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Background and objectives: The COVID-19 pandemic has forced universities to move the completion of university studies online. Spain's National Conference of Medical School Deans coordinates an objective, structured clinical competency assessment called the Objective Structured Clinical Examination (OSCE), which consists of 20 face-to-face test sections for students in their sixth year of study. As a result of the pandemic, a computer-based case simulation OSCE (CCS-OSCE) has been designed. The objective of this article is to describe the creation, administration, and development of the test. Materials and methods: This work is a descriptive study of the CCS-OSCE from its planning stages in April 2020 to its administration in June 2020. Results: The CCS-OSCE evaluated the competences of anamnesis, exploration, clinical judgment, ethical aspects, interprofessional relations, prevention, and health promotion. No technical or communication skills were evaluated. The CCS-OSCE consisted of ten test sections, each of which had a 12-minutes time limit and ranged from six to 21 questions (mean: 1.1 minutes/question). The CCS-OSCE used the virtual campus platform of each of the 16 participating medical schools, which had a total of 2,829 students in their sixth year of study. It was jointly held on two dates in June 2020. Conclusions: The CCS-OSCE made it possible to bring together the various medical schools and carry out interdisciplinary work. The CCS-OSCE conducted may be similar to Step 3 of the United States Medical Licensing Examination.

There is little evidence on the use of sodium−glucose cotransporter 2 inhibitors in hospitalised patients. This work aims to analyse the glycaemic and clinical efficacy and safety of empagliflozin continuation in patients with type 2 diabetes hospitalised for acute decompensated heart failure. This real-world observational study includes patients treated using our in-hospital antihyperglycaemic regimens (basal-bolus insulin vs. empagliflozin-basal insulin) between 2017 and 2020. A propensity matching analysis was used to match a patient on one regimen with a patient on the other regimen. Our primary endpoints were the differences in glycaemic control, as measured via mean daily blood glucose levels, and differences in the visual analogue scale dyspnoea score, NT-proBNP levels, diuretic response, and cumulative urine output. Safety endpoints were also analysed. After a propensity matching analysis, 91 patients were included in each group. There were no differences in mean blood glucose levels (152.1 ± 17.8 vs. 155.2 ± 19.7 mg/dL, p = 0.289). At discharge, NT-proBNP levels were lower and cumulative urine output greater in the empagliflozin group versus the basal-bolus insulin group (1652 ± 501 vs. 2101 ± 522 pg/mL, p = 0.032 and 16,100 ± 1510 vs. 13,900 ± 1220 mL, p = 0.037, respectively). Patients who continued empagliflozin had a lower total number of hypoglycaemic episodes (36 vs. 64, p &lt, 0.001). No differences were observed in adverse events, length of hospital stay, or in-hospital deaths. For patients with acute heart failure, an in-hospital antihyperglycaemic regimen that includes continuation of empagliflozin achieved effective glycaemic control, lower NT-proBNP, and greater urine output. It was also safer, as it reduced hypoglycaemic episodes without increasing other safety endpoints.

Resumen Antecedentes y objetivos La pandemia de la COVID-19 ha obligado a completar los estudios universitarios online. La Conferencia Nacional de Decanos de Facultades de Medicina coordina una prueba de evaluacion de competencias clinicas objetiva y estructurada (ECOE) de 20 estaciones presenciales a los estudiantes de sexto del grado. Como consecuencia de la pandemia se ha disenado una ECOE sustitutoria con casos-clinicos computarizados simulados (ECOE-CCS). El objetivo del articulo es describir la elaboracion, la ejecucion y el desarrollo de la prueba. Materiales y metodos Estudio descriptivo de la ECOE-CCS conjunta desde su gestacion en abril 2020 hasta su ejecucion en junio 2020. Resultados La ECOE-CCS evaluo las competencias de anamnesis, exploracion, juicio clinico, aspectos eticos, relaciones interprofesionales, prevencion y promocion de la salud. No se evaluaron habilidades tecnicas ni de comunicacion. La ECOE-CCS consistio en 10 estaciones de 12 minutos de duracion, con un numero de preguntas de seis a 21 (media: 1,1 minutos/pregunta). En la ECOE-CCS se utilizo la plataforma virtual del campus de cada una de las 16 facultades de Medicina que participaron, con un total de 2.829 estudiantes de sexto curso. Se realizo de una forma conjunta en dos fechas de junio del 2020. Conclusiones La experiencia de la ECOE-CCS permitio llevar a cabo una integracion y el trabajo interdisciplinar de las diferentes facultades de Medicina. La ECOE-CCS realizada podria asemejarse al Step 3 CCS de la United States Medical Licensing Examination.

