Evaluación del desarrollo de competencias de comunicación y capacidad de análisis en alumnos del practicum de farmacia / Evaluation of the development of communication and analysis skills in practicum students of pharmacy

El equipo de Prácticas Tuteladas de la Facultad de Farmacia de la Universidad de Sevilla, en sucompromiso de adecuación al Espacio Europeo de Educación Superior del Practicum de lalicenciatura, viene desarrollando desde el curso académico 2008-2009 un Proyecto de Innovación yMejora Docente dentro del I Plan Propio de Docencia de esta Universidad. Su objetivo es impulsarcambios en la metodología docente donde se de un mayor protagonismo al aprendizaje del estudiante,durante el cual, debe adquirir nuevas habilidades, destrezas, conocimientos, conductas o valores comoresultado del estudio, la experiencia, la instrucción y la observación. En este sentido, los alumnosdeben adquirir la habilidad de analizar el aprendizaje recibido, reconociendo sus limitaciones ydeficiencias, así como sus destrezas, y aprender a expresar de forma oral, escrita y sintéticamente susconocimientos y capacidades.Los profesores definieron los criterios de evaluación tanto de la actividad escrita como oral. Así seanalizaron aspectos relativos a la construcción del conocimiento como capacidad de análisis, síntesis,creatividad y pensamiento crítico, la presentación de la memoria e iniciativa y originalidad mostradapor el alumnado. Respecto a la expresión oral del trabajo desarrollado, los alumnos expusieron una delas competencias específicas definidas para la asignatura ante el equipo de Prácticas Tuteladas,apoyándose en una presentación en power point. Para la evaluación de esta actividad se valoraronademás aspectos como claridad de ideas, riqueza de vocabulario y selección del lenguaje adecuado ydiseño de la presentación(AU)

The team responsible for teaching the course “Prácticas Tuteladas” at the Degree of Pharmacy,University of Seville, in its commitment to adapting to the European Space for Higher Education , hasbeen developing since the 2008-2009 academic year an Innovation Project of Teaching Improvementthat belongs to the I Teaching Plan of the University. It aims to promote changes in teachingmethodology giving a stronger role to the student learning process, in which he must acquire newskills, abilities, knowledge, behaviours, or values as a result of the study, experience, training andobservation. In this sense, students must acquire the ability to analyze the learning received,recognizing their limitations and weaknesses and their skills and learn to express orally, written andsynthetically their knowledge and skills.The teachers previously defined the criteria for the evaluation of both written and oral activities.Teacher assessed the acquisition of different skills such as analysis capacity, synthesis, creativity andcritical thinking, quality of the report and initiative and originality displayed by the students.Regarding to the oral presentation of the work developed, the students gave a seminar about one of thecompetencies developed to the academic tutors using a power point presentation. For the evaluation ofthis activity other aspects such as clarity of ideas, vocabulary and appropriate terminology andpresentation design were also evaluated(AU)

Relationship between low bone mineral density and highly active antiretroviral therapy including protease inhibitors in HIV-infected patients.

PURPOSE: The objectives of this study were to determine the prevalence of osteopenia and the factors associated with its presence in HIV-infected patients under highly active antiretroviral therapy (HAART) and to assess the changes of bone mineral density (BMD) in a population followed prospectively. METHOD: BMD was assessed by dual-energy X-ray absorptiometry (DEXA) scans at the lumbar spine and at the femoral neck in 78 HIV-infected patients who had previously received HAART as the first antiretroviral regimen and in 11 antiretroviral-naive HIV-infected patients. BMD measurements were repeated in 70 treated patients who had completed 1 year of follow-up. RESULTS: Thirty-seven (42%) patients showed osteopenia at any localization. The prevalence of osteopenia in PI-naive patients was 23% versus 49% in individuals who had received PI at any moment [p =.001; adjusted odds ratio (95% CI) = 0.11 (0.02-0.48)]. The frequency of osteopenia was significantly higher among men than among women [50% vs. 17%; p =.016; adjusted OR (95% CI) = 12.1 (2.22-66.20)]. The level of plasma albumin was independently associated with osteopenia [adjusted OR (95% CI) per each g/dL of plasma albumin decrease 2.55 (1.18-10)]. In patients in whom a second DEXA was done, no significant changes in BMD were found. CONCLUSION: The prevalence of osteopenia in HIV-infected patients on HAART is high. Loss of BMD is associated with PI therapy, low plasma albumin level, and male sex. Osteopenia does not progress after 1 year of continued HAART.

