Aortoenteric fistulae and their multidisciplinary approach.

Aortoenteric fistula is an uncommun life-threatening condition which remains associated with significant morbidity and mortality. It can be primary (aneurysm, neoplasms, radiation therapy, infection) or secondary to vascular prosthesis. Early diagnosis and aggressive surgical treatment are very important to achieve optimal outcomes in these patients. The aim of this article is to highlight the importance of early diagnosis and multidisciplinary approach of aortoenteric fistula through the presentation of a clinical case.

La fístula aortoentérica es una patología poco frecuente, pero de riesgo vital, asociada a alta morbimortalidad. Puede ser primaria (aneurisma, neoplasia, radioterapia, infección) o secundaria a prótesis vascular. El diagnóstico precoz y el tratamiento quirúrgico agresivo son los pilares fundamentales para lograr buenos resultados en estos pacientes. El objetivo de este trabajo es destacar la importancia del diagnóstico precoz de la fístula aortoentérica y su manejo multidisciplinar, mediante la presentación de un caso clínico.

Deploying a novel custom mobile application for STEMI activation and transfer in a large healthcare system to improve cross-team workflow. STEMIcathAID implementation project.

BACKGROUND: ST-segment elevation myocardial infarction (STEMI) is a high-risk patient medical emergency. We developed a secure mobile application, STEMIcathAID, to optimize care for STEMI patients by providing a digital platform for communication between the STEMI care team members, EKG transmission, cardiac catherization laboratory (cath lab) activation and ambulance tracking. The aim of this report is to describe the implementation of the app into the current STEMI workflow in preparation for a pilot project employing the app for inter-hospital STEMI transfer. APPROACH: App deployment involved key leadership stakeholders from all multidisciplinary teams taking care of STEMI patients. The team developed a transition plan addressing all aspects of the health system improvement process including the workflow analysis and redesign, app installation, personnel training including user account access to the app, and development of a quality assurance program for progress evaluation. The pilot will go live in the Emergency Department (ED) of one of the hospitals within the Mount Sinai Hospital System (MSHS) during the daytime weekday hours at the beginning and extending to 24/7 schedule over 4-6 weeks. For the duration of the pilot, ED personnel will combine the STEMIcathAID app activation with previous established STEMI activation processes through the MSHS Clinical Command Center (CCC) to ensure efficient and reliable response to a STEMI alert. More than 250 people were provisioned app accounts including ED Physicians and frontline nurses, and trained on their user-specific roles and responsibilities and scheduled in the app. The team will be provided with a feedback form that is discipline specific to complete after every STEMI case in order to collect information on user experience with the STEMIcathAID app functionality. The form will also provide quantitative metrics for the key time sensitive steps in STEMI care. CONCLUSIONS: We developed a uniform approach for deployment of a mobile application for STEMI activation and transfer in a large urban healthcare system to optimize the clinical workflow in STEMI care. The results of the pilot will demonstrate whether the app has a significant impact on the quality of care for transfer of STEMI patients.

Cuando la ileítis de Crohn no es solo ileítis / When Crohn's ileitis is not just ileitis

RESUMEN En una minoría de pacientes con ileítis de Crohn (EC) de larga evolución, la recrudescencia de los síntomas puede representar una neoplasia ileal, con una clínica indistinguible de la enfermedad basal y por ende poco sospechada. Frecuentemente la patología tumoral se diagnostica en la pieza quirúrgica, tras una intervención por hemorragia u obstrucción intestinal. El objetivo de este trabajo es destacar la importancia de un diagnóstico diferencial ante una ileítis terminal en un paciente con EC con mala respuesta a tratamiento médico.

ABSTRACT In a minority of patients with long-standing Crohn's ileitis, the recrudescence of symptoms may represent a neoplasm involving the ileum that is clinically indistinguishable from the baseline disease and therefore poorly suspected. Tumors are often diagnosed in the surgical specimen, after an intervention due to bleeding or bowel obstruction. The aim of this study is to emphasize the importance of the differential diagnoses of terminal ileitis in a patient with CD with poor response to medical treatment.

