Taller interdisciplinario de resolución de problemas de la práctica profesional en el área clínico-quirúrgica en pequeños animales : Propuesta de innovación en el marco de la carrea de Medicina Veterinaria de la UNLP

El siguiente proyecto plantea la problemática referida a la magnitud de la fragmentación curricular en la carrera de Medicina Veterinaria de la Universidad Nacional de La Plata (UNLP), con el objetivo de desarrollar una propuesta de innovación tendiente a su superación en el área de la práctica docente. Dicha fragmentación se hace perceptible en la organización curricular, con asignaturas que se desarrollan predominantemente aisladas y en tiempos distintos, como también en la escasa relación que suele existir entre docentes de diferentes asignaturas. La integración de talleres en la propuesta curricular tiene la intención de promover en los estudiantes el aprendizaje a través de la presentación de problemas que simulen posibles situaciones laborales una vez graduado, desde una perspectiva interdisciplinaria a través de la realización de actividades que permitan la integración horizontal y vertical de contenidos y prácticas. Por consiguiente esta propuesta de innovación consiste en el diseño de un taller de resolución de problemas habitualmente presentados en la práctica profesional en el área clínica-quirúrgica en pequeños animales domésticos, en donde se genere un espacio de integración de contenidos de los cursos de Enfermedades de Caninos y Felinos Domésticos, curso de Clínica de Caninos y Felinos, Cirugía II, Métodos Complementarios de Diagnóstico Clínicos, curso de Análisis Clínicos veterinarios, Patología Especial, curso de Parasitología, curso de Farmacología General y Toxicología y el curso de Semiología. La finalidad del taller es producir un mecanismo que intente romper con el paradigma preponderante en la Facultad de Ciencias Veterinarias, mediante una reestructuración de las formas en que los estudiantes experimentan los contenidos curriculares y el aprendizaje en el aula, en particular en los recorridos finales de la carrera donde la fragmentación curricular influye directamente en el ejercicio de la práctica. Se intenta lograr una experiencia interdisciplinaria con el aporte de los docentes de los distintos cursos mencionados en forma simultánea en relación a la resolución de problemas contextualizados en dependencia al manejo de las especies caninas y felinos domésticos. La modalidad del taller a partir de una situación de un caso problema real, establece un poderoso instrumento que permitirá el uso a los estudiantes de conceptos aprendidos previamente en años previos de la carrera, para así integrar conocimientos adquiridos en diferentes contextos, y por lo tanto exhibir casos que puedan presentarse en el trabajo profesional futuro.Asesora pedagógica: Vanina CambiaggiFacultad de Ciencias Veterinaria

A case of dioctophymosis in a canine

El gusano gigante del riñón, Dioctophyme renale, es un nematodo zoonótico emergente. Esta parasitosis es muy frecuente en los caninos. En ellos adopta dos principales formas de presentación, la renal (principalmente en el riñón derecho) y la extrarrenal, aunque se puede albergar de ambas formas. Sin embargo, al ser una parasitosis dinámica, en forma directa o indirecta se ha postulado que una forma de presentación puede resultar en la otra. Se describen las alternativas clínicas y quirúrgicas de un caso de dioctofimosis con localización renal bilateral en un canino que reside fuera de la zona epidemiológica. Mediante estudios ecográficos se confirma la presencia de parásitos en ambos riñones del paciente, sin embargo al efectuar análisis de orina inicial no se hallaron huevos de Dioctophyma renale. Como tratamiento se realiza nefrectomía del riñón derecho y nefrotomía del riñón izquierdo. Los análisis de sangre realizados postquirúrgico presentan un aumento de la urea y creatinina. El tratamiento quirúrgico efectuado de la enfermedad es discutido e ilustrado.The giant kidney worm, Dioctophyme renale, is an emerging zoonotic nematode. It is a quite frequent parasitosis in canines. Inside of them it can take two main presentation forms, the renal (mostly in right kidney) and the extrarenal; although, there are cases in which it can be presented in both forms. However, since this is a dynamic parasitosis; directly or indirectly it has been postulated that one form of presentation can revert to the other. The clinical and surgical alternatives of a case of dioctopimosis with bilateral renal localization in a canine residing outside the epidemiological zone are described. Ultrasound studies confirm the presence of parasites in both kidneys while the initial urine analysis of the patient does not exhibit Dioctophyma renale eggs. Nephrectomy of the right and nephrostomy of the left kidney are performed for treatment. Post-surgical blood tests show an increase in urea and creatinine. The surgical treatment of the disease is discussed and illustrated.39-4

