Hemorheologic changes in type 2 diabetic patients with microangiopathic skin lesions. A linear discriminant categorizing analysis.

The development of diabetic microangiopathy may produce lesions in distinct organic territories (the skin, among others). With an intention of identifying hemorheologic variables for a better characterization of diabetic patients, we studied plasmatic and blood viscosities (P Visc at 2.30 s(-1) and B Visc at 4.60 and 230 s(-1)), fibrinogenemia, and erythrocytic aggregation in 40 type 2 diabetic patients (13 with microangiopathic skin lesions and 27 without) and in 30 healthy controls. Considering its alterations in diabetic patients and applying linear discriminant analysis, two models may be characterized: (a) discriminant function (Disc F)=0.58 aggregate shape parameter (ASP)-0.61 B Visc(230)+0.89 fibrinogenemia for discriminating healthy individuals from diabetic patients with microangiopathic skin lesions and (b) Disc F=6.325 ASP-0.347 B Visc(230)+0.013 fibrinogenemia for discriminating healthy controls from diabetic patients with and without microangiopathic skin lesions. Both models appear to be valid due to the following: (a) Model 1: a coefficient of canonic correlation of 0.924, a highly significant Mahalanobis distance (P<10(-3)), a correct percentage of classification (100%), and the centroids of each group (0.94 and 5.63); (b) Model 2: a coefficient of canonic correlation of 0.898, a highly significant Mahalanobis distance (P<10(-3)), a correct percentage of classification (85.7%), and the centroids of each group (-1.9, 1.9, and 2.4). Just as the alterations in the analyzed hemorheologic variables could be suggesting their possible involvement in the physiopathogenia of diabetic microangiopathic skin lesions, the proposed models could characterize a microcirculatory profile in diabetic patients for preventing irreversible damages.

La atención primaria de la salud y la especialización médica: ¿Categorías opuestas o complementarias? / Primary care and medical specialization: Complementary or mutually exclusive categories?

Fundamentos y Objetivos: Las conclusiones de Juan César García sobre especialización a fines de los 60s condujeron a describir aspectos actuales de la especialización; ampliarlos y cotejarlos con aquéllas e indagar las expectativas de los alumnos por ejercer o no en niveles de la Atención Primaria de la Salud – APS-) y su porqué. Material y Métodos: Para ello, fueron combinados métodos cualitativos y cuantitativos en ingresantes, alumnos avanzados y médicos. Resultados y Discusión: Entre ambas épocas, aumentó la intención por especializarse para el sistema de atención vigente (de 52 a 74 % en los ingresantes y de (..) (AU)

Background and Objectives: Juan César Garcia’s conclusions on specialization, reported in the late nineteen sixties, encouraged researchers to broaden their area of study and to investigate students ‘expectations regarding the practice of primary care. Material and Methods: Qualitative and quantitative methods were used to assess the attitudes of new students, advanced undergraduates and postgraduates regarding primary care and specialization (..) (AU)

Implementing a problem-based learning curriculum in an Argentinean medical school: implications for developing countries.

The authors review the difficulties that Argentina's medical schools, particularly the public ones, are likely to face when implementing a problem-based learning (PBL) curriculum, describe the barriers that were faced by their medical school as it implemented PBL, and point out the implications for medical education in developing countries with conditions and education programs similar to those in Argentina. Specifically, they (1) outline the basic requirements for successful implementation of a PBL curriculum, (2) describe the training contradiction in Argentina between a complex and heterogeneous health care system that forces specialization and medical schools' attempts to train generalists, and (3) review the effects on curriculum change of the size and the training levels of the student population and the availability of human and financial resources. This information indicates the context in which the Rosario University School of Medicine designed a new PBL curriculum and implemented it in 2002. The authors close by suggesting that schools in developing countries that are in circumstances similar to that of Rosario should consider whether a PBL curriculum is even appropriate for them, and should realize the difficulties (discussed in the article) they will have to overcome. Also, uncertainties about the efficacy of PBL create a case for exploring alternatives to PBL, including hybrid curricula. Considering the available research on curricular innovations such as PBL and the particular situations of their countries may help schools anywhere avoid wrong decisions about what curricula to implement.