Mobile application to optimize care for ST-segment elevation myocardial infarction patients in a large healthcare system, STEMIcathAID: rationale and design.

Aims: Technological advancements have transformed healthcare. System delays in transferring patients with ST-segment elevation myocardial infarction (STEMI) to a primary percutaneous coronary intervention (PCI) centre are associated with worse clinical outcomes. Our aim was to design and develop a secure mobile application, STEMIcathAID, streamlining communication, and coordination between the STEMI care teams to reduce ischaemia time and improve patient outcomes. Methods and results: The app was designed for transfer of patients with STEMI to a cardiac catheterization laboratory (CCL) from an emergency department (ED) of either a PCI capable or a non-PCI capable hospital. When a suspected STEMI arrives to a non-PCI hospital ED, the ED physician uploads the electrocardiogram and relevant patient information. An instant notification is simultaneously sent to the on-call CCL attending and transfer centre. The attending reviews the information, makes a video call and decides to either accept or reject the transfer. If accepted, on-call CCL team members receive an immediate push notification and begin communicating with the ED team via a HIPAA compliant chat. The app provides live GPS tracking of the ambulance and frequent clinical status updates of the patient. In addition, it allows for screening of STEMI patients in cardiogenic shock. Prior to discharge, important data elements have to be entered to close the case. Conclusion: We developed a novel mobile app to optimize care for STEMI patients and facilitate electronic extraction of relevant performance metrics to improve allocation of resources and reduction of costs.

Estrategia didáctica para preparar a los profesores de Inglés para impartir la medicina natural y tradicional / A Didactic Strategy to Train the Teachers of English to Teach Natural and Traditional Medicine

Se diseñó un modelo teórico contextualizado para la elaboración de una estrategia didáctica, dirigida a la preparación integral de los profesores de inglés en la enseñanza de la medicina natural y tradicional en la carrera de Medicina. Para ello se realizó un diagnóstico inicial, que permitió sintetizar las limitaciones e insuficiencias que poseen los profesores de inglés para la impartición de contenidos de medicina natural y tradicional, como estrategia curricular del Viceministerio de Docencia e Investigaciones del MINSAP. En la estrategia se incluyeron acciones para ser trabajadas dentro de la superación profesoral, el componente metodológico y el componente investigativo de los docentes de forma tal, que se revierta en un enriquecimiento de la competencia académica que deben poseer para su desempeño profesional, y de este modo enfrentar con éxito la tarea. La estrategia está destinada a todos los profesores de inglés del departamento, ya que estos rotan por los años de inglés general e inglés con fines específicos, respectivamente, y en dependencia de las necesidades de la institución (AU)

A contextualized theoretical model was designed in order to elaborate a didactic strategy intended for the comprehensive preparation of the teachers of English for the teaching of natural and traditional medicine in the specialty of Medicine. To fulfill this purpose an initial diagnosis was carried out which permitted to synthesize the limitations and insufficiencies of the teachers to teach the contents of natural and traditional medicine as a curricular strategy of the Ministry of Public Health. The strategy included actions to be performed within the professional upgrading, as well as the methodological and research component of the teachers. As a consequence, the strategy would lead to an enhancement of the academic competence needed for their professional performance in order to deal with the task successfully. The strategy is destined to all the teachers of the Department of English since they alternate through all the years included in the cycles of General English and English for Specific Purposes, depending on the needs of the college (AU)

Utilidad del tratamiento de la bursitis de hombro con acupuntura / Usefulness of the treatment of shoulder bursitis with acupuncture

