Perceptions of co-teaching as a pedagogical approach to integrate basic and clinical sciences.

Background: Medical curricula must provide students with basic and clinical competencies for critical reasoning and diagnosing. These competencies are better acquired when basic and clinical science are taught in an integrated and collaborative manner. In this study, we investigate whether supportive co-teaching (SCT) is an effective approach to promote integrated and reasoned learning as well as to help medical students applying theoretical concepts to clinical scenarios taught in a team-based learning (TBL) framework. Methods: We conducted a concurrent mixed methods study. For the qualitative part, we performed a focus group and semi-structured interviews to clinical and basic science teachers and medical students. Using conventional content analysis, themes were identified deductively. For the quantitative part, an analytical and descriptive observational study of the 2019-2020 cohort of first-year undergraduate medical students was conducted (107 students out of 220 completed the survey). For the descriptive study, questions were grouped into 5 categories. Results: Deductive themes from the analysis include relationship between clinical and basic science teachers, knowledge integration, methodology, teamwork and integrated Medicine and curricular design. Basic science and clinical teachers highlighted their relationship as critical to increase their mutual knowledge. This was supported by the student's opinion who very much valued their joint feedback. Regarding knowledge integration, both teachers and students found that horizontal and vertical integration enhanced applicability of basic knowledge to future clinical practice. The TBL methodology was very well perceived by both students and teachers and was highly motivating for students even though the need for commitment. Students considered that this program presented a great opportunity and expressed their interest in maintaining it in the future. These results were supported by the quantitative data. Conclusion: Our work supports the value of co-teaching in basic and clinical sciences within a TBL framework set in real clinical case scenarios. By employing this approach, students can actively apply their theoretical knowledge to clinical practice, enhancing their critical thinking, problem-solving, and clinical reasoning skills. Our findings can inform curriculum design and improved educational practice, leading to enhanced learning experiences for healthcare students and ultimately better patient care.

Engineered phalangeal grafts for children with symbrachydactyly: A proof of concept.

Tissue engineering approaches hold great promise in the field of regenerative medicine, especially in the context of pediatric applications, where ideal grafts need to restore the function of the targeted tissue and consider growth. In the present study, we aimed to develop a protocol to engineer autologous phalangeal grafts of relevant size for children suffering from symbrachydactyly. This condition results in hands with short fingers and missing bones. A previously-described, developmentally-inspired strategy based on endochondral ossification (ECO)-the main pathway leading to bone and bone marrow development-and adipose derived-stromal cells (ASCs) as the source of chondroprogenitor was used. First, we demonstrated that pediatric ASCs associated with collagen sponges can generate hypertrophic cartilage tissues (HCTs) in vitro that remodel into bone tissue in vivo via ECO. Second, we developed and optimized an in vitro protocol to generate HCTs in the shape of small phalangeal bones (108-390 mm3) using freshly isolated adult cells from the stromal vascular fraction (SVF) of adipose tissue, associated with two commercially available large collagen scaffolds (Zimmer Plug® and Optimaix 3D®). We showed that after 12 weeks of in vivo implantation in an immunocompromised mouse model such upscaled grafts remodeled into bone organs (including bone marrow tissues) retaining the defined shape and size. Finally, we replicated similar outcome (albeit with a slight reduction in cartilage and bone formation) by using minimally expanded pediatric ASCs (3 × 106 cells per grafts) in the same in vitro and in vivo settings, thereby validating the compatibility of our pediatric phalanx engineering strategy with a clinically relevant scenario. Taken together, these results represent a proof of concept of an autologous approach to generate osteogenic phalangeal grafts of pertinent clinical size, using ASCs in children born with symbrachydactyly, despite a limited amount of tissue available from pediatric patients.

Engineered human osteoarthritic cartilage organoids.

The availability of human cell-based models capturing molecular processes of cartilage degeneration can facilitate development of disease-modifying therapies for osteoarthritis [1], a currently unmet clinical need. Here, by imposing specific inflammatory challenges upon mesenchymal stromal cells at a defined stage of chondrogenesis, we engineered a human organotypic model which recapitulates main OA pathological traits such as chondrocyte hypertrophy, cartilage matrix mineralization, enhanced catabolism and mechanical stiffening. To exemplify the utility of the model, we exposed the engineered OA cartilage organoids to factors known to attenuate pathological features, including IL-1Ra, and carried out mass spectrometry-based proteomics. We identified that IL-1Ra strongly reduced production of the transcription factor CCAAT/enhancer-binding protein beta [2] and demonstrated that inhibition of the C/EBPß-activating kinases could revert the degradative processes. Human OA cartilage organoids thus represent a relevant tool towards the discovery of new molecular drivers of cartilage degeneration and the assessment of therapeutics targeting associated pathways.

