Didácticas innovadoras en el aprendizaje de la farmacología en estudiantes de medicina / Innovative teaching in pharmacology learning for medicine students

Introducción: la farmacología tiene alta relevancia en la formación del médico. Las clases expositivas son poco motivadoras para los estudiantes; esto ha llevado a incluir estrategias que despierten interés. Material y métodos: descripción de didácticas para apoyar el aprendizaje de la farmacología en tutorías por pares estudiantes (Caso clínico, Cubo mágico, Stop, Crucigrama, Parejas perfectas, Memoria al límite, Encapsúlate, Ritmo y fila, Ruleta, Sopa de letras, Cadeneta, Mapa conceptual y debate, Concéntrese). Se aplicó una encuesta semiestructurada para explorar la percepción de los estudiantes respecto de las tutorías. Resultados: la encuesta semiestructurada se aplicó a 37 estudiantes. El 65% está totalmente de acuerdo en que la asistencia a las monitorías de farmacología contribuye de manera positiva a su aprendizaje. El 40,5% refirió que las tutorías apoyan la obtención de un resultado favorable para la aprobación de la asignatura. El 62% manifestó la utilidad de las tutorías para definir los medicamentos que se usarán en el paciente. El 72,9% recomendaría a sus compañeros asistir a las tutorías. Entre el 24,3 y 48,6%, según la didáctica de aprendizaje, consideró que estas son excelentes. Discusión: se describe la experiencia del uso de didácticas que apoyan el aprendizaje de la farmacología, basadas en actividades lúdicas, promoviendo el aprendizaje significativo de la farmacología. En las tutorías con pares, los estudiantes se sienten en mayor confianza, participan activamente, lo que genera un ambiente que facilita el aprendizaje. Los estudiantes asistentes a las tutorías de farmacología refieren que hay empatía habitualmente con los tutores durante las sesiones. (AU)

Introduction: pharmacology is fundamental in the medical training. As theoretical classes hardly motivate students. This has led to include strategies that arouse interest. Methods: class syllabus, partnership working and informal activities by student tutors (clinical cases, crosswords, "cubo mágico", "stop", "parejas perfectas", "memoria al límite", "encápsulate", "ritmo y fila", "ruleta", "sopa de letras", "cadeneta", "concentrese" and brain storming) were sed in tutoring classes to help students in the pharmacology learning process. Questionnaires were used to collect feedback from students about tutorials. Results: the questionnaire was given to 37 students. 65% of them agreed on the positive impact the classes had on their learning; 40.5% found positive correlation between the tutoring classes and finals results; 62% referred that tutoring classes helped them defining how to match symptoms and drugs; 72.9% would recommend other students to attend the tutoring classes. Between 24.3% and 48.6% of the students, depending on the methods used, rated the experience as "excellent". Discussion: the experience regarding the use of new didactic methods was exposed. It encouraged students to approach pharmacology and it helped them improving their knowledge about the discipline through non-academic activities. Students reported that learning become easier during tutoring classes thanks to the informal context and informal relationship with the tutor. (AU)

Uso del dispositivo de asistencia respiratoria Novalung® como puente a trasplante pulmonar: Caso clínico / Bridge to lung transplantation with a novel pumpless lung assist device: Report of one case

Devices such as Novalung® can be used as a bridge to lung transplantation while waiting for a suitable donor. We report a 50 year-old male with a terminal pulmonary fibrosis and candidate for lung transplantation. He was admitted to the hospital due to a severe deterioration of his respiratory condition, with the presence of severe respiratory acidosis despite conventional invasive respiratory support. Respiratory support with Novalung® was started, resulting in a progressive reduction ofpCOz that became normal ten hours after the installation of the device. Five days later a successful lung transplantation wasperformed.

Análisis de los niveles de cortisol sérico en pacientes críticos con inestabilidad hemodinámica / Analysis of serum cortisol levels in critical patients with hemodynamic inestability

There is currently no consensus as to expected levels of serum cortisol (SC) in critical patients. Some authors, based on the ACTH test, consider 18 ug/dL and up as normal while others start >25-30 ug/dL. There are no reports of critical patients with Systemic Inflammatory Response Syndrome (SIRS). In this study we determine the SC in a group of critical patients with SIRS and correlate this value with the hemodynamic response and vasoactive drug requirements. SC was measured under conditions of stree defined by important hemodynamic instability within the SIRS context. We studied patients with no known history of steroid therapy nor use of other drugs that could alter the adrenal axis, and with no suspicion of adrenal failure. Enzimuntests Roche ES 300(CV 6 percent) was used. Based on our experience and on different studies, patients were classified into theree groups according to the SCvalue under stress. Group 1: SC <18 ug/dL, Group 2: SC 18,1 to 28 ug/dL, and Group 3: CS > 28 ug/dL. We studied 20 patients, 15 men and 5 women, all presenting SIRS, 17 with septic schock, 1 with severe head injuries, 1 hypovolemic shock, 1 postsurgery. The initial PA median was 80/50 mmHg. CS values varied between 10,3 and > 46 ug/dL. Group 1: 8/20 patients (40 percent) with a variation between 10,3 and 17,3 ug/dL; Group 2: 7/20 patients (35 percent) between 19,9 and 27,8 ug/dL, and Group 3: 5/20 (25 percent) between 30,8 and > 46 ug/dL. The most significant difference among groups was found in Group 1 patients who required maximun dosage of DVA and presented hemodynamic stabilization with 150 to 300 mg of hydrocortisone perc day. There were no differences between groups 2 and 3 in DVA dosage, which was lower than for Group 1, and these did not evidence hemodynamic stabilization with hydrocortisone. In conclusion: A SC level > 18 ug/dL can be expected in critical patients undergoing SIRS during periods of hemodynamic instability. 2.- SC values lower than 18 ug/dL contribute to the hemodynamic instability determined by the initial sickness, and these cases require the administration of hydrocortisone in stress dosage. 3.- Patients with cortisol levels over 18 ug/dL receive no benefits from hydrocortisone. 4.- More studies in this field are requires to establish different patterns of steroidad response in critical patients

Perfil lipídico en desnutrición infantil / Lipidic profile in children with severe malnutricion

Objetivo. Evaluar el perfil lipídico en niños con desnutrición severa. Diseño. Estudio experimental, comparativo. Población. Sesenta niños. Metodología. El grupo se dividió en dos: 30 niños con diagnóstico de marasmo/kwashiorkor (grupo experimental) y 30 niños sanos (control), similares en sexo y edad. A ambos grupos se les realizó la prueba sanguínea de perfil lipídico. Ambos grupos fueron comparados estadísticamente a través de la prueba de t Students. Resultados. Se encontró que no exite diferencia estadísticamente significativa entre el colesterol total del grupo experimental y el grupo control (137.8 vrs 154.6 mg/dl). Se encontró diferencia estadísticamente significativa en los niveles de colesterol de alta densidad entre ambos grupos (27 (experimental) vrs 41.8 (control) mg/dl), de baja densidad (79 vrs 96.3 mg/dl), de muy baja densidad (31.8 vrs 16.5 mg/dl) y de triglicéridos (159.1 vrs 82.4 mg/dl). Conclusiones. Los hallazgos confirman que en la desnutrición severa infantil existe una hipertrigliceridemia paradójica