Herbicides induce change in metabolic and genetic diversity of bacterial community from a cold oligotrophic lake.

Pristine cold oligotrophic lakes show unique physical and chemical characteristics with permanent fluctuation in temperature and carbon source availability. Incorporation of organic toxic matters to these ecosystems could alter the bacterial community composition. Our goal was to assess the effects of simazine (Sz) and 2,4 dichlorophenoxyacetic acid (2,4-D) upon the metabolic and genetic diversity of the bacterial community in sediment samples from a pristine cold oligotrophic lake. Sediment samples were collected in winter and summer season, and microcosms were prepared using a ration 1:10 (sediments:water). The microcosms were supplemented with 0.1 mM 2,4-D or 0.5 mM Sz and incubated for 20 days at 10 °C. Metabolic diversity was evaluated by using the Biolog Ecoplate™ system and genetic diversity by 16S rDNA amplification followed by denaturing gradient gel electrophoresis analysis. Total bacterial counts and live/dead ratio were determined by epifluorescence microscopy. The control microcosms showed no significant differences (P > 0.05) in both metabolic and genetic diversity between summer and winter samples. On the other hand, the addition of 2,4-D or Sz to microcosms induces statistical significant differences (P < 0.05) in metabolic and genetic diversity showing the prevalence of Actinobacteria group which are usually not detected in the sediments of these non-contaminated lacustrine systems. The obtained results suggest that contaminations of cold pristine lakes with organic toxic compounds of anthropic origin alter their homeostasis by inhibiting specific susceptible bacterial groups. The concomitant increase of usually low representative bacterial groups modifies the bacterial composition commonly found in this pristine lake.

[Effect of training with immersive virtual reality on the risk of falling in the elderly: a systematic review]. / Efecto del entrenamiento con realidad virtual inmersiva en el riesgo de caída de personas mayores: una revisión sistemática.

Aging entails changes in the human body, generating a decrease in physical capabilities, including the risk of falls. New therapies are currently emerging for the risk of falls and immersive virtual reality is one of them, giving the user a realistic feeling of a virtual environment. This systematic review aims to investigate the effects of immersive virtual reality on the risk of falling in older people. Randomized controlled clinical trials were included, with at least one intervention group that used immersive virtual reality, age >60 years and without multiple serious pathologies. Articles published until November 2023 were included, in accordance with the PRISMA guideline and including the PICO strategy, in the electronic databases PubMed, Scielo, Scopus, Semantic Scholar and Science Direct. From a total of 413 articles, 7 studies were selected, which met the pre-established inclusion and exclusion criteria. Of the studies reviewed, the majority found significant improvements in tests that measure risk of falls, only one study did not find improvements in this variable but did find improvements for walking speed and functional reach test. Despite the limited literature, it seems that these interventions can have a positive effect, becoming a good tool to reduce the risk of falling in older people.

Humanization in healthcare arises from the need for a holistic approach to illness. / Implantación de un proyecto de humanización en una Unidad de Cuidados Intensivos.

Suffering is not only exclusive to patients or their relatives, but also to the health professionals, who feel to be at the center of the depersonalization process. Over-technification and the fact that the disease process is sometimes the only focal point of our activities, together with the ever-increasing influence of institutional power seen in recent times, all cause the health professional to be the first in demanding a change in health institution dynamics. Following initial reflection from one of the most technified medical specialties (Intensive Care Medicine), classically isolated from the rest of the Hospital and from the community, we implemented a project aimed at securing integration and empathy in our approach to patients and their relatives in the Intensive Care Unit (ICU) of Infanta Margarita Hospital. The project was designed to incorporate tools for working on the most important elements of a humanization plan, i.e., the patients, their relatives, the health professionals and the community, attempting to disclose the work done in the ICU over a period of 12 months. This project is referred to as the Project ICU Infanta Margarita: 1 year: 12 months for 12 commitments.

Responses of serum androgen and insulin resistance to metformin and pioglitazone in obese, insulin-resistant women with polycystic ovary syndrome.