Resultados de la encuesta sobre la Implantación de la Toxicología en la Universidad Española / Toxicology implantation in the Spanish University: results of a survey

Se ha evaluado el grado de implantación de la Toxicología a nivel de pregrado y postgrado en 25 Universidades Españolas y en 3 Universidades de Sudamérica. Las experiencias y opiniones de un total de 67 Profesores implicados en la docencia de diversas asignaturas de Toxicología se han evaluado a través de una encuesta promovida por la Asociación Española de Toxicología. Tras la implantación de los nuevos Planes de Estudios, se observa un incremento notable de la presencia de la Toxicología en las diferentes Licenciaturas en las que adquiere el carácter de troncal. Sin embargo, su presencia es aún escasa en las Facultades de Bioquímica, Biología, Bioquímica, Química y en la mayoría de las Ingenierías. El incremento más sustancial se ha producido por la introducción de nuevas asignaturas de carácter obligatorio u optativo, que complementan los conceptos básicos impartidos en las asignaturas troncales de Toxicología. En la formación de postgrado, 10 Universidades intervienen en Programas de Doctorado Departamentales y 14 Universidades en Programas Interdepartamentales. En nuestra opinión, debe fomentarse esta participación así como la realización de cursos y/o seminarios relacionados con la Toxicología, para conseguir una adecuada preparación de los futuros toxicólogos (AU)

Juvenile neutrophilic eccrine hidradenitis: a vasculitis-like plantar dermatosis.

Neutrophilic eccrine hidradenitis is a variety of neutrophilic dermatosis described in patients with different neoplasms, most often leukaemia, and different chemotherapy regimens. It is characterised by neutrophilic infiltration of the eccrine coils of sweat glands. Recently it has been described in healthy juveniles, involving primarily the soles of the feet. We describe five new cases of juvenile neutrophilic eccrine hidradenitis all showing a good prognosis or a self-limiting course.

[Cerebral infarct in systemic lupus erythematosus]. / Infarto cerebral en el lupus eritematoso sistémico.

INTRODUCTION AND OBJECTIVE: Systemic lupus erythematosus is a syndrome of variable clinical and immunological expression, which may affect any organ. Stroke is an uncommon complication of systemic lupus erythematosus, attributed to many different etiopathogenic mechanisms such as early atherosclerosis, coagulopathy, vasculitis, cardiogenic embolism, etc. Our objectives were to analyze the incidence, clinical and immunological characteristics of this condition and to evaluate the therapeutic approach and evolution. CLINICAL CASES: We present the cases of six patients with cerebral infarcts who also had systemic lupus erythematosus. The frequency of cerebral infarct in our series of systemic lupus erythematosus was 6%. The average age was 45 years (range 13-67). All the cerebral infarcts occurred whilst the systemic lupus erythematosus was active. There were positive antiphospholipid antibodies in three of the patients and two patients had potentially embologenic cardiopathy (33%). Fifty percent of the patients required treatment with cyclophosphamide for their severe systemic disease and 66% received anticoagulants for an antiphospholipid syndrome and/or suspected thromboembolism. The clinical course was satisfactory in all cases but the one who died. CONCLUSIONS: The incidence of cerebral infarct in relation to systemic lupus erythematosus is low, and generally appears during advanced, active phases of the disease. The many etiopathogenic mechanisms involved generally act together so that it is difficult to say which is the main cause, especially in elderly patients. Amongst these mechanisms is the presence of antiphospholipid antibodies, detection of which is essential in this condition, and cardiogenic embolism. The evolution depends mainly on the multi-organ involvement and how early immunosuppressive and/or anticoagulant treatment is started.

