Academic climate and psychopathological symptomatology in Spanish medical students.

INTRODUCTION: Medical Education studies suggest that medical students experience depression, anxiety and psychopathological symptomatology in a proportion higher than in the rest of the population. In the present study, we aimed to conduct a nationwide analysis to describe student's perceptions of Educational Climate in Spanish medical schools, and its relationship with psychopathological symptomatology. METHODS: The study was carried out in 2022 in all 44 medical schools in Spain, and analyses the academic climate, and psychopathological symptomatology among medical students (n = 4374). To measure these variables, we used the Dundee Ready Education Environment Measure (DREEM) for academic climate, and the SA-45 (Symptom Assessment-45 Questionnaire was used to assess psychopathological symptomatology. RESULTS: The mean DREEM global score was low, 95.8 (SD 22.6). Worse perception of the academic climate has been found in females (t -2.21, p 0.027), in students of the clinical academic years (t 16.9, p < 0.001), and public medical schools ( t 15.6, p < 0.001). The SA45 general index score was high (p90) in 25.6% of participants. In respect of gender, female students presented higher levels of SA45 general index score, depression, interpersonal sensitivity, somatization, anxiety, obsession-compulsion, and phobic anxiety symptoms. Higher DREEM global and subscale scores corresponded to a higher SA-45 global index score and higher SA-45 subscale scores. CONCLUSIONS: Our study suggests a correlation between a poor perception of academic climate, increased depression, anxiety, and other psychopathological symptoms, with a pattern that varies between different faculties. The perception of academic climate varied between medical schools, as did the psychopathological symptoms scores. Our finding suggests the prevalence of these variables in medical students is, at least in part, attributable to factors directly related to the learning atmosphere.

Role of Nitric Oxide in the Altered Calcium Homeostasis of Platelets from Rats with Biliary Cirrhosis.

INTRODUCTION: Previously, we found that intracellular calcium (Ca2+) homeostasis is altered in platelets from an experimental model of liver cirrhosis, namely the bile-duct-ligated (BDL) rat. These alterations are compatible with the existence of a hypercoagulable state. OBJECTIVE: In the present study, we analyzed the role of nitric oxide in the abnormal calcium signaling responses of an experimental cirrhosis model, the bile duct-ligated rat. METHODS: Chronic treatment with L-NAME was used to inhibit NO production in a group of control and BDL animals, and the responses compared to those obtained in a control and BDL untreated group (n = 6 each). The experiments were conducted on isolated platelets loaded with fura-2, using fluorescence spectrometry. RESULTS: Chronic treatment with L-NAME increased thrombin-induced Ca2+ release from internal stores in both control and BDL rats. However, the effect was significantly greater in the BDL rats (p < 0.05). Thrombin-induced calcium entry from the extracellular space was also elevated but at lower doses and, similarly in both control and BDL platelets, treated with the NO synthesis inhibitor. Capacitative calcium entry was also enhanced in the control platelets but not in platelets from BDL rats treated with L-NAME. Total calcium in intracellular stores was elevated in untreated platelets from BDL rats, and L-NAME pretreatment significantly (p < 0.05) elevated these values both in controls and in BDL but significantly more in the BDL rats (p < 0.05). CONCLUSIONS: Our results suggest that nitric oxide plays a role in the abnormal calcium signaling responses observed in platelets from BDL rats by interfering with the mechanism that releases calcium from the internal stores.

What do Turkish, Spanish, and Pakistani medical students value in specialty training positions? A discrete choice experiment.