Se realizó un estudio observacional, descriptivo, prospectivo, durante el período comprendido del 7 de enero al 30 de diciembre de 2008, en pacientes portadores de bursitis de hombro, atendidos en el Centro de Desarrollo Provincial de Medicina Natural y Tradicional, ubicado en el Hospital Dr Ernesto Guevara de la Serna de Las Tunas. El universo estuvo constituido por todos los pacientes con el diagnóstico de bursitis de hombro que acudieron a la entidad antes mencionada y que fueron diagnosticados clínicamente. La muestra quedó constituida por 200 pacientes, que cumplieron con los criterios diagnósticos y de inclusión establecida para esta investigación, a los que se les aplicó tratamiento acupuntural, con el objetivo de describir la utilidad de la acupuntura en el tratamiento de la bursitis de hombro. Fueron estimulados los puntos Ig4, Ig11, Ig15 Vb21, TF14, Id9 y ah-shi. Los resultados mostraron que el grupo etáreo entre 41 y 50 años constituyó el de mayor incidencia y predominó el sexo femenino, la mayoría de los pacientes tratados con acupuntura tuvieron evolución satisfactoria, la mayor cantidad de pacientes resolvió su situación cuando han transcurrido seis sesiones de tratamiento, no se presentaron complicaciones en nuestro estudio. Se concluyó que el uso de la acupuntura, como método terapéutico en el tratamiento de la bursitis de hombro, resulta de gran utilidad y reporta beneficios a los pacientes(AU)

An observational, descriptive, prospective study was carried out during the period from January 7 to December 30, 2008 on patients with shoulder bursitis treated at the Natural and Traditional Medicine Provincial Development Center located at Dr Ernesto Guevara de la Serna Hospital of Las Tunas. The universe was formed by all the patients with such diagnosis who attended the institution and were clinically diagnosed. The sample included 200 patients who applied for the inclusion and diagnostic criteria established for this investigation, and who were treated with acupuncture to describe the usefulness of acupuncture in the treatment of shoulder bursitis. The points stimulated were Ig4, Ig11, Ig15 Vb21, TF14, Id9 and ah - shi. The results showed that the age group between 41 and 50 years old had a major incidence and the predominant sex was the female. Most of the patients treated with acupuncture had a satisfactory evolution and almost all of them solved the situation after six treatment meetings, with no complications during the study. It was concluded that the use of acupuncture as a therapeutic method in the treatment of shoulder bursitis has great use and brings benefits to the patients(AU)

Estrategia para la implementación de la medicina tradicional y natural en Psicología Médica II / Strategy for the implementation of traditional and natural medicine in Medical Psychology II

Se realizó una investigación observacional, descriptiva, con el objetivo de diseñar una estrategia metodológica para el uso de la Psicología en el aprendizaje de la Medicina Tradicional y Natural (MTN) en los estudiantes de tercer año de la carrera de medicina, de la Universidad de Ciencias Médicas de Las Tunas, en el período comprendido desde octubre de 2010 a octubre de 2011. El universo estuvo definido por el total de los programas de la carrera en el tercer año y la muestra quedó constituida por el programa de la asignatura de Psicología Médica lI. Los resultados mostraron que no está incluido en los programas de estudio el uso de la Psicología en el aprendizaje de la MTN. Dentro de los resultados obtenidos se determinó que los estudiantes no hacen uso de la Psicología para la adquisición de conocimientos pertenecientes a esta rama del saber; para contrarrestar este problema se diseñó una estrategia metodológica(AU)

An observational and descriptive investigation was carried out to design a methodological strategy for the use of Psychology in the learning of the Traditional and Natural Medicine (TNM) in 3rd year medicine students of the University of Medical Sciences of Las Tunas, in the period from October, 2010 to October, 2011. The universe was defined by all the syllabuses of the 3rd year subjects and the sample was constituted by the Medical Psychology lI syllabus. The results showed that the use of Psychology is not included in the syllabus of study for the learning of TNM. As part of the results obtained, it was determined that the students do not use Psychology for the acquisition of knowledge belonging to this branch of knowledge; a methodological strategy was designed in order to prevent this problem(AU)

Rinitis alérgica: actualización y opciones de tratamiento por Medicina Natural y Tradicional / Allergic rhinitis: update and treatment options by Natural and Traditional Medicine

