrantes que viajan a una zona endémica para visitar a familiares y amigos (Visiting Friends and Relatives) representaron el 62,5 % (n=15) y solo consta que recibiera quimioprofilaxis antipalúdica un paciente (6,7 %). Los signos clínicos más frecuentes fueron fiebre (86,9 %), hepatoesplenomegalia (70,8 %) y anemia (70,8 %). Plasmodium falciparum fue la especie más frecuentemente identificada (83,3 %; n=20). El tratamiento más empleado fue la combinación de dihidroartemisina y piperaquina por vía oral (41,6 %, n=10), con evolución favorable en todos los casos.Conclusiones. Los casos de paludismo infantil importado están aumentando en los últimos años. Las manifestaciones clínicas son inespecíficas en estos niños, por lo que es importante que los profesionales conozcan la enfermedad y tengan un alto índice de sospecha para iniciar el tratamiento precoz. Además, deben tomarse las medidas preventivas adecuadas antes de un viaje

Análisis de la demanda asistencial en dermatología de la población inmigrante

Objetivos: Conocer la demanda asistencial en dermatología de la población inmigrante (PI) y compararla con la de la población autóctona (PA).Métodos: Durante un año, se recogió prospectivamente el número de enfermedades atendidas en dermatología en el Departamento de Salud 19 de la Comunidad Valenciana.Resultados: De 39.160 episodios, 1.625 fueron en PI (4,1%). La asistencia por urgencias fue mayor en PI que en PA (el 7,7 frente al 3,0%; p < 0,001) y la actividad quirúrgica en PI fue menor que en PA (el 2,6 frente al 5%; p < 0,001). La demanda en la PI fue de 5,7 episodios por 100 inmigrantes, inferior a la PA (16,2). La razón de tasas estandarizada fue de 0,34. Los pacientes del norte de África (5,6 por 100 inmigrantes), Europa del este (4,8), África subsahariana (5,3) y Asia (4,2) consultaron menos que los latinoamericanos (8,5; p < 0,001).Conclusiones: La demanda en PI fue inferior a la PA y con un patrón de utilización diferente por países.Objective: To determine the utilization rate of a dermatology service among the immigrant population and compare this rate with that among the autochthonous population.Methods: Over a 1-year period, data on all patients attended in the Dermatology Service of Health Department 19 in the autonomous community of Valencia were prospectively collected.Results: Of 39,160 consultations, 1,625 were made by immigrants (4.1%). Attendance for dermatologic emergencies was greater in immigrants than in the autochthonous population (7.7% vs 3.0%; p<0.001), while surgical activity was lower in immigrants than in Spanish-born patients (2.6% vs 5%; p<0.001). Demand for consultation in the immigrant population was 5.7 visits per 100 immigrants, lower than that in the autochthonous population (16.2). The standardized rate ratio was 0.34. North Africans (5.6 per 100 immigrants), East Europeans (4.8), sub-Saharan Africans (5.3) and Asians (4.2) consulted less than Latin Americans (8.5; p<0.001).Conclusions: Demand was lower in the immigrant than in the autochthonous population, and the utilization pattern differed according to country

Autochthonous Outbreak of Cutaneous Leishmaniasis due to Leishmania infantum in Corrientes Province, Argentina

Endemic cutaneous leishmaniasis (CL) in northern Argentina has traditionally been caused by Leishmania braziliensis. This study aims to describe an outbreak of Leishmania infantum-caused human CL in the Department Capital of Corrientes Province, Argentina. We retrospectively analyzed the reported cases of CL in this area from May 2015 to December 2016. Eighty cases of CL were clinically and analytically diagnosed, and there was one case of visceral leishmaniasis in a boy who also had CL. Patients' median age was 33.6 years (range 1-89 years), and 18.5% were younger than 15 years; the male:female ratio was 3.5:1. Cases lived mostly in the municipality of Corrientes (72.8%), whereas 27.2% resided in Riachuelo. Although 67.9% had a single lesion, 32.1% had several. Molecular analyses showed that L. infantum was the causative species in all cases. Our results show that for the first time, there was an outbreak of CL by L. infantum in an urban area of Argentina

Análisis de la demanda asistencial en dermatología de la población inmigrante

Objetivos: Conocer la demanda asistencial en dermatología de la población inmigrante (PI) y compararla con la de la población autóctona (PA).Métodos: Durante un año, se recogió prospectivamente el número de enfermedades atendidas en dermatología en el Departamento de Salud 19 de la Comunidad Valenciana.Resultados: De 39.160 episodios, 1.625 fueron en PI (4,1%). La asistencia por urgencias fue mayor en PI que en PA (el 7,7 frente al 3,0%; p < 0,001) y la actividad quirúrgica en PI fue menor que en PA (el 2,6 frente al 5%; p < 0,001). La demanda en la PI fue de 5,7 episodios por 100 inmigrantes, inferior a la PA (16,2). La razón de tasas estandarizada fue de 0,34. Los pacientes del norte de África (5,6 por 100 inmigrantes), Europa del este (4,8), África subsahariana (5,3) y Asia (4,2) consultaron menos que los latinoamericanos (8,5; p < 0,001).Conclusiones: La demanda en PI fue inferior a la PA y con un patrón de utilización diferente por países.Objective: To determine the utilization rate of a dermatology service among the immigrant population and compare this rate with that among the autochthonous population.Methods: Over a 1-year period, data on all patients attended in the Dermatology Service of Health Department 19 in the autonomous community of Valencia were prospectively collected.Results: Of 39,160 consultations, 1,625 were made by immigrants (4.1%). Attendance for dermatologic emergencies was greater in immigrants than in the autochthonous population (7.7% vs 3.0%; p<0.001), while surgical activity was lower in immigrants than in Spanish-born patients (2.6% vs 5%; p<0.001). Demand for consultation in the immigrant population was 5.7 visits per 100 immigrants, lower than that in the autochthonous population (16.2). The standardized rate ratio was 0.34. North Africans (5.6 per 100 immigrants), East Europeans (4.8), sub-Saharan Africans (5.3) and Asians (4.2) consulted less than Latin Americans (8.5; p<0.001).Conclusions: Demand was lower in the immigrant than in the autochthonous population, and the utilization pattern differed according to country