Resumen Introduccion El proceso docente actual necesita cambios mediante la introduccion de las nuevas tecnologias de la informacion y la comunicacion (TIC) por medio de nuevos sistemas de hardware y software. Tras unos primeros anos de introduccion y adaptacion, hoy en dia, el uso de equipos informaticos fijos, portatiles, moviles y tabletas se ha convertido en un aspecto cotidiano para todos los individuos, permitiendo que nuevas tecnologias se puedan implantar de una manera mas natural. En este sentido, la Facultad de Medicina de Malaga se ha planteado el uso de mandos de respuesta interactivos mediante radiofrecuencias en actividades de grupo reducido ya que se postulan como una herramienta de gran utilidad que podrian mejorar la calidad de la docencia, permitiendo una evaluacion de la misma en tiempo real, superando la realizada por los metodos mas clasicos como el examen escrito u oral. Material y metodos Tras realizar cursos de formacion al personal implicado y dotar las aulas con el hardware preciso, se procedio a entregar a todos los alumnos un mando de respuesta interactiva por radiofrecuencia de forma gratuita para realizar diversas actividades en grupos reducidos un total de 12 asignaturas (6 basicas y 6 clinicas) mediante preguntas tipo test unirrespuesta y posteriormente una encuesta de satisfaccion. Se analizo la estadistica descriptiva y comparativa de los datos obtenidos. Resultados y discusion Los objetivos de nuestro estudio han ido enfocados a comprobar la eficacia de la implantacion de los mandos de respuesta interactiva en las actividades de grupo reducido en el grado en Medicina. Todos los resultados mostraron una distribucion normal. El numero de alumnos que participaron en la experiencia fue de 1.645, divididos en 6 asignaturas basicas y 6 clinicas. En el analisis conjunto el promedio de aciertos en las actividades de evaluacion de la docencia en grupos reducidos mediante test unirrespuesta fue de 73,3 ± 2,7% con un grado de satisfaccion de 4,3 ± 0,2 sobre 5. En el analisis comparativo entre asignaturas basicas y clinicas mediante t de Student, se observo un mayor promedio de aciertos en las asignaturas basicas (79,3 ± 2,9 vs. 67,3 ± 3,1) con un grado de satisfaccion similar (4,3 ± 0,3 vs. 4,2 ± 0,2). El uso de mandos de radiofrecuencia se ha mostrado como una herramienta util como apoyo a la docencia en grupos reducidos, facilitando una buena adquisicion de competencias especificas y un elevado grado de satisfaccion por parte del alumnado.

Introduction: The use of dipeptidyl peptidase-4 inhibitors in hospitalized patients is an area of active research. We aimed to compare the efficacy and the safety of the basal-bolus insulin regimen versus linagliptin-basal insulin in non-critically ill non-cardiac surgery patients in a real-world setting. Methods: We enrolled patients with type 2 diabetes hospitalized in non-cardiac surgery departments with admission glycated haemoglobin level < 8%, admission blood glucose concentration < 240 mg/dL, and no at-home injectable treatments who were treated with basal-bolus (n = 347) or linagliptin-basal (n = 190) regimens between January 2016 and December 2017. To match patients on the two regimens, a propensity matching analysis was performed. Results: After matching, 120 patients were included in each group. No differences were noted in mean blood glucose concentration after admission (p = .162), number of patients with a mean blood glucose 100–140 mg/dL (p = .163) and > 200 mg/dL (p = .199), and treatment failures (p = .395). Total daily insulin and number of daily insulin injections were lower in the linagliptin-basal group (both p