BACKGROUND: The aim of this study was to find out specialty training preferences of senior medical students from three medical schools in Turkey, Spain, and Pakistan. METHODS: A Discrete Choice Experiment was carried out using an electronic form for students in three countries in 2021-2022 term. Each choice set in the form consisted of two hypothetical specialty training positions. The attributes were location, earnings, working conditions, personal perspective, quality of education, probability of malpractice, and prestige. Conditional logit model was used to estimate participants' preferences and "willingness to accept" values. RESULTS: The most valued attribute was "personal perspective on specialty area" for Turkish and Spanish students, while this attribute was not meaningful for Pakistani students. Turkish students needed a 204% of change in their income for a swap between the specialty that they like and not like. This tradeoff necessitated a 300% change for Spanish students. The most valued attribute for Pakistani students, which was "working conditions", necessitated a 97% increase in income to switch from working in good conditions to working in poor conditions. CONCLUSION: In this first multinational DCE study in the medical education literature, we found the preferences of medical students in Turkey, Spain, and Pakistan are affected to various extents by several factors.

Vasoconstrictor and Pressor Effects of Des-Aspartate-Angiotensin I in Rat.

This study investigated the vasoactive effects of des-aspartate-angiotensin-I (DAA-I) in male Wistar rats on whole body vascular bed, isolated perfused kidneys, and aortic rings. Dose-response curves to DAA-I were compared with those to angiotensin II (Ang II). The Ang II-type-1 (AT1) receptor blocker, losartan, was used to evaluate the role of AT1 receptors in the responses to DAA-I. Studies were also conducted of the responsiveness in aortic rings after endothelium removal, nitric oxide synthase inhibition, or AT2 receptor blockade. DAA-I induced a dose-related systemic pressor response that was shifted to the right compared with Ang II. Losartan markedly attenuated the responsiveness to DAA-I. DAA-I showed a similar pattern in renal vasculature and aortic rings. In aortic rings, removal of endothelium and nitric oxide inhibition increased the sensitivity and maximal response to DAA-I and Ang II. AT2 receptor blockade did not significantly affect the responsiveness to DAA-I. According to these findings, DAA-I increases the systemic blood pressure and vascular tone in conductance and resistance vessels via AT1 receptor activation. This vasoconstrictor effect of DAA-I participates in the homeostatic control of arterial pressure, which can also contribute to the pathogenesis of hypertension. DAA-I may therefore be a potential therapeutic target in cardiovascular disease.

Effects of Flavonoids in Experimental Models of Arterial Hypertension.

Flavonoids are a class of substances of a vegetal origin with many interesting actions from the point of view of human disease. Interest in flavonoids in the diet has increased in recent years due to the publication of basic, clinical and epidemiological studies that have shown a whole array of salutary effects related to intake of flavonols and flavones as well as a lower morbility and mortality of cardiovascular diseases. Since arterial hypertension is the most common modifiable risk factor for cardiovascular diseases, this review will focus mainly on the effects of flavonoids on the cardiovascular system with relation to the elevation of blood pressure. Its antihypertensive effects as well as the many investigations performed in experimental models of arterial hypertension, are reviewed in this mini-review.

Depression, anxiety, burnout and empathy among Spanish medical students.

Medical Education studies suggest that medical students experience mental distress in a proportion higher than in the rest of the population In the present study, we aimed to conduct a nationwide analysis of the prevalence of mental health problems among medical students. The study was carried out in 2020 in all 43 medical schools in Spain, and analyzes the prevalence of depression, anxiety, empathy and burnout among medical students (n = 5216). To measure these variables we used the Beck Depression Inventory Test for assessing depression, the Maslach Burnout Inventory Survey for Students was used for burnout, the State-Trait Anxiety Inventory (STAI) was used to assess anxiety state and trait and the Jefferson Empathy Scale 12 to obtain empathy scores. In relation to depression, the data indicate an overall prevalence of 41%, with 23.4% of participants having moderate to severe levels, and 10% experiencing suicidal ideation. Burnout prevalence was 37%, significantly higher among 6th year than among 1st year students. Anxiety levels were consistent with those reported previously among medical students (25%), and were higher than in the general population for both trait and state anxiety. The prevalence of trait anxiety was higher among women. Empathy scores were at the top end of the scale, with the highest-scoring group (>130) containing a greater percentage of women. Similarly to those published previously for other countries, these results provide a clear picture of the mental disorders affecting Spanish medical students. Medicine is an extremely demanding degree and it is important that universities and medical schools view this study as an opportunity to ensure conditions that help minimize mental health problems among their students. Some of the factors underlying these problems can be prevented by, among other things, creating an environment in which mental health is openly discussed and guidance is provided. Other factors need to be treated medically, and medical schools and universities should therefore provide support to students in need through the medical services available within their institutions.

