Centenario de Médica, el legado mayor del Dr. Mario E. Dihigo / The centenary of Medica, the biggest legacy of Dr. Mario E. Dihigo

RESUMEN Introducción: el Dr. Mario E. Dihigo Llanos, junto a un grupo de colegas emprendedores, fundó en Matanzas, en 1921, la revista Médica (devenida Revista Médica Electrónica en 1997). Objetivos: resaltar el centenario de la publicación y contribuir a la preservación de la memoria del eximio pedagogo. Materiales y métodos: fueron utilizados métodos de la investigación histórica, como el analítico-sintético y el deductivo-inductivo, así como los submétodos cronológico y geográfico. Se realizaron entrevistas y se revisó el legado documental del Dr. Dihigo. La información fue triangulada con las fuentes referenciadas y con otras bibliografías y documentos consultados. Resultados: se resaltaron algunos de los aspectos más significativos relacionados con la vida y la obra del Dr. Dihigo, y se realizó una caracterización de las primeras etapas de la revista, donde se abordan su significación histórica y científica. Conclusiones: sus aportes en Medicina y Pedagogía, así como sus esfuerzos por establecer la revista Médica, son los mayores legados de Dihigo (AU).

ABSTRACT Introduction: Dr. Mario E. Dihigo Llanos, and a group of colleagues-enterprisers, founded the journal Medica (renamed Revista Medica Electronica in 1997) in Matanzas, in 1921. Objectives: to highlight the centenary of the journal and to contribute to keep the memory of the prominent pedagogue up. Materials and methods: methods of the historical research were used like the analytic-synthetic and the deductive-inductive ones, and also the chronological and geographic sub-methods. Interviews were made and the documental legacy of Dr. Mario Dihigo was reviewed. The information was compared with the referenced sources and the other referred bibliography and documents. Results: some of the most significant features of Dr. Dihigo's life and work were emphasized. A characterization of the first stages of the journal was carried out, approaching its historical and scientific significance. Conclusions: the main Dihigo's legacies were his contributions to Medicine and Pedagogy, and his efforts for founding the journal Medica (AU).

Curva de aprendizaje para el diagnóstico ecográfico específico de masas anexiales / Learning curve for the specific ultrasound diagnosis of adnexal masses

OBJETIVO: Determinar el tiempo que requiere una curva de aprendizaje para diagnóstico ecográfico específico histopatológico en masas anexiales basándonos en cálculos estadísticos no influidos por la prevalencia según diferentes grados de experiencia. MÉTODOS: Estudio observacional, descriptivo, transversal. Se estudiaron imágenes de 108 masas anexiales. La prueba estándar de oro fue el reporte histopatológico definitivo. Se comparó el rendimiento diagnóstico de 4 examinadores con la siguiente experiencia en diagnóstico ecográfico de patología anexial: A > 20 años, B ≤ 20 hasta > 10 años, C ≤ 10 hasta > 5 años y D ≤ 5 años, analizando solo imágenes y sin datos clínicos de las pacientes, para emitir un diagnóstico específico a libre escritura. RESULTADOS: Prevalencia de masas malignas 17,2 % (15/87). Nivel de confianza en los examinadores se consideró según falta de respuesta diagnóstica: alto (<6 %) con experiencia de más de 10 años y moderado a bajo ≤ 10 años. Examinadores con más de 5 años siempre mostraron likelihood ratio positivo mayor a 10, exactitud diagnóstica mayor a 90 % y Odds ratio diagnóstica mayor a 46, no así para examinador con menor tiempo de experiencia, quién presentó resultados con mala utilidad clínica. El cambio de probabilidad de acierto específico pre-test a post-test mejoró consistentemente con los años de experiencia. CONCLUSIÓN: Se necesitarían más de 10 años de experiencia con especial dedicación a ecografía ginecológica avanzada para un rendimiento diagnóstico específico deseado junto con alta confianza en ecografía de masas anexiales.

