Hasil untuk "Medicine (General)"

R. Bellazzi, B. Zupan

BACKGROUND The widespread availability of new computational methods and tools for data analysis and predictive modeling requires medical informatics researchers and practitioners to systematically select the most appropriate strategy to cope with clinical prediction problems. In particular, the collection of methods known as 'data mining' offers methodological and technical solutions to deal with the analysis of medical data and construction of prediction models. A large variety of these methods requires general and simple guidelines that may help practitioners in the appropriate selection of data mining tools, construction and validation of predictive models, along with the dissemination of predictive models within clinical environments. PURPOSE The goal of this review is to discuss the extent and role of the research area of predictive data mining and to propose a framework to cope with the problems of constructing, assessing and exploiting data mining models in clinical medicine. METHODS We review the recent relevant work published in the area of predictive data mining in clinical medicine, highlighting critical issues and summarizing the approaches in a set of learned lessons. RESULTS The paper provides a comprehensive review of the state of the art of predictive data mining in clinical medicine and gives guidelines to carry out data mining studies in this field. CONCLUSIONS Predictive data mining is becoming an essential instrument for researchers and clinical practitioners in medicine. Understanding the main issues underlying these methods and the application of agreed and standardized procedures is mandatory for their deployment and the dissemination of results. Thanks to the integration of molecular and clinical data taking place within genomic medicine, the area has recently not only gained a fresh impulse but also a new set of complex problems it needs to address.

Kei Ito, Akira Endo, Hiromasa Hoshi et al.

ABSTRACT Background Although surgical treatment is the primary measure for patients with perforated peptic ulcer (PPU), nonoperative management (NOM) has become a common alternative. However, risk score models predicting the success of NOM based on the analysis of a large number of patients remain scarce. We developed a clinically applicable scoring system to predict the success of NOM in patients with PPU using data from a large cohort. Method We analyzed data of the Perforated Peptic ulcer Analyzing Project (PPAP), which was a retrospective survey of adult patients with PPU between January 2011 to December 2022. The successful NOM case was defined as patients who survived until hospital discharge without requiring surgery. Factors associated with NOM were identified using a multivariable logistic regression analysis, and a scoring system to predict NOM was developed by weighting these factors based on the regression coefficients. Result Of 702 potentially eligible patients, 584 were treated with NOM, of which 130 patients (22.2%) were treated successfully. Age, sex, body temperature, heart rate, the extent of peritoneal irritation signs, C reactive protein, spread of ascites, and sepsis were included in the final model. Using these variables, we developed the scoring system named PPAP score, which had favorable discriminating ability with the area under receiving operating characteristic curve of 0.799. When the cut‐off was set to 56, the sensitivity and the specificity were 0.738 and 0.722, respectively. Conclusion A predictive scoring model was developed. However, external validation of the model is required to confirm its clinical applicability.

Zhen Wang, Honglei Guo, Yanqi Song et al.

Lung cancer is the most common malignant tumor in the world. Presently, there are still problems, including a high recurrence rate, resistance, and serious toxic side effects, even if conventional treatments like chemotherapy, radiotherapy, and targeted therapy have somewhat improved patient survival. Even though immune checkpoint inhibitors that target programmed cell death-1/programmed cell death ligand 1 have fundamentally altered the therapeutic paradigm, the core mechanism is strongly linked to tumor immune escape, and some patients continue to have poor response rates or treatment resistance. The mechanisms of immune escape in the immunological microenvironment of lung cancer, involving metabolic reprogramming, overexpression of immune checkpoint molecules, and abnormalities in antigen presentation, are systematically summarized in this review. The article also sums up new therapeutic targets and promising clinical trials. The goal is to provide a solid theoretical foundation for further research into the immune escape mechanism, the creation of new immunotherapeutic targets, and personalized therapeutic strategies.

Victor Fages, Gregory Baud, Marion Fericot et al.

