Evolution of medical education in the Department of Medicine of the Complutense University of Madrid in the last decade.

OBJECTIVES: This paper aims to show changes in Medical Education in the Department of Medicine at the Complutense University of Madrid in the last 10-15 years. RESULTS: Medical education in the Department of Medicine at the Complutense University of Madrid has undergone significant changes in the last 10-15 years. An attempt to summarize these shows that radical change in the teaching of medicine for both teachers and students has taken place in three areas: 1. Progressive development of Patient-centered medical education. 2. Development of a competency-based training concerned with the mastering of knowledge and skills and their evaluation through objective and structured clinical assessment tests. 3. Introducing simulation techniques and virtual reality in the teaching of clinical practice aimed at improving our students' training and enhancing patient safety. CONCLUSIONS: We believe that the changes applied have pleased students as well as teachers and even patients and are helping to improve the training of our students.

New horizons in anticoagulation: Direct oral anticoagulants and their implications in oral surgery.

BACKGROUND: Thrombotic disorders remain a leading cause of death in the Western World. For decades, vitamin K antagonists used in the prevention of this pathology, such as warfarin or sintrom, were the only oral agents available for long-term anticoagulation, in spite of their disadvantages. MATERIAL AND METHODS: An electronic database search was carried out on MedLine and The Cochrane Library Plus, without restrictions on the type of study nor dates, in English and Spanish. Abstracts were reviewed, and complete articles if necessary, considering all articles that included recommendations on DOACs and oral surgery. RESULTS: In recent years, the so-called "new oral anticoagulants" have been introduced in clinical practice to treat those patients whose medical conditions require long-term anticoagulant treatment, replacing traditional oral anticoagulants. CONCLUSIONS: The new oral anticoagulants represent new therapeutic options, with a number of advantages such as poor interaction with food, minor drug interactions, and do not require periodic dose adjustments or routine controls. The purpose of this review is to establish an update on the new oral anticoagulants: Dabigatran, Rivarozaban, Apixaban and Edoxaban.

Extra-large pore zeolite (ITQ-40) with the lowest framework density containing double four- and double three-rings.

The first zeolite structure (ITQ-40) that contains double four (D4) and double three (D3) member ring secondary building units has been synthesized by introducing Ge and NH(4)F and working in concentrated synthesis gels. It is the first time that D3-Rs have been observed in a zeolite structure. As was previously analyzed [Brunner GO, Meier, WM (1989) Nature 337:146-147], such a structure has a very low framework density (10.1 T/1,000 A(3)). Indeed, ITQ-40 has the lowest framework density ever achieved in oxygen-containing zeolites. Furthermore, it contains large pore openings, i.e., 15-member rings parallel to the [001] hexagonal axis and 16-member ring channels perpendicular to this axis. The results presented here push ahead the possibilities of zeolites for uses in electronics, control delivery of drugs and chemicals, as well as for catalysis.

[Use of mitomycin C in esophageal stenosis]. / Empleo de la mitomicina C en las estenosis esofágicas.

INTRODUCTION: Esophageal stenosis, due to its important implications on the patients' quality of life, poses a serious problem, often difficult to resolve, that requires therapeutical solutions that could irreversibly affect vital conditions and quality of life of those affected. For this reason our group has tried over the last thirty years to employ conservative solutions in the damaged aesophagus, showing that a complete cure is possible in most cases although the way to achieve this can be dramatically long. MATERIAL AND METHODS: We present our experience employing topical Mitomicyn C over the last year and a half in eight patients, six of them affected with caustic stenosis and two with secuelae of esophageal atresia, highlighting the three cases that received at least five applications of the product. We describe the method employed that consists in the spraying of the correct dose using a flexible fibroscope on the dilated area, loading the dose in the container of the cleaning water of the fibroscope, employing a system that permits only to apply the exact quantity necessary of the product. The application time is five minutes and the dose is 0.4 mg/ml applying 5ml or 10 ml according to the patient's weight ( under 12 kg = 2.5 ml and over 25 kg=5 ml). Upon completion of the application, a washing of the product is performed using the same fibroscope. RESULTS: From the eight cases in which it was applied, we analysed the three that received at least five doses. These were two boys of seven and eight years and a 25 year-old woman. In the children the dilatations interval has passed from 4-5 weeks to 8-11 respectively. The woman has passed from 12 to15 weeks. The children have been in the dilatation program more than 3 years and the woman more than 18. CONCLUSIONS: Although the time period that we have been applying Mitomicyn C is still short, the symptom-free interval after dilatations is proving to be highly promising. This fact is highlighted in those patients included in the dilatation program recently. We have not seen any adverse side effect from the application of the product.

