From Wintrobe to the XXI century. A Story of Inspiration and Effort

In 2014 we are celebrating the 80th anniversary of the Maxwell Myer Wintrobe´s pioneer works, one of the most important contributions in Clinical Laboratory and Medicine. Red cell indices continue to provide an essential support to the diagnosis and classification of anemia. The erythrocyte indices mean cell volume, mean cell hemoglobin concentration, mean cell hemoglobin are called the Wintrobe indices. Hematology automation has progressed steadily since Wallace Coulter first applied electrical impedance technology to counting red cells and white cells. Technological advances being incorporated into hematology analyzers since then are now allowing the access to more cellular information than was ever available before through a “simple routine CBC”. Current research is beginning to demonstrate that this information also has great potential to identify cellular changes that typically occur in several important medical conditions—bringing us all one step closer to using hematology analyzers as more than simple cell counters, but instead as powerful tools for the management of any medical condition that impacts the biology of blood cells. There are increasing amounts of data provided, which require specialist knowledge to interpret as well as understand the limitations in the measurement of the parameter. Both laboratory scientists and clinicians need to keep up to date with new parameters and methods in hematology, implying a stronger collaboration between them to improve clinical decision makin

Percepción del ambiente educacional en dos escuelas de medicina con currículo tradicional. Estudio longitudinal;

Background: To establish an educational environment that ensures the quality of the teaching-learning process is a challenge for any educational institution. The questionnaire DREEM (Dundee Ready Educational Environment Measure) is used to identify strengths and weaknesses of an educational environment and to compare different medical schools. Aim: To evaluate the changes in the perception of educational environment by students of the Schools of Medicine of the University of Zaragoza, UZar (Spain) and the University of Chile, UCh (Chile) at two points in their curricula. Material and Methods: DREEM questionnaire was answered by 90 students from the UZar and 87 students of the UCh, when they were in the first year (2009) and in the fourth year of their career (2012). Results: At both universities the overall mean scores of DREAM were significantly higher in students in their first year than those obtained in the fourth year (137.5/118.3 for UZar and 128.6/118.8 for UCh). Items with worse perception in the fourth year were observed in subscales Learning Perception and Atmosphere Perception. Items with good evaluation (= 3.0) were the subscales Perception of teachers, academic self-perception, perception of Environment and Social Self-perception. Conclusions: The perception of Chilean and Spanish students about their educational environments indicates that the stage of their medical training is more important than the geographical context or educational institution

Effect of two days treatment with orlistat on plasma leptin in obese patients without weight loss

Objective: Little is known about the impact of orlistat on the leptin system. We studied the plasma leptin and satiety sensation response for two days of orlistat treatment without hypocaloric diet and weight loss. Material and methods: Twenty obese female subjects were recruited from our medical outpatient clinics. All of these subjects had previously received advice on dietary restriction and lifestyle modification, but remained obese with a stable body weight for at least six months before recruitment for the study. Results: Subjects were given 120 mg orlistat 3 times daily and were asked to maintain their usual diet. At baseline and two days after the treatment with orlistat, physical examination, hunger and blood analysis were repeated. There were no significant differences observed regarding energy dietary intake, body weight and waist-hip ratio, or in plasma glucose, insulin c-peptide concentrations. Only plasma leptin and triglycerides concentrations decreased (p: 0.0001 and 0.01 respectively). Decrease in plasma leptin concentration was positively correlated with changes observed in plasma triglycerides concentration (p: 0.01, r2: 0.45). Pre-dinner hunger increased and was negatively correlated with decrease in leptin (p: 0.0001, r2: 0.74) and triglycerides (p: 0.02, r2: 0.59). Conclusion: These data suggest that the partial fat malabsorption induced by the treatment with orlistat quickly reduces plasma triglycerides and leptin. This decrease is associated with increased appetite before intake following the main meal of the day

Performance and comparability of laboratory methods for measuring ferritin concentrations in human serum or plasma: A systematic review and meta-analysis