Covalent Conjugation of Small Molecule Inhibitors and Growth Factors to a Silk Fibroin-Derived Bioink to Develop Phenotypically Stable 3D Bioprinted Cartilage.

Implantation of a phenotypically stable cartilage graft could represent a viable approach for repairing osteoarthritic (OA) cartilage lesions. In the present study, we investigated the effects of modulating the bone morphogenetic protein (BMP), transforming growth factor beta (TGFß), and interleukin-1 (IL-1) signaling cascades in human bone marrow stromal cell (hBMSC)-encapsulated silk fibroin gelatin (SF-G) bioink. The selected small molecules LDN193189, TGFß3, and IL1 receptor antagonist (IL1Ra) are covalently conjugated to SF-G biomaterial to ensure sustained release, increased bioavailability, and printability, confirmed by ATR-FTIR, release kinetics, and rheological analyses. The 3D bioprinted constructs with chondrogenically differentiated hBMSCs were incubated in an OA-inducing medium for 14 days and assessed through a detailed qPCR, immunofluorescence, and biochemical analyses. Despite substantial heterogeneity in the observations among the donors, the IL1Ra molecule illustrated the maximum efficiency in enhancing the expression of articular cartilage components, reducing the expression of hypertrophic markers (re-validated by the GeneMANIA tool), as well as reducing the production of inflammatory molecules by the hBMSCs. Therefore, this study demonstrated a novel strategy to develop a chemically decorated, printable and biomimetic SF-G bioink to produce hyaline cartilage grafts resistant to acquiring OA traits that can be used for the treatment of degenerated cartilage lesions.

The Potential Use of Near Infrared Spectroscopy (NIRS) to Determine the Heavy Metals and the Percentage of Blends in Tea.

The following study analyzed the potential of Near Infrared Spectroscopy (NIRS) to predict the metal composition (Al, Pb, As, Hg and Cu) of tea and for establishing discriminant models for pure teas (green, red, and black) and their different blends. A total of 322 samples of pure black, red, and green teas and binary blends were analyzed. The results showed that pure red teas had the highest content of As and Pb, green teas were the only ones containing Hg, and black teas showed higher levels of Cu. NIRS allowed to predict the content of Al, Pb, As, Hg, and Cu with ratio performance deviation values > 3 for all of them. Additionally, it was possible to discriminate pure samples from their respective blends with an accuracy of 98.3% in calibration and 92.3% in validation. However, when the samples were discriminated according to the percentage of blending (>95%, 95-85%, 85-75%, or 75-50% of pure tea) 100% of the samples of 10 out of 12 groups were correctly classified in calibration, but only the groups with a level of pure tea of >95% showed 100% of the samples as being correctly classified as to validation.

The prognostic impact of non-driver gene mutations and variant allele frequency in primary myelofibrosis.

Prognostic impact of non-MPN driver gene mutations in primary myelofibrosis. MIPSS70: Mutation-Enhanced International Prognostic Score System.

Inflammatory bowel disease: The role of commensal microbiome in immune regulation / Enfermedad inflamatoria intestinal: el rol de microbioma comensal en la regulación inmune

The incidence of inflammatory bowel disease (IBD) is increasing. Microbiome is one of the most important factors in its development and affects the different clinical outcomes of IBD patients depending on its composition and different alterations. We conducted a systematic review to discuss the association between microbiome and IBD in terms of immune regulation, and therapies that can modify microbiota. A comprehensive systematic literature search was performed through April 2020 in PubMed, Web of Science, the Cochrane Library, and clinicaltrials.gov. Inclusion criteria required IBD immune regulation and alternate therapeutics for IBD. This analysis helps explain the multifactorial origin of microbiome diversity including normal immune regulation, immune pathophysiology of IBD, and shows the evidence of several therapeutic targets to change microbiome in patients with IBD, such as prebiotics, probiotics, antibiotics, fecal microbiota transplant, and others.(AU)

La incidencia en enfermedad inflamatoria intestinal (EII) va en aumento. El microbioma es uno de los factores más importantes en su desarrollo y afecta los diferentes escenarios clínicos en pacientes con EII dependiendo de su composición y diferentes alteraciones. Se realizó una revisión sistemática para discutir la asociación entre el microbioma y EII relacionado con inmunorregulación y las terapias que pueden modificar la microbiota. Se realizó una búsqueda en la literatura hasta abril de 2020 en Pubmed, Web of Science, Cochrane library y clinicaltrials.gov. La inclusión del material requiere EII, inmunorregulación y las terapias alternativas para EII. Este estudio ayuda a explicar el origen multifactorial de la diversidad del microbioma incluyendo la inmunorregulación normal, fisiopatología inmuno de EII y muestra la evidencia de diferentes blancos terapéuticos para cambiar el microbioma en pacientes con EII como prebióticos, probióticos, antibióticos, trasplante de materia fecal, entre otros.(AU)