Empleo de la mitomicina C en las estenosis esofágicas / Use of mitomicyn C in esophageal stenosis

Introducción. Las estenosis esofágicas por las importantes implicaciones que tienen en la calidad de vida de los pacientes constituyen un grave problema, en general de difícil solución, que obliga a tomar decisiones terapéuticas que pueden condicionar de un modo irreversible las condiciones vitales y el confort de aquellos que las padecen. Por ese motivo, nuestro grupo optó desde hace más de 30 años por soluciones conservadoras sobre el esófago lesionado, demostrando que la curación completa es posible en la mayoría de los casos aunque el camino para conseguirla puede ser en ocasiones desesperantemente largo. Material y métodos. Presentamos el empleo tópico de mitomicina C en el ultimo año y medio en ocho pacientes afectos, seis de ellos de estenosis de tipo cáustico y dos casos de atresia de esófago, centrándonos fundamentalmente en los tres casos que han recibido al menos cinco aplicaciones del producto. Se describe el método empleado que consiste en el rociado de la dosis adecuada empleando un fibroscopio flexible sobre el área dilatada, cargando la dosis en el frasco de líquido de lavado del fibroscopio mediante un sistema que impulsa sólo la cantidad de producto deseado. El tiempo de aplicación es de cinco minutos y la dosis es de 0,4 mg/ml aplicando 2,5 o 5 ml según el peso del paciente (5 ml peso > 12 kg y 2,5 ml peso < 12 kg). Completada la aplicación se efectúa un lavado del producto con el mismo fibroscopio. Resultado. De los ocho casos en los que se ha aplicado, se analizan los tres que han recibido al menos cinco dosis. Se trata de dos niños de 7 y 8 años y una mujer de 25. En los niños el intervalo de dilataciones ha pasado de 4 y 5 semanas a 8 y 11 respectivamente. La mujer ha pasado de 12 a 15 semanas. Los niños llevaban más de tres años en programa de dilatación y la mujer más de 18. Conclusiones. Aunque el tiempo que llevamos aplicando la mitomicina C es todavía muy corto, resulta altamente prometedor el incremento del intervalo de tiempo libre de síntomas tras las dilataciones, hecho especialmente destacable en los pacientes con menos tiempo en programa de dilatación. No hemos evidenciado ningún efecto secundario tras la aplicación (AU)

Introduction. Esophageal stenosis, due to its important implications on the patients’ quality of life, poses a serious problem, often difficult to resolve, that requires therapeutical solutions that could irreversibly affect vital conditions and quality of life of those affected. For this reason our group has tried over the last thirty years to employ conservative solutions in the damaged aesophagus, showing that a complete cure is possible in most cases although the way to achieve this can be dramatically long. Material and Methods. We present our experience employing topical Mitomicyn C over the last year and a half in eight patients, six of them affected with caustic stenosis and two with secuelae of esophageal atresia, highlighting the three cases that received at least five applications of the product. We describe the method employed that consists in the spraying of the correct dose using a flexible fibroscope on the dilated area, loading the dose in the container of the cleaning water of the fibroscope, employing a system that permits only to apply the exact quantity necessary of the product. The application time is five minutes and the dose is 0.4 mg/ml applying 5ml or 10 ml according to the patient’s weight ( under 12 kg = 2.5 ml and over 25 kg=5 ml). Upon completion of the application, a washing of the product is performed using the same fibroscope. Results. From the eight cases in which it was applied, we analysed the three that received at least five doses. These were two boys of seven and eight years and a 25 year-old woman. In the children the dilatations interval has passed from 4-5 weeks to 8-11 respectively. The woman has passed from 12 to15 weeks. The children have been in the dilatation program more than 3 years and the woman more than 18. Conclusions. Although the time period that we have been applying Mitomicyn C is still short, the symptom-free interval after dilatations is proving to be highly promising. This fact is highlighted in those patients included in the dilatation program recently. We have not seen any adverse side effect from the application of the product (AU)