Severe insulin resistance is a key abnormality in obese women with polycystic ovary syndrome (PCOS). The purpose of this study was to evaluate whether pioglitazone decreases insulin resistance (IR) and hyperandrogenism to the same extent as metformin in obese women with PCOS who have not received any previous treatment. Fifty-two women with PCOS were randomly allocated to receive either pioglitazone (30 mg/d, n = 25) or metformin (850 mg three times daily, n = 27) and were assessed before and after 6 months. Body weight, body mass index, and waist to hip ratio increased significantly (P

Clinical significance of the translocation (11;14)(q13;q32) in multiple myeloma.

The most common chromosomal translocation in multiple myeloma (MM) is t(11;14)(q13;q32). Here, we describe the clinical characteristics of patients with MM who have this translocation. We have identified 24 patients at our institution who had t(11;14)(q13;q32) as determined by standard cytogenetic analysis (CC). Seven patients had the translocation detected at the time of original diagnosis and 17 at the time of relapse. Median survival in all patients after original diagnosis was 43 months; median survival after the translocation was detected was 11.9 months. Four patients had a clinical diagnosis of plasma cell leukemia. Most patients had an elevated beta2-microglobulin (13/20 had >4 microg/ml). The bone marrow (BM) labeling index (LI) of patients, at the time of translocation detection, was elevated in most (median 1.4%, 17/23 patients had BMLI > or = 1%). Of the 24 patients, 19 (79%) died of disease progression and 5 (21%) were alive with disease at last follow-up. Lytic lesions, bone pain, or compression fractures eventually developed in all patients. Patients with MM who have t(11;14)(q13;q32) detected by standard cytogenetics seem to have an aggressive clinical course.

Apical foraminal openings in human teeth. Number and location.

One hundred forty extracted permanent human teeth were prepared for examination with a scanning electron microscope to determine the number of foramina, their distances from the apices, and their locations. In most of the specimens, the root canals deviated to one side and ended short of the apices. Some specimens showed interradicular openings; others had configurations on the top of the apices that were similar to the crest on a helmet.

Implantación de un proyecto de humanización en una Unidad de Cuidados Intensivos / Humanization in healthcare arises from the need for a holistic approach to illness

La humanización en sanidad surge por la necesidad de acercarnos a una dimensión más holística de la enfermedad. El sufrimiento no solo es exclusivo de los pacientes y las familias, sino que el profesional se encuentra en el centro del proceso de despersonalización. El exceso de tecnificación y la colocación del proceso patológico en ocasiones como único objetivo de actuación, así como la hipertrofia del poder institucional que estamos viviendo en los últimos tiempos, hacen que en ocasiones el propio profesional sanitario sea el primero en demandar un cambio en el abordaje de la dinámica dentro de las instituciones sanitarias. Tras una reflexión inicial, desde el corazón de la medicina más tecnificada, como es la Medicina Intensiva, clásicamente aislada del resto del entorno hospitalario y de las familias, decidimos abordar un proyecto de integración, empatía y acercamiento a los pacientes y familiares de la Unidad de Cuidados Intensivos (UCI) del Hospital Infanta Margarita, en el que se pretendieron implementar herramientas para trabajar en los elementos más importantes de un plan de humanización (las familias, pacientes, profesionales, y nuestra comunidad), potenciando el dar a conocer el trabajo que se realiza en la UCI y que se desarrolló a lo largo de 12 meses, el proyecto: UCI Infanta Margarita, 1 año: 12 meses para 12 compromisos (AU)

Suffering is not only exclusive to patients or their relatives, but also to the health professionals, who feel to be at the center of the depersonalization process. Over-technification and the fact that the disease process is sometimes the only focal point of our activities, together with the ever-increasing influence of institutional power seen in recent times, all cause the health professional to be the first in demanding a change in health institution dynamics. Following initial reflection from one of the most technified medical specialties (Intensive Care Medicine), classically isolated from the rest of the Hospital and from the community, we implemented a project aimed at securing integration and empathy in our approach to patients and their relatives in the Intensive Care Unit (ICU) of Infanta Margarita Hospital. The project was designed to incorporate tools for working on the most important elements of a humanization plan, i.e., the patients, their relatives, the health professionals and the community, attempting to disclose the work done in the ICU over a period of 12 months. This project is referred to as the Project ICU Infanta Margarita: 1 year: 12 months for 12 commitments (AU)

[Hyperammonemic encephalopathy: nutritional assessment and management of a case]. / Encefalopatía hiperamoniémica: valoración y manejo nutricional a propósito de un caso.

