Learning anatomy through dissection: perceptions of a diverse medical student cohort / Aprendizaje de la anatomía a través de disección: percepción de una amplia cohorte de estudiantes de medicina

The debate on how best to teach anatomy and the central role of cadaveric dissections in medical training remains topical even today. Despite the use of a variety of teaching methodologies e.g. prosected specimens, plastinated specimens, cadaveric dissection and computer-assisted learning, the amount of time dedicated to a full body human dissection programme, its clinical relevance and whether it promotes deeper learning has become a bone of contention in problem- based learning context. The implementation of student centred, PBL curricula means that students' learning is autonomous, and studies suggest the link between students' approaches to learning with their perceptions of their learning environment. Therefore, this study explored the perceptions of an educationally diverse medical student cohort in a 5 year problem-based learning programme who learned anatomy through the dissection method, elaborating on the value of this subject to their medical studies. Quantitative and qualitative data was collected and thematically analysed. One hundred students of the MBChB2 cohort (44%) completed the questionnaire. The majority of the respondents (70%) reported a positive experience during anatomical dissection in terms of visual and clinical application whilst gaining anatomy understanding and skill. Students with prior educational qualifications (mature) and first time school leavers voiced similar complaints. Student responses differed qualitatively on how they benefitted from the dissection. This study confirms that dissection remains an effective method for basic anatomy teaching even in PBL contexts. It concludes with strategies to enhance the learning experiences of educationally diverse students.

El debate sobre la mejor manera de enseñar la anatomía y la relevancia de las disecciones de cadáveres en la formación médica sigue siendo un tema de actualidad. A pesar del uso de una variedad de metodologías de enseñanza, por ejemplo especímenes plastinados, la disección de cadáveres y el aprendizaje asistido por computador, el tiempo dedicado a un programa de disección de cuerpo completo, su relevancia clínica y el promover un aprendizaje más profundo se ha convertido en un tema de discordia en el contexto del aprendizaje de los estudiantes y sus percepciones del ambiente de aprendizaje. Este estudio investigó las percepciones desde un punto de vista educativo en un grupo de estudiantes de medicina en un programa de aprendizaje basado un estudio observacional, en un programa de 5 años basado en problemas a través del método de disección, evaluando el valor de este tema para sus estudios de medicina. Los datos cuantitativos y cualitativos fueron recolectados y analizados temáticamente. Un centenar de estudiantes de la cohorte MBChB2 (44%) completaron el cuestionario. La mayoría de los encuestados (70%) reportó una experiencia positiva durante la disección anatómica en términos de aplicación visual y clínica, mientras van adquiriendo comprensión de la anatomía y habilidad. Los estudiantes con títulos de estudios previos (maduros) y los recién egresados de la escuela secundaria expresaron quejas similares. Las respuestas de los estudiantes difieren cualitativamente en la forma en que se beneficiaron de la disección. Este estudio confirma que la disección sigue siendo un método eficaz para la enseñanza de anatomía básica incluso en contextos de ABP. El estudio concluye con estrategias para mejorar las experiencias de aprendizaje de los estudiantes basado en diversos problemas.

Alternativas para o controle de nematoides gastrintestinais de pequenos ruminantes / Alternative techniques for the control of gastrointestinal nematodes in small ruminants

Sheep and goat farming requires an efficient management program, due to losses caused by parasites in susceptible animals. Many factors may collaborate to improve infection tolerance in the herd, such as: genetics, nutrition, physiological status, and age. The problem caused by resistance to antihelmintic agents has led to the spread of alternative techniques for parasite controls. The latest strategies include selective treatment with the FAMACHA method, phytotherapy, biological control with predatory fungi, and strategies that still await scientific confirmation, such as homeopathy, the dilution of resistance with the introduction of susceptible parasites, and the combination of drugs without antihelmintic effect. The main objective of these methods is to reduce the usage of antiparasitic agents, thus slowing the development of resistance and promoting the better use of effective products and newly released products. The objective of this article is to describe techniques for controlling nematodes in small ruminants, and it is aimed at technicians interested in increasing their knowledge about the mechanisms of resistance to antihelmintic agents as well as alternatives to the use of these products.(AU)