This study was conducted to obtain data regarding the association of caregiver burden (CB) and neuropsychiatric symptoms (NPSs) in patients with Alzheimer’s disease. We conducted a series of multiple linear regressions to determine the relationship between CB and NPSs and whether the caregiver coping strategies mediated this relationship. The NPSs were assessed using the Neuropsychiatric Inventory, and caregivers were evaluated with the Caregiver Burden Interview and the Inventory and the Coping Strategies Inventory. Results show that patients with more frequent and severe NPS were more likely to be cared for by more burdened caregivers, and this was partially mediated by caregiver coping strategies. More disengagement (β = .330, P < .001) and less engagement coping (β = −.347, P < .001) were predictors for NPS after adjusting for patient and caregiver characteristics. These results may be useful with a view to designing treatment interventions that aim to modify the use of caregiver coping strategies and to reduce NPSs.

New Findings • What is the central question of this study?As the parabrachial complex plays a role in the cardiorespiratory response evoked from the hypothalamic defence area (pressor response and tachycardia) and the A5 region is involved in the responses evoked from the parabrachial complex, a possible interaction between the hypothalamic defence area and A5 is suggested. Accordingly, the present study was carried out to assess this hypothesis in rats. • What is the main finding and its importance?The neuromorphological, neuropharmacological and electrophysiological results of our study demonstrate, for the first time, that the A5 region is an important component of those brainstem pathways known to be involved in mediating the autonomic changes associated with the electrically evoked defence response. In order to assess the possible interactions between the pontine A5 region and the hypothalamic defence area (HDA), we have examined the pattern of double staining for c-Fos protein immunoreactivity (c-Fos-ir) and tyrosine hydroxylase, throughout the rostrocaudal extent of the A5 region in spontaneously breathing anaesthetized male Sprague–Dawley rats during electrical stimulation of the HDA. Activation of the HDA elicited a selective increase in c-Fos-ir with an ipsilateral predominance in catecholaminergic and non-catecholaminergic A5 somata (P < 0.001 in both cases). A second group of experiments was done to examine the importance of the A5 region in modulating the cardiorespiratory response evoked from the HDA. Cardiorespiratory changes were analysed in response to electrical stimulation of the HDA before and after ipsilateral microinjection of muscimol within the A5 region. Stimulation of the HDA evoked an inspiratory facilitatory response, consisting of an increase in respiratory rate (P < 0.001) due to a decrease in expiratory time (P < 0.01). The respiratory response was accompanied by a pressor response (P < 0.001) and tachycardia (P < 0.001). After muscimol microinjection within the A5 region, pressor and heart rate responses to HDA stimulation were reduced (P < 0.01 and P < 0.001, respectively). The respiratory response persisted unchanged. Finally, to confirm functional interactions between the HDA and the A5 region, extracellular recordings of putative A5 neurones were obtained during HDA stimulation. Seventy-five A5 cells were recorded, 35 of which were affected by the HDA (47%). These results indicate that neurones of the A5 region participate in the cardiovascular response evoked from the HDA. The possible mechanisms involved in these interactions are discussed.

Background/Objective: The heterogeneous clinical presentations of individuals with Autism Spectrum Disorders (ASD) pose a significant challenge for sample characterization. Therefore the main goal of DSM-5 must be to identify subgroups of ASD, including comorbidity disorders and severity. The main goal of this study is to explore the psychiatric comorbidities and the severity of symptoms that could be relevant for the phenotype characterization in ASD and also to compare these results according to the different classification criteria between the DSM-IV-TR and the DSM-5. Method: A comparative study of severity and psychiatric comorbidities was carried out between a sample of participants that only met criteria for Pervasive Developmental Disorder (PDD) according to the DSM-IV-TR and a sample of participants that also met ASD criteria according to DSM-5 classification. The recruitment of children was via educational (N=123). The psychiatric symptoms, comorbid disorders and severity of symptoms were assessed through The Nisonger Child Behavior Rating Form, clinical interview and The Inventory of Autism Spectrum Disorder, respectively. The psychiatric comorbidities considered were: anxiety, eating behavioural problems, self-aggressiveness, hetero-aggressiveness, self harm, obsessive compulsive disorder and attention deficit and hyperactivity disorder. Results: Statistically significant differences between both groups were found regarding obsessive compulsive disorder, eating behavioural problems and severity. Conclusions: The results support the hypothesis that patients who meet the DSM-5 criteria have more severe symptoms, not only regarding the core autistic symptoms but also in relation with psychiatric comorbidities. (C) 2016 Asociacion Espanola de Psicologia Conductual. Published by Elsevier Espana, S.L.U.