OBJECTIVE: To determine the time required for a learning curve of histopathological specific ultrasound diagnosis in adnexal masses based on statistical calculations not influenced by prevalence according to different degrees of experience. METHODS: Observational, descriptive, cross-sectional study. Images of 108 adnexal masses were studied. The gold standard test was the definitive histopathological report. The diagnostic performance of 4 examiners with the following experience in ultrasound diagnosis of adnexal pathology: A > 20 years, B ≤ 20 to > 10 years, C ≤ 10 to > 5 years and D ≤ 5 years was compared, analyzing only images and blinded of clinical data of the patients, to issue a specific diagnosis with free writing. RESULTS: Prevalence of malignant masses 17.2% (15/87). The level of confidence in the examiners was considered according to the lack of diagnostic response: high (<6%) with experience of more than 10 years and moderate to low ≤ 10 years. The examiners with more than 5 years always showed likelihood ratio positive greater than 10, diagnostic accuracy greater than 90% and diagnostic Odds ratio greater than 46, not so for the examiner with less experience time who presented results with little clinical utility. The change in specific probability from pre-test to post-test improved consistently with years of experience. CONCLUSION: More than 10 years of experience with special dedication to advanced gynecological ultrasound are probably needed for a desired specific diagnostic performance coupled with high confidence in adnexal mass ultrasound.

Avaliação em uma residência de radiologia: elaboração de um novo instrumento e experiência inicial / Assessment in a radiology residency: development of a new method and initial experience

Resumo: Introdução: A educação médica baseada em competências tem despertado interesse nas últimas décadas. A avaliação do educando constitui um de seus pilares centrais, devendo ser contínua, fundamentada em critérios claros e eminentemente formativa, sempre provendo feedback. A sistematização dos métodos de avaliação envolve variáveis como confiabilidade, validade, aceitabilidade, impacto educacional e custo. Na radiologia, a literatura carece de instrumentos específicos de avaliação, especialmente em programas de residência médica no Brasil. Objetivo: Este estudo teve como objetivos elaborar e implementar um instrumento avaliativo com caráter formativo para o Programa de Residência Médica em Radiologia e Diagnóstico por Imagem (PRM-RDI) do Hospital Universitário Onofre Lopes da Universidade Federal do Rio Grande do Norte (Huol-UFRN), que englobe competências específicas e crie oportunidades para feedback nos cenários de prática. Método: Trata-se de um estudo de abordagem descritiva, exploratória e de intervenção, com três etapas. As duas primeiras consistiram em oficinas com médicos residentes e preceptores: uma para conceituação e compreensão da avaliação por competências e de técnicas de feedback, e outra para construção coletiva de um instrumento avaliativo adequado à radiologia, definindo as competências mais importantes a serem avaliadas. Na terceira etapa, os pesquisadores acompanharam a aplicação inicial do instrumento pelos preceptores. Resultado: As duas oficinas tiveram participação de três pesquisadores, 16 preceptores e cinco residentes. O instrumento de avaliação resultante contém inicialmente um cabeçalho para preenchimento de dados do residente e do avaliador, do local e exame realizado. Há ainda sete competências que devem ser avaliadas em relação ao esperado para o nível do residente e uma escala para conceito geral da avaliação, seguida de campos para comentários do preceptor e do residente. O instrumento foi aplicado 33 vezes nos cenários de prática, num período de seis meses. Conclusão: A realização de oficinas de capacitação para os preceptores, com a introdução de uma nova cultura de avaliação, foi fundamental para a construção e experiência inicial na aplicação do instrumento no referido programa. O instrumento apresentou viabilidade, baixo custo e teve boa aceitabilidade entre preceptores e residentes, servindo como marco inicial na busca por uma avaliação sistematizada na residência médica na área de radiologia.

