Grupos de Estudio Dirigido en la educación veterinaria: una propuesta estudiantil para fortalecer la comunicación de los futuros profesionales / Directed Studies Groups in the veterinary education: a proposal to enhance communication in future professionals

De la lectura de solicitudes laborales para cualquier empresa, y en particular las relacionadas con la labor del Médico Veterinario, al mismo nivel que los conocimientos científico-técnicos se solicita que éste posea “espíritu proactivo”, “capacidad de liderazgo” “competencias para trabajar en equipo”, entre otras habilidades sociales importantes. Ya no alcanza con saberes “sabios” ni experiencia “técnica”, hoy se necesitan sujetos hábiles para la comunicación, con confianza en sí mismos y en los demás, solidarios, empáticos con su entorno y capaces de integrarse con éxito a equipos de trabajo. En el currículo oficial de la carrera de Medicina Veterinaria de la Universidad Nacional del Litoral, la habilidad de trabajar en equipo no forma parte de los contenidos específicos que el estudiante debe aprender. Los Grupos de Estudios Dirigidos (GED), son grupos de alumnos de distintos niveles de la carrera, que motivados por un tema en común gestionan tareas de profundización en temáticas específicas, investigación y/o extensión para fortalecerse en esa área. Para ellos aprender a trabajar en equipo implica aprender a comunicarse eficazmente, a ser solidario, a comprometerse con el logro de metas comunes, habilidades que no deben descuidarse y que son fundamentales para hablar de un profesional con una formación integral.

Reading job applications sent to any company and, particularly, those related to the Veterinary profession, it becomes clear that, apart from the required specific technical and scientific expertise, applicants should also have a proactive spirit, leadership abilities and the capacity to work in a team, among other important social skills. Nowadays, it's not enough having "wise" knowledge or "technical" expertise. Subjects should also have the ability to communicate effectively, demonstrate they can rely upon themselves and others, be sympathetic and empathetic and capable of integrating successfully in new work teams. In the official syllabus of the Veterinary Medicine career in Argentina, the ability to work in teams is not part of the specific content that the students have to learn. The Directed Studies Groups (DSG), are groups of students of different levels of the graduate course, that motivated by a common topic embark on tasks to deepen their knowledge on specific subjects, including research and / or extension. For them, learning to work in a team means learning to communicate effectively, to be supportive, to commit to the achievement of common goals, skills that should not be neglected and that are fundamental to speak of a professional with a comprehensive education.

SEOM clinical guideline on unknown primary cancer (2017).

Cancer of unknown primary site is a histologically confirmed cancer that manifests in advanced stage, with no identifiable primary site following standard diagnostic procedures. Patients are initially categorized based on the findings of the initial biopsy: adenocarcinoma, squamous-cell carcinoma, neuroendocrine carcinoma, and poorly differentiated carcinoma. Appropriate patient management requires understanding several clinical and pathological features that aid in identifying several subsets of patients with more responsive tumors.

Efectividad de una intervención educativa para acortar el tratamiento antibiótico parenteral en infecciones moderadas y graves en un hospital pediátrico de alta complejidad / Effectiveness of an educational intervention to shorten parenteral antibiotic treatment in moderate and severe infections in a tertiary-care pediatric hospital

Introducción: Las intervenciones destinadas a acortar la duración de los tratamientos antibióticos parenterales son consideradas estrategias de utilidad para reducir complicaciones relacionadas con los tratamientos parenterales prolongados en forma inadecuada, la selección de resistencia y los costos hospitalarios. El objetivo del estudio fue evaluar la efectividad de un programa para reducir la duración del tratamiento antibiótico parenteral innecesario en el tratamiento de infecciones moderadas y severas en niños hospitalizados. Material y Métodos: Estudio antes después sin grupo control. Se incluyeron niños entre 3 meses y 18 años que recibían tratamiento antibiótico parenteral como tratamiento de peritonitis, infección de piel y partes blandas, infección osteoarticular, neumonía neutropenia febril sin foco clínico de infección internados en el Hospital Garrahan. Período Pre-intervención (Pre-I) 2011 vs. Post-intervención 2012. Intervención: talleres interactivos, difusión de algoritmos diagnósticos y de tratamiento de las infecciones consideradas y monitoreo regular de las prescripciones antibióticas parenterales y su duración. Análisis estadístico: STATA version 8.0 software. Resultados: Pre-I vs. post-I se incluyeron un total de 194 vs. 227 pacientes respectivamente. La mediana de edad fue de 49 meses (RIC: 19-92 m) vs. 39 meses (13-108m), respectivamente p>0.05., se obtuvo documentación microbiológica en 52 (27%) vs. 63 (28%), p>0.05. La mediana de días de tratamiento antibiótico parenteral según pre vs. post I fue de 6 días (RIC: 5-7d.) vs. 3 días (RIC 2-4) para Infección de piel y partes blandas, 5 días (RIC: 3-8) vs. 4 días (RIC 3-6) para neumonía, 6 días (RIC:5-8) vs. 4 días (RIC:4-5) para peritonitis, 7 días(RIC: 6-8) vs. 5 días (RIC: 5-7 días) para infecciones osteoarticulares y 5 días (RIC: 4-6) vs. 4 días (RIC: 3-5) para neutropenia febril sin foco clínico de infección. Mediana del total de días de tratamiento antibiótico parenteral pre-I vs. post-I fue 6.5 días (RIC: 5-7) vs. 4 días (RIC: 4-5), p<0.01, la mediana días totales de internación fue de 7(6-8) vs. 5 (5-6) p<0.01. Conclusiones: Se observó una reducción en la duración de los tratamientos endovenosos de infecciones moderadas y graves en el periodo post-intervención generando una mayor disponibilidad de camas en la institución (au)

