Desarrollo de casos clínicos transversales: experiencia dinamizadora de la Unidad Docente de Toxicología de la Universidad de Barcelona / Development of transversal clinical cases: creating a dynamic experience for the Toxicology Teaching Unit of the Barcelona University

Se ha puesto en marcha un proyecto de innovación docente basado en el desarrollo de casos clínicos transversales a lo largo de las diferentes asignaturas del Grado de Farmacia. El objetivo es favorecer un aprendizaje integrador entre materias del grado, durante la carrera universitaria de los alumnos, mediante la elaboración de material docente adecuado para un uso transversal. También se propone desarrollar un "estilo" de comunicación entre profesores y un nuevo modelo de enseñanza en la universidad, que permita generar estrategias de coordinación del profesorado y de elaboración de materiales de uso común. La Unidad de Toxicología del Departamento de Salud Pública ha sido uno de los dinamizadores de este proyecto. Se ha escogido el alcohol como primer caso, introduciendo un personaje, Sam, un paciente de 20 años, que se inicia muy joven y del que veremos su evolución clínica. Sobre el guion básico del caso clínico, se han propuesto una serie de contenidosymaterialesespecíficosencadaunadelas asignaturas.El proyecto se inició en febrero de 2012, mediante una presentación a los alumnos de la asignatura de Bioquímica de primer curso, de los objetivos, la proyección de un documental, así como la distribución de un díptico informativo, y un posterior seminario. Los profesores consideramos muy satisfactoria y productiva esta experiencia. Creemos, que esta forma de trabajo en grupo colaborativo es una excelente herramienta para el aprendizaje de los alumnos y la formación del profesorado (AU)

A teaching innovation project based on the development of clinical cases across different subjects of Pharmacy Degree has been launched. The aim of this project is to promote integrative learning between the subjects, along the academic career, bydevelopingteachingmaterialssuitablefortransversaluse. Italso aims to develop a "style" of communication among teachers and a new model of teaching at the University by generating strategies for teachers' coordination and development of common teaching materials. The Toxicology Unit of the Department of Public Health has been one of the promoters of this project. Alcohol was chosen as first case by introducing a character, Sam, a patient of 20 years, who started very young in alcohol consumption and his clinical course will be seen along the different years. On the basic script of the case, a number of specific contents have been proposed to be covered in each subject. The project started in February 2012 with a presentation to the students of the first year degree, in the subject of Biochemistry, the objectives, a documentary film, the distribution of an informative leaflet and subsequent seminar. Teachers considered the experience as very satisfying and productive and trusted that the way of working in a collaborative group is an excellent tool for student's learning and teacher's training (AU)

Resultados del estudio del genotipado RhD fetal en plasma materno / Results of the study of the fetal RHD genotyping in maternal plasma

Introducción. Se evalúa la eficacia en la determinacióndel RhD fetal a partir de sangre materna.Material y métodos. Estudio prospectivo y descriptivo.Se obtuvieron 90 muestras sanguíneas de gestantes RhD negativo con pareja RhD positiva que controlaron su gestación en nuestro centro entre septiembre de 2004 y enero de 2006, previa autorización y consentimiento expreso de las pacientes. Las muestras de sangre materna se enviaron al laboratorio de biología molecular para cuantificar los exones 7 y 10 del gen RHD. Posterior-mente se compararon los resultados obtenidos del genotipado RHD fetal con el fenotipo de RhDde los recién nacidos.Resultados. El genotipado informó de 69 fetos RhD positivo (76,6%) y 21 RhD negativo (23,3%). Se obtuvieron seis falsos positivos y tres falsos negativos. La sensibilidad de la prueba fue del 95,45% y la especificidad del 75%.Discusión. Se detecta una elevada tasa de falsos negativos, que podría explicarse por diferentes razones relacionadas con la obtención y la manipulación de la muestra (semana de gestación, técnica de extracción y técnica de amplificación).Conclusiones. La elevada tasa de falsos negativos en ladeterminación del RhD fetal a partir de sangre materna, que corresponde a casos susceptibles de aloinmunización materna y por tanto de desarrollar enfermedad hemolítica del feto recién nacido, obliga a una correcta reevaluación de la técnica empleada y de la interpre-tación de los resultados

Introduction. We evaluate the effectiveness in thedetermination of the foetal RhD from the mother’s blood.Material and methods. 90 Rh negative pregnant womenwith positive RhD couples allowed us, by signing aconsent form, to use their blood samples for this study. All these patients have been monitored in our centre from September 2004 to January 2006. The maternal blood samples were sent to the molecular biology laboratory for the quantification of exones 7 and 10 of the RhD’s gene. After that, the results obtained from the foetal RhD genotypes were compared with the phenotypes of the newborn’s RhD.Results. The results of the genotyping showed that69 (76,6%) of the foetuses were RhD positive, whereas 21(23,3 %) were RhD negative. The sensitivity of the testwas 95.45% and the specificity 75%. Six tests came outfalse positives and three false negatives.Discussion. Several factors related to the obtainingof the sample and the way it is manipulated (pregnancyweek, the extraction or amplification technique) couldexplain the high rate of false negatives.Conclusion. The high prevalence of false negativesdetected after a foetal RhD test on maternal blood forcesus to reconsider the used technique and to improve theway we interpret the results, taking into account thatthere is a risk of maternal isoimmunization and consequently an haemolytic disease on the newborn (AU)

Usefulness of urinary nuclear matrix protein 22 (NMP22) as a marker for transitional cell carcinoma of the bladder.