La rinitis alérgica es un problema de salud muy común y una de las principales causas de consulta médica en el mundo. En Cuba se afirma que es una enfermedad subdiagnosticada y subtratada, motivo que llevó a realizar la presente revisión bibliográfica, donde se tienen en cuenta sus características clínicas, los elementos del diagnóstico y las opciones de tratamiento; con énfasis en el uso de la medicina natural y tradicional. Se definió una estrategia de búsqueda mediante palabras clave y descriptores relacionados, la que fue empleada en la gestión de información en los recursos disponibles en Infomed, tales como PubMed, HINARI, EBSCO y LILACS. Considerando que la enfermedad es un complejo de síntomas con un trasfondo genético, asociado a las reacciones de hipersensibilidad frente a alérgenos comunes, incluyendo los ácaros caseros, la caspa animal y el polen de hierbas, árboles y semillas; que la respuesta inflamatoria conduce a síntomas diversos, locales y sistémicos, que suelen ser molestos para el paciente y afectar su calidad de vida; que para su control se emplean numerosos fármacos como antihistamínicos, esteroides, antileucotrienos e inmunoterapia; que la aplicación de la acupuntura y otros métodos de la medicina tradicional y alternativa es un tema de debate en la actualidad, hasta 24 diferentes puntos de acupuntura han sido empleados en ensayos clínicos sobre la rinitis. Se puede concluir que la acupuntura se considera una alternativa muy segura en el tratamiento de la rinitis alérgica; los diferentes esquemas de tratamiento alivian o resuelven los síntomas y modifican algunos de los mediadores moleculares de la enfermedad, como las interleucinas(AU)

Allergic rhinitis is a very common health problem and one of the main causes of medical consultation all over the world. In Cuba, it is a subdiagnosed and subtreated illness, a reason that led to the present bibliographical review that takes into account its clinical characteristics, elements of diagnosis and options of treatment, emphasizing the use of natural and traditional medicine. A search strategy, using key words and related descriptors, was defined and used for the information management in the resources available on Infomed, such as PubMed, HINARI, EBSCO and LILACS. Considering that this illness is a symptoms´ complex with a genetic background, associated with reactions of hypersensitivity to common allergens- including home-bred acarus, animal dandruff and grass, trees and seeds pollen-; that the inflammatory response leads to diverse, local and systemic symptoms which usually annoy the patient and affect the quality of life; that there are numerous medicines like antihistamines, steroids, antileukotrienes and immunotherapy for the control of the illness; that the application of acupuncture and other methods of traditional and alternative medicine is a debate topic at present, up to 24 different acupunctural points have been used in clinical essays on the rhinitis. It is possible, then, to conclude that acupuncture is considered a very safe alternative for the treatment of allergic rhinitis. The different treatment schemes relieve or solve the symptoms and modify some of the molecular mediators of the illness, like interleukins(AU)

Uso de la terapia floral en los trastornos psiquiátricos menores / Use of the flower essence therapy in minor psychiatric disorders

El sistema floral de Bach surge en la década del 30 del pasado siglo en Inglaterra, gracias a la precisa observación que realizó su creador Edward Bach, al comprobar el poder que tenían las flores, objeto de su estudio sobre los estados emocionales, capaces de enfermar al ser humano. Sus postulados idealistas y alquímicos, referentes al origen y mecanismo de acción de sus preparados, contribuyeron al desarrollo de la medicina psicosomática y a la Psiconeuroinmunología, al concebir a la mente y al cuerpo como una unidad indisoluble y proponer un sistema terapéutico holístico, que dió al traste con el dualismo cartesiano, tan de moda en la medicina del siglo XX. Treinta y ocho flores y el remedio de rescate, capaces de influir en los estados emocionales básicos del ser humano, han quedado como legado cultural y científico, que dejó a la humanidad este gran médico.El presente trabajo se enmarca en el perfil de la Psiquiatría floral, basado en los trabajos originales del Dr Bach y continuadores de su obra, se realizó una minuciosa aplicación de la terapia floral a la propedéutica, la clínica psiquiátrica y la psicología médica, para establecer las recetas fundamentales, empleadas en el tratamiento de los trastornos psiquiátricos menores, teniendo en cuenta su empleo en el contexto de una relación médico paciente positiva, que de manera integral asume el tratamiento de los desordenes mentales, incluyendo los recursos psicológicos y sociales en el arsenal terapéutico, y tomando al método clínico como referente metodológico(AU)