Perception of Medical Professionalism among Medical Residents in Spain.

BACKGROUND: Medical professionalism, defined as commitment to the primacy of patient welfare, is the basis for doctor-patient-society relationships, but previous research with medical students has shown that professionalism and social commitment to medicine may be waning. To determine if this trend also appears in recently qualified practicing doctors, we surveyed 90 newly graduated doctors currently working as medical residents in two university hospitals in Murcia, Spain. A previously validated questionnaire that studies the perception of six categories (responsibility, altruism, service, excellence, honesty and integrity, and respect) defining medical professionalism was used. RESULTS: A good perception of professionalism was found among medical residents, with more than 70% positive responses in all these six categories. There is an increasing trend in the number of negative responses as the residency goes on. Altruism was the category with the greatest percentage of negative answers (22.3%) and Respect was the category with the lowest percentage (12.9%). CONCLUSIONS: The results show a good professionalism perception in medical residents, but also a slight decline in positive answers that began during medical school. A significant trend was found when including both students and residents. Although there were some differences between students and residents, these were not statistically significant. Educational interventions are needed both at the level of medical school and postgraduate medical residency.

Platelet function and microvesicle generation in patients with hemophilia A.

Our results do not support any effect of FVIII on platelet function in patients with severe HA treated under the regime of prophylaxis.

Las unidades de educación médica en las facultades de Medicina y de Ciencias de la Salud en España. ¿Son necesarias? / Medical education units in Medical and Health Sciences schools in Spain. Are they needed?

En una mayoría de países, la educación médica es una especialidad médica más y preside la vida académica en el grado, el posgrado y en la formación continuada. Pero la situación en España es muy mejorable. Aunque existe un creciente interés en la educación médica como disciplina o especialidad, la mayor parte de las facultades de Medicina españolas no disponen de una unidad o departamento de educación médica que se encargue del avance de la disciplina. Algunas facultades han dispuesto una unidad, cátedra, departamento o centro de estudios, adscrita o independiente a la dirección del centro, a veces sin relación orgánica alguna con el proceso de formación. En este artículo describiremos por qué creemos que estas estructuras son necesarias, su utilidad, así como sus funciones y el alcance de sus actividades. Analizaremos la situación actual en España con el ánimo de promocionar la creación de estas estructuras en todas las facultades de Medicina. Igualmente, repasaremos los mecanismos de los que se ha dotado a la formación especializada en el posgrado para dar respuestas a sus necesidades de formación

In a majority of countries, medical education is one more medical specialty and presides over academic life in undergraduate, graduate and continuing education. But, the situation in Spain is very improvable. Although there is a growing interest in medical education as a discipline or specialty, most of the Spanish faculties of Medicine do not have a unit or department of medical education, which is in charge of advancing the discipline. Some faculties have arranged a unit, chair, department or study center, attached or independent to the management of the center, sometimes without any organic relationship to the training process. In this article we will describe why we believe these structures are necessary, their usefulness, as well as their functions and the scope of their activities. We will analyze the current situation in Spain with the aim of promoting the creation of these structures in all the faculties of Medicine. We will also review the mechanisms that specialized postgraduate training has been equipped to provide answers to their training needs

Editorial for Special Issue-Biomarkers of Renal Disease.

The National Institutes of Health (NIH) Biomarkers Definitions Group has defined a biomarker as "A characteristic that is objectively measured and evaluated as an indicator of normal biologic processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention [...].

Aminopeptidases in Cardiovascular and Renal Function. Role as Predictive Renal Injury Biomarkers.