Synthesis of ITQ-21 in OH- media.

ITQ-21 has been synthesized from F- free gels; aluminum can be incorporated and this does not affect the rate of nucleation. The introduction of stoichiometric amounts of NH4F with respect to the number of double four rings (D4R) present in the structure leads to an increase in the nucleation and crystallization rate with a quantitative incorporation of fluoride ions into the solid.

Characterization of germanium site distribution in zeolite ITQ-7 by photoluminescence.

Zeolite ITQ-7 containing germanium emits luminescence upon excitation at the wavelength of the absorption maxima; control experiments with amorphous GeO2 and all-silica zeolites indicate that the emission is attributable to Ge atoms occupying framework positions; the emission decays on the nanosecond time scale and it fits to variable proportions of three exponential kinetics, this being compatible with the presence of three families of Ge atoms in the solid.

Recombinant factor VIIa in continuous infusion during central line insertion in a child with factor VIII high-titre inhibitor.

Recombinant factor VIIa (rFVIIa) is a recently added new tool for the treatment of haemophilia patients with inhibitors. A major drawback in the use of rFVIIa is its short half-life, which necessitates frequent bolus injections. Thus the use of rFVIIa in continuous infusion appears to be a good alternative. We describe the use of rFVIIa, administered by continuous infusion with a minipump during the insertion of a central venous catheter in a child with a high-titre factor VIII inhibitor. rFVIIa was administered as an intravenous bolus (90 micrograms kg-1 [4.5 kIU kg-1]), 1 h prior to central line insertion, after which the continuous infusion was immediately started for 5 days. The infusion rate was based on the clearance obtained from a previous pharmacokinetic study. Effective haemostasis and normal healing of surgical incisions were achieved after central line insertion. No local thrombophlebitis nor evidence of generalized activation of the coagulation cascade was observed. Single-dose pharmacokinetic parameter values were clearance (Cl) 34.6 mL h-1 kg-1, volume of distribution (Vd) 40.6 mL kg-1 and mean residence time (MRT) 1.17 h. The recovery was 2.27% U-1 kg-1. rFVIIa showed a monophasic decay. Cl during continuous infusion was 23.4 +/- 6.9 mL h-1 kg-1. The administration of rFVIIa by continuous infusion is effective, safe and more convenient when compared to other clotting factors. Moreover, continuous infusion provides significant economic savings (77% decrease in rFVIIa requirements).

Anesthetic efficacy of eutectic prilocaine-lidocaine cream in pediatric oncology patients undergoing lumbar puncture.

OBJECTIVE: To evaluate the efficacy of eutectic mixture of local anesthetics 5% (Emla) in reducing pain associated with lumbar punctures in children. DESIGN: Prospective, double-blind, randomized, placebo-controlled trial. SETTING: University pediatric hospital. PATIENTS: Eleven pediatric oncology patients (mean age 6.6 y, range 4-16) who underwent 31 lumbar punctures. MAIN OUTCOME MEASURES: The analgesic effect was measured by using two methods. The first was a 10-point visual analog scale reported by the patient and the second was an 8-point behavioral pain scale assessed by the nurse who applied the cream. RESULTS: Emla cream was associated with significantly lower pain scores than those with placebo as measured by the patient when the puncture was successful on the first attempt (2.0 +/- 1.6 Emla group, 3.8 +/- 1.9 placebo group; p < 0.05). CONCLUSIONS: The use of Emla cream may reduce pain substantially only in patients who undergo a successful lumbar puncture on the first attempt.