Bach's floral system arises in the 1930s in England thanks to the precise observation carried out by its creator Edward Bach after verifying the power of flowers, object of his study on the emotional states, capable of making human beings feel ill. His idealistic and alchemist postulates regarding the origin and mechanism of action of his preparations contributed to the development of psychosomatic medicine and psychoneuroimmunology by conceiving the mind and body an indissoluble unit and proposing a holistic therapeutic system that opposed Cartesian dualism, so much in fashion in the 20th century medicine.Thirty eight flowers and the rescue remedy, capable of influencing the basic emotional states of human beings, have remained as the cultural and scientific legacy this great doctor left to mankind.The present work focuses on the Floral Psychiatry profile, based on the original works of Dr Bach and the followers of his work. A meticulous application of the flower essence therapy into propaedeutics, psychiatric clinics and medical psychology is carried out here to establish the fundamental recipes used in the treatment of minor psychiatric disorders taking into account its use in the context of a positive doctor- patient relationship that assumes the treatment of mental disorders, including the psychological and social resources in the therapeutic arsenal and taking the clinical method as a methodological referent in an integral way(AU)

Uso del tratamiento acupuntural en los trastornos de adaptación a forma depresiva / Use of the acupunctural treatment in depressive adjustment disorders

Se realizó un estudio experimental, abierto y controlado durante el período comprendido entre diciembre de 2009 a junio de 2010 en pacientes con trastorno de adaptación a forma depresiva en el Centro Comunitario Provincial de Salud Mental de Las Tunas. El universo estuvo constituido por todos los pacientes que acudieron a la consulta de MNT de la entidad antes mencionada y que fueron diagnosticados clínicamente según la CIE-10. La muestra quedó constituida por el 100 por ciento de los pacientes que cumplieron los criterios diagnósticos y de inclusión, establecidos para la investigación, a los que se le aplicó tratamiento acupuntural y se comparó con el tratamiento convencional con amitriptilina para determinar la eficacia de la acupuntura, con validación estadística, a través del sistema epinfo 6,0. Inicialmente la depresión leve fue predominante con el 88 per cent y el insomnio fue el síntoma asociado más frecuente. Al terminar el tratamiento se encontró que la depresión se eliminó en la totalidad de los pacientes que recibieron acupuntura con solo 21 sesiones de tratamiento, los síntomas asociados desaparecieron en casi la totalidad de los pacientes y las reacciones adversas fueron mínimas. Por lo que se concluye que este tratamiento constituye una terapia efectiva en el trastorno de adaptación a forma depresiva (AU)

An experimental, open and controlled study was carried out during the period comprised between December, 2009 and June 2010 on patients with depressive adjustment disorders at the Provincial Community Mental Health Center of Las Tunas. The universe was constituted by all the patients who attended the Natural and Traditional Medicine consultation of the afore-mentioned institution and who were clinically diagnosed according to the 10th International Classification of Mental and Behavioural Disorders. The sample was constituted by 100 per cent of the patients who followed the diagnosis and inclusion criteria established for the investigation. The patients were applied the acupuntural treatment that was compared with the conventional treatment with amitriptyline to determine the efficacy of acupuncture, with statistical ratification through the epinfo 6,0 system. At the beginning, mild depression was predominant with 88 per cent and insomnia was the most frequent associated symptom. At the end of the treatment, it was found that depression was eliminated in all the patients who were treated with acupuncture with only 21 sessions of treatment, the associated symptoms disappeared in almost all the patients and the adverse reactions were minimal. At the end of the study it was concluded that this treatment constitutes an effective therapy for depressive adjustment disorders (AU)

Effects of in utero exposure to D-004, a lipid extract from Roystonea regia fruits, in the male rat: a comparison with finasteride.