Background Different laboratory methods are used to quantify ferritin concentrations as a marker of iron status. A systematic review was undertaken to assess the accuracy and comparability of the most used methods for ferritin detection. Methods and findings National and regional databases were searched for prospective, retrospective, sectional, longitudinal and case-control studies containing the characteristics and performance of at least one method for serum/plasma ferritin determinations in humans published to date. The analysis included the comparison between at least 2 methods detailing: sensitivity, precision, accuracy, predictive values, inter-methods adjustment, and use of international reference materials. Pooled method performance was analyzed for each method and across methods. Outcomes Search strategy identified 11893 records. After de-duplication and screening 252 studies were assessed, including 187 studies in the qualitative analysis and 148 in the meta-analysis. The most used methods included radiometric, nonradiometric and agglutination assays. The overall within-run imprecision for the most reported ferritin methods was 6.2±3.4% (CI 5.69–6.70%; n = 171), between-run imprecision 8.9±8.7% (CI 7.44–10.35%; n = 136), and recovery rate 95.6% (CI 91.5–99.7%; n = 94). The pooled regression coefficient was 0.985 among all methods analyzed, and 0.984 when comparing nonradiometric and radiometric methods, without statistical differences in ferritin concentration ranging from 2.3 to 1454 µµg/L. Conclusion The laboratory methods most used to determine ferritin concentrations have comparable accuracy and performance. Registered in PROSPERO CRD42016036222

From Wintrobe to the XXI century. A Story of Inspiration and Effort

In 2014 we are celebrating the 80th anniversary of the Maxwell Myer Wintrobe´s pioneer works, one of the most important contributions in Clinical Laboratory and Medicine. Red cell indices continue to provide an essential support to the diagnosis and classification of anemia. The erythrocyte indices mean cell volume, mean cell hemoglobin concentration, mean cell hemoglobin are called the Wintrobe indices. Hematology automation has progressed steadily since Wallace Coulter first applied electrical impedance technology to counting red cells and white cells. Technological advances being incorporated into hematology analyzers since then are now allowing the access to more cellular information than was ever available before through a “simple routine CBC”. Current research is beginning to demonstrate that this information also has great potential to identify cellular changes that typically occur in several important medical conditions—bringing us all one step closer to using hematology analyzers as more than simple cell counters, but instead as powerful tools for the management of any medical condition that impacts the biology of blood cells. There are increasing amounts of data provided, which require specialist knowledge to interpret as well as understand the limitations in the measurement of the parameter. Both laboratory scientists and clinicians need to keep up to date with new parameters and methods in hematology, implying a stronger collaboration between them to improve clinical decision making

Diseño e implementación de una práctica de metacognición en la asignatura de Fisiología Humana (Facultad de Medicina) Designing and implementing a practical on metacognition as part of the subject of Human Physiology (Faculty of Medicine)

Objetivo. Presentar el diseño y los resultados obtenidos en una práctica sobre metacognición en Fisiología Humana (Facultad de Medicina). Sujetos y métodos. Ciento diecinueve estudiantes (95 mujeres y 24 varones) asistieron a una práctica sobre metacognición en la asignatura de Fisiología Humana (Facultad de Medicina). La práctica se dividió en dos partes: en la primera, los estudiantes se determinaron el estilo de aprendizaje (test de Kolb) para poner de manifiesto que no todos aprenden de la misma manera, y se les hizo reflexionar sobre las características esenciales de cada estilo encontrado; en la segunda, escribieron las recomendaciones que harían a su mejor amigo/a sobre cómo estudiar fisiología y, posteriormente, las expusieron ante el resto. Resultados y conclusiones. Los resultados respecto a los modos de aprender mostraron dos hechos: uno, que la mayor puntuación se obtuvo en la conceptualización abstracta, tanto para varones como para mujeres, y, otro, referente a la segunda opción, que las mujeres señalaron la experimentación activa (significativamente mayor que en los varones), mientras que para éstos fue la observación reflexiva. Los estilos de aprendizaje de los estudiantes fueron convergentes y asimiladores, con escasa diferencia entre ambos. Por sexos, se observó que en los varones predominó el estilo asimilador (13 frente a 8), mientras que en las mujeres fue más frecuente el convergente (44 frente a 36). En la segunda parte de la práctica (metacognición) ambos grupos manifestaron utilizar las mismas estrategias, con independencia del estilo al que pertenecían. Determinadas estrategias fueron utilizadas por los estudiantes con niveles de sofisticación diferentes.<br>Aim. To present the design and results found in a practical lecture on metacognition in the subject of Human Physiology (School of Medicine). Subjects and methods. The practical lecture was attended by 119 students (95 women and 24 men). This one was divided into two parts: in the first, students determined by themselves their learning style (Kolb test) in order to show that not everyone learns the same way and makes them reflect on the essential features of each style found; in the second, they wrote on the recommendations made to his/her best friend on how to study the Physiology and then put them to rest. Results and conclusions. The results respect to the learning modes showed two facts: one, the highest score was obtained by abstract conceptualization, for both men and women; and another, in relation to the second option the active experimentation was reported by women (significantly greater than men) versus reflective observation indicated by men. Regarding learning styles of students, these were assimilator and converger, with little difference between them. By gender, the following fact was found: in men predominated assimilator style (13 versus 8), whereas women were the most converger one (44 versus 36). In the second part of the practical lecture (metacognition) both groups expressed to use the same learning strategies, independently of the learning style. Some strategies were used by students with different sophistication levels