Obesity is a major public health issue that affects a significant proportion of patients with end-stage renal disease (ESRD). In patients undergoing peritoneal dialysis (PD), obesity complicates treatment by increasing the risk of mechanical complications and infections and reducing the effectiveness of peritoneal exchanges. Furthermore, obesity limits access to kidney transplantation, making weight loss a crucial goal. Bariatric surgery is emerging as an effective strategy for improving metabolic condition and promoting placement on a transplant waiting list. Sleeve gastrectomy (SG) is now the preferred technique for helping obese patients on ESRD lose weight, particularly due to its favorable safety profile, reduced operating time, and absence of intestinal bypass, thus limiting the risk of deficiencies. The available data, although limited to case series and isolated reports, suggest that SG can be performed in PD patients either with early resumption of PD or after a temporary transition to hemodialysis depending on clinical status. Optimized protocols include a gradual resumption of PD at low volumes, minimizing the risk of leakage or infection. Bariatric surgery therefore appears feasible and generally safe in PD patients, provided that a rigorous multidisciplinary assessment and close nutritional monitoring are carried out to prevent malnutrition and sarcopenia. It is a relevant therapeutic option for improving access to kidney transplantation and optimizing the prognosis of obese patients with ESRD. This article was written following a presentation at the Société Francophone de Néphrologie, Dialyse et Transplantation 2025 on the feasibility of bariatric surgery in PD.

Xiaojin Gao, Mengyuan Liu, Jing Xu et al.

BackgroundEarly revascularization enables ST-elevation myocardial infarction (STEMI) patients with cardiogenic shock (CS) to initiate oral beta-blockers once hemodynamic stability is achieved, but the impact of such initiation on prognosis remains unknown. We aimed to describe the clinical use of oral beta-blockers and assess its impact on long-term outcomes in STEMI patients with CS in a real-world setting.Materials and methodsThe China Acute Myocardial Infarction registry (CAMI) is a prospective observational study that enrolls patients with acute myocardial infarction from three-level hospitals across 31 administrative regions in mainland China. Among 19,112 STEMI patients in the CAMI registry, a total of 744 STEMI patients who presented with CS at admission were analyzed. Multivariate regression models were used to evaluate the impact of in-hospital oral beta-blockers on 2-year outcomes. Inverse probability treatment weighting (IPTW) score was further used to address biases between the groups with and without oral beta-blockers. The primary endpoint was all-cause death.Results42.7% (n = 318) of the patients initiated in-hospital oral beta-blockers; these patients were in better states and more likely to receive primary percutaneous coronary intervention and secondary prevention at discharge. The crude 2-year all-cause mortality was 41.7%, with a lower rate in patients who received oral beta-blockers (24.2% vs. 54.8%, P < 0.001). However, after multivariate adjustment, patients who received oral beta-blockers showed a non-significant increase in 2-year mortality compared with non-users (HR = 1.29, 95% CI: 0.95–1.75, P = 0.099), and this increase became statistically significant in the subgroup of county-level hospitals (HR = 1.79, 95% CI: 1.03–3.09, P = 0.038, P-interaction = 0.010). Furthermore, after balancing the baseline covariates using IPTW and further adjusting for discharge medications, initiation of oral beta-blockers during hospitalization increased the risk of 2-year all-cause mortality (HR = 1.59, 95% CI: 1.18–2.13, P = 0.002).ConclusionNo benefit of in-hospital oral beta-blockers initiation on long-term all-cause mortality was found in Chinese STEMI patients with CS, and a trend toward increased mortality existed, especially in small-scale hospitals with insufficient experience in CS treatment.

Abdulla Mohamed, Samma Eraqe, Mai Mattar et al.

Introduction: Retronychia is a unique type of nail ingrowth that has been described by De Berker and Renall in 1999. We present a case that was diagnosed and treated involving a multidisciplinary team consisting of dermatologist, radiologist, and a general surgeon. Furthermore, recurrence of such condition was prevented by patient education and empowerment. Case presentation: This is a young female who presented with two months history of right great toe pain and discharge. Antibiotic alone was prescribed but did not show improvement. She previously underwent left side nail avulsion for a similar complaint. In examination, she had tender hallux valgus of the right big toe, associated with turbid discharge from the nail bed. We confirmed the diagnosis of retronychia using ultrasound and treated the condition with nail avulsion. However, she had signs of recurrence during follow up, and we advised her to raise the distal end of the nail manually using a local anesthetic which was successful. Discussion: This unique condition needs timely diagnosis to choose the proper treatment. Treatment depends on the stage, and starts with topical steroids and eventually might end with nail avulsion. Recurrence is uncommon, unlike our case. We hypothesized that early lifting of the distal end of the nail can prevent full recurrence. This maneuver proved to be effective in our case and there was no recurrence. Conclusion: Retronychia is a new term that shares treatment with other nail disorders. Patient education and empowerment is crucial in the treatment. Further studies in that matter are needed.

Toby Keys, Sarah Maeda, Meagan Johnson et al.