Abstract: Introduction: There has been a growing interest in competency-based medical education over the past few decades. Student assessment is one of its central pillars, and should be continuous, based on clear and eminently formative criteria, and provide constant feedback. The systematization of assessment methods involves variables such as reliability, validity, acceptability, educational impact and cost. In Radiology, the literature lacks specific assessment instruments, especially in Medical Residency Programs in Brazil. Objective: Our aim was to develop and implement an assessment tool with a formative character for the Radiology program of the Onofre Lopes University Hospital of the Federal University of Rio Grande do Norte, which encompasses specific skills and creates opportunities for feedback in practice scenarios. Method: The study has a descriptive, exploratory and interventionist approach, divided into three stages. The first two consisted of workshops with residents and preceptors, one to conceptualize and understand competency assessment and feedback techniques, and the other to collectively build an assessment tool appropriate for Radiology, defining the most important competencies to be assessed. In the third stage, the researchers monitored how the instrument was initially applied by the preceptors. Result: Both workshops were attended by the three researchers, sixteen preceptors and five residents. The resulting assessment instrument contains a header for resident and evaluator data, location and examination performed. Next, seven competencies that should be assessed in relation to what is expected for the resident's level, and an overall scale of the evaluation, followed by fields for comments by the preceptor and the resident. The instrument was applied 33 times in practice scenarios, over a six-month period. Conclusion: The execution of training workshops for preceptors, with the introduction of a new culture of assessment, was fundamental for the construction and initial experience in the application of the assessment tool in that program. This tool was found to be feasible, low cost and had good acceptability among preceptors and residents, serving as a starting point in the search for a systematic assessment in the Radiology residency program.

Semiology and radiology integration: a new trend in the teaching-learning process / Integração semiologia e radiologia: nova tendência no processo de ensino e aprendizagem

Abstract: Introduction: The development of clinical reasoning to diagnose diseases and order ancillary tests, such as radiology imaging, is based on history-taking and physical examination skills, which are developed during the semiology course. Objective: We aimed to evaluate the results of the innovative integration of two courses in the medical curriculum at our institution: Medical Semiology and Clinical Radiology. Methods: The sample consisted of 184 fifth-semester medical students attending the two courses simultaneously. Extra-class semiology-radiology sessions based on theoretical and practical topics integrating radiological images and semiological signs were conducted, and the results were assessed by applying a semi-structured questionnaire to the participants, in which all 18 items were rated on a scale from 0 (worst) to 10 (best). The normality hypothesis in score distribution was verified by the Kolmogorov-Smirnov test and the Shapiro-Wilk test. The distribution of the 18 scores were summarized by descriptive statistics and compared by Friedman's test, with post-hoc test in pairwise comparisons adjusted by Bonferroni test. Correlations between the scores were determined by Spearman's Rank Correlation Coefficients. Results: The overall mean score for the semiology-radiology sessions was high (8.55). Students were satisfied with the selection of clinical cases (8.46) and found that the semiology-radiology sessions contributed to the development of their clinical reasoning (8.58). Conclusion: Medical schools are facing new challenges in medical education. The innovative concept of Radiology-Semiology integrated teaching modality affects the students' self-perception ability to interpret radiological images and might be an educational strategy trend.

Resumo: Introdução: O desenvolvimento do raciocínio clínico para diagnosticar doenças e solicitar exames complementares, como os radiológicos, baseia-se na história e no exame físico, desenvolvidos durante o curso de Semiologia. Objetivo: Nosso objetivo foi avaliar os resultados da integração inovadora de duas disciplinas no currículo médico em nossa instituição: Semiologia Médica e Radiologia Clínica. Métodos: A amostra foi composta por 184 estudantes de Medicina do quinto semestre que participaram das duas disciplinas simultaneamente. Realizaram-se sessões extraclasse de semiologia e radiologia, baseadas em tópicos teóricos e práticos, integrando imagens radiológicas com sinais semiológicos. Avaliaram-se os resultados por meio da aplicação de um questionário semiestruturado aos participantes, no qual todos os 18 itens foram classificados em uma escala de 0 (pior) a 10 (melhor). A hipótese de normalidade na distribuição dos escores foi verificada pelos testes de Kolmorov-Smirnov e Shapiro-Wilk. As 18 distribuições de pontuação foram resumidas por estatística descritiva e comparadas pelo teste de Friedman, com teste post hoc em comparações pareadas ajustadas por Bonferroni. As correlações entre as pontuações foram determinadas pelos coeficientes de correlação de classificação de Spearman. Resultados: O escore médio geral para as sessões de semiologia e radiologia foi alto (8,55). Os estudantes ficaram satisfeitos com a seleção de casos clínicos (8,46) e descobriram que as sessões de semiologia-radiologia contribuíram para o desenvolvimento de seu raciocínio clínico (8,58). Conclusão: As escolas médicas enfrentam novos desafios na educação médica. O conceito inovador da modalidade de ensino integrado de radiologia-semiologia afeta a capacidade de autopercepção dos alunos para interpretar imagens radiológicas e pode ser uma tendência de estratégia educacional.

