Ibero-American consensus on learning outcomes for the acquisition of competencies by medical students through clinical simulation.

OBJECTIVE: Our aim was to reach expert consensus on specific learning outcomes (LOs) that can be achieved through clinical simulation aimed at developing the competencies that medical students need to be able to successfully manage patients and assume general clinical responsibilities. MATERIALS AND METHODS: The six-member scientific committee peer-reviewed Spanish reference documentation (in line with the Bologna Process) on required competencies in medical undergraduate students to select an initial set of 16 competencies that could feasibly be developed through simulation and a corresponding set of 75 LOs. Snowball sampling was used to identify candidates for an international panel of simulation experts. Applying a set of pre-defined criteria, 19 panelists from seven Spanish-speaking regions were recruited to participate in a modified two-round Delphi procedure based on electronic questionnaires and aimed at reaching formal consensus on appropriate LOs for simulated medical training. RESULTS: Final agreement between the panelists was high: no mean score fell below 7.26 of a maximum of 9, and all 75 LOs were agreed on, 74 in the first round and only one requiring the second round. The 16 LOs with mean scores in the top 25th percentile were selected as a set of core LOs to attain via simulation. CONCLUSIONS: This Ibero-American consensus on observable and measurable LOs, reflecting competencies that can feasibly be developed via clinical simulation, is a framework that aims at helping medical schools' plans and delivering specific kinds of undergraduate medical training through simulation. It is also proposed in a set of core LOs as a starting point for less experienced schools to design a simulated training program.

Dietary Polyphenols in the Prevention of Stroke.

Polyphenols have an important protective role against a number of diseases, such as atherosclerosis, brain dysfunction, stroke, cardiovascular diseases, and cancer. Cardiovascular diseases are the number one cause of death worldwide: more people die annually from cardiovascular diseases than from any other cause. The most important behavioural risk factors of heart disease and stroke are unhealthy diet, physical inactivity, tobacco use, and excess alcohol intake. The dietary consumption of polyphenols has shown to be inversely associated with morbidity and mortality by cardio- and cerebrovascular diseases. It is well-known that the protective effects of polyphenols in vivo depend on the grade how they are extracted from food and on their intestinal absorption, metabolism, and biological action with target tissues. The aim of this review was to summarise the relation between polyphenols of different plant sources and stroke in human intervention studies, animal models, and in vitro studies.

Growth hormone receptors in the atherinid Odontesthes bonariensis: characterization and expression profile after fasting-refeeding and growth hormone administration.

In order to improve the understanding of pejerrey Odontesthes bonariensis, growth hormone (Gh)-insulin-like growth factor-1(Igf1) axis, O. bonariensis growth hormone receptor type 1 (ghr1) and type 2 (ghr2) mRNA sequences were obtained. Both transcripts were ubiquitously expressed except in kidney, encephalon and anterior intestine. Alternative transcripts of both receptors were found in muscle. Interestingly, two different ghr2 transcripts with alternative polyadenylation (APA) sites located in the long 3' untranslated region (UTR-APA) were also found in liver. Hepatic ghr1, ghr2 and insulin-like growth factor type 1 (igf1) transcript levels were examined under two different metabolic conditions. In the first experimental condition, fish were fasted for 2 weeks and then re-fed for another 2 weeks. Despite igf1 mRNA relative expression did not show significant differences under the experimental period of time examined, both ghr transcripts decreased their expression levels after the fasting period and returned to their control levels after re-feeding. In the second treatment, recombinant O. bonariensis growth hormone (r-pjGh) was orally administered once a week. After 4 weeks of treatment, liver igf1, ghr1 and ghr2 mRNA relative expression increased (13, 4·5 and 2·1 fold, P < 0·05) compared to control values. These results add novel information to the growth hormone-insulin-like growth factor system in teleosts.

Evaluation of the genetic diversity of microsatellite markers among four strains of Oreochromis niloticus.