Purpose: Medical students of color (MSoC) regularly experience discrimination and mistreatment during medical school. Preceptors have the potential to provide meaningful support for MSoC while on their family medicine clerkship rotation.  This mixed-method study explores family medicine clerkship preceptors’ challenges, current practices, and institutional needs related to welcoming and supporting MSoC.   Methods: Any lead preceptor at a University of Washington-affiliated Family Medicine clerkship teaching site was eligible for this study. From June to September 2022, 7 focus groups were conducted with a total of 32 participants. Study team members coded transcripts for key themes related to participants’ experiences of working with MSoC. All participants were asked to complete a short survey, which included both demographic questions and questions regarding their beliefs and abilities to welcome and support MSoC. Results: Many preceptors felt underprepared and unsure about when and how to support MSoC. Current strategies employed by participants included adding a semi-scripted orientation conversation to discuss how they will be supported during the rotation and who they can talk to if they encounter any discrimination and/or microaggressions. Participants also suggested that the medical school should offer additional trainings for preceptors, such as mitigating microaggressions toward students. Conclusions: Lead preceptors are well positioned to empower and support the students they teach. This exploratory, single-institution study offers some insights into the challenges, current practices, and suggestions for institutions to support MSoC during clinical rotations.  We recommend additional research to help validate our findings.

Luís P. G. Monteiro, João Borges, João M. M. Rodrigues et al.

Marine-origin polysaccharides, in particular cationic and anionic ones, have been widely explored as building blocks in fully natural or hybrid electrostatic-driven Layer-by-Layer (LbL) assemblies for bioapplications. However, the low chemical versatility imparted by neutral polysaccharides has been limiting their assembly into LbL biodevices, despite their wide availability in sources such as the marine environment, easy functionality, and very appealing features for addressing multiple biomedical and biotechnological applications. In this work, we report the chemical functionalization of laminarin (LAM) and pullulan (PUL) marine polysaccharides with peptides bearing either six lysine (K₆) or aspartic acid (D₆) amino acids via Cu(I)-catalyzed azide-alkyne cycloaddition to synthesize positively and negatively charged polysaccharide-peptide conjugates. The successful conjugation of the peptides into the polysaccharide’s backbone was confirmed by proton nuclear magnetic resonance and attenuated total reflectance Fourier-transform infrared spectroscopy, and the positive and negative charges of the LAM-K₆/PUL-K₆ and LAM-D₆/PUL-D₆ conjugates, respectively, were assessed by zeta-potential measurements. The electrostatic-driven LbL build-up of either the LAM-D₆/LAM-K₆ or PUL-D₆/PUL-K₆ multilayered thin film was monitored in situ by quartz crystal microbalance with dissipation monitoring, revealing the successful multilayered film growth and the enhanced stability of the PUL-based film. The construction of the PUL-peptide multilayered thin film was also assessed by scanning electron microscopy and its biocompatibility was demonstrated in vitro towards L929 mouse fibroblasts. The herein proposed approach could enable the inclusion of virtually any kind of small molecules in the multilayered assemblies, including bioactive moieties, and be translated into more convoluted structures of any size and geometry, thus extending the usefulness of neutral polysaccharides and opening new avenues in the biomedical field, including in controlled drug/therapeutics delivery, tissue engineering, and regenerative medicine strategies.

Jinlong Ma, Liang Zhang, Cui Wang et al.

ObjectiveTo compare the mid-term outcomes of unicompartmental knee arthroplasty (UKA) that was performed in one knee and total knee arthroplasty (TKA) performed in the other knee in the same stage.MethodsThis is a retrospective study. A total of 63 patients (126 knees) scheduled for one-stage knee surgery due to osteoarthritis of both knees were selected, and all patients underwent one-stage mobile platform UKA and TKA of the other knee. Differences in general clinical data, functional recovery, complications, and prosthesis revision rates were assessed after UKA and TKA, respectively. The evaluation indicators for knee joint function recovery included the hospital for special surgery knee score (HSS), Joint Forgotten Score (JFS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Visual analog scale (VAS). Patient preference between UKA and TKA was also recorded.ResultsDuring a mean follow-up of 76.95 months (range, 65.00 to 87.00 months), there were no significant differences in postoperative complications between the two groups (P = 0.299); however, the prosthesis revision rate was higher in the UKA group than in the TKA group (P = 0.023). The incision length, operation time, blood loss, and postoperative drainage volume in the UKA group were significantly (P < 0.001) lower than those in the TKA group: JFS, ROM, and VAS in the UKA group were higher than those in the TKA group (P < 0.001, P = 0.023, P = 0.032), HSS and KOOS in TKA group were significantly (P < 0.001) higher than those in UKA group. At the last follow-up, 40% and 24% of patients preferred TKA and UKA, respectively.ConclusionsTKA was found to be superior to UKA in terms of HSS, KOOS, and VAS, while UKA had more significant advantages in terms of less surgical trauma, better ROM, and higher JFS. Complications were not different between groups, but UKA had a higher rate of prosthesis revision. After a follow-up of at least 5 years, more patients preferred TKA.