Development of a software for radiological breast mammography anatomy and technical procedures study / Desenvolvimento de un software para estudio de anatomia y procedimientos técnicos en mamografia radiológica de mama

The aim of this study was to develop a software for radiological breast mammography anatomy study. A descriptive and exploratory study was carried out using mammography images database. The software was created using well-known open source image J software. Eight mammographic images were selected including standard views: craniocaudal (CC) and mediolateral oblique (MLO) views, and supplementary views. The software was created as an image J plugin-in. The virtual environment presented multiple choice questions related to radiological breast anatomy and patient positioning criteria. The software launches by requiring the user to register their profile ( user ID) followed by the selection of mammography projection technique. As the second step, a screen with multiple choice questions opens according to the technique selected by the user. At the end of the evaluation, a report is presented containing date and time of evaluation, username and the score achieved. The report also provide feedback to the user and highlight where the user incorrectly identified the anatomy. The software allowed assist on multifactor mammography learning process for radiographers. However, It is necessary the improvement of software including high quality images and case study.

El objetivo de este estudio fue de el desarrollo de un software para estudio de anatomía y procedimientos en mamografía de mama. Se realizó un estudio descriptivo y exploratorio utilizando una base de datos de imágenes mamográficas. La aplicación se creó utilizando un conocido software (imagen J) de código abierto. Se seleccionaron ocho imágenes mamográficas que incluían proyecciones estándar: proyecciones craneocaudal (CC) y mediolateral oblicua (MLO) y proyecciones complementarias. El software fue creado como un complemento de imagen J. El entorno virtual presentó preguntas de múltiple opción relacionadas con la anatomía radiológica de la mama y los criterios de posicionamiento del paciente. El software se inicia solicitando al usuario que registre su perfil (ID de usuario) seguido de la selección de la técnica de proyección de mamografía. Como segundo paso, se abre una pantalla con preguntas de opción múltiple según la técnica seleccionada por el usuario. Al final de la evaluación, se presenta un informe que contiene la fecha y hora de la evaluación, el nombre de usuario y la puntuación obtenida. El informe también proporciona comentarios al usuario y destaca dónde el usuario identificó incorrectamente la anatomía. El software permitió asistir en el proceso de aprendizaje de mamografías multifactoriales para radiólogos. Sin embargo lo és necesaria la mejora del software, incluidas imágenes de alta calidad y estudios de casos.

Evolución histórica de la docencia de posgrado de la especialidad Imagenología en Sancti Spíritus / Historical evolution of the postgrad Imaging specialty teaching in Sancti Spíritus

RESUMEN Fundamento: En la provincia Sancti Spíritus se constató la ausencia de publicaciones sobre la historia de la docencia de posgrado en la especialidad Imagenología, por lo que se hizo necesaria una investigación que aportara información al patrimonio científico cubano en ciencias de la salud y a la formación del potencial humano actual y futuro. Objetivo: Describir la evolución histórica de la docencia de posgrado de la especialidad Imagenología en la provincia Sancti Spíritus. Desarrollo: Se realizó una investigación cualitativa con el uso de métodos teóricos: histórico-lógico, analítico-sintético y empíricos: entrevista y análisis documental, en el período comprendido desde 1976 hasta 2020. Resultados: Desde el surgimiento de Sancti Spíritus como provincia ya existían algunos médicos radiólogos, pero no fue hasta 1982 que comenzó oficialmente el estudio de la especialidad en el territorio, como filial de Villa Clara. Con la fundación de la Facultad de Ciencias Médicas en 1986 inició un nuevo capítulo de formación de especialistas en Radiología. Con el advenimiento de nuevas técnicas, en 2006 se cambió el nombre de la especialidad por Imagenología. En la actualidad se mantiene la formación regular de especialistas, incluidos residentes autofinanciados. Conclusiones: La Imagenología como especialidad de posgrado en la provincia Sancti Spíritus ha tenido un desarrollo histórico progresivo, gracias al fortalecimiento del claustro de profesores, la formación continua de recursos humanos para la atención a la población del territorio y los resultados científico-técnicos que avalan el progreso actual de la especialidad. La descripción de su evolución histórica permite perfeccionar la formación de las futuras generaciones, asimismo generar pautas para otras investigaciones.