OTC deficiency is a disorder of the urea cycle X-linked. It is manifested in men as severe hyperammonemia in the first days of life. In women the disease is milder severity. Various conditions cause decompensation with hyperammonemia. It could be fatal or cause permanent neurological damage. We report a 36 years old woman admitted for surgery, she suffered a decompensation in conjunction with surgical wound infection. Hyperammonemia caused neurological deterioration with decreased level of consciousness, tetraparesis and neurogenic dysphagia. The treatment consisting of low-protein diet, ammonium chelating drugs and dialytic measures, was effective in controlling hyperammonaemia and improving neurological status. This case illustrates the importance of nutritional support of patients with disorders of the urea cycle in the hospital because the descompensations are more frecuent here.

[Comparison of two types of surgical gastrostomies, open and laparoscopic in home enteral nutrition]. / Comparación entre dos tipos de gastrostomías quirúrgicas, abierta y laparoscópica, en nutrición enteral domiciliaria.

AIM: Exposing the complications of surgical gastrostomies used as way of home enteral nutritional support (HEN) and detecting the differences between the two techniques used in our environment: Open Surgery vs Laparoscopic Surgery. MATERIAL AND METHODS: Retrospective descriptive observational study of the surgical gastrostomies performed between 1994 and 2009 followed up by our unit. Have been analyzed the complications detected in our practice during the follow-up of patients with HEN performed via open laparotomy vs. laparoscopic tecniques, assessing: leaks of gastric fluid to the exterior, abdominal wall irritation, presence of exudate, presence of exudate with positive culture that required antibiotical treatment, burning or loss of substance of the periostomic zone, breach of balloon, decubitus ulcer caused by the tube and formation of granuloma. RESULTS: Between 1994 and 2009, 57 surgical gastrostomies were performed: 47 using the conventional laparotomic (open) tecnique and 10 laparoscopies. The average age of the patients was 57.51 ± 17.29 years old. The most common cause for the performance of surgical gastrostomy was esophageal cancer (38.6%) followed by neurologic alterations (26.3%) and head and neck tumors (26.3%). 97.9% of the patients who underwent to surgical gastrostomy presented at least one complication, meaning that only 2.1% were free of complications; meanwhile, 50% of the patients were laparoscopic gastrostomy was performed had none of these complications. The most common complications were the presence of leaks of gastric fluid and abdominal wall irritation that appeared on 89.4% and 83% respectively of the laparotomic gastrostomies versus the presence of only 30% of both complications in laparoscopic gastrostomies being the difference statistically significant (p < 0.01). CONCLUSIONS: After the introduction of the laparoscopic technique in the performance of surgical gastrostomies has been observed a decrease of the complications occured during the home enteral nutritional support related to surgical gastrostomies.

[Maternal and fetal outcomes in pregnancy following bariatric surgery]. / Resultados materno-fetales de la gestación tras cirugía bariátrica.