Different strains of Nile tilapia can be found worldwide. To successfully use them in breeding programs, they must be genetically characterized. In this study, four strains of Nile tilapia - UFLA, GIFT, Chitralada and Red-Stirling - were genetically characterized using 10 noncoding microsatellite loci and two microsatellites located in the promoter and first intron of the growth hormone gene (GH). The two microsatellites in the GH gene were identified at positions -693 to -679 in the promoter [motif (ATTCT)8 ] and in intron 1 at positions +140 to +168 [motif (CTGT)7 ]. Genetic diversity was measured as mean numbers of alleles and expected heterozygosity, which were 4 and 0.60 (GIFT), 3.5 and 0.71 (UFLA), 4.5 and 0.57 (Chitralada) and 2.5 and 0.42 (Red-Stirling) respectively. Genetic differentiation was estimated both separately and in combination for noncoding and GH microsatellites markers using Jost's DEST index. The UFLA and GIFT strains were the least genetically divergent (DEST  = 0.10), and Chitralada and Red-Stirling were the most (DEST  = 0.58). The UFLA strain was genetically characterized for the first time and, because of its unique origin and genetic distinctness, may prove to be an important resource for genetic improvement of Nile tilapia. This study shows that polymorphisms found in coding gene regions might be useful for assessing genetic differentiation among strains.

Isolation and characterization of 20 polymorphic microsatellite loci in the migratory freshwater fish Leporinus obtusidens (Characiformes: Anostomidae) using 454 shotgun pyrosequencing.

Twenty polymorphic microsatellite markers were developed for the Neotropical fish Leporinus obtusidens using a next generation sequencing approach and tested in two other characifomes species, Schizodon platae and Prochilodus lineatus. Microsatellite loci alleles in L. obtusidens ranged between 2 and 20 alleles per locus (mean = 5·7), with expected heterozygosity values ranging from 0·097 to 0·956 (mean = 0·578) and observed heterozygosity values ranging from 0·000 to 0·800 (mean = 0·400) in a sample of 20 specimens from the lower Paraná River (Argentina). Most of these markers will be a valuable tool for captive breeding and stocking programmes, as well as for analyses of population connectivity and genetic structure in this broadly distributed Neotropical migratory fish.

Effects of alcohol and polyphenols from beer on atherosclerotic biomarkers in high cardiovascular risk men: a randomized feeding trial.

BACKGROUND AND AIMS: Moderate alcohol consumption exerts a cardioprotective effect, but no studies have evaluated the alcohol-independent cardiovascular effects of the non-alcoholic components of beer. We aimed to evaluate the effects of ethanol and the phenolic compounds of beer on classical and novel cardiovascular risk factors. METHODS AND RESULTS: Thirty-three high risk male volunteers were included in a randomized, crossover feeding trial. After a washout period, all subjects received beer (30 g alcohol/d, 660 mL), the equivalent amount of polyphenols as non-alcoholic beer (990 mL), and gin (30 g alcohol/d, 100 mL) for 4 weeks. All outcomes were evaluated before and after each intervention period. Moderate alcohol consumption increased serum HDL-cholesterol (∼5%), ApoA-I (∼6%), ApoA-II (∼7%) and adiponectin (∼7%), and decreased serum fibrinogen (∼8%), and interleukin (IL)-5 (∼14%) concentrations, whereas the non-alcoholic fraction of beer (mainly polyphenols) increased the receptor antagonist of IL-1 (∼24%), and decreased lymphocyte expression of lymphocyte function-associated antigen-1 (∼11%), lymphocyte and monocyte expression of Sialil-Lewis X (∼16%) and monocyte expression of CCR2 (∼31%), and tumor necrosis factor (TNF)-ß (∼14%) and IL-15 (∼22%) plasma concentrations. No changes were observed in glucose metabolism parameters or in body weight and adiposity parameters. CONCLUSION: The phenolic content of beer reduces leukocyte adhesion molecules and inflammatory biomarkers, whereas alcohol mainly improves the lipid profile and reduces some plasma inflammatory biomarkers related to atherosclerosis.

Gazpacho consumption is associated with lower blood pressure and reduced hypertension in a high cardiovascular risk cohort. Cross-sectional study of the PREDIMED trial.

