Since the emergence of the Chat Generative Pre-Trained Transformer (ChatGPT), artificial intelligence (AI) has change how medical information is accessed, processed, and utilized. However, its use in clinical environments, particularly in plastic surgery, poses ethical, medical, and safety challenges, especially when it is employed to generate aesthetic recommendations without appropriate professional supervision. A descriptive analysis was conducted using standardized medical photographs of 20 female patients under 50 years of age from the author’s clinical database. Frontal projection images (thorax and abdomen) were uploaded to the ChatGPT-4 platform with the prompt: “What physical changes do you suggest?” and subsequently evaluated by board-certified plastic surgeons. The objective was to compare AI-generated recommendations with those provided by human specialists and to analyze the risks associated with using algorithms to validate or reinforce aesthetic standards. In 18 of the 20 patients (90 www.springer.com/00266 .
El cáncer colorrectal es el tercero en frecuencia a nivel mundial. En Chile, durante el año 2020 se diagnosticaron 5 914 nuevos casos. Su presentación obstructiva es una amenaza a la vida por la alteración fisiológica, sumado a su presentación en pacientes añosos. En los casos de pacientes con tumor en el colon derecho, la colectomía derecha con o sin anastomosis es el abordaje recomendado, mientras que una ileostomía como puente a una colectomía derecha puede ser una alternativa. Por otra parte, en pacientes con tumores de colon izquierdo, una colostomía permite una colectomía posterior. El procedimiento de Hartmann cobra valor en pacientes con tumores perforados, mientras que la colectomía subtotal o total está indicada en isquemia. En contexto de isquemia o perforación proximal, una estrategia consiste en la ileostomía, dejando temporalmente el tumor, pudiendo representar una alternativa a la colectomía. La instalación de stents puede considerarse una alternativa a la colostomía en centros experimentados. Dado el mal pronóstico del carcinoma metastásico y la alta morbilidad de la cirugía, se justifican nuevas estrategias. Este manuscrito tiene por objetivo demostrar las distintas formas de manejo de la presentación obstructiva del cáncer colorrectal.
PURPOSE:Etiologic patterns of epilepsy in low- and middle-income countries (LMICs) remain insufficiently characterized. We aimed to describe the causes and clinical features of active epilepsy in adults from seven Latin American (LA) countries using the 2017 ILAE etiologic classification. METHODS:We performed a retrospective multicenter case series based on medical records from 12 tertiary hospitals in Argentina, Brazil, Chile, Colombia, Ecuador, Mexico, and Uruguay (2019-2023). Adults (≥16 years) with active epilepsy, defined as at least one seizure in the past five years or ongoing antiseizure medication (ASM) use, were included. Etiology was categorized using the 2017 ILAE classification. RESULTS:A total of 3033 patients were included (mean age 32 years; 53 % women). Most had focal-onset seizures (73.5 %), and 63 % showed epileptiform EEG abnormalities. Etiology was identified in 65 % of cases and remained unknown in 35 %. Structural etiologies predominated (47 %), followed by genetic (10.5 %), infectious (5.4 %), immune (1 %), metabolic/toxic (0.8 %), and neurodegenerative (0.3 %). The most frequent structural causes were hippocampal sclerosis (25.8 %), malformations of cortical development (24.8 %), and stroke (18.6 %). Neurocysticercosis accounted for 41.6 % of infectious cases but only 2.3 % of the entire cohort. Etiologic distribution varied across countries and age groups. CONCLUSIONS:In this large Latin American case series, structural etiologies were the leading identified cause of active epilepsy, while one-third-of cases remained of unknown etiology. The relatively low prevalence of neurocysticercosis contrasts with classical assumptions and highlights the need for updated, region-specific data. Population-based and incident studies remain essential to better define etiologic determinants across Latin America.
Neonatal resuscitation requires mastery of technical and non-technical skills (NTS). The Neonatal Resuscitation Program (NRP) emphasizes ventilation, along with effective leadership, teamwork, and situational awareness. Simulation-based education is central to NTS training but is resource-intensive with limited access in low- and middle-income countries. Augmented reality (AR) medical simulations offer a scalable, remote solution with fewer logistical barriers. We conducted a prospective, single-arm feasibility study evaluating a remote AR medical simulation for assessing NTS during neonatal resuscitation. Instructors based in Northern California (Stanford School of Medicine) remotely facilitated pediatric and anesthesiology residents in Santiago, Chile (University of Chile) as team leaders in an NRP scenario delivered using an AR medical simulator. The primary outcome was NTS performance measured with the Anesthetists’ Non-Technical Skills (ANTS) tool. Secondary outcomes included the Behaviorally Anchored Rating Scale (BARS), system usability via the System Usability Scale (SUS), and ergonomics via the ISO 9241 − 400 scale. Thirty-four residents completed all sessions. Participants demonstrated adequate NTS performance, with ANTS scores 2.5–2.9 (scale 1–4) and BARS scores 5.2–5.4 (scale 1–9), similar to those observed in traditional, in-person simulations. SUS responses indicated high usability, and ergonomic results suggested minimal physical or cognitive burden. This feasibility study shows that participants demonstrated measurable NTS performance during remote, international AR neonatal resuscitation simulations, as assessed using ANTS and BARS.
