COVID-19 impact on the assessment methodology of undergraduate medical students: a systematic review of the lessons learned

The COVID-19 pandemic had a substantial social, economic, political, and educational impact worldwide. Due to the social contact restrictions, areas such as medical education were highly affected. Assessment in medical education, was already a sensitive topic, and it proved to be even more challenging as different teaching and learning contexts required huge adaptations in a short period. This systematic review provides an overview of the impact of COVID-19 on the assessment of medical students and can serve as a reference to improve this area. We conducted the review based on the PRISMA tool and searched in PubMed, EBSCO, and ScienceDirect. Studies describing the assessment methodologies used during the pandemic were included. Of the 501 initial articles, 18 were included in this review. Collected data was based on the regime, subject, teaching/assessment methodologies, platforms used, grades, students’ and teachers’ perceptions, and measures to prevent academic dishonesty. The results suggest that technology played a central role during the pandemic, and universities were concerned about the transition to online learning regarding teaching and assessment, but students and teachers should be prepared for it. Formative assessment methodologies and feedback were emphasized, and summative tools were adapted to prevent fraud. Students and teachers were generally satisfied with online learning and assessment, which had no significant difference in the examination scores, but they preferred conventional teaching. The COVID-19 pandemic brought an opportunity to analyze and rethink the medical curriculum. Thus, further investigations are needed on combining traditional and online teaching strategies and emphasis on the assessment

Estudio de la oxidación lipoproteica y marcadores de inflamación en pacientes con artritis reumatoide