D-004 is a lipid extract obtained from Cuban royal palm fruits, consisting of a mixture of free fatty acids, that prevents prostate hyperplasia induced with testosterone in rodents. This study investigated the possible alterations due to D-004 of androgen-dependent development after exposure in utero and compared them with those due to finasteride. Rats were randomized into five experimental groups: a control group, three groups treated with D-004 at 500, 750, or 1,000 mg/kg/day, respectively, and a group treated with finasteride (10 mg/kg/day). Male rats were treated 10 weeks before and during mating. Female rats were treated for 15 days prior mating, during mating, during pregnancy, and until lactation (day 21) except for those treated with finasteride, which were only administered the drug on gestational days 12-21. All male offspring were monitored individually until necropsy after postnatal day 90. The results of the present study indicate that D-004 induced no alterations in androgen-dependent development after the exposure in utero. Also, the current study demonstrated a permanent reduction in anogenital distance and retention of nipples in adult male rats exposed to finasteride during late gestation. Significant alterations induced by exposure to finasteride were mainly in tissues dependent on dihydrotestosterone during development.

Bases fisiológicas del tratamiento acupuntural en el síndrome del túnel del carpo / Physiological bases of the treatment of the carpal tunnel syndrome with acupuncture

Se realizó una revisión bibliográfica, sobre la aplicación de la acupuntura en el tratamiento del Síndrome del Túnel del Carpo (STC). El STC es la neuropatía por atrapamiento más común, afecta a un número importante de personas cada año y el dolor es el síntoma más frecuente. Para su alivio se emplean numerosos fármacos. La aplicación de la acupuntura tiene efectos analgésicos y antinflamatorios demostrados, que combinada con diferentes esquemas de tratamiento farmacológicos, ofrece múltiples ventajas en el manejo del STC y constituye una opción viable en la APS (AU)

A bibliographic review about the application of acupuncture in the treatment of the Carpal Tunnel Syndrome (CTS) was carried out. CTS is a very common neuropathy that affects an important number of people every year and pain is its most frequent symptom. To treat this illness numerous drugs are used. The application of acupuncture has proven analgesic and anti-inflammatory effects, which combined with different schemes of pharmacological treatment, offers numerous advantages in the medication of CTS and constitutes a viable option in primary care(AU)

La depresión según la Medicina Tradicional Asiática / Depression according to Traditional Asian Medicine

La Medicina Tradicional Asiática es un sistema teórico filosófico, sustentado en la investigación y la observación, que de un modo dialectólogo establece las leyes que rigen el micro y macro cosmos. Tiene su origen en la filosofía Oriental a partir del confucionismo, el taoísmo y el budismo. La depresión es un trastorno mental, caracterizado por un bajo estado de ánimo y sentimientos de tristeza, asociado a alteraciones del pensamiento, la actividad y el comportamiento. Este trabajo aborda las teorías fundamentales de la Medicina Tradicional Asiática: la teoría de los órganos y vísceras (zan-fu), la teoría del yin y el yang, la teoría de los cinco elementos (u-tsin), la teoría de los componentes básicos (jing, qi, xue, jing-ye) y la teoría de los meridianos (tsin-lo), estableciendo una fundamentación teórica de la depresión a partir de las teorizaciones tradicionales asiáticas(AU)