Andrea Boccatonda, Lorenzo Andreetto, Damiano D’Ardes et al.

Non-alcoholic fatty liver disease (NAFLD) is defined as a chronic liver disease characterized by excessive fat accumulation in the liver without another obvious cause (no excessive alcohol consumption, hepatotoxic medications, toxins, viral infections, genetic hepatic diseases), therefore it is an exclusion diagnosis. The term NAFLD literally refers to non-alcohol related hepatopathy and does not adequately correlate with metabolic dysfunction and related cardiovascular risks. Therefore, researchers and scientific societies have moved towards changing the terminology. The novel nomenclature for a metabolic-associated fatty liver disease (MAFLD) has been proposed in 2020 by a group of experts to overcome the issues related to the old terminology. The diagnosis of MAFLD is based on the presence of hepatic steatosis and at least one between these three conditions: type 2 diabetes mellitus (T2DM), obesity or metabolic dysregulation. MAFLD has been shown to be an independent risk factor for cardiovascular diseases and atherosclerosis. It is better related to the main risk factors for atherosclerosis and cardiovascular diseases than NAFLD, such as dyslipidemia, T2DM and hypertension. The aim of this review is to highlight the reasons why the term NAFLD is moving to the term MAFLD, what are the conceptual basis of this choice and its clinical implications, particularly in the cardiovascular field.

Fan Xia, Peiyu Xing, Hao Zhang et al.

We performed a retrospective, observational study of 51 eyes in 51 treatment-naïve patients with polypoidal choroidal vasculopathy (PCV), whose lesion ranged within the 6 × 6 mm scope of optical coherence tomography angiography (OCTA). The patients were divided into an ill-defined group and a well-defined group based on the pattern of branching vascular network (BVN) on OCTA. BVN morphology was not related to baseline best-corrected visual acuity (BCVA). However, the BCVA in the ill-defined BVN group (−0.18 [interquartile range: −0.40 to 0.00]) was significantly improved after anti-vascular endothelial growth factor (VEGF) injections, compared with that (0.00 [interquartile range: −0.18 to 0.00]) in the well-defined group (z = 2.143, <i>p</i> = 0.032). Multiple logistic regression analysis showed that male sex, fewer injections, and the presence of polypoidal lesions on OCTA images at baseline predicted a poor prognosis in patients with polypoidal lesions on OCTA images after anti-VEGF therapy (all <i>p</i> < 0.05). Finally, BCVA at baseline and the number of injections were protective factors for BCVA after anti-VEGF therapy (all <i>p</i> < 0.05). In contrast, a history of hypertension and macular edema at baseline were risk factors for BCVA after anti-VEGF injections (all <i>p</i> < 0.05). Our results revealed the visual and morphological prognosis of patients with active subfoveal circumscribed PCV after anti-VEGF therapy.

Jean-Michel Darves-Bornoz

Psychological trauma primarily affects children and adolescents; it mostly results from physical and sexual maltreatment. In the Medico-Judicial Unit Center for Sexual Violence Victims in Tours, France, which I joined in 1992 for research and to give treatment, underage patients represented about three-quarters of patients. At the same time, a national survey was conducted in collaboration with Marie Choquet’s “Adolescent Health” group (INSERM), which targeted several thousand adolescents representing the general population. It revealed that almost one out of five adolescents had experienced physical or sexual assault, and that although the number of sexual assaults probably does not exceed that of physical assaults, most of the time their psychological consequences do considerably exceed those of physical assaults. Several symptoms appear after experiencing rapes or assaults. They have a distinct semiology and independent evolutions. We isolated three of them: dissociative and phobic traumatic syndrome, re-experiencing traumatic syndrome, and borderline-like traumatic syndrome. They are generally triggered all at the same time or in close succession. Re-experiencing traumatic syndrome is profound, but the other two are often more worrying, particularly in relation to children and adolescents, because they generate disorders in their psychological development.

Miljenko Markovic, Ganesh Narayanasamy, Sotirios Stathakis et al.