A criação de ovinos e caprinos depende de um manejo eficiente, devido, principalmente, ao prejuízo causado por parasitos em animais susceptíveis. Vários fatores colaboram para que os animais tolerem as infecções parasitárias, como: genética, nutrição, estado fisiológico e idade. O grave problema causado pela resistência anti-helmíntica promoveu a difusão de técnicas alternativas de controle parasitário. Dentre essas novas estratégias incluem-se a adoção do tratamento parcial seletivo com o método FAMACHA, fitoterapia, controle biológico com o uso de fungos nematófagos e estratégias que ainda necessitam de mais dados como a homeopatia, a diluição da resistência com a introdução de parasitos sensíveis e a combinação de produtos químicos sem efeito antiparasitário. O objetivo central destes métodos é reduzir o uso de antiparasitários, retardando o desenvolvimento da resistência, e promover melhor utilização de produtos ainda eficazes na propriedade e de novos produtos que venham a ser lançados. Este artigo abordará as técnicas descritas acima para o controle de nematoides de pequenos ruminantes e é direcionado aos técnicos interessados em ampliar seu conhecimento sobre os mecanismos de resistência dos parasitos aos anti-helmínticos e de alternativas ao uso desses produtos.(AU)

Alternativas para o controle de nematoides gastrintestinais de pequenos ruminantes / Alternative techniques for the control of gastrointestinal nematodes in small ruminants

Sheep and goat farming requires an efficient management program, due to losses caused by parasites in susceptible animals. Many factors may collaborate to improve infection tolerance in the herd, such as: genetics, nutrition, physiological status, and age. The problem caused by resistance to antihelmintic agents has led to the spread of alternative techniques for parasite controls. The latest strategies include selective treatment with the FAMACHA method, phytotherapy, biological control with predatory fungi, and strategies that still await scientific confirmation, such as homeopathy, the dilution of resistance with the introduction of susceptible parasites, and the combination of drugs without antihelmintic effect. The main objective of these methods is to reduce the usage of antiparasitic agents, thus slowing the development of resistance and promoting the better use of effective products and newly released products. The objective of this article is to describe techniques for controlling nematodes in small ruminants, and it is aimed at technicians interested in increasing their knowledge about the mechanisms of resistance to antihelmintic agents as well as alternatives to the use of these products.

A criação de ovinos e caprinos depende de um manejo eficiente, devido, principalmente, ao prejuízo causado por parasitos em animais susceptíveis. Vários fatores colaboram para que os animais tolerem as infecções parasitárias, como: genética, nutrição, estado fisiológico e idade. O grave problema causado pela resistência anti-helmíntica promoveu a difusão de técnicas alternativas de controle parasitário. Dentre essas novas estratégias incluem-se a adoção do tratamento parcial seletivo com o método FAMACHA, fitoterapia, controle biológico com o uso de fungos nematófagos e estratégias que ainda necessitam de mais dados como a homeopatia, a diluição da resistência com a introdução de parasitos sensíveis e a combinação de produtos químicos sem efeito antiparasitário. O objetivo central destes métodos é reduzir o uso de antiparasitários, retardando o desenvolvimento da resistência, e promover melhor utilização de produtos ainda eficazes na propriedade e de novos produtos que venham a ser lançados. Este artigo abordará as técnicas descritas acima para o controle de nematoides de pequenos ruminantes e é direcionado aos técnicos interessados em ampliar seu conhecimento sobre os mecanismos de resistência dos parasitos aos anti-helmínticos e de alternativas ao uso desses produtos.

Severe endocrine and nonendocrine manifestations of the McCune-Albright syndrome associated with activating mutations of stimulatory G protein GS.

McCune-Albright syndrome (MCAS) is a sporadic disease classically including polyostotic fibrous dysplasia, café au lait spots, sexual precocity, and other hyperfunctional endocrinopathies. An activating missense mutation in the gene for the alpha subunit of GS, the G protein that stimulates cyclic adenosine monophosphate formation, has been reported to be present in these patients. The mutation is found in variable abundance in different affected endocrine and nonendocrine tissues, consistent with the mosaic distribution of abnormal cells generated by a somatic cell mutation early in embryogenesis. We describe three patients with MCAS who had profound endocrine and nonendocrine disease and who died in childhood. Two of the patients were severely ill neonates whose complex symptoms did not immediately suggest MCAS. A mutation of residue Arg201 of GS alpha was found in affected tissues from all three children. A review of the literature and unpublished case histories emphasizes the existence of other patients with severe and unusual clinical manifestations. We conclude that the manifestations of MCAS are more extensive than is generally appreciated, and may include hepatobiliary disease, cardiac disease, other nonendocrine abnormalities, and sudden or premature death.

