[Disciplinar thematic integration in medicine: a proposal from histology and embryology]. / Integración temática disciplinar en medicina: una propuesta desde histología y embriología.

This paper intends to clarify a concept with multiple meanings and a complex reality. It starts providing varied histological and embryological examples apt to contribute the stimulation of teacher and student imaginations in favor of a crucial skill, as thematic integration is, into the present and changing curricula in Medicine in particular and Health Sciences in general. In this sense, it offers linear and branched sequences as well as consolidation graphics which focusing in both disciplines may also include other basic ones, key for clinic diagnosis, among the competences to be developed. After registering some preliminary results revealing the need of its continuous and progressive training along the complete medical career, its own integrative value and the integrative one for their teachers due to its natural link with other basic ones is outlined, its relevance for undergraduate is reaffirmed and possible future variations for them are previewed, considering the present exponential growth of science and technology.

Este trabajo intenta aclarar un concepto con múltiples significados y una realidad compleja y proveer ejemplos de distinta dificultad centrados en la Histología y la Embriología, potencialmente útiles para currículos tradicionales y, esencialmente, para aquéllos en vías de transformación dentro de la Medicina en particular y de las Ciencias de la Salud en general. En ese sentido, propone secuencias lineales, ramificadas y gráficas de consolidación que, pivoteando en ambas disciplinas, pueden comprender también a otras ciencias básicas, todas de significado clave para el diagnóstico clínico. Tras registrar algunos resultados que, aunque limitados, revelarían la necesidad de su entrenamiento continuo y en complejidad creciente a lo largo de la carrera médica, se subraya su valor integrador intrínseco así como la potencialidad integradora que desarrolla en quienes las cultivan en virtud de su ligazón natural con otras disciplinas básicas. Asimismo, a la par que se reafirma la relevancia de una y otra en el grado, se vislumbran posibles variaciones en las mismas en virtud de los exponenciales avances científico-tecnológicos de la hora.

Integración temática disciplinar en medicina: una propuesta desde histología y embriología / [Disciplinar thematic integration in medicine: a proposal from histology and embryology].

This paper intends to clarify a concept with multiple meanings and a complex reality. It starts providing varied histological and embryological examples apt to contribute the stimulation of teacher and student imaginations in favor of a crucial skill, as thematic integration is, into the present and changing curricula in Medicine in particular and Health Sciences in general. In this sense, it offers linear and branched sequences as well as consolidation graphics which focusing in both disciplines may also include other basic ones, key for clinic diagnosis, among the competences to be developed. After registering some preliminary results revealing the need of its continuous and progressive training along the complete medical career, its own integrative value and the integrative one for their teachers due to its natural link with other basic ones is outlined, its relevance for undergraduate is reaffirmed and possible future variations for them are previewed, considering the present exponential growth of science and technology.

La agregación eritrocitaria en la fisiopatogenia de las lesiones cutáneas microangiopáticas diabéticas / Erythrocytic aggregation in the physiopathogenesis of diabetic microangiopasthic skin lesions

Introducción: La diabetes puede producir importantes lesiones cutáneas; algunas microangiopáticas (dermopatía diabética, púrpura pigmentaria, eritrosis, eritema símil erisipela, rubeosis facial y telengiectasias periungueales). Existe creciente evidencia de que las anormalidades hemorreológicas desempeñan un papel definido en esta enfermedad. En consecuencia, este trabajo analiza la agregación eritrocitaria en pacientes diabéticos con y sin lesiones cutáneas Pacientes y método: Se estudió clínica, dermatológica y hemorreológicamente a 86 pacientes con diabetes tipos 1 y 2, de ambos sexos y edades similares, con lesiones cutáneas (28) y sin ellas (58), y 20 controles sanos. La agregación eritrocitaria se midió mediante observación microscópica directa y procesamiento numérico de las imágenes digitalizadas recogidas a través del llamado Parámetro de Forma de los Agregados (ASP). Los datos se analizaron con ANOVA y las pruebas de la t de Student y de la *2. Resultados: El tiempo de evolución de los pacientes diabéticos con lesiones cutáneas fue más prolongado y su ASP (0,692 ± 0,066) excedió significativamente el de los controles (0,288 ± 0,134) (p = 0,65 fue superior en aquéllos que presentaban lesiones cutáneas (el 80 frente al 45%; p = 0,006). Conclusiones La agregación eritrocitaria puede participar en el desarrollo de la microangiopatía diabética y en la aparición de las citadas lesiones dermatológicas