ABSTRACT Background: In Sancti Spíritus province, the absence of publications on the history of Imaging postgraduate teaching was verified, thus, it was necessary an investigation that would provide information to the Cuban-health sciences-scientific heritage and also to the formation of the current and future human potential. Objective: To describe the historical evolution of Imaging postgraduate teaching in Sancti Spíritus province. Development: A qualitative research was carried out with the use of theoretical methods: historical-logical, analytical-synthetic and empirical: interview and documentary analysis, from 1976 to 2020. Results: Since the emergence of Sancti Spíritus as province, there were already some radiologists, but it was not until 1982 that the study of the specialty in the territory officially began as a Villa Clara´s subsidiary. In 1986, with the founding of the Faculty of Medical Sciences, a new chapter of training to Radiology specialists began. In 2006, with the advent of new techniques, the name of the specialty was changed to Imaging. At present, the regular training of specialists is maintained, including self-financed residents. Conclusions: Imaging as a postgraduate specialty in Sancti Spíritus province has had a progressive historical development, thanks to the strengthening of the teaching staff, the continuous training of human resources for the care of the population in the territory, also the scientific-technical results that support the current progress of the specialty. The description of its historical evolution allows to improve the training of future generations, as well as to generate guidelines for other investigations.

Evaluación de habilidades transversales de comunicación y colaboración a través de un examen clínico objetivo estructurado de radiología de urgencias para residentes de un programa universitario de especialidad en radiología / Assessment of generic skills in communication and collaboration through an objective structured clinical examination in emergency radiology in a university residency program in Chile

Introducción: La Radiología de Urgencias es una unidad de aprendizaje longitudinal a toda la residencia. En ella los residentes se enfrentan a patología de urgencia en distintas modalidades de imagen. Además del dominio cognitivo, los residentes deben desarrollar habilidades de comunicación y colaboración que les permitan enfrentar adecuadamente los turnos de residencia. Previo a incorporarse a los turnos nocturnos, los residentes deben aprobar un Examen Clínico Objetivo Estructurado (ECOE). Propósito: Evaluar competencias de comunicación y colaboración a través de estaciones de ECOE de Radiología de Urgencias aplicado a residentes de 2º año de residencia. Metodología: Se seleccionaron objetivos específicos a evaluar para las competencias de comunicación y colaboración y contenidos de Radiología Abdominal, Osteoarticular y Pediátrica para diseñar tres estaciones de ECOE, las cuales fueron incorporadas en el instrumento de evaluación aplicado el año 2017. Se calcularon porcentajes de logro por estación y tipo de pauta de evaluación. Para evaluar la implementación de las estaciones, se diseñó y aplicó una encuesta de percepción a los residentes. Resultados: Se diseñaron tres estaciones, dos para el rol Comunicador y una para el rol Colaborador. La validez de contenido se aseguró a través de un panel de expertos. Los porcentajes de logro global en las estaciones fluctuaron entre 74,7% y 95,6%. Las estaciones fueron bien evaluadas por parte de los residentes, quienes valoraron la incorporación de competencias diferentes al dominio cognitivo en el instrumento de evaluación. Conclusión: El ECOE permite certificar habilidades transversales como comunicación y colaboración de manera apropiada

Introduction: Emergency radiology (ER) is taught and learned throughout the entire residency. Trainees are exposed to different subspecialties ER cases and through varied imaging techniques. In addition to the "medical expert" domain, residents must develop communication and collaboration skills that will help them during their call schedule. Before they can take night-call, radiology residents must pass an Objective Structured Clinical Examination (OSCE). Purpose: To evaluate communication and collaboration competencies on an ER-OSCE applied to second-year radiology residents. Methods: Specific learning objectives were defined to evaluate communication and collaboration skills in abdominal, musculoskeletal and pediatric ER. Three OSCE stations were designed for this purpose and added to the evaluation instrument in 2017. On each station, resident performance was assessed with a specific template and percentage of goal achievement was calculated. Trainee´s opinion of this new modality was obtained through a perception survey. Results: Three stations were designed, two for the communicator role and one for the collaborator competency. Validity of content confirmed through an expert panel. Percentages of goal achievement on each station varied between 74,7% and 96,6. The new stations were positively evaluated by residents, which valued that competencies other than "medical expert" were being assessed. Conclusion: ER-OSCE allows the appropriate assessment of generic competencies such as communication and collaboration in radiology.