Errors evolution and analysis in antineoplastic drug preparation during one year.

We analyzed the errors occurring in the preparation circuit of cytotoxic mixtures of the Centralized Cytotoxic Preparation Unit during one year. Analysis of their evolution meant the investigation of twenty parameters susceptible to error. Each parameter was considered one error opportunity. Error has been defined either by the lack of data or mistake in the controlled parameter. In 4,734 preparations (94,680 parameters) there were 314 errors. The percentage of error per parameter in the first month of study was 0.74; at sixth was 0.34 and the last month was 0.26. Only in four months the day of maximum number of preparations coincided with the day of maximum number of errors. We conclude that the percentage of errors in the preparation process is low with a tendency to decrease and that the number of daily preparations is not the single factor that influences the production of errors.

Nonenzymic translocation and spontaneous release of noncognate peptidyl transfer ribonucleic acid from Escherichia coli ribosomes.

Poly(uridylic acid)-programmed ribosomes have been used to synthesize the noncognate peptidyl-tRNA Ac-Phe-Tyr-tRNATyr and its cognate counterpart Ac(Phe)2-tRNAPhe. After synthesis, Ac(Phe)2-tRNAPhe remains, as expected, in the ribosomal acceptor (A) site, but the noncognate AcPhe-Tyr-tRNATyr does not; part of it spontaneously falls off the ribosome and the rest translocates, without elongation factor (EF) G, to the ribosomal donor site. The inhibitor of translocation viomycin prevents both the spontaneous release and the nonenzymatic translocation by confining the noncognate peptidyl-tRNA to the A site. Under these conditions, the interaction of AcPhe-Tyr-tRNATyr with the A site appears to be similar to that of Ac(Phe)2-tRNAPhe without the antibiotic, and EF-G promotes the translocation and subsequent elongation of both peptidyl-tRNAs to comparable extents. The results indicate that, without viomycin, the noncognate peptidyl-tRNA is weakly held in the ribosomal A site and support the proposal that the release of peptidyl-tRNA occurring during protein synthesis in vivo is related to a ribosomal editing mechanism which discards mistranslated nascent proteins [Menninger, J. R. (1977) Mech. Ageing Dev. 6, 131].

The binding of non-cognate Tyr-tRNATyr to poly(uridylic acid)-programmed Escherichia coli ribosomes.

The poly(U)-dependent binding of Tyr-tRNATyr to Escherichia coli ribosomes has been studied using a highly purified system. Binding is maximal at 10 mM magnesium acetate (up to 0.7 molecule Tyr-tRNATyr/ribosome), and requires the presence of elongation factor (EF) T (a mixture of EF-Ts and EF-Tu), GTP, NH4+ ions and an aminoglycoside antibiotic (streptomycin, neomycin B, kanamycin B or gentamicin C1a). Under limiting and up to saturating concentrations of EF-T, one molecule of GTP is hydrolyzed per molecule of Tyr-tRNATyr bound, suggesting that 'proof-reading' mechanisms involving the hydrolysis of GTP are inoperative in the presence of the antibiotics. Binding of Tyr-tRNATyr apparently takes place at the ribosomal acceptor site, since peptide bonds are readily formed with N-acetyl-Phe-tRNA prebound to the ribosomal donor site. In contrast to Phe-tRNAPhe binding, Tyr-tRNATyr binding is impaired by the omission of the 50-S subunit, the replacement of GTP by its non-hydrolyzable analogs guanyl-5'-yl methylene diphosphonate and guanyl-5'-yl iminodiphosphonate, and also by the presence of the antibiotic streptogramin A. This suggests that the correct interaction of Tyr-tRNATyr with the peptidyl transferase centre is essential for the stability of this ligand on the ribosome. Moreover, the aminoglycoside antibiotics are also necessary, even after the binding reaction is complete, to maintain Tyr-tRNATyr on the ribosome.