BACKGROUND: Obesity is the most frequent metabolic disease in the World, and is associated with several comorbidities. Bariatric procedures arise as a promising treatment when classical approach is ineffective. Half of the operated patients are reproductive-aged women and there is evidence that obesity is related to worse maternal and fetal outcomes. Because nutritional status is affected by bariatric surgery and is a vital component during pregnancy, the aim of our study is to asses the impact of bariatric surgery on pregnancy in these patients. MATERIAL AND METHODS: We studied 10 women and 15 pregnancies following bariatric surgery between 2003 and 2009. The visits took place every three months by an obstetrician and an endocrinologist with experience in nutrition, recording clinical features and lab work. RESULTS: We found iron deficiency in 80% of the pregnancies, vitamin D in 46,7%, vitamin A in 20%, vitamin E in 13,3% and vitamin B12 in 26,7%. There were no complications during pregnancy, except one case of gravidic hiperemesis. There were nine deliveries without malformations, three of them were small for gestational age newborns and one suffered aspiration pneumonia. There were three stillbirths and one preterm delivery with fetal death. CONCLUSIONS: our results show fewer complications during pregnancy in these women than obese women and similar to general population.

Bowel obstruction after treatment of intra-abdominal tumors.

BACKGROUND: Tumors of the solid viscera are one of the most common types of pediatric malignancies. Due to the intra-abdominal location of many of these neoplasms, laparotomy and/or bowel resection are often necessary, predisposing patients to postoperative intestinal obstruction. Additionally, chemotherapy and radiation therapy may lead to acute and chronic bowel injury, also potentially predisposing these patients to postoperative bowel obstruction. We reviewed our data over an eleven-year period to identify the incidence of obstruction as well as factors associated with its development. METHODS: A retrospective data analysis of all patients diagnosed with intra-abdominal Wilms' tumor, rhabdomyosarcoma, neuroblastoma, and Hodgkin's and non-Hodgkin's lymphoma in a single institution from 1997 to 2007 was conducted. Data collected included demographic factors, operations, incidence of small bowel obstruction (SBO) and the use of adjuvant or neoadjuvant chemoradiation therapy. Patients who developed SBO were compared to those who did not develop obstruction. Data comparisons were analyzed statistically using Fisher's exact test, 2-tailed Student's t-Test, or chi-square proportional analysis with significance reported for p<0.05. RESULTS: A total of 291 patients were identified during the study period. Mean age at diagnosis was 8.1+/-5.8 years. Males accounted for 57% of all patients. Tumor distribution was as follows: Wilms' tumor: 56 (19%); non-Hodgkin's lymphoma: 71 (24%); Hodgkin's lymphoma: 64 (22%); rhabdomyosarcoma: 32 (11%); and neuroblastoma: 68 (24%). There were a total of 12 bowel obstructions in 11 patients (3.7%). Mean follow-up for all patients was 3.6+/-2.7 years. Children with bowel obstruction were more likely to be male (4.5:1, p=0.061) and younger (4.2 years versus 8.1 years; p=0.087). Wilms' tumor accounted for 45% of patients with bowel obstruction, but made up only 19% of the study population. The incidence of bowel obstruction in patients with Wilms' tumor was 8.9% compared to an overall incidence of 3.8% (p=0.043). CONCLUSION: Bowel obstruction is relatively uncommon after intra-abdominal malignancies in children. Wilms' tumor, rhabdomyosarcoma and Burkitt's lymphoma appear to be associated with the highest risk of bowel obstruction.

Anquilosis de la articulación temporomandibular: Una revisión de la literatura / Temporomandibular joint ankylosis: A review

La anquilosis de la articulación temporomandibular (ATM) corresponde a un trastorno temporomandibular clasificado dentro de la hipomovilidad mandibular crónica. La literatura define anquilosis como una inmovilidad anormal de la mandíbula, desorden que lleva a una restricción de la apertura bucal con reducción parcial de los movimientos mandibulares o una completa inmovilidad de la mandíbula. El objetivo del presente artículo es realizar una revisión en cuanto a la clasificación, epidemiología, etiopatogenia, diagnóstico y tratamiento de la anquilosis de la articulación temporomandibular (AU)

Ankylosis of the temporomandibular joint (TMJ) corresponds to a temporomandibular disorder classified into chronic mandibular hypomobility. Ankylosis defines literature as an abnormal jaw immobility disorder that leads to a restriction of mouth opening with partial reduction of mandibular movement or complete immobility of the jaw. The aim of this article is to review the classification, epidemiology, etiology, diagnosis and treatment of temporomandibular joint ankylosis (AU)