Background: Caregiving for people with Alzheimer's disease (AD) is highly stressful and has significant negative consequences, such as anxiety and depression. Previous research offers conflicting findings as to whether coping strategies are associated with greater psychological distress or not. We conducted this study with a view to obtaining new data regarding the association of coping strategies and psychological distress in AD caregivers.Methods: Eighty people with AD and their primary caregivers living in the community were recruited from local health services. Purposive recruitment was carried out to ensure that the sample was representative of people living with dementia in terms of dementia severity, gender, and care setting. We used the State-Trait Anxiety Inventory to measure anxiety, the Beck Depression Inventory to measure depression, and the Coping Strategies Inventory to measure coping strategies.Results: Most caregivers reported higher anxiety and depression levels. Use of disengagement coping strategies (Wald = 3.35, p = 0.01) and higher caregiver burden (Wald = 4.83, p = 0.02) predicted anxiety on logistic regression. In turn, use of disengagement coping strategies (Wald = 12.48, p = 0.001) and higher caregiver burden (Wald = 6.91, p = 0.009) predicted depression on logistic regression.Conclusion: These results may be useful for designing treatment interventions that aim to modify the use of coping strategies and thus reduces caregiver anxiety and depression.

The objective of this study is to obtain preliminary normative data on the performance the Pyramids and Palm Trees Test (PPT) for a Spanish-speaking population. The effects of age, gender, and educational level on the PPT test were also analyzed. A total of 234 healthy participants, with a broad range of age (18–80 years) and education (1–20 years) performed the three-picture version of the PPT. The mean performance was 51.1 out of 52 possible points (SD= 1.3). PPT performance did not vary with age or gender. However, subjects with less than 6 years of formal education scored significantly lower than those with more than 6 years of education though this effect was confounded with age because the group with lower education was also older. Given the ceiling effects of the PPT, further investigation is needed to determine if the visual PPT is sensitive to mild semantic memory impairment. (JINS, 2008,14, 148–151.)

1. In order to assess the importance of the parabrachial nuclei in modulating cardiorespiratory activity, electric current or microinjections of glutamate were used to stimulate discrete regions of the parabrachial nuclei in anaesthetized rats. 2. Stimulation of cell bodies in the medial region of the parabrachial nuclei and in the Kölliker-Fuse nuclei, caused an expiratory facilitatory response. This consisted mainly of a decrease in respiratory rate as measured by observing phrenic nerve activity. 3. Stimulation of cell bodies in the lateral region of the parabrachial nuclei caused an inspiratory facilitatory response. This consisted mainly of an increase in respiratory rate. 4. At the majority of sites (16 out of 20) where changes in respiratory rate were elicited by glutamate injection or electrical stimulation an increase in blood pressure was observed. The coexistence of increases in blood pressure and heart rate indicates the presence of inhibition of the heart rate component of the baroreflex and/or an increase in cardiac sympathetic drive. 5. The expiratory facilitatory response was not evoked reflexly by the rise in blood pressure since it was still present after administration of guanethidine, which abolished the rise in blood pressure. 6. The interactions between the parabrachial nuclei and the medullary respiratory complex in eliciting these changes are discussed.