Experimental equations to calculate aminoglycoside clearances through cuprophan dialyzers.

Aminoglycosides are a group of antibiotics of particular interest because of their widespread use in the treatment of infections caused by gram-negative bacteria. However, they are difficult to dose accurately because of their narrow therapeutic range and overdosing produces a large number of toxic effects. This paper describes a study carried out with the aim of ensuring the accurate administration of these antibiotics in end-stage renal disease patients undergoing hemodialysis, by developing equations which enable the dosage for individual patients to be calculated according to the dialyzer being used and the operational conditions set up during the dialysis session.

Thrombolytic therapy in pulmonary embolism of Behçet's disease.

We report the case of a patient with Behçet's disease who presented with deep vein thrombosis and pulmonary embolism. In spite of being treated initially with anticoagulants, corticosteroid and oral cyclophosphamide, the patient presented again with a new pulmonary embolism. This critical situation made us initiate thrombolytic therapy with a urokinase "bolus' followed by continuous infusion through a catheter into the pulmonary artery. Treatment response was good and 2 years later there was no evidence of new thrombotic episodes.

[Reactive arthritis caused by Yersinia enterocolitica and Chlamydia trachomatis]. / Artritis reactivas por Yersinia enterocolitica y Chlamydia trachomatis.

We studied the clinical course, microbiological investigations and laboratory parameters in 10 patients with reactive arthritis (ReA). The number of patients with arthritis included was 10. Triggering agents were: seven patients had positive agglutinating antibody against Yersinia enterocolitica. Three cases had positive antibody test against Chlamydia trachomatis. In all patients antibody test were recovered. The clinical finding were: 4 patients with polyarthritis, 4 mono-oligoarthritis and two cases sacroileitis. The mean of index active joints were 6 (1-14). More frequent pattern were episodes of arthritis with lower limbs joints involvement. Outcome were of 12.1 (2-24) months. All of culture were negative. The laboratory parameters were unremarkable, except ESR were higher, HLA B-27 were positive in 70% of patients. The radiological signs and synovial biopsy studies were not conclusive. Eight patients were treated with antibiotics, not did antibiotics affect over duration of ReA.

Pulmonary amyloidosis and unusual lung involvement in SLE.

The association of systemic lupus erythematosus (SLE) with amyloidosis is exceptional. We present a 37-year-old patient who was diagnosed five months earlier for SLE. She developed an acute episode of chest pain, cough and dyspnoea. Hypoxemia and obstructive changes in respiratory tests were present. The chest X-ray was repeatedly normal. Open lung biopsy revealed lupus pneumonitis with positive stain for immunoglobulins and complement, bronchiolitis obliterans, and pulmonary amyloidosis.

Drug dosage in end-stage renal disease (ESRD) patients undergoing haemodialysis. A predictive study based on a microcomputer program.

Drug dosage in end-stage renal disease (ESRD) patients undergoing haemodialysis is a very complex problem because of numerous variables relating to the patient, the type of drug administered and the type of dialysis and dialyser. We carried out a multifactorial study of these parameters using a microcomputer program written in BASIC. Three sets of data were fed into the computer: those relating to the biophysical characteristics of the patient, the type of dialysis and dialyser to be used, and others relating to the chemical and pharmacokinetic characteristics of the drug. From these, a predictive intravenous dosage regimen (bolus and infusion) was compiled for each ESRD patient. To check the program we used 2 drugs (tobramycin and vancomycin) and several types of dialyser. The findings were that, with tobramycin, an ESRD patient should be given different postdialytic doses, depending on the type of dialyser used. The maintenance doses calculated by the program were similar to those usually administered to patients receiving clinical treatment with this drug. In the case of vancomycin, the program calculated the clearance value in vivo through the 'Hemoflow F60' dialyser with a polysulphone membrane. The computer program calculated the maintenance dosage of vancomycin that should be given after each dialysis cycle so that its concentration did not fall below its minimum therapeutic concentration.

