Fiabilidad de un examen clínico objetivo estructurado para predecir la futura competencia profesional de estudiantes de medicina / Reliability of an objective structured clinical examination to assess the future professional competence of medical students

Introducción: Cuando con los resultados de un examen clínico objetivo estructurado (ECOE) se decide sobre la futura competencia profesional de estudiantes de medicina, la fiabilidad de dicha prueba debe adecuarse a esta finalidad. Objetivo: Calcular la fiabilidad (alfa de Cronbach) de una serie de ECOE y su relación con la duración, número de participantes, estaciones, ítems y evaluadores. Sujetos y métodos: Se analizan 14 ECOE realizados a 2.995 estudiantes de cuarto y quinto curso de la Facultad de Medicina de Granada desde 2004 a 2013. Resultados: La fiabilidad fue ≥ 0,70 en el 92,84% de los ECOE. También fue significativamente ≥ 0,70 cuando la duración total fue ≥ 60 minutos (p = 0,042), el número de estaciones ≥ 10 (p = 0019), el número de ítems ≥ 50 (p = 0,018) y el número de evaluadores ≥ 6 (p = 0,018). No se observaron diferencias con el número de estudiantes ni con las opciones al ítem utilizadas. Conclusiones: Los ECOE cuyos resultados se utilicen para aprobar asignaturas de la carrera de medicina deben tener una fiabilidad ≥ 0,70. Para alcanzar dicha fiabilidad o mayor, el formato debe constar de al menos 10 estaciones, durar ≥ 60 minutos, tener ≥ 50 ítems y ≥ 6 evaluadores

Introduction: When the future professional competence of medical students is decided based on results of an objective structured clinical examination (OSCE), the reliability of this test should be adequate to this purpose. Aim: To calculate the reliability (Cronbach's alpha) of each one of OSCEs we performed and its relationship with the duration, number of participants, stations, items and evaluators. Subjects and methods: Fourteen OSCE tests performed to 2995 medical students of 4th and 5th year of the Faculty of Medicine of Granada between 2004 to 2013 were analyzed. Results: The reliability was ≥ 0.70 in 92.84% of the OSCEs. It was also significant ≥ 0.70 with a total duration ≥ 60 minutes (p = 0.042), and a number of stations ≥ 10 (p = 0.019), a number of items ≥ 50 (p = 0.018) and a number of evaluators ≥ 6 (p = 0.018). No differences with the number of students, neither with the options to the item were observed. Conclusions: The OSCEs carried out in centers which results are used to approve subjects of the medical career, must have a reliability ≥ 0.70. To achieve this reliability or greater, the format should consist of at least: 10 stations, a duration ≥ 60 minutes, and having ≥ 50 items and ≥ 6 evaluators

Spanish consensus on vulvar disorders in postmenopausal women.

INTRODUCTION: The consequences of vulvar disorders in terms of health, sexuality, and quality of life are usually undervalued, with disparities in the conceptual, diagnosis and treatment criteria. AIM: The objective of this guide will be to analyse the factors associated with the diagnosis and treatment of vulvar disorders and to provide recommendations for the most appropriate diagnostic and therapeutic measures. METHODOLOGY: A panel of experts from various Spanish scientific societies related to sexual health (Spanish Menopause Society [SMS] and the Asociación Española de Patología Cervical y Colposcopia [AEPCC]) met to reach a consensus on these issues and to decide the optimal timing and methods based on the best evidence available. RESULTS: We recommend a biopsy of all vulvar lesions with an uncertain diagnosis, especially with asymmetry, irregular borders, variegated and irregular colour and diameter >6mm. For vulvodynia, we recommend the use of lubricants or topical treatments with lidocaine or bupivacaine, amitriptyline, baclofen or triamcinolone. For vulvar epithelial disorders, we recommend beginning with topical corticosteroids of moderate to high potency. For sexual dysfunction, a multidisciplinary approach is the best management strategy in these patients.

Extended regimens of combined hormonal contraception to reduce symptoms related to withdrawal bleeding and the hormone-free interval: a systematic review of randomised and observational studies.

OBJECTIVE: To assess whether continuous and extended regimens (CRs/ERs) of combined hormonal contraceptives (CHCs) improve symptoms related to withdrawal bleeding or the hormone-free interval and to compare the efficacy, safety, and cost of CRs/ERs to those of conventional 28-day regimens. STUDY DESIGN: A literature search of the PubMed database was conducted for randomised clinical trials (RCTs) and observational studies published in any language between 2006 and 2013. RESULTS: Sixteen RCTs and 14 observational studies evaluated issues related to our objectives. CRs/ERs, whose efficacy and safety were comparable to those described for conventional regimens, were preferred due to their improvement of symptoms related to withdrawal bleeding or the hormone-free interval and the lower costs resulting from the reduced incidence of these symptoms. CONCLUSION: The contraceptive efficacy and safety of CR/ER use of CHCs is at least equal to that of 28-days conventional regimens, and this use may have some cost savings. CRs/ERs are recommended for women willing to take a CHC for treatment of symptoms related to withdrawal bleeding or the hormone-free interval.