Liderando el cambio: hacia un currículo integrado para ciencias biomédicas. Experiencia de la Universidad Europea de Madrid / Leading change: moving towards an integrated curriculum suitable for biomedical sciences. Experience from Universidad Europea de Madrid

Las ciencias biomédicas han experimentado una gran revolución en un corto período. Este avance es posible a través del estudio continuado de los mecanismos moleculares, genéticos y fisiológicos de los procesos biológicos, y ello contribuye a una mejor comprensión del funcionamiento normal de nuestro cuerpo y establece el conocimiento de las bases de la patología. Esto implica que los profesionales de ciencias de la salud deben desarrollar competencias y capacidades especiales que les permitan establecer nexos dinámicos entre las ciencias básicas y su práctica profesional. El diseño curricular más adecuado para la formación en estas competencias y capacidades se logra a través del currículo integrado. El aprendizaje integrado es un proceso centrado en el alumno, mediante el cual se adquieren conocimientos de manera flexible e individualizada a largo plazo. En la Universidad Europea de Madrid hemos afrontado esta nueva necesidad utilizando un modelo de aprendizaje integrado de materias básicas indicado para abordar la integración curricular progresiva, y que hemos denominado WSLA (Work Stations Learning Activities). Se basa en una modificación del aprendizaje basado en equipos adaptada a las directrices europeas y españolas, especialmente indicada para los grados de ciencias de la salud. Utilizando el modelo WSLA podemos crear módulos de actividades de aprendizaje integrado adaptables a distintas situaciones, desde clases magistrales hasta gamificación o prácticas de laboratorio. Proponemos nuestro modelo WSLA como una opción flexible y escalable para adoptar la integración de manera escalonada como paso previo a la integración curricular completa

Biomedical sciences have faced a strong developmental shift in a short period of time. This advance has been boosted by the study of the molecular, genetic and physiological mechanisms of the biological processes. This has a direct effect on the better understanding of the normal functioning of our body and establishes the bases of pathology knowledge. Thus, health science professionals must develop new skills and abilities that allow them to establish links between basic sciences and their professional practice. The most appropriate curricular design for competency and capacity building is achieved through the integrated curriculum. Integrated learning is a student-centered process, through which knowledge is developed lifelong in a flexible and individualized manner. At the Universidad Europea de Madrid we have faced new demands by using a model of integrated learning of basic subjects especially suitable to achieve progressive curricular integration. We have named this new model WSLA (Work Stations Learning Activities) and it is based on a modification of the team based learning adapted to the European and Spanish guidelines especially indicated for the Degrees of Health Sciences. Using the WSLA model different modules of integrated learning activities can be created and adapted to different situations, including master classes, gamification or laboratory practices. We propose our WSLA model as a scalable and flexible option to adopt the stepwise integration as a stage prior to the complete curricular integration

Biomarcadores de la microcirculación versus escala SOFA como predictores de mortalidad en choque séptico / Biomarkers of microcirculation versus SOFA scale as predictors of mortality in septic shock / Biomarcadores de microcirculação vs escala sofa como preditores de mortalidade em choque septico

Resumen: Objetivo: Demostrar que la suma de los biomarcadores de la microcirculación: delta de CO2, déficit de base, lactato y ScVO2 central son mejores predictores de mortalidad que la escala SOFA en el choque séptico. Método de estudio: Este estudio se programó para realizarse en la Unidad de Cuidados Intensivos (UCI) de un hospital de la Ciudad de México en un periodo comprendido de 1o marzo de 2014 a 1o julio de 2017. Se trata de un estudio comparativo, ambispectivo, observacional y descriptivo. Una vez que se obtuvieron estos datos, se asignó un puntaje a cada uno de los biomarcadores basándose en estudios realizados anteriormente y se creó una nueva escala de valoración a la que se integraron los biomarcadores, la cual fue llamada «escala de biomarcadores de microcirculación¼ (EBM). De acuerdo con el puntaje obtenido se le asignó un porcentaje de mortalidad que se comparó con la mortalidad de la escala de SOFA ya predeterminada para pacientes con choque séptico. Los resultados arrojados de estas escalas se agruparon en gráficas de correlación de Pearson como variables cuantitativas, en el eje de las abscisas se colocaron los días de estancia hospitalaria y en el eje de las ordenadas el puntaje obtenido. Posteriormente se realizó una asociación con escalas de Pearson entre el puntaje obtenido en las escalas y el porcentaje de mortalidad de cada una de las escalas, logrando una correlación lineal en las dos escalas; sin embargo, se hicieron tablas de correlación entre la escala de SOFA y EBM con el porcentaje de mortalidad en un periodo de 30 días. Conclusión: Se descubrió que aunque la capacidad de pronosticar la muerte es más significativa en la escala de SOFA, es poco sensible y más específica; en tanto que la escala de EBM resultó con una sensibilidad de 100% para pronosticar la muerte con una especificidad de 76%, por lo que se considera una escala válida para determinar la muerte en la UCI; no obstante, se requieren estudios más amplios para cotejar la especificidad de esta escala.