Endocannabinoid-related compounds in gastrointestinal diseases

The endocannabinoid system (ECS) is an endogenous signalling pathway involved in the control of several gastrointestinal (GI) functions at both peripheral and central levels. In recent years, it has become apparent that the ECS is pivotal in the regulation of GI motility, secretion and sensitivity, but endocannabinoids (ECs) are also involved in the regulation of intestinal inflammation and mucosal barrier permeability, suggesting their role in the pathophysiology of both functional and organic GI disorders. Genetic studies in patients with irritable bowel syndrome (IBS) or inflammatory bowel disease have indeed shown significant associations with polymorphisms or mutation in genes encoding for cannabinoid receptor or enzyme responsible for their catabolism, respectively. Furthermore, ongoing clinical trials are testing EC agonists/antagonists in the achievement of symptomatic relief from a number of GI symptoms. Despite this evidence, there is a lack of supportive RCTs and relevant data in human beings, and hence, the possible therapeutic application of these compounds is raising ethical, political and economic concerns. More recently, the identification of several EC-like compounds able to modulate ECS function without the typical central side effects of cannabinomimetics has paved the way for emerging peripherally acting drugs. This review summarizes the possible mechanisms linking the ECS to GI disorders and describes the most recent advances in the manipulation of the ECS in the treatment of GI diseases

Short- and long-term therapeutic efficacy of nutritional therapy and corticosteroids in paediatric Crohn's disease

Background. Comparative data on the therapeutic efficacy of different enteral nutrition formulas and corticosteroids to obtain clinical remission and to induce mucosal healing influencing long-term disease course in paediatric Crohn's disease are still scarce. Aims. To investigate the efficacy of nutritional therapy using three different formulas versus corticosteroids to achieve clinical remission as well as to induce intestinal mucosal healing in active Crohn's disease children. Duration of remission and effect on growth recovery were also assessed. Patients and methods. Clinical, laboratory, endoscopic and histological data of all new diagnosed active Crohn's disease paediatric cases were retrospectively recorded and reviewed. Thirty-seven children (median age 12.1 years) received nutritional therapy (12 polymeric; 13 semi-elemental; 12 elemental diet) and 10 subjects (median age 12.4 years) received corticosteroids. Results. Similar clinical remission rate were observed after 8 weeks of treatment: 86.5% children receiving nutritional therapy versus 90% treated with corticosteroids. Improvement in mucosal inflammation occurred in 26 out of 37 (64.8%) patients on nutritional therapy and in 4 out of 10 (40%) children on steroids (p < 0.05). Finally, seven subjects on nutritional therapy and none on corticosteroids achieved complete mucosal healing (p < 0.005) at the end of the treatment. Nutritional therapy was more effective than corticosteroids in improving nutritional status and linear growth recovery. Compared to corticosteroids, the duration of clinical remission was longer in the nutritional therapy groups without differences among the three different formulas. Conclusions. In children with active Crohn's disease, nutritional therapy is more effective than corticosteroids to improve intestinal inflammation and to maintain a more sustained clinical remission. (c) 2005 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved

Update on Foregut Molecular Embryology and Role of Regenerative Medicine Therapies