Desarrollo de un curriculum de radiología para la formación médica de pregrado: experiencia de una escuela de medicina de Chile / Development of radiology curriculum in undergraduate medical education: experience of a chilean school of medicine

Existe consenso por parte de las autoridades académicas y los estudiantes de Medicina de pregrado que es necesaria la incorporación de la Imagenología a los planes de estudio de la carrera. Sin embargo, esto no se ha traducido en una participación constante de los médicos radiólogos en la formación de los futuros médicos. Nuestra Escuela de Medicina implementó un nuevo plan de estudios el año 2015 el que, entre otros aspectos, acortó la duración de la carrera de 7 a 6 años e integró la Imagenología en forma longitudinal a lo largo de la malla curricular. Para llevar a cabo este proceso de integración curricular fue necesario la decisión departamental y de la Dirección de Pregrado, para así identificar las oportunidades de incorporación de médicos radiólogos en la educación médica de pregrado.

There is wide agreement between teachers, students and authorities in the Schools of Medicine regarding the need of incorporating Medical Imaging teaching for undergraduates. Nonetheless, there is no active nor constant participation of radiologists in teaching for Medicine students. In our Medical School a new program was implemented in 2015, with a duration of 6 years (instead of 7 years, as previously), incorporating Medical Imaging teaching across the curriculum. To achieve the latter objective it was necessary to actively involve the Radiology (Medical Imaging) Department and the Undergraduate Director, identifying the opportunities to incorporate radiologists in medical teaching.

An innovative ex-vivo model for rapid change of the papilla for teaching advanced endoscopic retrograde cholangiopancreatography procedures / Modelo ex-vivo inovador de troca rápida da papila para o ensino de procedimentos avançados na colangiopancreatografia endoscópica retrógrada

ABSTRACT Background: Models for endoscopic retrograde cholangiopancreatography training allow practice with an expert feedback and without risks. A method to rapidly exchange the papilla can be time saving and accelerate the learning curve. Aim: To demonstrate a newly method of rapid exchange papilla in ex-vivo models to teach retrograde cholangiopancreatography advanced procedures. Methods: A new model of ex-vivo papilla was developed in order to resemble live conditions of procedures as cannulation, papilotomy or fistula-papilotomy, papiloplasty, biliary dilatation, plastic and metallic stentings. Results: The ex-vivo model of papilla rapid exchange is feasible and imitates with realism conditions of retrograde cholangiopancreatography procedures. Conclusion: This model allows an innovative method of advanced endoscopic training.

RESUMO Racional: Nas últimas décadas os simuladores de colangiopancreatografia retrógrada tiveram grande evolução. Atualmente dispõem-se de vários métodos para realizar o treinamento minimizando os riscos de complicações e tornando a curva de aprendizagem muito rápida. Objetivo: Demonstrar uma variação dos modelos ex-vivos desenvolvidos para o treinamento avançado em colangiopancreatografia retrograda. Método: Foi criado um modelo ex-vivo simulando fatores e condições reais para o treinamento avançado de colangiopancreatografia retrograda como canulação, papilotomia, fistulotomia, papiloplastia e uso de próteses plásticas e metálicas. Resultados: Esse modelo ex-vivo, com a possibilidade de troca rápida da papila, mostrou-se viável e no treinamento simula condições muito próximas às reais. Conclusão: Neste modelo há grande inovação para o treinamento de novos endoscopistas em procedimento avançados na colangiopancreatografia retrógrada.