Early embryonic morphology sonographically assessed and its correlation with yolk sac in missed abortion.

PURPOSE: To provide additional information about embryo morphology sonographic assessment and its correlation with yolk sac. METHODS: A systematic study in 200 consecutive cases of missed abortion <10 weeks diagnosed by transvaginal ultrasound. RESULTS: In 104 gestations of embryos with morphological abnormalities, 88 (84.6 %) were at least 1 week smaller than expected for gestational age and 16 (15.4 %) were the expected size. From 32 normal morphologic embryos, 7 (21.9 %) were at least 1 week smaller than expected for gestational age, and 25 (78.1 %) were the expected size (p < 0.005). Normal morphologic embryos are linked more frequently with normal yolk sac (62.5 %). Findings in anembryonic gestations (GD1) included an absent yolk sac (46.9 %) and a cystic yolk sac (25 %). Likewise, findings in GD2-3 embryos included more frequently a cystic yolk sac (42.9 %) and an absent yolk sac (32.5 %). GD4 embryos are associated with an echogenic yolk sac (40 %), a relatively small-hypoplastic- (40 %) and a relatively large-cystic- (20 %). In DI embryos, yolk sac appears cystic (62.5 %) or echogenic (37.5 %). CONCLUSIONS: Our study proves the correlation between morphology of conceptuses and yolk sac appearance in cases of missed abortion.

Lowering the age at menarche and risk of early menarche in a population of Spanish postmenopausal women during the past two decades.

AIM: The purpose of this study is to confirm in our population the decreasing secular trend in the age of menarche (AAM) observed in other European countries. Another aim is to investigate the association between early menarche and breast cancer, metabolic disorders risk or early menopause. MATERIALS AND METHODS: We conducted a nationwide population-based study of 1980 Caucasoid Spanish postmenopausal women from 2003 to 2006 to investigate the AAM, the duration of the fertile period and the relation of early menarche with breast cancer and some metabolic disorders. RESULTS: Regression analysis of AAM demonstrates a trend towards the younger AAM in our population during the past decades (P > 0.001). Parallel to this decrease we observe a significant increase in the fertility period and the height of our population (P < 0.001). In the women with AAM less than 11 years, there is an increased risk of hypercholesterolaemia, being overweight and obesity. However, early menarche does not raise the risk of adult onset diabetes, hypertension or breast cancer. CONCLUSIONS: These data indicate a decreasing secular trend of AAM in a Spanish population in the last decades. Furthermore, hypercholesterolaemia and obesity, but not breast cancer, appears to be influenced by younger AAM. Only women who have their menarche at the age of nine years or less are more likely to have an earlier menopause.

Multigenic combination of estrogen-related genes is associated with age at natural menopause in a Spanish population.

OBJECTIVE: Age at natural menopause (ANM) can be considered a complex parameter that depends on the interaction of multiple factors. In the present study, the role of interaction between genetic variants within estrogen synthesis and signalling pathways in the ANM in Spanish women is studied. MATERIAL AND METHODS: Nine single nucleotide polymorphisms (SNPs) located at different candidate genes related to the estrogen signalling pathway were analysed in 1980 Spanish postmenopausal women. RESULTS: Independently, none of the nine markers were significantly associated with early ANM. Only heterozygosis at the NRIP rs2229741 locus could be associated with early menopause; however, this marker does not maintain statistical significance. In contrast, linear regression analysis suggests several epistatic interactions including these markers in relation to ANM, especially between ESR2, NRIP1 and BMP15. The genetic variant that appears most in these interactions is that of the BMP15 rs3897937. It was observed that AA-TC combined genotype for NRIP-BMP15 (rs3897937), respectively, appears to be associated with a lower ANM than other possible combinations of these SNP (46.1+/-5.9 versus 50.4+/-3.3; P = 0.002). In the multilocus analysis, the multigenic interaction formed by ESR2 (AA), BMP15 rs3897937 (TC) and NRIP1 (AA) has the lower ANM (45.37+/-6.8 versus 48.69+/-5; P = 0.038). CONCLUSIONS: The results suggest that epistatic interactions of estrogen-related alleles may contribute to variance in ANM in Spanish women. Moreover, BMP15 and NRIP1 also appear as attractive candidate genes for premature menopause but require further investigation to confirm them.