Diseño e implementación de una práctica de metacognición en la asignatura de Fisiología Humana (Facultad de Medicina)

Objetivo. Presentar el diseño y los resultados obtenidos en una práctica sobre metacognición en Fisiología Humana (Facultad de Medicina). Sujetos y métodos. Ciento diecinueve estudiantes (95 mujeres y 24 varones) asistieron a una práctica sobre metacognición en la asignatura de Fisiología Humana (Facultad de Medicina). La práctica se dividió en dos partes: en la primera, los estudiantes se determinaron el estilo de aprendizaje (test de Kolb) para poner de manifiesto que no todos aprenden de la misma manera, y se les hizo reflexionar sobre las características esenciales de cada estilo encontrado; en la segunda, escribieron las recomendaciones que harían a su mejor amigo/a sobre cómo estudiar fisiología y, posteriormente, las expusieron ante el resto. Resultados y conclusiones. Los resultados respecto a los modos de aprender mostraron dos hechos: uno, que la mayor puntuación se obtuvo en la conceptualización abstracta, tanto para varones como para mujeres, y, otro, referente a la segunda opción, que las mujeres señalaron la experimentación activa (significativamente mayor que en los varones), mientras que para éstos fue la observación reflexiva. Los estilos de aprendizaje de los estudiantes fueron convergentes y asimiladores, con escasa diferencia entre ambos. Por sexos, se observó que en los varones predominó el estilo asimilador (13 frente a 8), mientras que en las mujeres fue más frecuente el convergente (44 frente a 36). En la segunda parte de la práctica (metacognición) ambos grupos manifestaron utilizar las mismas estrategias, con independencia del estilo al que pertenecían. Determinadas estrategias fueron utilizadas por los estudiantes con niveles de sofisticación diferentes

Efectos a corto y largo plazo de la administración de calcitonina y calcio sobre el calcio, magnesio y fósforo inorgánico en sangre en la osteoporosis posmenopáusica

This paper studies the effects of the administration of calcitonin (CT) and Ca on post menopausal osteoporosis, immediately (short-term) and after three months (long-term) of treatment, on total and ionic calcium (Ca), magnesium (Mg), inorganic phosphorus (Pi), calcitonin (CT) and parathyroid hormone (PTH) in plasma. The short-term results show a decrease in total and ionic Ca and Pi four hours after the beginning of the treatment; at seven hours, only Pi varies. A decrease in the total and ionic Ca was observed after three months of CT treatment (long-term effects). No hormonal (PTH and CT) variations were found either in the short or the long-term. However, the PTH/CT ratio decreased significantly during the experiment and this may be an important factor in explaining the long-term Ca variations

Estilos de aprendizaje de estudiantes de medicina en universidades latinoamericanas y españolas: relación con los contextos geográficos y curriculares Medical students learning styles in Latin American and Spanish universities: relation with geographical and curricular contexts