Traditional Asian Medicine is a theoretical philosophical system based on investigation and observation, which from a dialectical way establishes the laws that rule the micro- and macro- cosmos. It has its origin in the Oriental philosophy of Confucius, Taoism and Buddhism points of view. Depression is a mental condition characterized by low mood and feelings of sadness, associated to alterations of thought, activity and behaviour. This paper covers the main theories of Traditional Asian Medicine: the theory of organs and viscera (Zan-fu), the Yin and yang theory, the theory of the five elements (u-tsin), the theory of basic components (jing, gi, xue, jing-ye) and the theory of meridians (tsin-lo), establishing the theoretical basics of depression from the traditional Asian theorizations(AU)

Identificación de necesidades de aprendizaje pedagógicas en los profesores del Programa Nacional de Formación del Médico Integral Comunitario / Pedagogical learning needs análisis in the teachers of the Nacional Training Program of the Comprehensive Community Doctor

Se realizó un estudio descriptivo con el objetivo de identificar las necesidades de aprendizaje, relacionadas con el desarrollo de la preparación pedagógica en los profesores que imparten la Asignatura Morfofisiología Humana II en el Programa Nacional de Formación del Médico Integral Comunitario del estado Sucre en la República Bolivariana de Venezuela y en Cuba, en el Proyecto de Policlínico Universitario en el Municipio Las Tunas, de la provincia Las Tunas. El mismo se realizó en el período de febrero a octubre del año 2006 en Venezuela y durante el periodo de septiembre de 2008 a enero del año 2009, en la provincia Las Tunas. La muestra venezolana estuvo constituida por el total de 25 profesores que imparten la asignatura. Los resultados mostraron que el claustro, en su mayoría, tiene menos de un año de experiencia docente y 88 por ciento de los profesores son especialistas en Medicina General Integral. Además, se identificaron necesidades de aprendizaje sobre la gestión docente, como aspecto fundamental en el trabajo docente metodológico(AU)

A descriptive study was carried out with the objective of identifying the learning needs related to the development of the pedagogical training of the teachers who teach the subject Human Morphophysiology II of the National Program for the training of the Community Doctor at the state of Sucre in Venezuela and in the University Polyclinics Project in the municipality of Las Tunas, Cuba. The study was performed in Venezuela in the period between February and October, 2006, and in Cuba between September 2008 and January 2009, with a sample of 25 teachers. The results showed that most of the teaching staff is composed of professionals with less than one year of teaching experience, and that 88 per cent of the teachers are specialists in Comprehensive General Medicine. Besides, the learning needs about teaching management were identified, seeing this topic as a key feature of the teaching/ methodological work(AU)

Oral subchronic toxicity of a lipid extract from Roystonea regia fruits in mice.

D-004 is a lipid extract of royal palm (Rosytonea regia) fruits that prevents prostate hyperplasia induced with testosterone in rodents. Previous studies have shown no D-004-related toxicity in rats, but no study in mice had been reported. D-004 (500, 1000, and 2000 mg/kg) was evaluated in a subchronic (eight weeks) study in NMRI mice. No evidences of treatment-related toxicity were detected. Thus, body-weight gain, clinical observations, food consumption, blood biochemical, hematology, organ-weight ratios, and histopathological findings were similar in control and treated groups. This study supports that D-004 orally administered up to 2000 mg/kg did not induce treatment-related toxicity.

Effects of D-003 on hepatic drug-metabolizing enzyme activities in rats.

D-003 is a mixture of very-long-chain aliphatic acids with cholesterol-lowering and concomitant anti-platelet effects. The microsomal cytochrome P-450 system comprises a superfamily of proteins present in hepatic and extrahepatic tissues that is responsible for the metabolism of many drugs. The present study was undertaken to investigate the effects of D-003 on in vivo drug-metabolizing hepatic enzymes. Two experimental series (n = 6 animals/group) were performed. In the first series rats were randomly distributed in one control and two groups treated with D-003 at 1,000 and 2,000 mg/kg for 14 days. In the second one they were distributed in one control and three groups treated with D-003 (250, 500, and 1,000 mg/kg) for 6 months. All treatments were orally administered by gastric gavage. Control rats were orally treated only with acacia gum/water vehicle. The content of microsomal P-450, b (5) cytochromes, total sulfhydryl groups, nonprotein sulfhydryl groups, and protein-bound sulfhydryl groups as well as the activities of NADPH cytochrome c reductase, aminopyrine demethylase, dimethylnitrosamine N-demethylase, 7-ethoxyresorufin O-deethylation, 7-pentoxyresorufin O-depentylation, and cytosolic glutathione S-transferase were assessed. D-003 administered up to 2,000 mg/kg or 1,000 mg/kg during 14 days or 6 months did not affect the activities of the hepatic drug-metabolizing enzymes investigated. It is concluded that D-003 is not metabolized by the liver cytochrome system and that potential risk derived from drug-to-drug interactions between D-003 and concomitant drugs appears to be low.