Stimulation of statural growth by recombinant insulin-like growth factor I in a child with growth hormone insensitivity syndrome (Laron type)

We studied the effects of 9 months of treatment with twice-daily subcutaneous injections of insulin-like growth factor I (IGF-I), 120 micrograms/kg per dose, in a 9.7-year-old child with growth hormone insensitivity syndrome, in whom short-term studies had suggested that IGF-I might promote linear growth. Height velocity increased from 6.5 cm/yr (+1.7 SD score) to 11.4 cm/yr (+8.8 SD score). Serum concentrations of IGF-I increased from pretreatment values of 9 +/- 2 micrograms/L to a peak of 347 +/- 26 micrograms/L after 2 hours. Serum concentrations of IGF-II were unchanged. Basal but not stimulated growth hormone concentrations were decreased. During the first 12 days of treatment, serum concentrations and the 24-hour urinary excretion of urea nitrogen were decreased by 28% and 10%, respectively (p < 0.05), there was a 2.4-fold increase in urinary excretion of calcium (p < 0.001), and creatinine clearance and urine volume increased by 22% and 55%, respectively (p < 0.02). The changes in serum levels of urea nitrogen and in urinary calcium and creatinine clearance were still evident at 10 weeks. Fasting and postprandial serum glucose concentrations remained normal. We conclude that IGF-I given as twice-daily subcutaneous injections is effective in stimulating statural growth without producing the hypoglycemia and hyperglycemia observed when IGF-I is infused continuously.

High incidence of perinatal insult in children with idiopathic hypopituitarism.

The perinatal histories of 46 children with idiopathic hypopituitarism were assessed in order to define the relationship between perinatal insult and the development of hypopituitarism. Compared to normal control siblings, the pregnancies resulting in hypopituitary children were complicated by a significantly higher incidence of vaginal bleeding at various times during gestation (13 pregnancies). Twenty-four percent of the hypopituitary children were delivered by breech, three times the incidence of control siblings and seven times the incidence of breech deliverery in the general population. Prolonged or unusually short labors were more common in the hypopituitary children (13 patients), as were signs of intrapartum distress and asphyxia (10 patients). At the time of the study, 19 hypopituitary children had neurologic abnormalities; of these, 15 had histories of significant perinatal insult. The findings in this study suggest that, in many cases, perinatal insults may cause hypopituitarism.

Serum somatomedin-C in hypopituitarism and in other disorders of growth.

Serum levels of somatomedin-C have been measured by a competitive membrane binding assay in normal individuals, in hypopituitary dwarfs, and in children with growth retardation from causes other than growth hormone deficiency. The mean level in untreated hypopituitary children is about 40% of that of age-matched normal children. Treatment of hypopituitary dwarfs with human growth hormone results in prompt increases in the serum concentration of somatomedin-C. Normalization of somatomedin is associated with the return of pituitary function in hospitalized psychosocial dwarfs. Supporting the possibility that somatomedin-C plays a pivotal role in skeletal growth is the finding that serum levels in hypopituitary children correlate with growth rate both on and off growth hormone therapy. In our hands, this assay has proved to be an efficient, reliable method for the diagnosis of growth hormone deficiency.

Adverse effects of large doses of medroxyprogesterone (MPA) in idiopathic isosexual precocity.

PIP: Medroxyprogesterone (MPA) is a progestin with no clinically detectable estrogenic and androgenic properties used in the treatment of sexual precocity. This report presents the results of administering large intramuscular doses of MPA (200 to 300 mg every 7 to 10 days for periods ranging from 5 to 40 months) in 3 girls and 1 boy with rapidly progressing idiopathic sexual precocity (e.g., breast enlargement, penile enlargement, pubic hair growth). Urinary steroids were measured by bioassay, standard modification of the double isotope derivative method, and other standard methods. The MPA regimen suppressed the signs and symptoms of precocious puberty. The 3 girls did not have further menstrual flow, breast tissue regressed, uterine size decreased, and vaginal cornification diminished, although not to prepubertal levels. A marked decrease in frequency of erections, no further penile enlargement, and only minimal progression of sexual hair were observed in the boy (the testis continued to enlarge, however). Excessive weight gain, rapid rate of linear growth and skeletal maturation were observed in the children during treatment, as was blood pressure elevation. The effectiveness of MPA appears to be mediated by the suppression of pituitary gonadotropin secretion. However, there was no consistent reduction of urinary gonadotropin levels, and suppression of gonadal stimulation was incomplete. Evidence of drug toxicity precludes further administration of high dosages of MPA even for research purposes.^ieng