Introduction: Clinical evaluation of a two-dimensional (2D) liquid-filled ion chamber detector array used in the verification of highly modulated small beams of stereotactic body radiation therapy (SBRT) has been conducted. Materials and Methods: Measurements with the Octavius 1000 SRS (PTW, Freiburg, Germany) detector with 977 liquid-filled ion chambers were compared against EDR2 film and PTW Octavius Seven29. The performance of detector array has been evaluated on ten SBRT patient plans. Dose profiles of individual and composite fields' calculated using Pinnacle3 treatment planning system were compared against measurements with Octavius 1000 SRS detector array, EDR2 film, and Octavius Seven29 detector. Gamma index and profile comparison were used in the evaluation and assessment of the detector's performance. Results: The Gamma index measurements show agreement between Pinnacle3 computations and Octavius 1000 SRS array, PTW Octavius Seven29, and EDR2 film for >90% of the points using 2%, 2 mm tolerance criteria. Profiles obtained with the Octavius 1000 SRS were in agreement with the EDR2 film profiles, demonstrating the detector's superior sampling rate. Conclusions: The Octavius 1000 SRS is a dosimetrically accurate device to perform quality assurance checks in SBRT treatments. The broad range of measurements performed in this study quantified the dosimetric accuracy of Octavius 1000 SRS detector in the clinical setup of the small fields in radiotherapy.

Hidenori Yamaguchi, Satoru Murata, Shiro Onozawa et al.

Objectives: To determine the incidence of rare spontaneous isolated visceral artery dissection (SIVAD), characterize its pathogenesis, and suggest treatment strategies. Materials and Methods: We reviewed abdominal contrast-enhanced computed-tomography (CE-CT) scans from January 2005 to December 2016 retrospectively in our institution, identified 47 SIVAD patients and classified them into a symptomatic (n = 22) or asymptomatic group (n = 25). Further, we classified the five types based on the CE-CT images. Patient characteristics, incidence, vascular risk factors, complications, symptoms, treatments outcomes, and morphology features on CE-CT images were analyzed. Results: SIVAD was seen on 0.09% of all abdominal CE-CT scans, and 0.68% of all abdominal CT-CT scans obtained for the evaluation of acute abdominal symptoms. The asymptomatic group had significantly fewer patients with periarterial fat stranding or branch vessel involvement on CE-CT images (p < 0.01). The mean length of the dissection was longer in the symptomatic group (p < 0.05). In the asymptomatic group, dissection-related abdominal symptoms and complications did not develop; followed-up CE-CT scans showed improvement in the dissection lesions in 1 (4.0%) patient, no changes in 22 (88.0%), and complete remodeling in 2 (8.0%). In the symptomatic group, one patient presented with organ ischemia at diagnosis and five patients developed organ ischemia underwent endovascular intervention. In the remaining 16 patients received nonoperative intervention only, followed-up CE-CT scans showed improvement in 13 (86.7%), and complete remodeling in 2 (13.3%). Conclusions: Symptomatic SIVAD patients should be hospitalized because some of those may experience organ ischemia or aneurysm formation. Endovascular intervention is a feasible treatment for complications of SIVAD. Keywords: Celiac artery, Mesenteric artery, Dissection, Endovascular intervention, Stent, Coil

Grgov Saša, Dugalić Predrag, Tomašević Ratko et al.

Bacground/Aim. Endoscopic mucosal resection (EMR) or mucosectomy is a removing method of flat or sessile lesions, laterally spreading tumors and carcinoma of the colon or the rectum limited to mucosa or the surface part of the submucosa. The aim of the study was to estimate the efficacy and safety of EMR in removing flat and sessile colorectal adenomas. Methods. This prospective study involved 140 patients during the period of 8 years. A total of 187 colorectal adenomas were removed using the EMR method “inject and cut with snare”. Results. The approximate size of mucosectomised adenomas was 13.6 mm (from 8 mm to 60 mm). There was a total of 48 (25.7%) flat adenomas and 139 (74.3%) sessile adenomas, (p < 0.01). Using “en bloc” and “piecemeal” resection, 173 (92.5%) and 14 (7.5%) of colorectal adenomas were removed, respectively. In all the cases, a complete removal of colorectal adenomas was achieved. Two (1.4%) patients had adenoma removal with intramucosal carcinoma each. In the average follow-up period of 21.2 ± 17.8 months, 2 (1.4%) patients had adenoma relapse after EMR. Considering complications, there was bleeding in 1 (0.7%) patient with a big rectum adenoma removed with EMR. Furthermore, one (0.7%) patient had a postcoagulation syndrome after cecal adenoma was removed by EMR. Conclusion. EMR is an efficient, safe and minimally invasive technique of removing flat and sessile adenomas in the colon and the rectum, with a very low percentage of adenoma recurrence over a long period of monitoring.