Aminopeptidases (APs) are metalloenzymes that hydrolyze peptides and polypeptides by scission of the N-terminus amino acid and that also participate in the intracellular final digestion of proteins. APs play an important role in protein maturation, signal transduction, and cell-cycle control, among other processes. These enzymes are especially relevant in the control of cardiovascular and renal functions. APs participate in the regulation of the systemic and local renin-angiotensin system and also modulate the activity of neuropeptides, kinins, immunomodulatory peptides, and cytokines, even contributing to cholesterol uptake and angiogenesis. This review focuses on the role of four key APs, aspartyl-, alanyl-, glutamyl-, and leucyl-cystinyl-aminopeptidases, in the control of blood pressure (BP) and renal function and on their association with different cardiovascular and renal diseases. In this context, the effects of AP inhibitors are analyzed as therapeutic tools for BP control and renal diseases. Their role as urinary biomarkers of renal injury is also explored. The enzymatic activities of urinary APs, which act as hydrolyzing peptides on the luminal surface of the renal tubule, have emerged as early predictive renal injury biomarkers in both acute and chronic renal nephropathies, including those induced by nephrotoxic agents, obesity, hypertension, or diabetes. Hence, the analysis of urinary AP appears to be a promising diagnostic and prognostic approach to renal disease in both research and clinical settings.

Chronic model of tympanic perforation in rats with mitomycin C and dexamethasone.

A rat model of chronic tympanic membrane perforation was developed to be used in the search of new materials for the sealing of these perforations. A longitudinal study was carried out in rats subjected to incisional myringotomy followed by the application of mitomycin C alone or with dexamethasone. Rats were checked at days 3, 7, 10, 14 and weekly thereafter until perforation closure, for up to 6 months. The addition of dexamethasone is a key component in order to obtain a chronic opening. Myringotomies treated with saline had a mean healing time of 8.5 days. At 8 weeks, between 62.5% and 77.7% of tympanic membranes treated with mitomycin C and dexamethasone remained perforated and at 6 months this number fell to 21.4%. This technique is able to maintain most tympanic membrane perforations patent for at least 8 weeks. This rat model is adequate for its use in preclinical or translational research.

Mismatch between student and tutor evaluation of training needs: a study of traumatology rotations.

OBJECTIVE: An e-portfolio was used to determine the optimal number of times students need to repeat a procedure before they are fully capable of performing it without supervision. The results were compared with the actual number of repetitions performed during the internship period. We also asked these students and their teachers about the optimal number of times each skill should be repeated before it could be considered fully acquired. The questionnaire was answered by 98.6% of the students and 70.3% of their teachers. RESULTS: Both students and teachers agreed on a similar optimal value for 16 out of the 21 clinical procedures selected; in the remaining 5, teachers thought that students needed to repeat the procedure more times than the number stated by students. When these optimal values were compared with the actual values recorded in the portfolio during the internships, it was found that about half of all clinical procedures were carried out fewer times than expected, thus providing important feedback about the rotation-based training process. Quantitative information collected in the portfolios revealed a moderate mismatch between students' and teachers' perceptions of training needs.

Estilos de salud y hábitos saludables en estudiantes del Grado en Farmacia / Health styles and habits in Pharmacy students

Algunos estudios realizados sobre los estilos de vida de los estudiantes universitarios han demostrado la existencia de estilos de vida poco saludables, sugiriéndose además que, durante la etapa universitaria, los estudiantes abandonan hábitos saludables y adquieren otros nocivos. No hay duda de que ciertos tipos de conductas como el tabaquismo, una dieta poco saludable, la vida sedentaria o un excesivo consumo de alcohol podrían contribuir por sí solos a aumentar la morbilidad e, incluso, la mortalidad. Por ello, en este estudio se pretende analizar los estilos de vida de los estudiantes del Grado en Farmacia de la Universidad de Murcia, en el que se forman los futuros profesionales que luego tendrán un gran papel en el control de la calidad de vida de la población. Para ello, hemos diseñado y validado un instrumento que evalúa dichos estilos de vida de los estudiantes universitarios. El cuestionario recoge aspectos como las características sociodemográficas, datos socioeconómicos, estado de salud y calidad de vida, actividad física, tabaco, alcohol y otras drogas, hábitos alimentarios y conducta sexual. En general, la calidad de vida de los estudiantes es mayoritariamente buena, aunque se discuten hábitos como el tabaquismo o el consumo de alcohol que muestran una clara tendencia a empeorar durante la etapa universitaria. El cuestionario utilizado podría ser una herramienta útil y fiable para identificar hábitos de vida poco saludables o posibles problemas de salud

