Apoptotic regulator BCL-2 blockade as a potential therapy in classical Hodgkin Lymphoma.

The challenge in classical Hodgkin Lymphoma (cHL) management is the 30-40% of refractory/relapsed cases. AIMS: The aim of this work was to determine whether NIK and BCL-2 could be useful as prognosis biomarkers in cHL. In addition, we evaluated BCL-2 as a directed-therapy in cHL cell lines using venetoclax. MAIN METHODS: We evaluated NIK and BCL-2 expression in 112 untreated cHL patients' lymph-node biopsies by immunohistochemistry. cHL cell lines were treated with venetoclax alone or combined with vincristine or doxorubicin. Cell viability, metabolic activity and cell death were analyzed by trypan-blue exclusion method, MTS assay and FDA/IP staining respectively. KEY FINDINGS: No correlation between NIK or BCL-2 expression and the majority of the clinical parameters was found. Patients with ≥60% BCL-2+ HRS-cells had a shorter disease-free survival (DFS) and overall survival (OS) (p = 0.002, p = 0.02 respectively). A decision tree analysis, in a 30 patients subgroup, showed that patients with <60% NIK+ HRS-cells but with ≥60% BCL-2+ HRS-cells had a worse outcome in terms of DFS and OS. These parameters performed better as prognosis indicators as compared to the diagnosis bone marrow status. Human cHL cell lines U-H01, KM-H2, L1236, SUPHD1, L540 showed sensitivity to venetoclax. The co-treatment effect of venetoclax and vincristine or doxorubicin on cell viability was diverse depending on the cell line evaluated. SIGNIFICANCE: BCL-2 should be considered as a prognosis biomarker as well as a potential new therapeutic target in cHL. We report for the first time the cytotoxic effect of venetoclax in human cHL cell lines.

Sexual health educational intervention in medical students.

INTRODUCTION: The National Autonomous University of Mexico Faculty of Medicine created the Adolescent Pregnancy Prevention Program, which is aimed at students. OBJECTIVE: To determine the sexual-reproductive health profile of medical students through a diagnostic questionnaire and of those who participated in an educational intervention on sexuality (three modules). METHOD: First-year undergraduate students, schoolyear 2017-2018, participated. Students were considered to be trained when they took at least one module. RESULTS: The questionnaire was answered by 1157 students, 21.9 % participated in at least one module, 43.1% had initiated sexual activity and 25 % received the educational intervention. Not having used a condom in their last intercourse was identified in 20 %, and a high prevalence of intercourse under the influence of alcohol was observed. CONCLUSIONS: It is important for specific sexuality competences to be promoted among those who will be doctors in the future.

INTRODUCCIÓN: La Facultad de Medicina de la Universidad Nacional Autónoma de México creó el Programa de Prevención de Embarazo en Adolescentes, dirigido a estudiantes. OBJETIVO: Determinar el perfil de la salud sexual-reproductiva de estudiantes de medicina mediante un cuestionario diagnóstico y de quienes participaron en una intervención educativa de sexualidad (tres módulos). MÉTODO: Participaron estudiantes del primer año de la carrera, ciclo 2017-2018. Se consideró que el estudiante fue capacitado cuando cursó al menos un módulo. RESULTADOS: Contestaron el cuestionario 1157 estudiantes, 21.9 % participó en al menos un módulo, 43.1 % había iniciado vida sexual y 25 % recibió la intervención educativa. El 20 % no usó condón en su última relación y se observó alta prevalencia de relaciones sexuales bajo el influjo de alcohol. CONCLUSIONES: Es importante promover competencias específicas en sexualidad entre quienes serán los futuros médicos.