Introduction: Interventions to shorten parenteral antibiotic treatment are considered useful strategies to reduce complications related to inadequately long parenteral treatment, resistance, and hospital costs. The aim of this study was to assess the effectiveness of a program for the reduction of unnecessary parenteral antibiotic treatment in the management of hospitalized children with moderate and severe infections. Material and methods: A before-and-after study without control group. Children between 3 months and 18 years of age receiving parental antibiotics for the treatment of peritonitis, skin and soft tissue infection, osteoarticular infection, pneumonia, and febrile neutropenia without a clear focus of infection admitted to the Garrahan Hospital were included in the study. Pre-intervention period (Pre-I) 2011 vs. post-intervention period 2012. Intervention: Interactive workshops, diffusion of diagnostic and treatment algorithms for infections used, and regular monitoring of prescriptions for parenteral antibiotics and their duration. Statistical analysis: STATA version 8.0 software. Results: In the pre-I vs. post-I a total of 194 vs. 227 patients were included, respectively. Median age was 49 months (IQR: 19-92 m) vs. 39 months (13-108 m), respectively, p>0.05. Microbiological documentation was obtained in 52 (27%) vs. 63 (28%) patients, p>0.05. Median days of parenteral antibiotic treatment in the pre vs. post I period was 6 days (IQR: 5-7 d) vs. 3 days (IQR: 2-4 d) for skin and soft tissue infection, 5 days (IQR: 3-8) vs. 4 days (IQR: 3-6) for pneumonia, 6 days (IQR: 5-8) vs. 4 days (IQR: 4-5) for peritonitis, 7 days (IQR: 6-8) vs. 5 days (IQR: 5-7 days) for osteoarticular infections, and 5 days (IQR: 4-6) vs. 4 days (IQR: 3-5) for febrile neutropenia without a clear focus of infection. Median total days of parenteral antibiotic treatment in the pre vs. post I period was 6.5 days (IQR: 5-7) vs. 4 days (IQR: 4-5), p<0.01 and the median total days of length of hospital stay was 7 (IQR: 6-8) vs. 5 (IQR: 5-6), p<0.01. Conclusions: A decrease in the duration of intravenous treatment duration for moderate and severe infections was observed in the post-intervention period leading to an improved availability of beds at the institution (AU)

Síndrome Poliglandular Autoinmune Tipo II: Posible Asociación con HLA DRB1*-DQB1* / Possible association of Type II Autoimmune Polyendrocrine Syndrome with HLA DRB1*-DQB1*

Los síndromes poliendocrinos autoinmunes (APS) asocian enfermedades endocrinas autoinmunes con otros desórdenes autoinmunes no endocrinos. El APS tipo II se caracteriza por compromiso primario suprarrenal, tiroideo y/o DM tipo I. Presentamos un paciente masculino de 46 años que fue internado por astenia, adinamia, hiporexia, severa disminución de peso, mareos y vómitos. Antecedente de obesidad y diabetes diagnosticada 3 años antes. Presentaba hipotensión arterial, hiperpigmentación de mucosas y pliegues, anemia, hiponatremia e hipoglucemias frecuentes a pesar de la disminución de la dosis de insulina. Se diagnosticó insuficiencia suprarrenal, concomitantemente con hipotiroidismo y diabetes tipo 1, todas de origen autoinmune, iniciándose reemplazo hormonal. Se encontró una posible asociación del HLA DRB1*-DQB1* en los estudios genéticos. Conclusiones: Nuestro paciente presenta el HLA DQB1*0302 descripto en el APSII, pero el HLA DRB1 *08 encontrado no está descripto en este síndrome ni en ningún otro desorden autoinmune. En pacientes con Diabetes tipo 1 que disminuyan el requerimiento insulínico, habría que descartar insuficiencia suprarrenal, un componente del APS II, como factor etiológico, a pesar de su baja prevalencia.