Some studies on the lifestyles of university students have demonstrated the existence of unhealthy lifestyles, suggesting that during the university stage, students abandon healthy habits and acquire other harmful ones. There is no doubt that certain types of behaviours such as smoking, an unhealthy diet, a sedentary lifestyle or an excessive consumption of alcohol could, in themselves, contribute to increase morbidity, and even mortality. For this reason, this study intends to analyse the lifestyles of Pharmacy Degree students of the University of Murcia, who, as future professionals, will then play a major role in the control of the quality of life of the population. To do this, we have designed and validated questionnaire that evaluates the lifestyles of university students, and includes aspects such as socio-demographic characteristics, socioeconomic data, health status and quality of life, physical activity, tobacco, alcohol and other drugs, eating habits, and sexual behaviour. In general, the quality of life of the students is mostly good, although habits such as smoking or alcohol consumption show a clear tendency to worsen during the university stage. The questionnaire used could be a useful and reliable tool to identify unhealthy life habits or possible health problems

La automedicación en estudiantes del Grado en Farmacia / Self-medication in Pharmacy students

La automedicación es la administración de medicamentos para aliviar un síntoma o curar una enfermedad sin pasar por el control médico. Este comportamiento está muy extendido a nivel mundial, incluso dentro de la universidad en la que se forman los futuros profesionales que configurarán los servicios sanitarios de la comunidad. Aunque existen estudios relativos a las conductas de automedicación en la población universitaria en otros países, existen pocos datos relativos a este comportamiento en nuestro ámbito. El propósito de este estudio es estimar el nivel de automedicación en un colectivo universitario, así como los factores asociados a este comportamiento. El hábito de automedicación es muy frecuente en nuestra población de estudio, con una media de un 72,5%. Este valor va ascendiendo curso a curso desde un 53% en el primer curso de carrera hasta el 93% en el último. Casi el total de los alumnos admite la automedicación con analgésicos y es de destacar la automedicación con antibióticos (13,6%) utilizados para situaciones clínicas poco definidas. Más preocupante aún es la automedicación con medicamentos bajo receta regulada, como es el caso de los ansiolíticos y tranquilizantes, usado por un 5% de los estudiantes. Concluimos que el alto porcentaje de automedicación de la población general se ve prácticamente correspondido en esta población de estudiantes de Farmacia. Los medicamentos más consumidos son los analgésicos, antihistamínicos y antigripales; existen, además, porcentajes bajos pero notables de automedicación con antibióticos y ansiolíticos, lo que resulta más preocupante

Self-medication is the administration of medications to relieve a symptom or cure a disease without medical supervision. This behaviour is very widespread worldwide, even within the university in which the future professionals who will play a major role in the community health services are trained. Although there are studies concerning self-medication behaviours in the university population in other countries, there is little data regarding this behaviour in our field. The purpose of this study is to estimate the level of self-medication in a university group of students, as well as the factors associated with this behaviour. The habit of self-medication is very frequent in our study population, with a mean of 72.5%. This figure increases from year to year, from 53% in the first year to 93% in the last. Almost all students admit self-medication with analgesics, and it is worth noting the self-medication with antibiotics (13.6%) used for poorly defined clinical situations. Even more worrying is self-medication with prescription drugs, such as anxiolytics and tranquillisers, used by 5% of students. We conclude that the high percentage of self-medication of the general population is practically matched in this population of pharmacy students. The most commonly used drugs are analgesics, antihistamines and anti-influenza, and there are also low but notable percentages of self-medication with antibiotics and anxiolytics, which is more worrying

Moderate Effect of Flavonoids on Vascular and Renal Function in Spontaneously Hypertensive Rats.