Intervención educativa sobre salud sexual en estudiantes de medicina / Sexual health educational intervention in medical students

Resumen Introducción: La Facultad de Medicina de la Universidad Nacional Autónoma de México creó el Programa de Prevención de Embarazo en Adolescentes, dirigido a estudiantes. Objetivo: Determinar el perfil de la salud sexual-reproductiva de estudiantes de medicina mediante un cuestionario diagnóstico y de quienes participaron en una intervención educativa de sexualidad (tres módulos). Método: Participaron estudiantes del primer año de la carrera, ciclo 2017-2018. Se consideró que el estudiante fue capacitado cuando cursó al menos un módulo. Resultados: Contestaron el cuestionario 1157 estudiantes, 21.9 % participó en al menos un módulo, 43.1 % había iniciado vida sexual y 25 % recibió la intervención educativa. El 20 % no usó condón en su última relación y se observó alta prevalencia de relaciones sexuales bajo el influjo de alcohol. Conclusiones: Es importante promover competencias específicas en sexualidad entre quienes serán los futuros médicos.

Abstract Introduction: The National Autonomous University of Mexico Faculty of Medicine created the Adolescent Pregnancy Prevention Program, which is aimed at students. Objective: To determine the sexual-reproductive health profile of medical students through a diagnostic questionnaire and of those who participated in an educational intervention on sexuality (three modules). Method: First-year undergraduate students, schoolyear 2017-2018, participated. Students were considered to be trained when they took at least one module. Results: The questionnaire was answered by 1157 students, 21.9 % participated in at least one module, 43.1% had initiated sexual activity and 25 % received the educational intervention. Not having used a condom in their last intercourse was identified in 20 %, and a high prevalence of intercourse under the influence of alcohol was observed. Conclusions: It is important for specific sexuality competences to be promoted among those who will be doctors in the future.

Twelve years after abortion decriminalization in Mexico City: Can we still remain an island of liberties?

Latin America hosts the most restrictive abortion legislation globally. In 2007, Mexico, the second largest Catholic country in the world, decriminalized elective abortion within the first twelve weeks of pregnancy in the capital: Mexico City (also known as Federal District of Mexico). Following the reform, the Mexico City Ministry of Health (MX-MOH) implemented safe and legal services. Free services are provided to Mexico City residents and a sliding fee of up to $100 is applied to women from other Mexican states. Conscientious objection (CO) was addressed and included in service provision guidelines. Since 2007, 18 of 32 states amended their penal codes to restrict abortion. The road toward increasing access to abortion services at the MX-MOH included a shift from dilation and curettage (D&C) to medical abortion (MA), first with the misoprostol-alone regimen, followed by the combined mifepristone-misoprostol regimen. Manual vacuum aspiration is offered to out-of-state-women or to those beyond the gestational age where MA is less effective. Contraceptive uptake among abortion seekers is high (up to 95% of them prefer a free method of their choice). The Legal Interruption of Pregnancy program at the MX-MOH continues to provide effective, safe, reliable, and free services. However, women from indigenous groups residing in rural areas, those with low schooling, and adolescents with an unintended pregnancy who live in rural, urban, peri-urban districts, and at the state level are underserved despite being legally eligible to receive abortion services. Therefore, information and services for the disadvantaged groups need to be strengthened.

Alternative and canonical NF-kB pathways DNA-binding hierarchies networks define Hodgkin lymphoma and Non-Hodgkin diffuse large B Cell lymphoma respectively.

PURPOSE: Despite considerable evidence that supports the NF-kB role in the immune system and lymphomagenesis, it is unclear whether specific NF-kB dimers control a particular set of genes that account for their biological functions. Our previous work showed that Hodgkin Lymphoma (HL) is unique, among germinal center (GC)-derived lymphomas, with respect to its dependency on Rel-B to survive. In contrast, diffuse large B-Cell lymphoma (DLBCL) including both Activated B-Cell-Like and Germinal Center B-Cell-Like, requires cREL and Rel-A to survive and it is not affected by Rel-B depletion. These findings highlighted the activity of specific NF-kB subunits in different GC-derived lymphomas. METHODS: Sequenced chromatin immunoprecipitated DNA fragments (ChIP-Seq) analysis revealed an extensive NF-kB DNA-binding network in DLBCL and HL. The ChIP-Seq data was merged with microarray analysis following the Rel-A, Rel-B or cRel knockdown to determine effectively regulated genes. RESULTS: Downstream target analysis showed enrichment for cell cycle control, among other signatures. Rel-B and cRel controlled different genes within the same signature in HL and DLBCL, respectively. BCL2 was exclusively controlled by Rel-B in HL. Both mRNA and protein levels decreased following Rel-B depletion meanwhile there was no change upon cRel knock-down. BCL2 exogenous expression partially rescued the death induced by decreased Rel-B in HL cells. CONCLUSION: The Rel-B hierarchical network defined HL and the cRel hierarchical network characterized DLBCL. Each Rel member performs specific functions in distinct GC-derived lymphomas. This result should be considered for the development of targeted therapies that are aimed to selectively inhibit individual NF-kB dimers.