Consultable des del TDXTítol obtingut de la portada digitalitzadaLa artritis reumatoide (AR) es una enfermedad inflamatoria cr_nica que se ha asociado a un incremento de enfermedad cardiovascular (ECV). La causa de este elevado riesgo de ECV no se conoce, se ha sugerido que la actividad inflamatoria de la AR pudiera dar lugar a una aterog_nesis acelerada. La arteriosclerosis es la causa subyacente de la ECV y se caracteriza por una acumulaci_n de lipoprote_nas apo B, matriz extracelular, c_lulas, y por un aumento de la oxidaci_n lip_dica en la _ntima de la pared arterial. Estudios experimentales sugieren que la oxidaci_n lip_dica y la inflamaci_n juegan un papel principal en la arteriosclerosis y sus consecuencias cl_nicas. Marcadores de inflamaci_n como la proteina C reactiva (PCR), las mol_culas de adhesi_n o la fosfolipasa A2 secretora del grupo IIA (sPLA2-IIA) se han relacionado con un mayor riesgo de ECV. Adem_s, la sPLA2-IIA se ha encontrado en lesiones ateroscler_ticas de arterias humanas. En pacientes con AR se han observado alteraciones en el perfil lip_dico caracterizadas por una disminuci_n en las concentraciones plasm_ticas de colesterol total y de lipoprote_nas tanto HDL como LDL. Aunque, este perfil lip_dico no implica un mayor riesgo aterog_nico. El objetivo de nuestro estudio fue investigar en pacientes con AR si la actividad inflamatoria de la enfermedad induce cambios cualitativos en las part_culas lipoproteicas mediados por acciones enzim_ticas de la sPLA2-IIA y oxidativas que derivan en lipoprote_nas m_s aterog_nicas, con la finalidad de contribuir a explicar la elevada mortalidad por ECV descrita en estos pacientes. M_todos: Estudiamos en pacientes con AR y en un grupo control: marcadores de inflamaci_n sist_micos, el perfil lip_dico, las subfracciones de la LDL y HDL, la afinidad de la LDL por el glucoaminoglicano (GAG) condroitin 6-sulfato, la susceptibilidad a la oxidaci_n de la LDL y los niveles en plasma de vitaminas A y E. Resultados: Los pacientes con AR (n=31) y el grupo control (n=28) presentaron niveles en plasma similares de colesterol total, triglic_ridos, Apo-A, Apo-B, HDL y VLDL. Los niveles de LDL en plasma fueron m_s bajos en pacientes con AR. Los pacientes con AR presentaron un aumento significativo de los niveles en plasma de sPLA2-IIA, ICAM, PCR, fibrin_geno, IFNg y TNFa en comparaci_n con el grupo control. Los pacientes con AR presentaron niveles de LDL-1 densas y peque_as m_s altos (p<0.05) y m_s bajos de HDL-2 densas (p<0.001) que el grupo control. Adem_s, las LDL de los pacientes con AR presentaron una mayor afinidad por los GAG (Kd 204 ± 22.4 nM Apo B) en comparaci_n con el grupo control (Kd 312 ± 364 nM Apo B) (p<0.05). La Kd-LDL se correlacion_ inversamente con los niveles en plasma de LDL-1 (r=-0.566, p<0.004). En los pacientes con AR encontramos una correlaci_n positiva y significativa entre marcadores de inflamaci_n (PCR, ICAM, sPLA2-IIA) y las LDL-1. Las HDL-2 se correlacionaron negativamenre con la sPLA2-IIA. Los niveles en plasma de vitamina A fueron m_s bajos en pacientes y los de vitamina E similares en ambos grupos. Los par_metros oxidativos, medidos a trav_s de las diferentes fases de formaci_n de dienos conjugados, fueron similares en pacientes y controles. En pacientes con AR encontramos una correlaci_n inversa entre sPLA2-IIA, PCR y las vitaminas antioxidantes, as_ como una correlaci_n positiva entre la Kd-LDL y la lag phase en oxidaci_n de las LDL. Conclusi_n y discusi_n: En pacientes con AR hemos encontrado niveles elevados de LDL densas y peque_as con una alta afinidad por los componentes de la matriz extracelular. La afinidad de las LDL por los GAG se correlacion_ positivamente con los niveles de sPLA2-IIA y con una mayor suceptibilidad a la oxidaci_n de las LDL. Estos marcadores lipoproteicos aterog_nicos sumado a la inflamaci_n cr_nica podr_an contribuir a explicar el aumento de mortalidad por ECV en pacientes con AR.Rheumatoid arthritis (RA) is a chronic inflammatory disease that has been associated with an increase in cardiovascular diseases (CVD). The cause of increased risk for CVD in patients with RA is unknown. It has been postulated that the chronic inflammation associated with RA could lead to an accelerated atherogenesis. Atherosclerosis, the underlying cause of CVD, is characterized by acumulation of Apo B lipoproteins, extracelular matrix, cells, and by an increase of the lipid peroxidation in the intima of the arterial wall. Experimentals studies data suggest that inflammation and the lipid peroxidation plays a significant role in atherogenesis and its clinical consequences. Plasma levels of inflammatory markers such as C-reactive protein (CRP), solubles adhesion molecules and secretory group phospholipase A2 (sPLA2-IIA) have been associated with a higher risk of CVD. Furthermore, the sPLA2-IIA is present in atherosclerotic lesions of human arteries. Lipid anormalities, such as decreased serum cholesterol and cholesterol levels in lipoproteins (low density (LDL) and high density (HDL) lipoproteins) have been described in patients with RA. However, this lipoprotein profile does not imply a higher atherogenic risk. The aim of our study was to investigate in patients with RA if inflammatory activity of the disease induce qualitatives changes in the lipoproteins particles mediated by enzymatics actions of the sPLA2-IIA and oxidatives that derive in more atherogenic lipoproteins, with the finality of to contribute to an explanation of the high risk of CVD in RA patients. Methods: We studied in RA patients as well as in the control group: Plasma inflammatory markers, lipid profile, the size distribution of plasma lipoprotein subclasses, the binding affinity of LDL to chondroitin 6-sulfate glycosaminoglycan (GAG), the susceptibility of LDL to oxidation and the concentrations of vitamins A and E. Results: RA patients (n=31) and matched controls (n=28) had similar plasma concentrations of cholesterol, triglycerides, Apo B, Apo A-I, VLDL and HDL. RA patients had significantly lower plasma levels of LDL. RA patients had significantly higher plasma levels of sPLA2-IIA, ICAM, CRP, fibrinogen, TNFa, and IFNg compared with controls. RA patients also had significantly higher levels of small, dense LDL-1 (p<0.05) and lower levels of small HDL-2 particles (p<0.001) compared with controls. In addition, LDL from RA patients had a significantly higher affinity (Kd) to GAG (mean ± SD Kd 204 ± 22.4 nM Apo B) than did LDL from control subjects (Kd 312 ± 364 nM Apo B) (p<0.05). This Kd value showed a significant negative correlation with the plasma levels of LDL-1 (r=-0.566, p<0.004). In RA patients, a significant positive correlation was obtained between sPLA2-IIA and CRP, ICAM, and LDL-1. HDL-2 showed a negative correlation with sPLA2-IIA. Plasma levels of vitamin A were lower in patients, and similar levels of vitamin E were observed in both groups. Oxidative variables, measured as the diferent phases of conjugated diene formation, were similar in patients and controls. We found a significant inverse correlation between vitamin A and E, and sPLA2-IIA. We found a positive correlation between the Kd-LDL and the lag phase of LDL oxidation in RA patients. Conclusion and discusion: In patientes with RA, we found elevated levels of small, dense LDL with high affinity for arterial matrix components. The LDL affinity to GAG showed a positive correlation with the plasma levels of sPLA2-IIA and the susceptibility to the oxidation of the LDL. These atherogenic lipoprotein factors combined with the presence of chronic inflammation may contribute to the high CVD related mortality in RA patients