Davis-Ajami ML, Wu J, Downton K et al.

Mary Lynn Davis-Ajami,1 Jun Wu,2 Katherine Downton,3 Emilie Ludeman,3 Virginia Noxon4 1Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD, USA; 2South Carolina College of Pharmacy, University of South Carolina, Greenville, SC, USA; 3Health Sciences and Human Services Library, University of Maryland, Baltimore, MD, USA; 4Department of Clinical Pharmacy and Outcomes Science, South Carolina College of Pharmacy, University of South Carolina, Columbia, SC, USA Abstract: Epoetin zeta was granted marketing authorization in October 2007 by the European Medicines Agency as a recombinant human erythropoietin erythropoiesis-stimulating agent to treat symptomatic anemia of renal origin in adult and pediatric patients on hemodialysis and adults on peritoneal dialysis, as well as for symptomatic renal anemia in adult patients with renal insufficiency not yet on dialysis. Currently, epoetin zeta can be administered either subcutaneously or intravenously to correct for hemoglobin concentrations &le;10 g/dL (6.2 mmol/L) or with dose adjustment to maintain hemoglobin levels at desired levels not in excess of 12 g/dL (7.5 mmol/L). This review article focuses on epoetin zeta indications in chronic kidney disease, its use in managing anemia of renal origin, and discusses its pharmacology and clinical utility. Keywords: biosimilar, chronic kidney disease, epoetin alfa, erythropoiesis, renal anemia, Retacrit&reg;

Ferraro ZM, Boehm KS, Gaudet LM et al.

Zachary M Ferraro,1 Kaitlin S Boehm,1 Laura M Gaudet,2,3 Kristi B Adamo1,4,5 1Healthy Active Living and Obesity Research Group, Children&#39;s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; 2Horizon Health Network, Saint John, New Brunswick, Canada; 3Department of Obstetrics and Gynaecology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; 4School of Human Kinetics, Faculty of Health Sciences, 5Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada Introduction: There is discord between the recall of maternity care providers and patients when it comes to discussion of gestational weight gain (GWG) and obesity management. Few women report being advised on GWG, physical activity (PA), and nutrition, yet the majority of health care providers report discussing these topics with patients. We evaluated whether various Canadian maternal health care providers can identify appropriate GWG targets for patients with obesity and determine if providers report counseling on GWG, physical activity, and nutrition. Methods: A valid and reliable e-survey was created using SurveyMonkey software and distributed by the Society of Obstetricians and Gynaecologists of Canada listserve. A total of 174 health care providers finished the survey. Respondents self-identified as general practitioners, obstetricians, maternal-fetal medicine specialists, midwives, or registered nurses. Results: GWG recommendations between disciplines for all body mass index categories were similar and fell within Health Canada/Institute of Medicine (IOM) guidelines. Of those who answered this question, 110/160 (68.8%) were able to correctly identify the maximum IOM GWG recommended for patients with obesity, yet midwives tended to recommend 0.5&ndash;1 kg more GWG (P = 0.05). PA counseling during pregnancy differed between disciplines (P < 0.01), as did nutrition counseling during pregnancy (P < 0.05). Conclusion: In contrast to patient reports, the majority of health care providers document counseling on GWG, PA, and nutrition and appropriately identify GWG limits for obese patients. However, the content and quality of the discourse between patient and provider warrants further investigation. Keywords: gestational weight gain, nutrition, obesity, physical activity, pregnancy

Fatih ALTINTOPRAK, Enis DİKİCİER, Muhammed AKYÜZ et al.

Magdiel Rodríguez Labrada, Lázaro Sarduy Bermúdez

A review of the literature related to the specialty of Otolaryngology was conducted to update current concepts used in malignant external otitis in order to improve the quality of the scientific and care services provided by our center and to improve educational aspects in undergraduate and postgraduate teaching. The current trend in the literature reviewed is to use the term malignant external otitis instead of malignant external otitis in diabetics. In the formation of the present generation of doctors, it is needed to constantly renew knowledge, and in light of the changes and development of science, the specialty of Otolaryngology is not exempt. The general aspects of this condition, and the behavior and actions as a community physician, are described.