Autoimmune polyendocrine syndromes (APS) are the association of autoimmune endocrine diseases with other non-endocrine autoimmune disorders. Type II APS is defined by occurrence of Addison´s disease with thyroid autoimmune disease and/or type 1 diabetes mellitus. We present a 46-year-old male patient who was hospitalized because of asthenia, adynamia, hyporexia, severe loss of weight, dizziness and vomiting. Diabetes mellitus had been diagnosed 3 years earlier when he was obese. He presented arterial hypotension, anemia, darkening of the skin and oral mucosa, hyponatremia and frequent hypoglycemia although his insulin dose was decreased. Adrenal insufficiency was diagnosed together with hypothyroidism and type 1 diabetes, all of them of autoimmune origin. Hormonal replacement treatment was initiated. Genetic studies were performed and a new polymorphism was found. Conclusions: HLA DRB1 *08 found in our patient has not been described in APS II or in any other autoimmune disorders. He also has HLA DQB1*0302 described in previous reports related to APS II. In type 1 diabetic patients whose insulin requirement decreases, it would be advisable to rule out adrenal insufficiency, a component of APS II, as an etiologic factor in spite of its low prevalence. In diabetic obese patients (mainly young) who lose weight without a defined cause, type 1 diabetes mellitus should be excluded.

Model of computerized academic medical clinic.

In the traditional medical graduation course, the student receives a great amount of information while training at the Outpatient Care; the student assumes the physician's role, collecting all the information regarding the patient's clinical history and learns to get along with patients as well. During the attendance process, several factors interfere in the academic teaching, such as limitations of room numbers, amount of patients, difficulties in obtaining medical records, paper illegibility, among other problems. Due to those difficulties, the Model of Computerized Academic Health Clinic, implies in a new learning paradigm in the medical practice, rethinking the traditional process of learning-attendance, where the old model, in which attendance is restricted to a place, is extended in an open atmosphere of shared knowledge, rich of computer resources. The pilot project was implanted in the Pediatrics General Health Clinic of UNIFESP/EPM. It allows that the fifth-year medical students, residents, trainees and tutors use computerized clinics, connected with the academic net of UNIFESP and to the Internet. All the computing and information resources settled at the Outpatient Care improved the organization of its services, increased the medical students' curiosity, improved their participation in learning through interactive programs and clinical attendance.

[Total anomalous pulmonary venous connection. Experience with 70 cases]. / Drenagem anômala total de veias pulmonares. Experiência com 70 casos.

PURPOSE: To evaluate the clinical and surgical experience with consecutive patients with isolated total anomalous pulmonary venous connection admitted to the Heart Institute, São Paulo, Brasil. METHODS: Hospital records of 70 consecutive patients (January 1985 to December 1993) were retrospectively reviewed. There were 28 girls and 42 boys whose ages ranged from two days to four years (mean 20.4 +/- 29 weeks). The following variables were selected for analysis: anatomic type, age at admission, clinical status, the presence of infection, restrictive atrial septal defect, and the presence of pulmonary venous obstruction. Univariate and multivariate analysis were used to identify possible risk factors for death. RESULTS: The abnormal anatomical connection was supracardiac in 63%, cardiac in 17%, infracardiac in 8.5% and mixed in 11.5% of the cases. Eighteen (25.7%) patients were admitted in poor clinical condition. Infection, mainly pulmonar, was present in 31 (44%) patients. Pulmonary venous obstruction was present in 21% of the patients. Atrial septostomy was performed in 38 patients, 13 of them admitted in a poor clinical status. The preoperative mortality was 15.7% and the operative, 17%. Statistical analysis demonstrated that infection, poor clinical status and age were risk factors for death. CONCLUSION: Surgical correction of total anomalous pulmonary venous drainage in infancy can be performed at low risk with good results. However early referral to a cardiac care center, agressive preoperative stabilization and postoperative care are important.