Abstract: Objective: To demonstrate that the sum of the biomarkers of the microcirculation: CO2 delta, baseline, lactate and central ScVO2 are better predictors of mortality than the SOFA scale in septic shock. Study Study method: This study was scheduled to be performed in the ICU of the Hospital of Mexico City in a period from 1 of March 2014 to 1 of July 2017. This is a comparative, ambispective, observational and descriptive. Once these data were obtained, a score was given for each of the biomarkers based on previous studies and a new titration scale was performed where biomarkers were integrated, which was called «microcirculation biomarkers scale¼ (EBM) and according to the obtained score was assigned a percentage of mortality which was compared with the mortality of the SOFA scale already predetermined for patients with septic shock. The results obtained from these scales were grouped in Pearson correlation graphs as quantitative variables, in the abscissa axis were placed the days of hospital stay and in the axis of the ordinates the obtained score. Subsequently, an association was made with Pearson scales between the scores obtained in the scales with the percentage of mortality of each of the scales, obtaining a linear correlation in the two scales. However, correlation tables between the SOFA and EBM Scale were made The percentage of mortality in a period of 30 days. Conclusion: It was found that the ability to predict death, which is more significant in the SOFA scale is less sensitive and more specific, however, the EMB scale resulted with a sensitivity of 100% to predict death with a specificity of 76%. Therefore, it is considered a valid scale to determine death in the ICU, however, more studies are required to compare the specificity of this scale.

Resumo: Objetivo: Demonstrar que a soma dos biomarcadores da microcirculação: Delta de CO2, déficit de base, lactato e ScVO2 central são melhores preditores de mortalidade do que a escala de SOFA no choque séptico. Método do estudo: Este estudo foi programado para ser realizado na UTI de um hospital na Cidade do México em um período de 1 de março de 2014 a 1 de julho de 2017. Se trata de um estudo comparativo, ambispectivo, observacional e descritivo. Uma vez que esses dados foram obtidos, foi atribuída uma pontuação para cada um dos Biomarcadores com base em estudos anteriores e foi feita uma nova escala de avaliação onde os Biomarcadores foram integrados, denominado «escala de biomarcadores de microcirculação¼ (EBM) e de acordo com o escore obtido, foi atribuída uma percentagem de mortalidade que foi comparada com a mortalidade da escala de SOFA já predeterminada para pacientes com choque séptico. Os resultados obtidos a partir dessas escalas foram agrupados em gráficos de correlação de Pearson como variáveis quantitativas, no eixo das abcissas foram colocados os dias de internação e no eixo das ordenadas o escore obtido. Posteriormente, foi feita uma associação com as escalas de Pearson entre o escore obtido nas escalas com a porcentagem de mortalidade de cada uma das escalas, obtendo uma correlação linear nas duas escalas, no entanto, foram feitas tabelas de correlação entre o SOFA e a escala EBM com a porcentagem de mortalidade em um período de 30 dias. Conclusão: Verificou-se que a capacidade de prognosticar a morte, a qual é mais significativa na escala SOFA é pouco sensível e mais específica, porém a escala EMB resultou com uma sensibilidade de 100% e uma especificidade de 76% para prognosticar a morte. O que é considerado uma escala válida para determinar a morte na UTI, no entanto, são necessários mais estudos para verificar a especificidade desta escala.

Valores de referencia del test de marcha de seis minutos en niños sanos / Reference values for the 6-minutes walking test in healthy Chilean children

Background: The 6-minutes walking test (6WT) is the ideal submaximal test for the evaluation and follow-up of patients with chronic respiratory diseases. There are no reference values (RV) for Chilean children using the American Thoracic Society guidelines. Aim: To generate 6WT reference values for Chilean children aged 6 to 14 years. Material and Methods: 6MW was evaluated in 192 healthy children (100 women) aged between 6 and 14 years. The test was carried out in a 30 m long indoor flat surface. Children also answered a survey about health problems and their weight and height were recorded. Results: The distance walked by women and men was 596.5 ± 57 and 625 ± 59.7 m respectively (p < 0.05). There was a significant correlation between the distance walked and height (r = 0.58), age (r = 0.56), weight (r = 0.54) and reserve heart rate (r = 0.21). Conclusions: These results can be used as reference values for the 6WT in Chilean children aged 6 to 14 years. They are similar to those reported abroad.