Introduction: Diabetes can produce significant skin lesions. Some of them are linked to microcirculatory changes (diabetic dermopathy, pigmentary purpura, erythrosis, erysipela-like erythema, facial rubeosis, and perionychial telangiectases). There is increasing evidence that hemorheological abnormalities play a definitive role in diabetes mellitus. Consequently, the present study analyzed red blood cell aggregation in diabetic patients with and without skin lesions. Patients and method: Eighty-six type 1 and type 2 diabetic patients of both sexes and similar ages, with (28) and without (58) skin lesions and 20 healthy controls underwent clinical, dermatological and hemorheological studies. Red blood cell aggregation was measured using direct microscopic observation and the recorded digitized images were numerically processed through the aggregate shape parameter (ASP). ANOVA, Student's t-test and the chi-square test were employed. Results: Diabetic patients with skin lesions had longer disease duration than those without and their ASP (0.692 ± 0.066) significantly exceeded that of controls (0.288 ± 0.134) (p = 0.65 was higher in those with cutaneous lesions than in those without (80% versus 45%, p = 0.006). Conclusions: Red blood cell aggregation may participate in the development of diabetic microangiopathy and in the appearance of the above-mentioned dermatologic lesions

Onset and evolution of nephropathy in rats with spontaneous diabetes mellitus.

The occurrence of renal diabetic complications was studied in diabetic nonobese IIM/FmeSS (eSS) rats. The results were compared with eumetabolic Wistar rats paired by sex and age. Between 6 and 12 months of age, eSS male rats had higher fructosamine values and glucose intolerance as well as increasing proteinuria and uremia. Enhancement in water, calcium and phosphorus fractional excretion with a concomitant lower sodium excretion, was observed from 12 months of age on. 18- and 21-month-old eSS rats exhibited fasting hyperglycaemia and rising values of fructosamine, glucose intolerance and glycosuria. Simultaneously, a notorious worsening of proteinuria as well as alterations in glomerular filtration were verified. Optic microscopy of 12-month-old eSS rat kidneys showed areas of tubular dilatation with protein cylinders. In 21-month-old eSS animals, kidneys appeared overtly damaged. Increased capsular, glomerular and Henle's thin loop diameters were verified in 12- and 21-month-old eSS rats. Glomeruli showed diffuse hypertrophy of mesangial tissue and thickening of the basement membrane. Areas of markedly atrophic and dilated tubules containing acidophilic proteinaceous material were observed. At age of 21 months, kidneys of eumetabolic Wistar control rats presented foci of interstitial and pielic inflammatory infiltrates.

[Intestinal alterations and reduction of growth in prepuberal rats fed with soybean]. / Alteraciones intestinales y disminución del crecimiento en ratas prepúberes alimentadas con soja.

Weanling rats from the inbred lines alpha and beta were fed with a soybean-cereal mixture used for human consumption (AN). A group fed with laboratory rat chow was used as reference (AC). Growth and other nutritional parameters as well as intestinal morphohystometry were evaluated from 22 to 44 days of age. Growth rate and final weight were greater with AC in both lines of rats. The greater initial food conversion efficiency of AN diet, compared to AC, decreased rapidly with the progression of age, particularly in the beta strain. Nitrogen (N) and lipid fecal contents were significantly larger for AN in both lines. Apparent nitrogen digestibility, expressed as the difference between N intake and fecal N with respect to N intake was AC < AN (p < 0.01) for line alpha and AC > AN (p < 0.01) for line beta. The weight and the mucosal total width of the small intestine were AC > AN in both lines. AN produced a significant decrease of villi goblet cells in both strains (p < 0.005). Cecum weight was AC > AN (p < 0.01) for the beta strain. These results alert about uncontrolled consumption of soybean products without adequate inhibition of antinutritional factors, a potential risk for growing animal populations.

Influence of gonadectomy in eSS diabetic rats.

The influence of gonadectomy on some variables related to the diabetic syndrome was studied in the eSS line of rats, a nonobese model of spontaneous non-insulin-dependent diabetes, whose biochemical and histopathological manifestations are more severe in males than in females. Rats were gonadectomized at 90 days of age. Spayed animals showed higher body weight, impaired intolerance to glucose at 9 and 12 months of age, lower insulinemia and a decreased number of large pancreatic islets. Castrated rats revealed lower body weight when compared with controls. However, those males did not evidence impairment in the intolerance to glucose, changes insulinemia or remarkable modifications in endocrine pancreas histology. In kidneys, a lower cellular area in superficial proximal convoluted tubules was noticed. Despite the lower biomass registered in orchidectomized animals, their diabetic evolution was not modified. Conversely, ovariectomy appeared to be a worsening factor.

Female reproductive profile in a fertile, genetically obese line of rats.