BACKGROUND AND AIM: Hypertension is a major public health problem and a leading cause of death and disability in both developed and developing countries, affecting one-quarter of the world's adult population. Our aim was to evaluate whether the consumption of gazpacho, a Mediterranean vegetable-based cold soup rich in phytochemicals, is associated with lower blood pressure (BP) and/or reduced prevalence of hypertension in individuals at high cardiovascular risk. METHODS AND RESULTS: We selected 3995 individuals (58% women, mean age 67 y) at high cardiovascular risk (81% hypertensive) recruited into the PREDIMED study. BP, weight, and dietary and physical activity data were collected. In multivariate linear regression analyses, after adjustment, moderate and high gazpacho consumption categories were associated with reduced mean systolic BP of -1.9 mm Hg [95% confidence interval (CI): -3.4; -0.6] and -2.6 mm Hg (CI: -4.2; -1.0), respectively, and reduced diastolic BP of -1.5 mm Hg (CI: -2.3; -0.6) and -1.9 mm Hg (CI: -2.8; -1.1). By multiple-adjusted logistic regression analysis, gazpacho consumption was associated with a lower prevalence of hypertension, with OR = 0.85 (CI: 0.73; 0.99) for each 250 g/week increase and OR = 0.73 (CI: 0.55; 0.98) for high gazpacho consumption groups compared to the no-consumption group. CONCLUSIONS: Gazpacho consumption was inversely associated with systolic and diastolic BP and prevalence of hypertension in a cross-sectional Mediterranean population at high cardiovascular risk. The association between gazpacho intake and reduction of BP is probably due to synergy among several bioactive compounds present in the vegetable ingredients used to make the recipe.

Abordaje en el cribado de cáncer mamario en grupos poblacionales de riesgo elevado / Breast cancer screening in high risk populations

El objetivo de este trabajo es definir qué pacientes integran los grupos de riesgo alto e intermedio de padecer cáncer mamario, hacer una revisión de los estudios de cribado con resonancia magnética añadida a mamografía en pacientes de alto riesgo (y describir las características de imagen de los cánceres en este grupo), revisar los estudios con resonancia magnética realizados en subgrupos de riesgo intermedio, y realizar una actualización en recomendaciones en el cribado en pacientes con riesgo alto e intermedio (basada en las recomendaciones recientes de las principales sociedades/guías americanas y europeas)(AU)

We aim to define which patients make up the populations with high and intermediate risk of developing breast cancer, to review the studies of screening with magnetic resonance imaging in addition to mammography in high risk patients (describing the imaging characteristics of the cancers in this group), to review the studies of screening with magnetic resonance imaging in patients with intermediate risk, and to update the guidelines for screening in patients with high or intermediate risk (based on the recent recommendations of the main scientific societies/American and European guidelines)(AU)

[Breast cancer screening in high risk populations]. / Abordaje en el cribado de cáncer mamario en grupos poblacionales de riesgo elevado.

We aim to define which patients make up the populations with high and intermediate risk of developing breast cancer, to review the studies of screening with magnetic resonance imaging in addition to mammography in high risk patients (describing the imaging characteristics of the cancers in this group), to review the studies of screening with magnetic resonance imaging in patients with intermediate risk, and to update the guidelines for screening in patients with high or intermediate risk (based on the recent recommendations of the main scientific societies/American and European guidelines).

Sonographic findings of additional malignant lesions in breast carcinoma seen by second look ultrasound.

OBJECTIVE: The aim is to show ultrasound (US) findings of additional malignant lesions of breast carcinoma visualized on targeted second-look US that were not identified by mammography or US prior to the time of diagnosis. MATERIALS AND METHODS: A double-blind retrospective review of the US results from January 2008 through August 2010 of 228 patients with known breast cancer was conducted by two expert radiologists. The focus of the review was on the second-look US characteristics (following BI-RADS criteria) of 26 documented additional malignant lesions of the 76 with successful sonographic correlation from the 123 lesions detected by magnetic resonance imaging (MRI). All of them, before the MRI, had an initial mammography and a US with a histopathological biopsy of the primary lesion. RESULTS: Approximately 60 to 70% of the findings were classified as BI-RADS 2 and BI-RADS 3, while assessing the final US category. The review of the second-look US showed the size of the second malignant additional lesion ranged from 3 to 22 mm, of which 90% were smaller than 10 mm and 66% were smaller than 7 mm. CONCLUSIONS: Most additional malignant lesions, nonpalpable carcinomas, which were previously not detected by mammography and US at first-look diagnosis, were detected by a targeted second-look US examination. These lesions were of category BI-RADS 2 and BI-RADS 3 and smaller than 7 mm.

Aprendiendo de los errores: fenómeno EDTA / Learning from errors: EDTA phenomenon

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[Serous oligocystic adenoma of the pancreas]. / Adenoma seroso oligoquístico del páncreas.

Serous oligocystic or macrocystic adenoma of the pancreas is a very uncommon morphological variant of what was classically termed microcystic adenoma of the pancreas. This is a benign neoplasm; however, its radiological appearance mimicks that of potentially malignant mucinous neoplasms of the pancreas. Therefore, radiologists need to be familiar with this entity to ensure the most appropriate therapeutic management and help to avoid unnecessary surgery.