Effects of antagonists and inhibitors of ethylene biosynthesis on maize root elongation.

During the first days of development, maize roots showed considerable variation in the production of ethylene and the rate of elongation. As endogenous ethylene increases, root elongation decreases. When these roots are treated with the precursor of ethylene aminocyclopropane- 1-carboxylic acid (ACC), or inhibitors of ethylene biosynthesis 2-aminoethoxyvinyl glycine (AVG) or cobalt ions, the root elongation is also inhibited. Because of root growth diminishes at high or reduced endogenous ethylene concentrations, it appears that this phytohormone must be maintained in a range of concentrations to support normal root growth. In spite of its known role as inhibitor of ethylene action, silver thiosulphate (STS) does not change significantly the root elongation rate. This suggests that the action of ethylene on root elongation should occur, at least partially, by interaction with other growth regulators.

Transvaginal sonographic evaluation of subendometrial-myometrial contractility in women using a copper-releasing intrauterine device.

BACKGROUND: The aim of this study was to determine the effects of a copper-releasing intrauterine device (IUD) on myometrial contractility midway through the menstrual cycle. STUDY DESIGN: Uterine peristalsis was studied midway through the cycle with transvaginal sonography in two groups of women, a control group and women in whom a copper-releasing IUD had been inserted. RESULTS: The results showed that 12 months after insertion, no uterine motility could be detected with sonography in any of the women with an IUD, but motility did occur in all the controls. CONCLUSIONS: Subendometrial-myometrial contractility midway through the menstrual cycle had been abolished in patients with a copper-releasing IUD. The loss of motility may inhibit sperm transport from the cervix to the oviduct and account for at least part of the contraceptive effect of these devices.

Gore-Tex mesh pelvic occlusion and secondary colpopexy: A new surgical technique for posthysterectomy vaginal vault prolapse.

OBJECTIVE: This article presents and discusses a new surgical abdominal technique for the treatment of posthysterectomy vaginal vault prolapse. METHOD: It provides support of the peritoneal surface of the pelvic floor by means of a Gore-Tex mesh, which closes this space. The vaginal vault is fixed to the centre of the mesh. STUDY DESIGN: Descriptive study. RESULTS: Sixteen patients with vaginal vault prolapse were operated on and postoperative follow-up time ranged from 16 to 46 months. There was only one case in which the mesh had to be removed due to infection and posterior erosion of the vaginal wall, and no cases of recurrent vaginal vault prolapse. CONCLUSION: A Gore-Tex mesh, placed at the top of the vaginal vault and extending across the pelvic floor, can effectively treat posthysterectomy vault prolapse.

Propuesta para el monitoreo delos compromisos internacionales en materia de salud asumidos por Bolivia

El propósito es proponer el establecimiento de un sistema que le permita al gobierno de Bolivia efectuar el monitoreo, análisis e información permanente sobre el tema salud para poder definir estrategias y políticas que permitan un mejor aprovechamiento de los conocimientos y y recursos a su disposición

Anormalidades fetais diagnosticadas ecograficamente e que têm resoluçåo espontânea intra-útero ou no período neonatal / Ultrasound diagnostic of fetal anomalies with intra-utero or neonatal spontaneous resolution

Apresenta-se a evoluçåo de 12 casos de anomalias fetais que apresentaram resoluçåo espontânea intra-útero ou no período neonatal. As lesöes fetais foram cisto de plexo coróideo (4 casos), higroma cístico (1 caso), ascite (1 caso), arritmias cardíacas (6 casos). Discute-se a natureza e evoluçåo das lesöes fetais reversíveis

Cinetica de la tostacion del sulfuro de zinc

Contenido: Cap.1 Introduccion.Generalidades.Proposito del estudio.Formas mineralogicos del sulfuro de zinc.Concentrados de zinc Cap.2 Analisis comparativo del horno de lecho fluidizado con otros tipos de hornos en el proceso de tostacion del sulfuro de zinc.Objetivo.Definicion de los tipos de hornos cap.3 Mecanismo y cinetica de la tostacion de concentrados de zinc en lechos fluidizados.Primera parte.Consideraciones previas al estudio de la cinetica.Segunda parte.Estudio de la cinetica de la tostacion.Tipos de minerales a utilizarse en la investigacion.Equipo a utilizarse en la investigacion.Metodologia para el estudio de la cinetica de oxidacion del sulfuro de zinc.Modelos para el proceso de oxidacion del sulfuro de zinc.Primer modelo.Segundo modelo.Tercer modelo.