The female reproductive profile of a fertile genetically obese line of rats, named beta, is characterized. Hypophysis, ovaries, oviducts, and uteri weights do not differ from those of nonobese controls. Histological features in ovary, uterus, and vagina in beta line and alpha controls are similar, in agreement with classical descriptions in the subject. Vaginal opening, number of estrus, number of corpora lutea at ovulation time, and pregnancy patterns (i.e., ovary weight, number of corpora lutea, sites of implantation, and living fetuses, as well as productivity, fertility, litter size, and preweaning mortality) show no significant differences between obese and nonobese animals. From a reproductive standpoint, obese beta line would behave as nonobese. Up to now beta would represent the only fertile genetically obese line of rats, appearing as a profitable biological model to widen and deepen reproductive analysis on obesity.

Effects of dietary sucrose option on the diabetic syndrome of the eSS rat.

The eSS rat is a model of human spontaneous non-insulin-dependent diabetes. Male eSS rats were divided at the age of 4 months into two groups (eSSA and eSSB), both receiving the usual commercial balanced diet with sucrose also made available to eSSA. Sucrose intake did not imply a higher caloric diet, and no differences were found between groups in body weight and plasma triglyceride levels from 6 to 12 months of age. Sucrose option resulted in lower protein, lipid and carbohydrate intakes in eSSA animals. Plasma glucose values were higher in eSSA at different times of the tolerance curve. Likewise, eSSA kidneys showed significantly higher capsular and glomerular diameters and there was a discrete PAS-positive thickening of their basement membrane. We conclude that prolonged ad libitum sucrose intake, without weight gain, causes a moderate metabolic impairment and renal lesions in the eSS diabetic rat.

[Erroneous extrapolation as a frequent defect in medical students]. / La extrapolación errónea como defecto frecuente en alumnos de medicina.

Scientific aptitude development, useful for methodic management of information, is indispensable for teaching and learning, investigation, medical practice and customary life. Correct extrapolation is one of its components. This work deals with appropriate use of extrapolation among medical students. 118 students from a potentially experimented, interested and adapted population were analyzed (103 coursing 2nd. year and the others, last years). All of them were exposed simultaneously and without opportunities of exchanging opinions, to three tests: graphical, clinical and general (open answer). Results point out extrapolation as a current defect in the studied population. Deficiencies in related teaching experiences are also revealed. On the other hand, certain designs--although in the general low level of correct answers--appeared more familiar than others to the students. A deepening of analysis in extrapolation scientific aptitude and preventive exposition to valid experiences since 1st. year of medical career is proposed.

[Design, evaluation and application of a model for evaluating the cognitive abilities related to scientific aptitude in medical students]. / Diseño, validación y aplicación de un modelo evaluador de habilidades cognitivas relacionadas con la aptitud científica en alumnos de medicina.

A model for evaluating the cognitive ability related to scientific aptitude consisting of 10 different problems is presented. The design conditions, validity and the application of the model to selected second year Medical students as well as randomly chosen first, third and sixth year students are described. The authors record and analyze global results as well as the results of individual or group of problems, concluding on the validity and fiability of the model as well as on the detection of failures in student's performances inspite of the effort made. Future action is proposed.

[Innovative approach of teaching-learning of histology and embriology]. / Enfoque innovador de la enseñanza-aprendizaje de histología y embriología.

The paper presents an innovative approach to the teaching-learning of histology and embryology. The traditional teaching of the subject in the Faculty of Medical Sciences of Rosario National University, Santa Fe, Rosario, Argentina, up to 1974 is subjected to critical analysis, and on this basis the need for the innovation is propounded and the method for applying it proposed. A detailed account is given of the theoretical framework of the experiment reported, of the general and specific objectives of the teaching-learning technique, and of the thematic units into which the curriculum was divided. In the teaching-learning plan followed--described in the article--the conventional professorial lecture and its accompanying practical demonstrations are replaced by round tables and theoretical-practical tasks requiring active involvement and integrating theory and practice, in which teams tackle problems under teacher coordination. It also provides for evaluation of the students, teachers and course and eliminates the conventional examination.

Enfoque innovador de la enseñanza-aprendizaje de histología y embriología / Innovative approach of teaching-learning of histology and embriology

The paper presents an innovative approach to the teaching-learning of histology and embryology. The traditional teaching of the subject in the Faculty of Medical Sciences of Rosario National University, Santa Fe, Rosario, Argentina, up to 1974 is subjected to critical analysis, and on this basis the need for the innovation is propounded and the method for applying it proposed. A detailed account is given of the theoretical framework of the experiment reported, of the general and specific objectives of the teaching-learning technique, and of the thematic units into which the curriculum was divided. In the teaching-learning plan followed--described in the article--the conventional professorial lecture and its accompanying practical demonstrations are replaced by round tables and theoretical-practical tasks requiring active involvement and integrating theory and practice, in which teams tackle problems under teacher coordination. It also provides for evaluation of the students, teachers and course and eliminates the conventional examination (Au)