Adenoma seroso oligoquístico del páncreas / Serous oligocystic adenoma of the pancreas

El adenoma seroso oligoquístico o macroquístico de páncreas es una variante morfológica muy poco frecuente del llamado clásicamente adenoma microquístico de páncreas. Es una neoplasia benigna cuya apariencia radiológica, sin embargo, recuerda a las neoplasias mucinosas de páncreas, con potencial maligno. El radiólogo debe, por lo tanto, estar familiarizado con esta entidad, con el fin de plantear el manejo terapéutico más apropiado y evitar en lo posible cirugías innecesarias (AU)

Serous oligocystic or macrocystic adenoma of the pancreas is a very uncommon morphological variant of what was classically termed microcystic adenoma of the pancreas. This is a benign neoplasm; however, its radiological appearance mimicks that of potentially malignant mucinous neoplasms of the pancreas. Therefore, radiologists need to be familiar with this entity to ensure the most appropriate therapeutic management and help to avoid unnecessary surgery (AU)

Molecular cloning, expression and immunological characterization of pejerrey (Odontesthes bonariensis) growth hormone.

Growth hormone is an essential polypeptide required for normal growth and development of vertebrates. The pejerrey fish, Odontesthes bonariensis, is a South American atherinid freshwater fish considered as a promising species for aquaculture. Although growth hormone has been characterized in a number of fish, there are no published data on the structure of this hormone in atherinids, except that of a related species Odontesthes argentinensis. In this paper, the molecular cloning, expression and immunological characterization of pejerrey growth hormone (pjGH) is described. The predicted amino acid sequence of pjGH cDNA consisted of 204 amino acid residues with an estimated molecular mass of 23 kDa. Amino acid sequence was highly conserved among the two Atheriniformes where the growth hormone sequences are known (99% aa identity), highly to moderately conserve (75-92% aa identity) when compared to the other members of Acantopterigii superorder and clearly less conserved (49-66% identity) when compared to Salmoniformes (Protacanthopterygii), Cypriniformes and Siluriformes (Ostariophysi). A phylogenetic tree depicting the relationship of various teleost GH nucleotide sequences was inferred. Pejerrey GH was produced using recombinant DNA technology in a bacterial system, representing the first time an atherinid growth hormone protein was expressed as a recombinant protein in Escherichia coli. A specific antiserum of this hormone was raised in rabbits and its specificity tested by using Western blot and immunocytochemistry. The distribution of pjGH mRNA was also studied by RT-PCR and Southern blot analysis. The transcript was detected not only in the pituitary gland but also in the testis.

Paciente en programa de mantenimiento con metadona / Patient in maintenance programme with methadone

Objetivo: Se presenta el caso clínico de un paciente varón de 43 años, heroinómano en tratamiento de mantenimiento con metadona, diagnosticado de infección por el virus de la inmunodeficiencia humana (VIH) desde 1991. Material y métodos: Se revisa la historia toxicológica del paciente, así como su patología orgánica y psiquiátrica y la problemática social que su dependencia le ha producido. Resultados: Después de describir detalladamente la historia toxicológica del paciente, se realiza el diagnóstico principal y el de otros trastornos psiquiátricos concomitantes según criterios DSM-IV. Se mencionan las posibilidades de tratamiento para el trastorno por dependencia de opiáceos, y se analiza con detalle el tratamiento sustitutivo con agonistas (metadona). Conclusiones: En el paciente heroinómano, un objetivo prioritario es la adherencia al tratamiento ya que con ello se consigue una reducción o supresión del consumo, un control sanitario de sus patologías concomitantes y una mejora de la conflictiva social, lo que redundará en una mejora en su calidad de vida. Los tratamientos sustitutivos con agonistas (metadona, buprenorfina, etc.) han demostrado ser muy útiles en este sentido ya que al aliviar los síntomas de abstinencia y bloquear el deseo de consumir opiáceos tienen muy buena aceptación en estos pacientes