Many studies have shown that flavonoids are effective as antihypertensive drugs in arterial hypertension. In the present work, we have analyzed the effects of some flavonoid extracts in the spontaneous hypertensive rat model (SHR). An important feature of this study is that we have used a low dose, far from those that are usually applied in human therapy or experimental animals, a dose that responded to the criterion of a potential future commercial use in human subjects. Treatments were carried out for 6 and 12 weeks in two groups of SHR rats, which received apigenin, lemon extract, grapefruit + bitter orange (GBO) extracts, and cocoa extract. Captopril was used as a positive control in the SHR group treated for 6 weeks (SHR6) and Diosmin was used as the industry reference in the SHR group treated for 12 weeks (SHR12). Captopril and GBO extracts lowered the high arterial pressure of the SHR6 animals, but none of the extracts were effective in the SHR12 group. Apigenin, lemon extract (LE), GBO, and captopril also improved aortic vascular relaxation and increased plasma and urinary excretion of nitrites, but only in the SHR6 group. Kidney and urinary thiobarbituric acid reactive substances (TBARS) were also significantly reduced by GBO in the SHR6 rats. Apigenin also improved vascular relaxation in the SHR12 group and all the flavonoids studied reduced urinary thiobarbituric acid reactive substances (TBARS) excretion and proteinuria. Vascular abnormalities, such as lumen/wall ratio in heart arteries and thoracic aorta, were moderately improved by these treatments in the SHR6 group. In conclusion, the flavonoid-rich extracts included in this study, especially apigenin, LE and GBO improved vascular vasodilatory function of young adult SHRs but only the GBO-treated rats benefited from a reduction in blood pressure. These extracts may be used as functional food ingredients with a moderate therapeutic benefit, especially in the early phases of arterial hypertension.

Flavonoids in Kidney Health and Disease.

This review summarizes the latest advances in knowledge on the effects of flavonoids on renal function in health and disease. Flavonoids have antihypertensive, antidiabetic, and antiinflammatory effects, among other therapeutic activities. Many of them also exert renoprotective actions that may be of interest in diseases such as glomerulonephritis, diabetic nephropathy, and chemically-induced kidney insufficiency. They affect several renal factors that promote diuresis and natriuresis, which may contribute to their well-known antihypertensive effect. Flavonoids prevent or attenuate the renal injury associated with arterial hypertension, both by decreasing blood pressure and by acting directly on the renal parenchyma. These outcomes derive from their interference with multiple signaling pathways known to produce renal injury and are independent of their blood pressure-lowering effects. Oral administration of flavonoids prevents or ameliorates adverse effects on the kidney of elevated fructose consumption, high fat diet, and types I and 2 diabetes. These compounds attenuate the hyperglycemia-disrupted renal endothelial barrier function, urinary microalbumin excretion, and glomerular hyperfiltration that results from a reduction of podocyte injury, a determinant factor for albuminuria in diabetic nephropathy. Several flavonoids have shown renal protective effects against many nephrotoxic agents that frequently cause acute kidney injury (AKI) or chronic kidney disease (CKD), such as LPS, gentamycin, alcohol, nicotine, lead or cadmium. Flavonoids also improve cisplatin- or methotrexate-induced renal damage, demonstrating important actions in chemotherapy, anticancer and renoprotective effects. A beneficial prophylactic effect of flavonoids has been also observed against AKI induced by surgical procedures such as ischemia/reperfusion (I/R) or cardiopulmonary bypass. In several murine models of CKD, impaired kidney function was significantly improved by the administration of flavonoids from different sources, alone or in combination with stem cells. In humans, cocoa flavanols were found to have vasculoprotective effects in patients on hemodialysis. Moreover, flavonoids develop antitumor activity against renal carcinoma cells with no toxic effects on normal cells, suggesting a potential therapeutic role in patients with renal carcinoma.