["Sacroiliitis" as the initial manifestation of hepatocarcinoma]. / "Sacroileítis" como manifestación inicial de un hepatocarcinoma.

The hepatocellular carcinomas rarely develop in absence of a previous hepatopathy and their first clinical manifestations are not related, in general, to the metastasis located at the bones of the pelvic girdle. We present a multifocal hepatocarcinoma in a 17-year-old woman without known risk factors, whose initial manifestation was a clinical radiological picture suggesting left sacroiliitis. We stress this rare manifestation preceding the diagnosis of neoplasia two years later.

[Asymmetric polyarthritis in Sézary's syndrome]. / Poliartritis asimétrica en el síndrome de Sézary.

We present the case of a patient with negative serology asymmetric polyarthritis and erythematous-squamous cutaneous lesions of two years evolution, initially attributed to psoriasis, which histopathology (hyperkeratosis, epidermic infiltration due to atypical CD4+ lymphocytes with formation of Pautrier's microabscesses) together with hematological findings (persistent lymphocytosis with cells with cerebriform nucleus, 97% CD4+) allowed the diagnosis of Sézary's syndrome. To our knowledge, this is the eight documented case of arthritis in Sézary's syndrome and the first one with asymmetric chronic polyarthritis.

[Vascular manifestations in 30 cases of Behçet's disease]. / Manifestaciones vasculares en 30 casos de enfermedad de Behçet.

Vascular manifestations on Behçet's disease (BD) vary from 25 to 65% according to different series. Affects both arteries as veins, but superficial thrombophlebitis is the most frequent disorder. Disorders with higher morbidity like deep venous thrombosis, and arterial aneurisms can appear, even in the lungs. In our series of 30 patients we found an incidence of 46% of vascular manifestations, mainly (92%) superficial thrombophlebitis. We highlight the presence of a femoral aneurism, which was resected, and discuss its evolution and response to treatment with prednisone and cyclophosphamide. We review in-depth the vascular manifestations in the Spanish and International scientific literature, paying special interest to aneurism dilatations.

[Osteoporosis as the first manifestation of minor beta-thalassemia]. / Osteoporosis como primera manifestación de la beta-talasemia minor.

We present the case of a 48-year-old premenopausal woman with right lumbosciatalgia secondary to osteoporosic vertebral collapses. Two of her three offsprings, a 31-year-old man and a 16-year-old woman, had chronic dorsolumbalgia, the study of which suggested the diagnosis of minor beta-thalassemia. As opposed to thalassemic osteoarthropathy, frequently observed in the forms of "major" and "minor" beta-thalassemia, rheumatic manifestations have almost never been described in the "minor" forms. We highlight the possibility of symptomatic osteoporosis as the first manifestation and we review the locomotive disorders associated to this hemoglobinopathy.

HLA and Behçet's disease in northern Spain: their lack of correlation with arthritis pattern.

We have studied the characteristics of arthritis present in 32 patients with Behçet's disease (BD), and how this arthritis is related to the HLA markers class I. 84% of the patients presented arthritis, the most common being mono-arthritis as the initial presentation, and oligoarthritis in subsequent episodes. In 63% of the cases, the development was in episodes of acute/subacute arthritis. We found statistically significant association between antigens B-5 and B-51, and the group with BD, with a relative risk of 3.89 and 4.71 respectively. The attempt to relate markers B-5, B-51 and B-27 to the presence of arthritis as well as to its manifestation and further development was not conclusive.