Objetivo. Determinar si los estilos de aprendizaje (EA) de los estudiantes de medicina se correlacionan con el contexto geográfico, con el contexto curricular o con el nivel de la carrera. Sujetos y métodos. El estudio se realizó en 490 estudiantes de las Escuelas de Medicina de las Universidades de Chile (Santiago, Chile), Nacional de Cuyo (Mendoza, Argentina), San Francisco Xavier (Sucre, Bolivia), Zaragoza y País Vasco (España). Se aplicó el cuestionario Honey-Alonso, que valora la preferencia por cada uno de cuatro EA: activo, reflexivo, teórico y pragmático. También se evaluó el EA de acuerdo al modelo de Kolb. Resultados. Al relacionar el EA con el contexto geográfico se observó que mientras los estudiantes de universidades españolas muestran un estilo preferentemente asimilador, siguiendo la denominación de Kolb, para Chile fue el acomodador y para Bolivia los estudiantes se distribuyen entre los estilos asimilador y divergente. Al comparar la distribución de los EA durante el tercer curso de medicina en dos facultades que poseen diferente currículo, no se observaron diferencias significativas. Los EA en una Facultad de Medicina con un currículo basado en asignaturas (Chile) no mostraron diferencias en los tres cursos del estudio (1.º, 3.º y 5.º), siendo preferentes los estilos reflexivo y teórico. Conclusiones. El estudio permitió establecer diferencias significativas entre los estilos de aprendizaje de los estudiantes de Medicina en relación con el contexto geográfico, más que con los diferentes currículos, o a lo largo de los distintos cursos de la carrera.Aim. To establish a correlation between medical student learning styles (LS) and the geographical context, the curricular context and different academic levels. Subjects and methods. The study was performed in 490 undergraduate students from Medical Schools of the Universities of Chile (Santiago, Chile), Nacional de Cuyo (Mendoza, Argentina), San Francisco Xavier (Sucre, Bolivia), Zaragoza and País Vasco (Spain). The instrument used was the Honey-Alonso learning style questionnaire that assesses the student preference for one of four LS: active, reflexive, theoretic and pragmatic. In addition, LS according to the Kolb inventory were also assessed. Results. Using the Kolb inventory, significant differences were found when the LS were correlated with the geographical context. While Spanish students showed a high preference for the assimilator style of learning, Chilean students resulted to be mainly accommodators, and Bolivian students were both assimilators and divergent. Comparing the LS distribution during the third course in two universities with different curricula (problem and lecture based learning), there were no significant differences. LS of medical students from a Medical School with a lecture based curriculum (University of Chile) were not significantly different during the first, the third and the fifth level of their undergraduate students. They showed a significant preference for reflexive and theoretic styles of learning. Conclusions. The present study allowed demonstrating that significant differences among the styles of learning of medical students correlated with the geographical context more than with the different curricula, or along the different courses of the career

Estilos de aprendizaje de estudiantes de medicina en universidades latinoamericanas y españolas: relación con los contextos geográficos y curriculares

Objetivo. Determinar si los estilos de aprendizaje (EA) de los estudiantes de medicina se correlacionan con el contexto geográfico, con el contexto curricular o con el nivel de la carrera. Sujetos y métodos. El estudio se realizó en 490 estudiantes de las Escuelas de Medicina de las Universidades de Chile (Santiago, Chile), Nacional de Cuyo (Mendoza, Argentina), San Francisco Xavier (Sucre, Bolivia), Zaragoza y País Vasco (España). Se aplicó el cuestionario Honey-Alonso, que valora la preferencia por cada uno de cuatro EA: activo, reflexivo, teórico y pragmático. También se evaluó el EA de acuerdo al modelo de Kolb. Resultados. Al relacionar el EA con el contexto geográfico se observó que mientras los estudiantes de universidades españolas muestran un estilo preferentemente asimilador, siguiendo la denominación de Kolb, para Chile fue el acomodador y para Bolivia los estudiantes se distribuyen entre los estilos asimilador y divergente. Al comparar la distribución de los EA durante el tercer curso de medicina en dos facultades que poseen diferente currículo, no se observaron diferencias significativas. Los EA en una Facultad de Medicina con un currículo basado en asignaturas (Chile) no mostraron diferencias en los tres cursos del estudio (1.º, 3.º y 5.º), siendo preferentes los estilos reflexivo y teórico. Conclusiones. El estudio permitió establecer diferencias significativas entre los estilos de aprendizaje de los estudiantes de Medicina en relación con el contexto geográfico, más que con los diferentes currículos, o a lo largo de los distintos cursos de la carrera