Cateter doble J migrado e incrustado en vejiga. Presentación de un caso y revisión de la literatura / Double J catheter migrated to the bladder and encrusted. Case report and bibliographic review

OBJETIVO: La obstrucción de vía urinaria es una de las patologías de mayor prevalencia en Urología. El manejo de la misma incluye medidas conservadoras (analgesia y fluidoterapia) e invasivas (derivación de vía urinaria). El método más empleado en la actualidad para derivar la vía es la utilización de catéter ureterales de tipo doble J. Las complicaciones del mantenimiento en vía urinaria de los stents doble J han sido ya estudiadas y son bien conocidas. Presentamos un caso clínico de un catéter doble J migrado a vejida, calcificado e incrustado y hacemos una revisión de la literatura existente. MÉTODOS: Hombre de 28 años de edad al que se le diagnostica de catéter doble J enrollado en vejiga y calcificado. El paciente es intervenido de cistolitotomía suprapúbica satisfactoriamente. Realizamos una búsqueda bibliográfica en Medline mediante los términos "ureteral stent" + "incrusted stent", "bladder ureteral stent", "bladder incrusted stent" y "ureteral stent complicactions". RESULTADOS: En la actualidad se encuentra libre de enfermedad. Encontramos un total de 45 artículos que respondieron a los criterios de búsqueda, de los que seleccionamos los de mayor índice de citación. CONCLUSIONES: EL empleo de catéter doble J para derivar la vía urinaria es un método seguro y bien tolerado aunque no exento de complicaciones, es por ello por lo que hemos de concienciar a los pacientes de la necesidad de someterse a controles periódicos e instruirlos ante posibles síntomas y/o signos que puedan indicar alteraciones de la posición y/o estado del stent(AU)

OBJECTIVE: Urinary tract obstruction is one of the most prevalent diseases in urology. The handling of it includes conservative (analgesia and fluid therapy) and invasive (urinary diversion) measures. Ureteral stent is the method currently employed for urinary tract diversion. Complications of urinary tract stents maintenance have already been studied and are well known. We report a case of ureteral stent migrated to the bladder, calcified and embedded and we review the existing literature. METHODS: A 28 year-old man with the diagnosis of ureteral stent coiled in bladder and calcified. The patient was successfully operated of suprapubic cystolithotomy.We conducted a Medline search using the terms "ureteral stent" + "embedded stent", "bladder ureteral stent", "incrusted bladder stent" and "ureteral stent complicactions". RESULTS: He is currently free of disease. We found a total of 45 articles that responded to the search criteria, from which we select the highest citation index. CONCLUSIONS: The use of ureteral stents for urinary diversion of the upper urinary tract is safe and well tolerated but not without complications, that is why we have to raise awareness among patients of the need to undergo periodic inspections and instruct them to possible symptoms and / or signs that may indicate changes in position and / or state of the stent(AU)

Oxigenoterapia Hiperbárica (OHB) en el manejo de la cistitis hemorrágica radioinducida / Hyperbaric Oxygen Therapy for the management of hemorrhagic radio-induced cystitis

OBJETIVO: La Cistitis rádica (CRAD) es una enfermedad inflamatoria vesical que se presenta de forma más grave como hematuria anemizante. Los tratamientos clásicos no consiguen controlar la enfermedad a medio-largo plazo ya que no actúan sobre su patogénesis. Evaluamos la respuesta clínica de pacientes con cistitis radioinducida tras ser tratados mediante Oxigenoterapia Hiperbárica.MÉTODOS: Estudio prospectivo en el que se incluyen 38 pacientes, 21 hombres y 17 mujeres, edades desde los 46 a los 75 (media de edad de 66.5 años) sometidos a radioterapia (RT) pélvica, diagnosticados de CRAD +/- proctitis radioinducida (PRAD) y que clínicamente referían hematuria, y síndrome miccional. El tratamiento se aplicó en una cámara de tipo multiplaza, los pacientes respiraban O2 al 100% a una presión ambiental de 2-2,5 ATAs (atmósferas de presión ambiental). Recibieron una media de 29.9 sesiones (rango 10-48 sesiones), el seguimiento medio fue de 56 meses (rango 4-72 meses).RESULTADOS: La hematuria se ha resuelto hasta la fecha de forma completa en 35 pacientes, un paciente presenta actualmente hematurias no anemizantes ocasionales, a razón de una 1 trimensual. Requiriendo reingreso 6 de ellos, 5 por hematuria anemizante y 1 por pielonefritis aguda obstructiva. El tratamiento fue bien tolerado por los pacientes, 1 experimentó barotrauma que requirió de miringotomía.CONCLUSIONES: La CRAD puede tratarse de forma satisfactoria mediante OHB, consiguiendo mejoría clínica, desde las primeras sesiones en la mayoría de ocasiones, con una tolerancia más que aceptable por parte de los pacientes(AU)