In spontaneously breathing, decerebrate cats, extracellular recordings in the intermediate region of the ambiguus complex have been used to characterize the activity of inspiratory laryngeal motoneurones (ILMNs) during mechanical stimulation of tracheal irritant receptors. Laryngeal resistance was measured using an isolated larynx in situ. The effect of tracheal stimulation was analysed successfully in twenty-seven neurones. Eleven were ILMNs and sixteen inspiration-related neurones. Inspiration-related neurones increased their phasic discharge frequency during tracheal stimulation while ILMNs fired tonically, during both the inspiratory and the expiratory efforts of the cough. The tonic discharge of ILMNs coincided with a decrease of laryngeal resistance.

La extraccion de los trombos pulmonares en el tromboembolismo pulmonar masivo antes de 1953 (operacion de Trendelenburg) cosecho fracaso tras fracaso. Desde el advenimiento de la circulacion extracorporea (CEC) el porcentaje de exito de esta operacion mejoro notablemente, no habiendo dejado de aumentar hasta la actualidad, existiendo series que reflejan porcentajes de hasta el 94% de supervivencia inmediata, con 86 y 83% de supervivencia actuarial a 1 y 3 anos. Presentamos un caso de paciente varon de 35 anos sin enfermedad previa ni antecedentes familiares de enfermedad tromboembolica. Consulta por insuficiencia respiratoria, siendo diagnosticado por tomografia computarizada de tromboembolismo en AP izquierda, la cual ocluye. El ECO-Doppler de MMII descarta trombosis venosa profunda (TVP). Una nueva tomografia computarizada informa de persistencia de la obstruccion de AP izquierda y sus ramas, que parece haber aumentado. En ecocardiografia transtoracica (ETT) dilatacion de cavidades derechas con funcion de ventriculo derecho (VD) normal y presion sistolica de la arteria pulmonar (PSAP) de 70 mmHg. Los estudios para investigar trombofilia fueron negativos. Tras unos dias empeora su situacion, produciendose dos paradas cardiorrespiratorias, de las que es reanimado y tratado inmediatamente con TNK. La tomografia computarizada muestra la existencia de nuevo episodio de tromboembolismo pulmonar que afecta a la AP derecha gravemente. Es intervenido quirurgicamente bajo CEC sin parada circulatoria, extrayendose molde trombotico de tronco y ambas ramas de la AP. La evolucion postoperatoria fue favorable. En tomografia computarizada de control se observan limpios el tronco y las ramas de la AP, con cierto compromiso en ramas subsegmentarias de la AP izquierda. Se muestran imagenes de la intervencion y tomografia computarizada pre y posquirurgicas.

Presentamos un caso de paciente mujer de 38 anos con antecedentes de coartacion aortica tipica leve, que consulta por clinica de disfagia lusoria, objetivandose masa pulsatil en la fosa supraclavicular izquierda en la exploracion fisica. Se practica angiotomografia computarizada que muestra aneurisma sacular localizado en arco aortico, cuyo origen se encuentra entre los origenes de las arterias carotida y subclavia izquierdas y se extiende hasta la zona coartada, con diametro maximo de 8 cm. La arteria carotida izquierda es hipoplasica y la subclavia derecha es aberrante, naciendo de la aorta descendente y cruzando la linea media hasta alcanzar MSD. Es intervenida quirurgicamente a traves de esternotomia media y toracotomia anterolateral izquierda. Tras establecer bypass femorofemoral izquierdo se clampa arco aortico entre el origen de ambas carotidas y distalmente a la coartacion, resecando el aneurisma que incluye los origenes de ambas arterias subclavias, interponiendo a continuacion injerto vascular tubular de dacron de 20 mm de diametro, reinsertando en el mismo la arteria subclavia izquierda. No se reimplanto la arteria subclavia derecha. El control de la presion arterial se establecio mediante sendas canulas en aorta ascendente y arteria femoral derecha. En el postoperatorio se produjo trombosis venosa del eje subclavio izquierdo secundario verosimilmente a la seccion iatrogena del tronco venoso innominado y que se resolvio satisfactoriamente con tratamiento convencional. Se muestran las imagenes de la tecnica quirurgica y la idoneidad de la correccion quirurgica con la angiotomografia computarizada postoperatorio.