Medical education from the point of view of medical students: Results from four participatory Delphi panels in Quito, Ecuador.

BACKGROUND: Medical curricula have historically been designed in a top-down approach, usually excluding students. While Delphi panels have been used as a tool for medical education curricula design, none have been conducted in Ecuador. In addition, no such approach has ever included students both as panelists and researchers. MATERIAL AND METHODS: Four Delphi panels were developed and conducted using a participatory approach that allowed medical students to take part both as expert panelists and researchers: specifically, students developed the questionnaire and conducted a qualitative synthesis. Questionnaire responses were anonymized and dispatched online to panelists. The information was organized and collected to develop the qualitative syntheses and prepare the final statements. RESULTS: Thirty-two medical students participated between February and May 2018. A total of 32 questions were developed, corresponding to five different categories. For some questions, consensus was reached; for other questions, general statements were obtained.Discussion and conclusion: Developing the questionnaire, responding to it and analyzing the answers allowed students to raise significant concerns regarding medical education topics proposing relevant policy and curricula change. Participatory Delphi panels can be an efficient tool to obtain organized feedback, improve student class involvement, and promote research skills.

Follow-up monoclonal gammopathy of undetermined significance in kidney transplant.

OBJECTIVE: The aim of this work was to review the incidence of monoclonal gammopathy of undetermined significance (MGUS) and complications in kidney transplant (KT) patients at the Puerta del Mar Hospital in Cádiz, Spain. This diagnosis was not considered to be a contraindication for transplantation. METHODS: To estimate the incidence of MGUS in KT patients we used the database of our hospital, which included 1,016 patients who received a KT from 1992 to 2012 with a median follow-up of 30 months. The incidence of MGUS in non-transplant patients was estimated from the literature. RESULTS: Out of 1,016 KT patients, 16 developed MGUS; 10 (72.5%) were >50 years old. Two patients developed post-transplantation lymphoproliferative disorders. No cases of progression to multiple myeloma or amyloidosis were seen during immune suppression therapy or after. CONCLUSIONS: MGUS was >100 times more frequent in KT recipients than in the general population (P < .05). But in contrast to MGUS in general population, progression to plasma cell dyscrasia in these patients was absent and its incidence is unknown in KT patients.

[Neuromotor assessment of patients with spastic cerebral palsy treated with orthopedic surgery at the National Rehabilitation Institute]. / Evaluación neuromotora de pacientes con parálisis cerebral espástica tratados con cirugía ortopédica en el Instituto Nacional de Rehabilitación.

BACKGROUND: Cerebral palsy (CP) is a static neurologic condition resulting from a brain lesion occurring before the completion of brain development. The goal of management is not cure, but increasing patients' functionality and improving their capabilities and maintaining their locomotion, cognitive development, social interaction and independence. The best results are obtained with an early and intensive management that includes physical and occupational therapy, medical and surgical treatments, mechanical aids and the management of concomitant conditions. OBJECTIVE: To assess the neuromotor improvement in patients with spastic CP after surgical treatment at the National Rehabilitation Institute. PATIENTS AND METHODS: Patients with a diagnosis of spastic CP who presented at the Pediatric Rehabilitation outpatient service were referred to the Joint CP Clinic from January 2007 to January 2008, and underwent surgical treatment of the pelvic limbs. They were assessed 3 times and underwent neuromotor tests with gross motor function measure (GMFM), which was rated with the gross motor function classification system (GMFCS). RESULTS: Most of the patients had improvement in the muscle tone and contracture assessments as well as in the GMFM, and their self-mobility increased one level. CONCLUSIONS: Significant improvements were seen in the muscle tone and contractures after surgery; the GMFM and the self-mobility levels in the GMFCS also improved. Multiple level surgery together with a postoperative physical therapy program results in considerable improvements in the gross motor function measure of patients with spastic CP.

[Viral agents related to diarrheic syndrome in kidney transplanted patients]. / Agentes virales asociados al sindrome diarreico en pacientes trasplantados renales.

The aim of this study was to report on the occurrence of conventional and emerging viral agents as well as their etiological link with diarrhea in kidney transplanted subjects from Cordoba, Argentina. A total of 42 stool samples were analysed. They were obtained from both ambulatory and hospitalized kidney transplanted patients with and without diarrhea after transplant. All patients were under immunosuppressive treatment with steroids, azatioprine and cyclosporine or tacrolimus. Results revealed the presence of group A rotavirus and picobimavirus in three patients suffering from severe diarrhea (33.33%). No enteric bacterial agent was isolated from these patients. The presence of viral agents was related to high levels of cyclosporine in blood (> 290 ng/ml) or prolonged immunosuppressive treatment. On the other hand, no virus was detected in any of the samples collected from asymptomatic individuals (p < 0.05). These findings suggest that viruses are implicated in the etiology of diarrheal disease in these patients.

Agentes virales asociados al sindrome diarreico en pacientes trasplantados renales. / [Viral agents related to diarrheic syndrome in kidney transplanted patients]

The aim of this study was to report on the occurrence of conventional and emerging viral agents as well as their etiological link with diarrhea in kidney transplanted subjects from Cordoba, Argentina. A total of 42 stool samples were analysed. They were obtained from both ambulatory and hospitalized kidney transplanted patients with and without diarrhea after transplant. All patients were under immunosuppressive treatment with steroids, azatioprine and cyclosporine or tacrolimus. Results revealed the presence of group A rotavirus and picobimavirus in three patients suffering from severe diarrhea (33.33

). No enteric bacterial agent was isolated from these patients. The presence of viral agents was related to high levels of cyclosporine in blood (> 290 ng/ml) or prolonged immunosuppressive treatment. On the other hand, no virus was detected in any of the samples collected from asymptomatic individuals (p < 0.05). These findings suggest that viruses are implicated in the etiology of diarrheal disease in these patients.

[Trypanocidal structure- activity relationship in 9-thioalkylacridines]. / Relations structure-activité trypanocide chez les 9-thioalkylacridines.

A set of 9-thioalkylacridinones, has been prepared and investigated "in vitro" against T. cruzi. Structure-antiparasitic activity relationships are detailed with a view to identify the major structural parameters for the activity under consideration.

A protein secreted by Trypanosoma cruzi capable of inducing the entry of inert particles into HeLa cells.

Trypanosoma cruzi requires an intracellular environment to multiply within its mammalian host. We describe the purification and some properties of a protein secreted exclusively by the metacyclic (infective) forms of the parasite. This permeabilizing protein (relative molecular mass 64,000) was secreted under our experimental conditions only when the parasites interacted with HeLa cells, HeLa membranes, or wheat-germ lectin. The protein is thermostable, and its biological activity is inhibited by formaldehyde but not by ethanol or acetone. At low concentrations and over short treatment times, this protein acts as a permeabilizer and induces endocytosis. No significant protease or neuraminidase activity was found. When adsorbed onto bentonite particles and incubated in the presence of non-phagocytic cells the protein facilitated the penetration of the particles into the cells. Immune serum directed against the protein neutralized its cytotoxic action and reduced the rate of penetration of metacyclic forms into both macrophages and non-phagocytic cells. Our results suggest that the protein secreted by the parasite plays a key role in the penetration of its infective form into the host cell.