Efectividad de una intervención educativa semipresencial para la formación docente en el área de salud pública / Effectiveness of a blended learning education intervention for the teaching training in the Public Health area

Introducción. La formación docente debe orientarse a la actualización en contenidos específicos de una asignatura y en aspectos pedagógicos según los cambios educativos globales. En la Facultad de Medicina de la UNAM se imparten cursos dirigidos a estudiantes de pregrado que se formarán como docentes. El objetivo de este estudio fue diseñar, implementar y evaluar un curso-taller semipresencial de formación docente, dirigido a estudiantes con interés en profesionalizarse en una materia de salud pública. Sujetos y métodos. Ejes del curso: fundamentos de la asignatura y bases pedagógicas (impartido en 60 horas, 40 presenciales y 20 en línea). Se evaluó el avance con un test pre-postintervención, un instrumento de escenarios simulados y una rúbrica de presentación frente a grupo. Se calcularon medidas de resumen, pruebas de diferencias de medianas y dos modelos MANOVA para las calificaciones pre-post. Resultados. 49 participantes; un 73% concluyó el curso. La mediana de edad fue de 20 años, y la razón hombre-mujer, de 0,65. Medianas de calificaciones: preintervención, 4,53; postintervención, 7,24 (p < 0,05); bases pedagógicas, 9; presentación frente a grupo, 8,8. En ambos modelos MANOVA se observó que pertenecer a años avanzados de la carrera se relaciona con mayores puntuaciones (p < 0,05). El 16% de los participantes fueron seleccionados como docentes en formación para formar parte de la plantilla académica de la institución. Conclusiones. Este estudio puede considerarse como un referente para propiciar el reporte detallado de otros cursos, considerando el diseño instruccional, la evaluación de su impacto y su éxito en la incorporación temprana de estudiantes como profesores (AU)

Introduction. Teacher training must focus on updating specific contents of a subject and on pedagogical aspects according to global educational changes. At the Faculty of Medicine in UNAM there are courses addressed to undergraduate students who will be trained as teachers. The aim of the study was to design, implement and assess a blended learning course workshop in teacher training for medical students with an interest in specializing in Public Health subject. Subjects and methods. Course's axes: subject's foundations and pedagogical basis (taught in 60 hours, 40 on-site class and 20 online). The advancement was assessed with a pre- and post-test, a simulated scenario tool and a rubric for in front of a group presentation. Summary measurements were calculated, median differences tests and two MANOVA models for pre- and post-test grades. Results. 49 participants; 73% concluded the course. The age range was 20 years old and the male-female ratio was 0.65. Grades' median: pre-intervention, 4.53; post-intervention, 7.24 (p < 0.05); pedagogical bases, 9; in front of a group presentation, 8.8. In both MANOVA models it was observed that being at advanced levels of the career was related with higher scores (p < 0.05). Sixteen percent of the participants were chosen as 'teachers in training' to conform the academic board of our institution. Conclusions. This study may be considered as a referent to promote a detained report of other teacher training courses for students, considering the instructional design, the impact of its assessment and the success in an early incorporation of students as teachers (AU)

La formación docente evaluada por método mixto / Teaching training assessed through mixed-method