OBJECTIVES: Radio-induced cystitis (RADC) is an inflammatory bladder disease that presents as anemic-hematuria in its most serious form. Classic treatments can not control the disease in the mid-to-long term because they don`t treat the pathogenesis of the disease. Thus, we evaluated the effectiveness of hyperbaric oxygen (HBO) therapy as a potential treatment for patients with RADC.METHODS: This prospective study included 38 patients, 21 men and 17 women, mean age of 66.5 years (46-75), who had been subjected to pelvic radiotherapy (RT), with the diagnosis of RADC with or without radio-induced proctitis (RADP), gross hematuria and lower seurinarytract symptoms. HBO treatment was applied in a multi-place chamber; patients breathed pure oxygen (100%) at 2-2.5 atmospheres of pressure (ATAs). Patients received an average of 31.2 sessions (10-48 sessions) and the median follow-up period was 56 months (4-72 months).RESULTS: Hematuria was completely resolved in 34 of the 38 patients. After HBO 6 patients required readmission, 5 for anemic hematuria and 1 for acute obstructive pyelonephritis. In general, patients tolerated treatment well; however, one patient experienced barotrauma requiring myringotomy.CONCLUSIONS: HBO can be used to satisfactorily treat RADC, leading to clinical improvements that begin during the initial sessions in the majority of cases, and with a more than acceptable level of patient tolerance(AU)

Empleo de la oxigenoterapia hiperbárica en Urología / Hypebaric oxygen treatment in urology

OBJETIVO: La oxigenoterapia hiperbárica (OHB) se ha empleado de forma existosa en numerosas patologías que derivan de la hipoxia tisular gracias al aporte extra de oxígeno que permite a los tejidos.En este trabajo se realiza una revisión exhaustiva acerca de toda la literatura existente en 2010 en la que se emplea OHB en patología urológica.MÉTODOS: Realizamos una búsqueda en Medline introduciendo los términos “hyperbaric oxygen”, “radic cistitis”, “interstitial cistitys”, “ hemorraghic cistitys”, “urological/pelvic fistula” y “Fournier´s gangrene”.Las búsquedas se centraron en estudios en humanos únicamente publicados en cualquier idioma.RESULTADOS: 56 trabajos publicados, 1 ensayo clínico controlado aleatorizado (ECA), 7 revisiones (review) y 48 series de casos (SC) de los que tan solo uno fué prospectivo en los que se exponen a un total de 695 pacientes. Sólo en un estudio se emplearon mediciones de oxígeno tisular para definir la hipoxia. El número de las sesiones de terapia de oxígeno hiperbárico varió desde 4 hasta 44 sesiones. (media 19,2 sesiones/paciente)CONCLUSIONES: La evidencia que se extrae de la mayoría de trabajos consultados procede de series de casos, de modo que es baja, sin embrago, en la mayoría de estudios los resultados en cuanto al manejo de los pacientes es bueno o muy bueno así que parece que la OHB puede ser de gran utilidad en enfermedades urológicas que deriven de hipoxia tisular(AU)

OBJECTIVES: Hyperbaric oxygen therapy (HBO) has been successfully used in several disorders derived from tissue hypoxia, due to the extra oxygen supply to the tissues it enables.In this manuscript we performed a systematic review including all the existing data published until 2010 about HBO in urologic disorders.METHODS: We performed a Medline search using the terms “hyperbaric oxygen”, “radical cystitis”, “interstitial cystitis”, “hemorrhagic cystitis”, “urological/pelvic fistula” and “Fournier´s gangrene”. The search was restricted to human clinical trials published in any language. RESULTS: We found 56 papers: 1 randomized controlled trial, 7 reviews and 48 case reports; only one of them was a prospective study. A total of 695 patients were included. Just one study used tissue oxygen measurement to define hypoxia. The number of hyperbaric oxygen therapy sessions ranged from 4 to 44 (mean 19.2 sessions/patient).CONCLUSIONS: The level of evidence from most reviewed papers is low because most of them are case series. Nevertheless, results of most of those studies regarding patient management are good or very good. So it seems that HBO can be very useful in urological diseases related to tissue hypoxia(AU)

Litiasis vesical gigante. Presentación de un caso y revisión de la literatura / No disponible

OBJETIVO: La litiasis es una de las patologías más prevalentes en urología. Sin embargo son poco frecuentes a nivel vesical.Las litiasis vesicales producen, generalmente, síndrome miccional y hematuria y se llega al diagnóstico después de pruebas de imagen.Presentamos un caso clínico en el que se describe la litiasis vesical primaria de mayor tamaño recopilada y hacemos una revisión de la literatura existente. MÉTODOS: Presentamos un caso clínico de un hombre de 43 años de edad diagnosticado de litiasis vesical de más de 10 cm de diámetro.Realizamos una búsqueda en Medline utilizando los siguientes términos: giant bladder stone, giant bladder lithiasis, blader lithiasis, giant bladder litiasis.RESULTADO: Nuestro paciente fue diagnosticado de litiasis vesical tras realización de Rx simple de aparato urinario y sometido a cistolitotomía. Actualmente se encuentra asintomático y libre en enfermedad.Encontramos más de 232 artículos referentes a este tema en Medline de los que seleccionamos los de mayor citación y los de los últimos 10 años.CONCLUSIONES: La litiasis vesical gigante es una enfermedad muy rara que requiere diagnósticos por imagen, la prueba patrón oro para su filiación es la cistoscopia diagnóstica aunque en ocasiones, mediante una Rx simple de abdomen o ECO urológica es suficiente.Debido a su tamaño, la cistolitotomía es todavía el tratamiento de elección para esta enfermedad(AU)