Objective: The case of a patient addicted to heroine, receiving maintenance treatment with methadone and diagnosed as HIV positive since 1991, is presented. Material and methods: The toxicological history of a 43 year old male is revised, as is his organic and psychiatric pathology and the social problem that his dependency has produced. Results: After describing the patient's toxicological history in detail, the principal diagnosis is carried out along with that of other concomitant psychiatric disorders following the DSM-IV criteria. The possibilities for treatment of the opiate dependency disorder are mentioned, and the substitution treatment with agonists (methadone) is analysed in detail. Conclusions: For the patient addicted to heroine, the priority is to maintain adherence to the treatment, as this will achieve a reduction or suppression of the consumption, health control of accompanying pathologies and an improvement in the social conflict situation, all of which will result in an improvement in the quality of life. The substitution treatment with agonists (methadone, buprenorphine, etc.) has shown itself to be useful in this sense since, on alleviating the symptoms of abstinence and blocking the desire to consume opiates, it has been well accepted among these patients

[Treatment with nebulized lidocaine in steroid-dependent asthma]. / Tratamiento con lidocaína nebulizada del asma corticodependiente.

BACKGROUND: The management of glucocorticoid dependent and resistant asthma encompasses a group of problems, affecting as much control of clinical symptoms as the onset of adverse effects to prolonged use of steroids. MATERIALS AND METHODS: Woman 52 years old, steroid dependent asthma fifteen years ago. She has important adverse effects in consequence of the use of systemic glucocorticoids. The employment of methotrexate attained decrease in the dosage of steroids temporarily. The worsening of the clinical situation and deterioration of secondary effects by use of steroids necessitated treatment with nebulized lidocaine. A 2% solution to initial dosage was administered three times daily. The maximal dosage needed was 80 mg three times daily. RESULTS: After three months of lidocaine treatment, the patient was able to reduce oral steroids eventually discontinuing these drugs, and the effects secondary to exogenous hypercortisolism disappeared. Moreover, an improvement in clinical symptoms and quality of life was observed with stability in the pulmonary function. CONCLUSIONS: The use of nebulized lidocaine could be useful and provide alternatives in patients with severe asthma.

Tratamiento con lidocaína nebulizada del asma corticodependiente / Treatment with nebulized lidocaine to steroid-dependent asthma

Antecedentes: El cuidado de los pacientes con asma bronquial corticodependiente y corticorresistente supone un conjunto de problemas, que afectan tanto a la situación clínica como al desarrollo de efectos adversos secundarios a una prolongada terapia esteroidea. Material y métodos: Mujer de 52 años con asma corticodependiente de 15 años de evolución con manifestaciones clínicas de hipercortisolismo. El uso de metotrexato oral consiguió un descenso transitorio en las dosis de esteroides. El agravamiento de la situación clínica obligó a un aumento de las dosis de esteroides con el consiguiente empeoramiento de los efectos secundarios. Por este motivo se instauro tratamiento con lidocaína nebulizada al 2 % a dosis iniciales de 40 mg cada 8 horas hasta una dosis máxima de 80 mg cada 8 horas. Resultados: Tras 3 meses de tratamiento con lidocaína nebulizada se reducen las dosis de corticoides orales hasta la suspensión total de estos con la desaparición o mejoría de los efectos secundarios al hipercortisolismo. Se produjo una mejoría en su situación clínica así como un aumento en la calidad de vida de la paciente con estabilidad en los parámetros de función pulmonar. Conclusiones: El uso de lidocaína nebulizada podría representar una alternativa eficaz y segura en el tratamiento del asma de difícil manejo

Background: The management of glucocorticoid dependent and resistant asthma compases a group of problems, So much control of clinical symptoms and onset of adversa effects to prolongad use of steroids. Materials and methods: Woman 52 years cid, steroid dependent asthma fifteen years ago. She was important adversa effects in consecuence the use sistemic glucocorticoids. The employment of metotrexate attained decrease in the dosage of steroids temporally. The wrong of clinical situation and deterioration secondary effects by use of steroids maked to start treatment with nebulized lidocaine of a 2 % solution to initial dosage was a three times daily. The maximal dosage needy was made of 80 mg three times daily. Results: After three months of beginning from lidocaine treatment, patient obtained to reduce orally steroid up to discontinuance or these drugs and the effects secondary to exogenous hypercortisolism disappeared. Moreover, A improvement in clinical symptoms and quality of lita was observad with stability in the pulmonary function. Conclusions: The use of nebulized lidocaine could be a useful and gafe alternativa in patients with severa asthma

Prosopagnosia y simultagnosia aisladas debidas a infarto isquémico en territorio occipito-temporal derecho / Isolated prosopagnosia and simultagnosia due to ischemic infarction in right occipitotemporal territory

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