Encefalopatía hiperamoniémica; valoración y manejo nutricional a propósito de un caso / Hyperammonemic encephalopathy; nutritional assessment and management of a case

El déficit de Ornitintranscarbamilasa (OTC) es un trastorno del ciclo de la urea ligado al cromosoma X. Se manifiesta en el varón como hiperamoniemia severa en los primeros días de vida. En la mujer la enfermedad esmás leve. Diversas situaciones pueden provocar una descompensación con hiperamoniemia que puede ser letal o provocar daños neurológicos permanentes. Presentamos una mujer de 36 años que ingresó para cirugía y que sufrió una descompensación coincidiendo con infección de la herida quirúrgica. La hiperamoniemia provocó un deterioro neurológico con disminución del nivel de conciencia, tetraparesia y disfagia neurógena. Con tratamiento, que consistió en dieta hipoproteica, quelantes de amonio y medidas dialíticas, se consiguió controlar la hiperamoniemia y mejorar el estado neurológico. Este caso ilustra la importancia del soporte nutricional especializado de los pacientes con trastornos del ciclo de laurea en el ámbito hospitalario por darse frecuentemente situaciones que favorecen las descompensaciones (AU)

OTC deficiency is a disorder of the urea cycle X-linked. It is manifested in men as severe hyperammonemia in the first days of life. In women the disease is milder severity. Various conditions cause de compensation with hyperammonemia. It could be fatal or cause permanent neurological damage. We report a 36 years old woman admitted forsurgery, she suffered a de compensation in conjunction with surgical wound infection. Hyperammonemia caused neurological deterioration with decreased level of consciousness, tetraparesis and neurogenic dysphagia. The treatment consisting of low-protein diet, ammonium chelating drugs and dialytic measures, was effective incontrolling hyperammonaemia and improving neurological status. This case illustrates the importance of nutritional support of patients with disorders of the urea cyclein the hospital because the descompensations are more frecuent here (AU)

Comparación entre dos tipos de gastrostomías quirúrgicas, abierta y laparoscópica, en nutrición enteral domiciliaria / Comparison of two types of surgical gastrostomies, open and laparoscopic in home enteral nutrition

Objetivo: Exponer las complicaciones de las gastrostomías quirúrgicas utilizadas como vía de soporte nutricional enteral domiciliario (SNED) y detectar si existen diferencias entre las dos técnicas usadas en nuestro medio: Cirugía abierta vs laparoscópica. Material y métodos: Estudio observacional descriptivo de carácter retrospectivo de las gastrostomías quirúrgicas realizadas entre los años 1994 y 2009 seguidas por nuestra unidad. Se han analizado las complicaciones detectadas en consulta durante el seguimiento de pacientes con SNED a través de gastrostomía quirúrgica realizada con técnica laparotómica abierta vs laparoscópica, valorando: fuga del contenido gástrico al exterior, irritación de la pared abdominal, presencia de exudado, presencia de exudado con cultivo positivo que requirió tratamiento antibiótico, quemadura o pérdida de sustancia de la zona periostomía, rotura de balón, úlcera de decúbito por la sonda y formación de granuloma. Resultados: Durante los años 1994-2009 se realizaron 57 gastrostomías quirúrgicas: 47 por técnica laparótomica (abierta) convencional y 10 por vía laparoscópica. La edad media de los pacientes fue de 57,51 ± 17,29 años. La causa más frecuente que motivó la realización de la gastrostomía quirúrgica fue el cáncer de esófago (38,6%) seguido de alteraciones neurológicas (26,3%) y tumores de cabeza y cuello (26,3%). El 97,9% de los pacientes a los que se realizó una gastrostomía quirúrgica abierta presentaron al menos una complicación, es decir que solo el 2,1% estuvieron libres de complicaciones; mientras que el 50% de los que se sometieron a una gastrostomía laparoscópica no tuvo ninguna. Las complicaciones más frecuentes fueron la presencia de fuga del contenido gástrico y la irritación de la pared abdominal que se presentaron en el 89,4% y 83% respectivamente de las gastrostomías laparotómicas frente a la aparición de solo el 30% de ambas complicaciones en las gastrostomías laparoscópicas siendo la diferencia estadísticamente significativa (p < 0,01). Conclusiones: Tras la introducción de la técnica laparoscópica en la realización de las gastrostomías quirúrgicas se ha observado una disminución de las complicaciones que se presentan durante la Nutrición Enteral Domiciliaria relacionadas con las gastrostomías quirúrgicas (AU)