OBJECTIVE: Urinary lithiasis is a very frequent urological disease but bladder lithiasis is very uncommon.Patients usually refer voiding symptoms and hematuria. The diagnosis is made after imaging tests.We report a clinical case describing a giant bladder stone and perform a bibliographic review.METHODS: A 43 year old man with the diagnosis of giant bladder stone (more than 10 cm diameter).We searched Medline using the terms: giant bladder stone, giant bladder lithiasis, bladder lithiasis, giant bladder lithiasis.RESULTS: We made the diagnosis of giant bladder stone after a simple kidney, ureter and bladder (KUB) X Ray. The treatment for this patient was a cystolithotomy.We found more than 230 reports at Medline and chose the most referred ones and the last 10 years reports.CONCLUSIONS: Giant bladder lithiasis is a very rare pathology. The gold standard for diagnosis is cystoscopy but sometimes with a KUB Xray or an ultrasound is enough.Because of its size, cistolitotomy is the correct treatment for giant bladder stone(AU)

Carcinoma neuroendocrino de c¨¦lulas grandes de vejiga. Revisi¨®n bibliogr¨¢fica / Large cell neuroendocrine carcinoma of the urinary bladder. Bibliographic review

OBJETIVO: El Carcinoma Neuroendocrino de C¨¦lulas Grandes (CNCG), es un tumor poco frecuente en vejiga. Pretendemos actualizar los criterios diagn¨®sticos, caracter¨ªsticas anatomopatol¨®gicas e inmunohistoqu¨ªmicas, pron¨®stico y tratamiento de esta patolog¨ªa.Realizamos una revisi¨®n bibliogr¨¢fica y estudio descriptivo de los casos de CNCG de vejiga publicados en la literatura internacional.RESULTADOS: Existen 17 casos publicados de CNCG de vejiga. Las variantes histol¨®gicas mixtas constituyen el 50% y muestran escasa mejor supervivencia que las puras. El 70% son ¡ÝT3 al diagn¨®stico, y presentan una supervivencia libre de enfermedad (SLE) del 25%, mientras que la SLE para los T2 es del 100%. La cistectom¨ªa radical con linfadenectom¨ªa, combinada con quimioterapia preferiblemente neoadyuvante, consigue reducir la recurrencia local y a distancia, as¨ª como aumentar la supervivencia del CNCG de vejiga.CONCLUSIONES: El CNCG de vejiga es un tumor con alta tasa de recurrencia local y a distancia, con baja supervivencia, que requiere un diagn¨®stico precoz, y tratamiento temprano y combinado(AU)

OBJECTIVES:Large cell neuroendocrine carcinoma (LCNEC) of the urinary bladder is very rare. We intend to update diagnostic criteria, pathologic and immunohistochemical characteristics, prognosis and treatment options.All published articles related with LCNEC of the urinary bladder have been reviewed and a descriptive study has been done.RESULTS: A total of 17 LCNEC of the bladder has been found. The 50% of all LCNEC of the bladder are mixed histological variant. This variant implies a better prognosis than the pure variant. The 70% of LCNEC of the bladder were ¡ÝT3 at the time of diagnosis and the survival rate was 25%, whereas T2 tumors showed a survival rate of 100%. Radical cystectomy with lymphadenectomy combined with chemotherapy can sometimes reduce local and distant recurrence and improve survival of LCNEC of the bladder. CONCLUSIONS: LCNEC of the bladder is a tumor with high rate of local and distant recurrence, as well as low survival, requiring early diagnosis and aggressive combined treatment(AU)

Estratificación de riesgo de morbimortalidad en pacientes neutropénicos febriles hematooncológicos utilizando dos escalas de predicción / Risk stratification of mortality in patients febrile neutropenic hemato using two scales prediction

Determinar el pronóstico de mortalidad en los pacientes hematooncológicos con neutropenia febril a través del score de MASCC y el de PARK. Se realizó un estudio descriptivo, prospectivo constituido por 34 pacientes hematooncológicos, neutropénicos febriles hospitalizados del Hospital Universitario de Caracas, a quienes se aplicaron ambos score. No se halló correlación estadística. Sin embargo, se observó que en el grupo de bajo riesgo según el score de MASCC estuvieron todos los pacientes que fallecieron, mientras que según el score de PARK fallecieron principalmente los pacientes con valor de PCR mayor o igual a 20. El score de MASCC pareciera no ser una herramienta útil para evaluar pronóstico en estos pacientes, siendo probablemente más útil el score de PARK en especial el valor de PCR en el ingreso...