Efecto de la dopamina inhalada en la presión arterial de pacientes con insuficencia renal: cronica en hemodiálisis / Effect of the dopamine inhaled in the presion arterial of patients with insuficience renal: chronic in hemodialisis

La vía común de administración de la Dopamina es la intravenosa a infusión continua con efectos sistémicos que requieren de monitorización cardiovascular. En trabajos anteriores hemos utilizado la dopamina inhalada en pacientes con crisis de asma bronquial y hemos demostrado un efecto broncodilatador. En este estudio prospectivo, evaluamos los efectos de Dopamina inhalada a dosis de 3 µg/kg/min en 21 pacientes con insuficiencia renal crónica en hemodiálisis de los cuales 16 eran hipertensos, 5 normotensos y 11 pacientes normotensos sanos como control. Los resultados nos permiten concluir: 1. La Dopamina inhalada redujo significativamente la presión arterial del grupo control con una presión sistólica de 1162 ± 3,22 mmHg a 100 ± 3,22 mmHg (p<0,002) y el valor de presión diastólica de 72 ± 2,38 mmHg a 65 ± 2,36 mmHg (p<0,05), pero no redujo la presión arterial de los pacientes con Insuficiencia Renal Crónica. 2. Los mecanismos de control de presión arterial en ambos grupos son diferentes, esto condiciona una respuesta cardiovascular distinta a la Dopamina.

Six-month toxicity study of oral administration of D-003 in Sprague Dawley rats.

BACKGROUND: D-003 is a mixture of high molecular weight aliphatic primary acids purified from sugarcane wax (Saccharum officinarum) having cholesterol-lowering and antiplatelet effects. AIM: This study was undertaken to investigate the toxicity induced by long-term oral administration of D-003 for 6 months to Sprague Dawley rats of both sexes. METHODS: Rats were randomly divided into four groups (20 rats of each sex/group): a control group. which received the vehicle, and three treatment groups, which received oral D-003 at doses of 250, 500 and 1000 mg/kg/day, respectively. Daily clinical observations and control of bodyweight and food consumption were conducted throughout the study period. On completion of active treatment, animals were sacrificed. Pharmacological effects associated with D-003 such as inhibition of platelet aggregation and increase in bleeding time were assessed in two satellite groups (14 animals of each sex/group): a control group and a group treated with the highest dose of D-003. Assessments of platelet aggregation to collagen were performed at baseline and at 6 months, and assessments of bleeding time were done at baseline, after 3 and 6 months of treatment, and after 30 days' washout. RESULTS: As expected, D-003 significantly inhibited platelet aggregation. Bleeding time was increased after 3 months of treatment with D-003; this increase was maintained at 6 months, and was reversible after washout. Coagulation factors such as prothrombin time and kaolin-activated thromboplastin-time, which were determined in eight male animals from each group, were unaffected by D-003. Data analyses of bodyweight gain, food consumption, clinical observations, blood biochemistry, haematology, organ weight ratios and histopathological findings did not show trends related to D-003 dose or significant differences between control and treated groups. CONCLUSION: It was concluded that the highest studied dose of D-003 (1,000 mg/kg/day) represented a non-toxic dose level in the present chronic toxicity study in rats.