Aim: Exposing the complications of surgical gastrostomies used as way of home enteral nutritional support (HEN) and detecting the differences between the two techniques used in our environment: Open Surgery vs Laparoscopic Surgery. Material and methods: Retrospective descriptive observational study of the surgical gastrostomies performed between 1994 and 2009 followed up by our unit. Have been analyzed the complications detected in our practice during the follow-up of patients with HEN performed via open laparotomy vs. laparoscopic tecniques, assessing: leaks of gastric fluid to the exterior, abdominal wall irritation, presence of exudate, presence of exudate with positive culture that required antibiotical treatment, burning or loss of substance of the periostomic zone, breach of balloon, decubitus ulcer caused by the tube and formation of granuloma. Results: Between 1994 and 2009, 57 surgical gastrostomies were performed: 47 using the conventional laparotomic (open) tecnique and 10 laparoscopies. The average age of the patients was 57.51 ± 17.29 years old. The most common cause for the performance of surgical gastrostomy was esophageal cancer (38.6%) followed by neurologic alterations (26.3%) and head and neck tumors (26.3%). 97.9% of the patients who underwent to surgical gastrostomy presented at least one complication, meaning that only 2.1% were free of complications; meanwhile, 50% of the patients were laparoscopic gastrostomy was performed had none of these complications. The most common complications were the presence of leaks of gastric fluid and abdominal wall irritation that appeared on 89.4% and 83% respectively of the laparotomic gastrostomies versus the presence of only 30% of both complications in laparoscopic gastrostomies being the difference statistically significant (p < 0.01). Conclusions: After the introduction of the laparoscopic technique in the performance of surgical gastrostomies has been observed a decrease of the complications occured during the home enteral nutritional support related to surgical gastrostomies (AU)

Resultados materno-fetales de la gestación tras cirugía bariátrica / Maternal and fetal outcomes in pregnancy following bariatric surgery

Introducción: La obesidad es la enfermedad metabólica más frecuente en el mundo y conlleva múltiples comorbilidades,siendo la cirugía bariátrica (CB) una opción terapéutica cuando fallan las medidas clásicas. La mitad de los pacientes intervenidos son mujeres en edad fértil y está demostrado que la obesidad se asocia a peores resultados obstétricos y fetales. Dado que el estado nutricional se ve afectado por la CB y es un factor esencial para el adecuado desarrollo del embarazo, el objetivo de nuestro trabajo es valorar los efectos de la CB sobre la gestación en mujeres obesas intervenidas. Material y métodos: Seguimiento de 10 mujeres y 15 gestaciones tras CB durante el periodo 2003-2009. Se realizaron visitas trimestrales en consultas de Nutrición y Obstetricia, con evaluación clínica y de laboratorio en cada una.Resultados: Se evidenció deficiencia de hierro en el80% de las gestaciones, de vitamina D en el 46,7%, de vitaminaA en el 20%, de vitamina E en el 13,3% y de vitamina B12 en el 26,7%. No hubo complicaciones durante la gestación salvo un caso de hiperémesis gravídica. Hubo9 partos de recién nacidos vivos sin malformaciones de los cuales 3 fueron recién nacidos pequeños para la edad gestacional (RNPEG) y uno presentó neumonía por aspiración de meconio. Hubo 3 abortos y un parto prematuro con feto muerto. Conclusiones: En nuestro grupo de estudio hubo menos complicaciones durante la gestación comparado con lo descrito en obesas no operadas y similares a la población general (AU)