Beneficial Effects of Different Flavonoids on Vascular and Renal Function in L-NAME Hypertensive Rats.

BACKGROUND: we have evaluated the antihypertensive effect of several flavonoid extracts in a rat model of arterial hypertension caused by chronic administration (6 weeks) of the nitric oxide synthesis inhibitor, L-NAME. METHODS: Sprague Dawley rats received L-NAME alone or L-NAME plus flavonoid-rich vegetal extracts (Lemon, Grapefruit + Bitter Orange, and Cocoa) or purified flavonoids (Apigenin and Diosmin) for 6 weeks. RESULTS: L-NAME treatment resulted in a marked elevation of blood pressure, and treatment with Apigenin, Lemon Extract, and Grapefruit + Bitter Orange extracts significantly reduced the elevated blood pressure of these animals. Apigenin and some of these flavonoids also ameliorated nitric oxide-dependent and -independent aortic vasodilation and elevated nitrite urinary excretion. End-organ abnormalities such as cardiac infarcts, hyaline arteriopathy and fibrinoid necrosis in coronary arteries and aorta were improved by these treatments, reducing the end-organ vascular damage. CONCLUSIONS: the flavonoids included in this study, specially apigenin, may be used as functional food ingredients with potential therapeutic benefit in arterial hypertension.

Studying Medicine and being a doctor in Spain.

This article was migrated. The article was marked as recommended. In Spain, and probably around the world, the degree of Medicine is one of the most appreciated studies by the students. Not only the influence of job prospects, better than in other University careers, but also the study of a scientific career with many specialization areas or the joy felt by doctors when they manage to help a very sick patient, are some reasons to undertake the adventure to become a doctor. Since the demand to study Medicine is so high, it is not strange that most people with interest stay out of the process, since, at least in Spain, only the high school students with the best records are able to enter into a School of Medicine. But becoming a doctor is more than the study of a University Degree for 6 years. They need also a postgraduate specialization (MIR), in Hospitals of the National Health System, as a necessary step in order to be able to practice Medicine, either in public or private institutions. However, this road is not free from problems since there has been a decrease in the number of MIR specialization places offered without a similar reduction in the number of undergraduate positions. Moreover, the number of medical schools has not stopped growing and places Spain as one of the countries with the highest ratio of Medical Schools per inhabitant. This situation can lead to a scenario similar to that experienced in the 80s and 90s, where we witnessed an increase in the number of Specialist Physicians without Official Title (called MESTOS). As of November 2018, around 4,000 medical graduates cannot access specialized health training and may be forced into unemployment or emigration.

Bile Acids Do Not Contribute to the Altered Calcium Homeostasis of Platelets from Rats with Biliary Cirrhosis.

Previously, we have found that intracellular calcium homeostasis is altered in platelets from an experimental model of liver cirrhosis, the bile-duct ligated (BDL) rat; these alterations are compatible with the existence of a hypercoagulable state and related to an enhanced intracellular calcium release evoked by thrombin and an increased amount of calcium stored in the intracellular organelles. In the present study we have investigated the role of bile acids in those alterations of the BDL cirrhotic model. Cholic acid (CA) or deoxycholic acid (DCA) did not change P-selectin expression or platelet aggregation in any group but elevated baseline platelet calcium levels. Incubation with both bile acids reduced calcium release after stimulation with thrombin in the absence of extracellular calcium. Pretreatment with CA but not with DCA reduced significantly thrombin-induced calcium entry in all three experimental groups. The capacitative calcium entry was also significantly lower in platelets pretreated with both bile acids. The simultaneous addition of thapsigargin and ionomycin to estimate the total amount of calcium in platelet internal stores was decreased by pretreatment with both CA and DCA, although these changes were significantly different in the control rats only with CA and in the BDL platelets with DCA. These results indicate that CA and DCA reduce calcium movements in platelets of control and BDL animals, thus suggesting that bile acids do not participate in the alterations observed in the BDL cirrotic model.