INTRODUCCIÓN: Actualmente, los planes de estudio de medicina en el mundo enfatizan el desarrollo de las competencias profesionales. Para ello es indispensable contar con programas de capacitación docente que incidan en el cambio de referentes pedagógicos de los profesores y adquirir así estrategias de enseñanza que se dirijan al logro del perfil del egresado. Para evaluar el cumplimiento de lo anterior, los beneficios de una metodología mixta son particularmente evidentes cuando se estudian iniciativas nuevas y sus interacciones en investigación educativa médica. OBJETIVO: Evaluar por metodología mixta la formación docente de un grupo de profesores que asistieron a un curso-taller. Sujetos y métodos. Se evaluó cuantitativamente el impacto del curso por los cambios en los referentes pedagógicos de los profesores que asistieron al curso y cualitativamente por grupos focales que permitieron la agrupación de las narrativas. RESULTADOS: El referente tradicional después de la impartición del curso denotó una gran heterogeneidad entre tres de las estrategias (planeación, metodología y evaluación), no así con las de aprendizaje y relación docente-alumno; las estrategias en el referente alternativo y tecnología educativa se mantuvieron homogéneas. Los profesores expresaron que los cursos eran beneficiosos para la implementación de las competencias, pero que era necesario enfatizar más sobre la aplicación de las estrategias. CONCLUSIÓN: Los análisis cuantitativo y cualitativo mostraron que el curso-taller de formación docente coadyuvó a modificar la preferencia de los profesores por referentes pedagógicos distintos al tradicional, lo cual resulta de trascendencia para el desarrollo adecuado de un modelo educativo orientado a competencias

INTRODUCTION: Medical curricula are currently focusing on the development of professional competences worldwide. In order to accomplish this, it is essential to have teaching training programs that influence on the pedagogical references change of teachers and develop teaching strategies that are addressed to the fulfillment of the graduate’s profile. To achieve this, the benefits of mixed-method are particularly evident when new initiatives together with their interactions in medical education research are being studied. AIM: To assess teaching training of a group of teachers attending a workshop through mixed-method. Subjects and methods. The impact of the course was quantitatively assessed according to the pedagogical references changes and qualitatively through focal groups of teachers who had attended the workshop; this allowed the grouping of narratives. RESULTS: The conventional referent after taking the course showed a wide heterogeneity among three strategies (planning, methodology and assessment) opposite to those of learning and teacher-student relationship; the strategies in the alternative referent and teaching technology remained homogenous. Teachers reported that the courses were beneficial for implementing competences but that it was not necessary to emphasize the application of strategies. CONCLUSION: The quantitative and qualitative analyses showed that the teaching training workshop contributed to the teachers’ change in their pedagogical references preference other than the conventional one, which is completely determinant for the appropriate development of a teaching model oriented to competences

Tricobezoar gástrico: caso clínico / Gastric trichobezoar: case report

Los Bezoares del tracto digestivo representan una patología poco frecuente y con presentaciones clínicas que dependen del tipo de bezoar. Esta patología ocurre en estómagos normales a causa de ingestión de sustancias u objetos que no atraviesan el píloro y como complicación secundaria a cirugía gástrica. El tricobezoar corresponde a un bezoar constituido por pelo; la sospecha clínica de esta entidad se establece en pacientes jóvenes habitualmente de sexo femenino que tienen masa epigástrica palpable y en algunas ocasiones baja de peso negando la ingestión de cabello. El diagnóstico se puede realizar con exámenes contrastados del tracto digestivo y mediante endoscopía, siendo este último el método de elección. El tratamiento puede ser endoscópico o quirúrgico y depende de las características del bezoar. Se presenta un caso clínico y se revisa la literatura relacionada con esta patología.

Digestive tract bezoars are a rare pathology with clinical presentations depending on the type of bezoar. This condition occurs in normal stomachs due to ingestion of substances or objects that do not pass through the pylorus as a secondary complication to gastric surgery. The tricobezoar corresponds to a bezoar composed of hair. The clinical suspicion of this entity is established in young patients usually female with palpable epigastric mass and sometimes weight loss denying the ingestion of hair. The diagnosis can be made through contrasting reviews of the digestive tract or through endoscopy, the latter being the method of choice. The treatment may be endoscopic or surgical depending on the characteristics of the bezoar. We present a case report and review of the literature regarding this disease.