Background: Obesity is the most frecuent metabolic disease in the World, and is associated with several comorbidities. Bariatric procedures a rise as a promising treatment when classical approach is in effective. Half of the operated patients are reproductive-aged women and there is evidence that obesity is related to worse maternal and fetal outcomes. Because nutritional status is affected by bariatric surgery and is a vital component during pregnancy, the aim of our study is to asses the impact of bariatric surgery on pregnancy in these pacients. Material and methods: We studied 10 women and 15 pregnancies following bariatric surgery between 2003 and 2009. The visits took place every three months by an obstetrician and an endocrinologist with experience innutrition, recording clinical features and lab work. Results:We found iron deficiency in 80% of the pregnancies,vitamin D in 46,7%, vitamin A in 20%, vitamin E in13,3% and vitamin B12 in 26,7%. There were no complications during pregnancy, except one case of gravidic hiperemesis. There were nine deliveries without malformations, three of them were small for gestational age newborns and one suffered aspiration pneumonia. There were three stillbirths and one preterm delivery with fetal death. Conclusions: our results show fewer complications during pregnancy in these women than obese women and similar to general population (AU)

Rabdomiólisis secundaria a hiponatremia / Rhabdomyolysis secondary to hyponatraemia

No disponible

Estrategia de motivación para estudiantes de primer año de Medicina, Universidad San Sebastián, Concepción, Chile / Motivation strategy for first year medical students, Universidad San Sebastián, Concepción, Chile

En el marco de un nuevo modelo educativo formativo, la Universidad San Sebastián apunta al desarrollo de estrategias pedagógicas que sitúan al estudiante en el centro de las acciones. Es así como surge la necesidad de incrementar la motivación en los jóvenes que ingresan a la carrera de medicina, profesión desde siempre ligada a los valores sociales y el altruismo. Este trabajo explora la relevancia del contacto temprano con el paciente y el hospital como fuentes de motivación en primer año. Sujetos y métodos. Todos los estudiantes de primer año de medicina (n = 115) fueron invitados a visitar voluntariamente un hospital. Allí, los estudiantes recorrieron el establecimiento y sostuvieron una conversación libre con un paciente. Las opiniones se recogieron a través de un escrito libre. Resultados. Se inscribieron 95 estudiantes, de los cuales 68 concurrieron a la visita. Al consultar sobre la vivencia con el paciente, los estudiantes se refirieron positivamente a ésta. La ansiedad al inicio de la conversación fue uno de los aspectos más mencionados, al igual que la importancia de conocer el futuro lugar de trabajo. Conclusiones. La experiencia evidenció un alto interés en participar. Asimismo reveló elementos de la vida afectiva de los estudiantes, pilar fundamental de la educación médica. Finalmente, se aconseja la temprana relación con el paciente y con el hospital como agentes motivacionales en primer año. Se sugiere incorporar tareas y complementar la evaluación con herramientas que permitan obtener información objetiva sobre los aprendizajes adquiridos (AU)

Introduction. In the context of a new educational model of training, Universidad San Sebastián aims to develop teaching strategies that place the student at the center of action. Thus, it arises the need to increase motivation in young people entering the medical program, a profession that always has been linked to social values and altruism. This paper explores the relevance of early contact with the patient and the hospital as sources of motivation in the first year. Subjects and methods. All first year medical students (n = 115) were invited to visit a hospital voluntarily. There, the students visited the facilities and held a free conversation with a patient. The views were collected through a free writing. Results. 95 students were enrolled, of whom 68 did the visit. When consulted about the patient experience, students spoke positively of it. The anxiety at the beginning of the conversation was one of the most mentioned aspects as it was the importance of knowing the future workplace. Conclusions. The experience showed a high level of interest in participating. Also, it revealed elements of the student’s emotional life, basis of major importance for the medical education. Finally, it is recommend the early relationship with the patient and the hospital as motivational agents in the first year. It is suggested the incorporation of tasks and complementing of the evaluation with tools that allow obtaining objective information on apprenticeship (AU)