Respiratory immunohistochemical study in rats exposed to cigarette smoke and alcohol

PURPOSE: To investigate the effects of exposure to cigarette and alcohol on immunohistochemical disorders caused by these attacks to respiratory system of rats. METHODS: Sixty male Wistar rats in four groups: control, cigarette smoke, alcohol and cigarette smoke + alcohol during 260 days. Immunohistochemistry was performed by researching survivin and protein P53 expressions and apoptotic index in parenchymal lung and trachea using TUNEL technique. RESULTS: There was body growth impairment in all experimental groups. Both smoker groups animals had higher trachea survivin expression and bronchial higher apoptotic index. The trachea apoptotic index was also higher in the cigarette smoke group as well as in the alveoli in the cigarette smoke + alcohol group. The three experimental groups showed negative immunoexpression for P53. CONCLUSIONS: this model resulted in immunohistochemical changes caused mainly by exposure to cigarette smoke. There was a synergistic action between alcohol and tobacco in the growth impairment in animals as well as in the cellular apoptotic index. The positive immunoexpression for tracheal survivin in animals from both groups exposed to tobacco smoke and associated with a negative P53 immunoexpression suggests that despite the aggression, carcinogenesis has not happened yet. In addition, the bronchial higher apoptotic index in smokers may be responsible for emphysema. .

Clotting Factor XIII and desmopressin improve hemostasis in uncontrolled bleeding

PURPOSE: To investigate hemostatic effects of supplementary factor XIII and desmopressin (DDAVP) in resuscitation of uncontrolled bleeding. METHODS: Fifty-four rabbits were randomized in nine groups: G1: Sham; G2: FXIII and normotensive resuscitation (NBP); G3: FXIII and permissive hypotension (PH) (MAP 60% baseline); G4: FXIII/DDAVP/NBP; G5: FXIII/DDAVP/PH; G6: NBP only; G7: FXIII no hemorrhage; G8: FXIII/DDAVP no hemorrhage; G9: PH only. Thromboelastometry and intra-abdominal blood loss were assessed. Scanning electron microscopy (EM) of the clots was performed. RESULTS: Compared to Sham, only G8 (FXIII/DDAVP w/o hemorrhage) showed clotting time (CT) significantly lower (p<0.05). NBP alone (G6) resulted in significantly prolonged CT compared to G2, G3 and G5 (p<0.05). Similarly, median alpha angle was significantly larger in G3,4,5, and 9 compared to G6 (p<0.05). Area under the curve was significantly greater in G5 than G2. Intra-abdominal blood loss was lower in G5 and G9 compared to G2 and G6. FXIII/DDAVP and PH resulted in more robust fibrin mesh by EM. CONCLUSIONS: Normotensive resuscitation provokes more bleeding and worsens coagulation compared to pH, that is partially reversed by factor XIII and desmopressin. FXIII and DDAVP can synergistically improve coagulation. Permissive hypotension reduces bleeding regardless of those agents. .

La evaluación en Radiología como aporte pedagógico / Evaluation in Radiology as a pedagogic contribution

Tras definir lo que se considera evaluación (esto es, un proceso sistemático de recolección y análisis de información para tomar decisiones en el ámbito del aprendizaje de la Radiología en la carrera de Medicina), hay que precisar sus características: la finalidad (para qué evaluamos), el objeto (qué contenidos evaluamos), con qué referentes de valor (es decir, con qué los comparamos), cuándo debemos evaluar, con qué rigor o qué costos. Así, luego de responder estas preguntas, podemos seleccionar los procedimientos más adecuados para una evaluación, teniendo siempre en cuenta que ésta responde a un proceso, mientras que la calificación implica ya una decisión. Existen distintos tipos de evaluación: la inicial, que no tiene por qué ser nominal y está orientada a definir el nivel que tienen los estudiantes al inicio de la asignatura; la normativa o de orientación, que tiene carácter relativo, en tanto se evalúa según los resultados del grupo; y la absoluta o criterial, que se basa en las pautas establecidas, convirtiendo a los objetivos planteados en el elemento clave para diseñar la enseñanza y el examen. La evaluación puede utilizarse como un instrumento de motivación. Para ello, hay que establecer propósitos claros y relevantes, así como también es necesario explicar cómo corregir los errores. Las preguntas orales en clase, bien organizadas, también funcionan como estímulo. Dentro del triple dominio a considerar (cognitivo, afectivo y psicomotor) deben considerarse los objetivos a medir de menor a mayor nivel. Es decir, los conocimientos necesarios, la comprensión de dichos conceptos, su aplicación en la práctica (en un contexto diferente en el que se han aprendido) y las llamadas “operaciones superiores”(capacidad de análisis, síntesis y valoración).A partir de ahí, se decidirán las cualidades técnicas de la evaluación: su validez interna y externa, en relación con el grado de dificultad y discriminación; su fiabilidad, esto es, su precisión y consistencia...