OBJECTIVES: The purpose of this study was to evaluate an immunoassay for urinary nuclear matrix protein, NMP22, as a novel marker for urothelial cancer. PATIENTS AND METHODS: NMP22 values were determined for 71 patients and 21 healthy volunteers. Each subject provided a single (3 voids) urine sample for analysis at the time of entry into the study. Each sample was assayed for levels of NMP22. RESULTS: When the cut-off value was set at 10 U/ml, the positive rate for urinary NMP22 in bladder cancer was 37.8% (17 out of 45), whereas that in post-treatment cases and benign diseases was 30.8% (8 out of 26) compared to 14.3% (3 out of 21) for healthy volunteers. This cut-off value provided a sensitivity of 37.8% and a specificity of 80.9%. In the bladder cancer group, NMP22 levels were related to tumor size, shape, grade and stage. CONCLUSIONS: Despite the many reports that suggest NMP22 as a promising urinary marker for monitoring transitional cell carcinoma, this study does not support its usefulness as a substitute tool for urinary cytology in the control of bladder tumors.

[Prostatic abscess: diagnosis and treatment]. / Abscesos prostáticos: diagnóstico y tratamiento.

Prostatic abscesses are an infrequent pathology, probably due to a better and early management of prostatic infections. Predisposing factors in this pathology are diabetes mellitus, urethral catheterism or manipulation, and immunodepressed states like AIDS. Nowadays, ultrasonography is an excellent diagnostic method of this pathology, and serves as a guidance of directed drainage. We present five cases in which the size of the abscess was determining in relation to the therapeutic attitude. Abscesses of less than 2 cm, measured by transrectal ultrasonography, can be evacuated by directed puncture, followed by antibiotic treatment. When the diameter of the abscess is greater than 2 cm, we realize a perineal drainage with a catheter placed with transrectal ultrasonography. Currently, TUR and other methods seems to be overcome.

Markers of hepatitis C infection among hemodialysis patients with acute and chronic infection: implications for infection control strategies in hemodialysis units.

To evaluate strategies for screening patients on hemodialysis (HD) for markers of acute and chronic hepatitis C virus (HCV) infection, we studied sixty-nine patients at a single center over a 36-month period. Serum samples were tested for alanine aminotransferase (ALT) levels, anti-HCV and HCV RNA at 3-4 month intervals. Anti-HCV was tested for by EIA1, EIA2, and RIBA2. HCV RNA was detected by polymerase chain reaction (PCR). In addition, IgM antibody to the c33 antigen of HCV was detected by an experimental EIA. Of the 43 HD patients at the start of the study, anti-HCV was detected by EIA1 in 13 (30%). All EIA1 positive patients and 14 (47%) of the 30 EIA1 negative patients tested positive by EIA2. Thus, at the start of the study 27 (63%) of 43 patients tested positive for anti-HCV by EIA2. The presence of anti-HCV among EIA2 positive patients was confirmed by RIBA2 in all patients. Based on the PCR results, the sensitivity, specificity, positive predictive value and negative predictive value for EIA1 were 48%, 100%, 53% and 100%, respectively, and for EIA2 were 100%, 100%, 100% and 100%, respectively. During follow-up, 26 EIA2 negative patients began HD in the unit. Of the 42 EIA2 negative patients, five (12%) seroconverted for anti-HCV during follow-up. All five patients with new HCV infection tested positive for HCV RNA three months prior to the detection of anti-HCV by EIA2.(ABSTRACT TRUNCATED AT 250 WORDS)

[Bladder lavage cytology in the diagnosis and follow-up of superficial bladder cancer]. / La citología del lavado vesical en el diagnóstico y seguimiento del cáncer vesical superficial.

Classical mictional cytology (MC) has a series of widely recognized limitations for the diagnosis and follow-up of surface vesical carcinoma (SVC). A prospective study was conducted in 171 patients with suspected signs and symptoms or a background of SVC using cystoscopy, MC and vesical lavage cytology (LC). Overall sensitivity was 98.8%, 45.4% and 66.6% respectively. LC showed a significant difference (p < 0.05) when compared to MC in suspected disease with no SVC background, and follow-up with endovesical prophylaxis.

[Intermittent hydronephrosis]. / Hydronéphrose intermittente.