To determine the mortality prognosis in hematooncologic neutropenic febrile patients using MASCC and Park scores. Both scores were applied to 34 hospitalized patients of the Hospital Universitario de Caracas, Venezuela, in a descriptive, prospective study. No statistic correlation was found. However we found that that the patients who died were clasiffied as low risk by the Score of MASCC and had PCR values of 20 or more Parks score. MASCC ìs score seems not to be a useful tool to evaluate the prognosis of these patients versus the Park ìs, score wich was more useful especially taking in account the PCR value on the first day of admission...

Histiocitoma fibroso maligno de la vejiga concomitante con carcinoma in situ. Aportación de un caso / Malignant fibrous histiocytoma of the urinary bladder concomitant with carcinoma in situ: a case report

El histiocitoma fibroso maligno (HFM) es el sarcoma más común de los tejidos blandos en el adulto; sin embargo, su existencia en el tracto urinario es excepcional. Realizamos una extensa revisión de la bibliografía al respecto, habiendo encontrado hasta la actualidad 29 casos de HFM de la vejiga. Presentamos el caso de un HFM de la vejiga en un paciente con diagnóstico y seguimiento por carcinoma in situ. Describimos la forma de presentación, las variedades anatomopatológicas, las características inmunohistoquímicas, la clasificación, los factores pronósticos y el tratamiento del HFM de la vejiga(AU9

Malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma in the adult. However, it is only very rarely found in the urinary bladder, with only 29 cases reported to date. We present a further case of MFH of the bladder occurring in a patient diagnosed with carcinoma in situ and describe the presentation, morphology, immunohistochemistry, histological grading, prognosis and treatment(AU)

Agregación globular: consistecia y validéz de la "Oftalmoangioscopia conjuntival" / Globular aggregation: congesteme and validity of the \"Oftalmoangyoscopy conjunctival\"

Evaluar la consistencia y validez de la "Oftalmoangioscopia conjuntival" en el diagnóstico de agregación globular en vasos conjuntivales, como evidencia clínica de Velocidad de Sedimentación Globular (VSG) aumentada. Estudio de Corte Transversal. Se evaluaron dos muestras de 32 pacientes de ambos sexos, hospitalizados en los Servicios de Medicina Interna del Hospital Universitario de Caracas. La primera muestra está compuesta de 20 pacientes femeninos y 12 masculinos, la segunda 17 y respectivamente. Los treinta y dos pacientes de cada muestra fueron seleccionados por azar simple por un clínico independiente quien registró: identificación, datos demográficos y último valor de VSG. los pacientes fueron evaluados individualmente por seis observadores: Dos médicos Especialistas en Medicina Interna, dos médicos Generales Residentes del primer año del Postgrado de Medicina, dos estudiantes de Pregrado del quinto año del régimen anual. La"oftalmoangioscopia conjuntival" fue demostrada y estandarizada previamente entre los seis observadores (Siguiendo la descripción de Muci-Mendoza), las dos muestras fueron evaluadas con un lapso entre ellas de quince días, utilizando para el entrenamiento individual en la técnica. La consistencia se estudió como variabilidad interobservador, calculada a través del estadístico Kappa pesado, la validez de la técnica fue explorada con el cálculo de las probabilidades intermedias (sensibilidad, especificidad) y probabilidades posteriores (valores predictivos positivos y negativos). El acuerdo de los seis observadores estimado a través del Kappa pesado entre mínimo y regular, independientemente del nivel de experiencia de los observadores; con amplias variaciones en los valores de sensibilidad, especificidad y valores predictivos positivos y negativos. la "oftalmoangioscopia conjuntival" como técnica semiológica para el diagnóstico de agregación globular en los vasos conjuntivales y marcador clínico de VSG elevada resultó inconsistente y poco válida independientemente del nivel de experiencia del observador

Significado del pulso venoso espontaneo en la retina / Heaning of the spontaneous venous pulsation in the retina

El hallazgo del pulso venoso espontáneo en una o varias venas retinianas en un porcentaje apreciable de la población mundial, ha sido un fenómeno que se viene estudiando desde finales del siglo pasado. Su etiología ha sido explicada mediante diversas teorías. Con el estudio de la incidencia del pulso venoso espontáneo en pacientes y en la población general, se llegó a comprender su mecanismo de producción, y ha llegado a ser un instrumento clínico de despistaje en el campo de la neuroftalmología. Antes de entrar es su importancia clínica se deben considerar algunos aspectos