Radiology Residents' Awareness about Ionizing Radiation Doses in Imaging Studies and Their Cancer Risk during Radiological Examinations

OBJECTIVE: Imaging methods that use ionizing radiation have been more frequent in various medical fields with advances in imaging technology. The aim of our study was to make residents be aware of the radiation dose they are subjected to when they conduct radiological imaging methods, and of cancer risk. MATERIALS AND METHODS: A total of 364 residents participated in this descriptive study which was conducted during the period between October, 2008 and January, 2009. The questionnaires were completed under strict control on a one-to-one basis from each department. A chi2-test was used for the evaluation of data obtained. RESULTS: Only 7% of residents correctly answered to the question about the ionizing radiation dose of a posteroanterior (PA) chest X-ray. The question asking about the equivalent number of PA chest X-rays to the ionizing dose of a brain CT was answered correctly by 24% of residents; the same question regarding abdominal CT was answered correctly by 16% of residents, thorax CT by 16%, thyroid scintigraphy by 15%, intravenous pyelography by 9%, and lumbar spine radiography by 2%. The risk of developing a cancer throughout lifetime by a brain and abdominal CT were 33% and 28%, respectively. CONCLUSION: Radiologic residents should have updated knowledge about radiation dose content and attendant cancer risks of various radiological imaging methods during both basic medical training period and following practice period.

Evaluating the Accuracy of Emergency Medicine Resident Interpretations of Abdominal CTs in Patients with Non-Traumatic Abdominal Pain

Abdominal computed tomography (CT) is widely used as a diagnostic tool in emergency medicine (EM) to accurately diagnose abdominal pain. EM residents must be able to offer preliminary interpretations of CT imaging. In this study, we evaluated the preliminary interpretation ability of a sample of emergency residents presented with adult abdominal CT images, and compared their results with those of radiology residents. We conducted a prospective observational study from November 16, 2008 to June 30, 2009. During this time, we gathered preliminary interpretations of consecutive abdominal CT made by emergency and radiology residents. We assessed the discrepancy rates of both samples by comparing their findings to the final reports from attending radiologists. A total of 884 cases were enrolled in the present study. The discrepancy rates of emergency and radiology residents were 16.7% and 12.2%, respectively. When female genital organs, peritoneum, adrenal glands, or the musculoskeletal system were abnormal, we found that emergency residents' preliminary interpretations of CT images were insufficient compared to those of radiology residents. Therefore more formal education is needed to emergency residents. If possible, the preliminary interpretations of radiology attending physicians are ideal until improving the ability of interpretations of emergency residents in abdomen CT.

Apuntes sobre la enseñanza-aprendizaje de la radiología oral / Notes on the teaching-learning process of oral radiology

El innegable impacto que la radiología oral ha tenido sobre los diagnósticos clínicos y la incidencia de su prácticapara profesionales, teóricos, instructores y empíricos; lo mismo que para los pacientes constituyen el centro de este ensayo. El objetivo fue establecer un marco pedagógico y académico sobre el cual se evidenciara que enseñar radiología es tambiénuna cuestión y una oportunidad de aprendizaje. Se ofrece una mirada vivencial fundamentada en las experiencias y reflexiones surgidas en la enseñanza y aprendizaje de la radiología oral durante varios años. Finalmente se propone la enseñanza de la radiología como una disciplina que implica comprender una compleja práctica en la que se insertan y complementan saberes teóricos, prácticos y empíricos.

The remarkable impact that oral radiology has had on the clinical diagnosis and the importance of its practice for professionals, theoreticians, empirics and instructors, as well as patients, is the central objective of this essay. The objective was to establish a pedagogic and academic framework over which it will be evident that the teaching of radiology is also a matter oflearning opportunity (apprenticeship). A realistic point of view is offered, based on reflections and experiences arisen from the teaching and learning of oral radiology over several years. Finally as a proposal, the author suggests assuming the teaching of radiology as a complex practice in which theoretical, empirical and practical factors are complemented.