Intermittent hydronephrosis is a frequent cause of obstruction in the ureteropelvic junction in the adult. Diagnosis is based on intravenous pyelography, echography and renal scintigraphy with or without hyperdiuresis. We report a case of intermittent hydronephrosis successively affecting both kidneys.

Late seroconversion of C virus markers in hemodialysis patients.

We examined the prevalence of the IgG C virus C 100-3 antibody (anti-HCV) in a group of 43 patients on hemodialysis in our center during three periods: A: 1988; B: 1989; C: 1990. During period A, the anti-HCV prevalence was 30% (13 of 43 patients), these patients being regarded as chronic carriers of these antibodies. In period B, two patients displayed seroconversion, and another seven during period C, all of whom had tested negative during period A. These patients were considered acute. During the three years under study, all of the patients shared the same hemodialysis monitors. High ALT values were found in four of nine acute patients (44.4%) and nine of thirteen (69.23%) of the chronic patients. In 10 anti-HCV patients, hypertransaminemia continued long-term (> 6 months). Two patients had been given contaminated blood, four were multi-transfused (> 14 transfusions), two less than 4 units, and one had never received a transfusion. The period between the initial high and/or maximum ALT and the determination of HCV Ac was up to 10 to 11 months in three patients. These findings indicate the lack of sensitivity of ALTs as a diagnostic tool for HCV, the possible late C 100-3 seroconversion, which makes it necessary to carry out periodic serological checks in hemodialysis patients and the decisive role transfusions in HCV transmission, without excluding other possible intra-dialysis contagion sources.

Urinary schistosomiasis with cutaneous lesions.

We report a case of urinary schistosomiasis with simultaneous presence of cutaneous lesions in a white male. The literature is reviewed, and the frequency, characteristics and physiopathology are discussed.

[Testicular and epididymal malacoplakia. Presentation of a case and review of the literature]. / Malacoplaquia testicular y epididimaria. Aportación de un caso y revisión de la literatura.

A case of testicular malacoplakia and epididymis in a 62 year old man is presented. A literature review is made (only 6 cases describing epididymal malacoplakia have been reported), commenting on the clinical, diagnostic, anatomopathological, pathogenic and therapeutic aspects of malacoplakia.

[Mycobacterium fortuitum in patients with chronic renal insufficiency: apropos of 2 cases]. / Mycobacterium fortuitum en pacientes con insuficiencia renal crónica: a propósito de 2 casos.

Mycobacterium fortuitum is a rapidly growing mycobacteria recovered from human infections such as skin, soft tissue, skeletal and pulmonary infectious diseases. We report 2 cases of M. fortuitum isolation from clinical samples from two patients placed on dialysis program. Our clinical findings were: The first, the presence of an abscess in the area of insertion of a CAPD catheter and the second, the detection of a lobar pneumonia in a patient placed on long-term hemodialysis program. We consider this report to be important because of the few reported cases of non tuberculous mycobacterial infections in patients with chronic renal failure.

[Pyonephrosis as a cause of acute peritonitis. Review of the literature and report of a case]. / Pionefrosis como causa de peritonitis aguda. Revisión de la literatura y aportación de un caso.

We report on a 52-year-old patient with spontaneous intraperitoneal rupture of pyonephrosis. The diagnostic features, preoperative findings and treatment are discussed and the literature reviewed.

[Calcified kidney masses. Study of 23 cases]. / Masas renales calcificadas. Estudio de 23 casos.

We consider the presence of calcifications in a series of 107 renal masses by means of simple X-ray, echography and CAT, in which 23 cases (21.4%) were found. The most effective exploration for revealing them was CAT (in 13% of the cases, the only one). We found a relative higher frequency of calcification in the benign masses (31%) than in the neoplastic ones (17%). In the latter we found no differences in survival as compared with the non-calcified ones. No pattern of calcification proved characteristic of benignity or of neoplasia. The variety of malignant renal mass most often calcified was the papillary hypernephroma (57.1%).

[Physical exercise and serum potassium in renal insufficiency]. / Ejercicio físico y potasio sérico en la insuficiencia renal.

In order to study the effect of physical exercise on serum potassium in renal failure, twelve patients currently on chronic dialysis were subjected to physical exercise by means of an ergometric bicycle. The initial serum potassium was 5.2 +/- 0.6 mmol/l and after the performance of 3.304 +/- 1.583 kilopondimeters of total work, serum potassium was not modified: 5.5 +/- 0.6 mmol/l (p = NS). With regard to the parameters that regulate the intra-cellular distribution of serum potassium, physical exercise aggravated metabolic acidosis, decreasing the blood pH: from 7.33 +/- 0.05 to 7.23 +/- 0.08 (p less than 0.01) and plasma bicarbonate: from 19 +/- 3 mmol/l to 14 +/- 4 mmol/l (p less than 0.01); this was accompanied by a significant and percentage-wise similar increase in plasma epinephrine and norepinephrine. Patients with end-stage renal failure can perform moderate physical exercise, since this does not produce significant changes in serum potassium.