Esophageal atresia (OA) represents one of the commonest and most severe developmental disorders of the foregut, the most proximal segment of the gastrointestinal (GI) tract (esophagus and stomach) in embryological terms. Of intrigue is the common origin from this foregut of two very diverse functional entities, the digestive and respiratory systems. OA appears to result from incomplete separation of the ventral and dorsal parts of the foregut during development, resulting in disruption of esophageal anatomy and frequent association with tracheo-oesophageal fistula. Not surprisingly, and likely inherent to OA, are associated abnormalities in components of the enteric neuromusculature and ultimately loss of esophageal functional integrity. An appreciation of such developmental processes and associated defects has not only enhanced our understanding of the etiopathogenesis underlying such devastating defects but also highlighted the potential of novel corrective therapies. There has been considerable progress in the identification and propagation of neural crest stem cells from the GI tract itself or derived from pluripotent cells. Such cells have been successfully transplanted into models of enteric neuropathy confirming their ability to functionally integrate and replenish missing or defective enteric nerves. Combinatorial approaches in tissue engineering hold significant promise for the generation of organ-specific scaffolds such as the esophagus with current initiatives directed toward their cellularization to facilitate optimal function. This chapter outlines the most current understanding of the molecular embryology underlying foregut development and OA, and also explores the promise of regenerative medicine

Genetic variants associated with gastrointestinal symptoms in Fabry disease.

Gastrointestinal symptoms (GIS) are often among the earliest presenting events in Fabry disease (FD), an X-linked lysosomal disorder caused by the deficiency of α-galactosidase A. Despite recent advances in clinical and molecular characterization of FD, the pathophysiology of the GIS is still poorly understood. To shed light either on differential clinical presentation or on intervariability of GIS in FD, we genotyped 1936 genetic markers across 231 genes that encode for drug-metabolizing enzymes and drug transport proteins in 49 FD patients, using the DMET Plus platform. All nine single nucleotide polymorphisms (SNPs) mapped within four genes showed statistically significant differences in genotype frequencies between FD patients who experienced GIS and patients without GIS: ABCB11 (odd ratio (OR) = 18.07, P = 0,0019; OR = 8.21, P = 0,0083; OR=8.21, P = 0,0083; OR = 8.21, P = 0,0083),SLCO1B1 (OR = 9.23, P = 0,0065; OR = 5.08, P = 0,0289; OR = 8.21, P = 0,0083), NR1I3 (OR = 5.40, P = 0,0191) and ABCC5 (OR = 14.44, P = 0,0060). This is the first study that investigates the relationships between genetic heterogeneity in drug absorption, distribution, metabolism and excretion (ADME) related genes and GIS in FD. Our findings provide a novel genetic variant framework which warrants further investigation for precision medicine in FD

Prevalence of Non-erosive Esophageal Phenotypes in Children. A European Multicenter Study

Background/aims: Since available data on pediatric non-erosive esophageal phenotypes (NEEPs) are scant, we investigated their prevalence and the phenotype-dependent treatment response in these children. Methods: Over a 5-year period, children with negative upper endoscopy, who underwent esophageal pH-impedance (off-therapy) for persisting symptoms not responsive to proton pump inhibitor (PPI)-treatment, were recruited. Based on the results of acid reflux index (RI) and symptom association probability (SAP), patients were categorized into: (1) abnormal RI (non-erosive reflux disease [NERD]), (2) normal RI and abnormal SAP (reflux hypersensitivity [RH]), (3) normal RI and normal SAP (functional heartburn [FH]), and (4) normal RI and not-reliable SAP (normal-RI-not otherwise-specified [normal-RI-NOS]). For each subgroup, treatment response was evaluated. Results: Out of 2333 children who underwent esophageal pH-impedance, 68 cases, including 18 NERD, 14 RH, 26 FH, and 10 normal-RI-NOS were identified as fulfilling the inclusion criteria and were analyzed. Considering symptoms before endoscopy, chest pain was more reported in NERD than in other cases (6/18 vs 5/50, P = 0.031). At long-term follow-up of 23 patients (8 NERD, 8 FH, 2 RH, and 5 normal-RI-NOS): 17 were on PPIs and 2 combined alginate, 1 (FH) was on benzodiazepine + anticholinergic, 1 (normal-RI-NOS) on citalopram, and 3 had no therapy. A complete symptom-resolution was observed in 5/8 NERD, in 2/8 FH, and in 2/5 normal-RI-NOS. Conclusions: FH may be the most common pediatric NEEP. At long-term follow-up, there was a trend toward a more frequent complete symptom resolution with PPI-therapy in NERD patients while other groups did not benefit from extended acid-suppressive-treatment