Apolipoprotein B and non-high-density lipoprotein cholesterol reveal a high atherogenicity in individuals with type 2 diabetes and controlled low-density lipoprotein-cholesterol

Background: Lipid-lowering therapy is guided by Low-density-lipoprotein cholesterol (LDL-c) levels, although the cardiovascular disease (CVD) risk could be better reflected by other lipid parameters. This study aimed at comparing a comprehensive lipid profile between patients with type 2 diabetes mellitus (T2DM) with LDL-c concentration within and above target. Methods: A comprehensive lipid profile was characterized in 96 T2DM patients. The European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) 2016 and 2019 Guidelines for the Management of Dyslipidemias were used to define LDL-c targets. Results: In this population, only 28.1 and 16.7% of patients had mean LDL-c levels within target, as defined by the 2016 and 2019 guidelines, respectively. Applying the 2016 guidelines criteria, in patients with LDL-c within target, 22, 25 and 44% presented non-high-density lipoprotein cholesterol (non-HDL-c), Apolipoprotein B (ApoB) and oxidized LDL-c levels above the recommended range, respectively, whereas according to the 2019 guidelines criteria, 50, 39 and 44% of the patients with LDL-c within target had elevated high-density lipoprotein cholesterol (HDL-c), ApoB and oxidized LDL-c levels, respectively. LDL-c was strongly correlated with non-HDL-c (r = 0.850), ApoB (r = 0.656) and oxidized LDL-c (r = 0.508). Similarly, there was a strong correlation between non-HDL-c with both ApoB (r = 0.808) and oxidized LDL-c (r = 0.588). Conclusions: These findings emphasize the limitations of only considering LDL-c concentration for cardiovascular (CV) risk assessment. Targeting only LDL-c could result in missed opportunities for CV risk reduction in T2DM patients. These data suggest that non-HDL-c, ApoB and oxidized LDL-c levels could be considered as an important part of these patients' evaluation allowing for a more accurate estimation of CV risk and hopefully better management of these high-risk patients.info:eu-repo/semantics/publishedVersio

Dietary parameters in patients with drug allergy: Assessing dietary inflammatory index

Background Research on the increasing incidence of allergic diseases evidenced the role of diet as a potential key factor. Diet can modulate the low-grade systemic inflammation related to obesity and several diseases. There are no published data on drug allergy. Aim To investigate a potential association between diet, including dietary inflammatory index (DII), and drug allergy. Also, to evaluate correlations between diet and obesity, inflammatory and metabolic parameters in patients with drug allergy. Methods Ninety consecutive patients studied for suspected drug allergy were evaluated in terms of dietary parameters, anthropometric measurements, bioimpedance and biochemical analysis. DII was calculated based on information collected from a food frequency questionnaire. Results After diagnostic work-up, 39 patients had confirmed drug allergy and 45 excluded, representing the study group and the control group, respectively. The majority (79%) were female, with mean age of 39.58±13.3 years. The 84 subjects revealed an anti-inflammatory diet pattern. No significative difference was found in DII scores between drug allergic patients and controls (-3.37±0.95 vs -3.39±0.86, p = 0.985). However, the patients with drug allergy revealed higher obesity and inflammatory parameters. A significative negative correlation was found between DII and adiponectin levels, in the control group (r = -0.311, p = 0.040). In the patient group, a significative positive correlation was observed between DII and triglycerides (r = 0.359, p = 0.032). No other correlations were found between DII and the assessed parameters. Patients with drug allergy presented a significative higher intake of mono-unsaturated fatty-acids comparing to controls (19.8±3.7 vs 17.8 ± 4.0, p = 0.021). No other statistically significant differences were achieved in dietary parameters, between patients and controls. Conclusion The population assessed in this study revealed an anti-inflammatory diet profile. Although we have found in a previous work that the same patients with drug allergy revealed higher obesity and inflammatory parameters, the DII did not allow to distinguish between patients with drug allergy or controls. The DII scores correlated with triglycerides levels in the drug allergy patients and inversely with adiponectin levels in the control group. Larger studies are needed to clarify the potential role of the diet in drug allergy and its outcomes. (c) 2022 Dias de Castro et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Aplicaciones del láser Doppler en odontología

El flujómetro de láser Doppler es un método no invasivo que proporciona una medida continua del registro del flujo sanguíneo a nivel microvascular. Un haz de luz láser incidente en cualquier tejido humano, es dispersado tanto en las estructuras estáticas como por los glóbulos rojos. Los haces devueltos por los glóbulos rojos sufren una desviación en su frecuencia de acuerdo con el efecto Doppler, mientras que los dispersos por el tejido estático permanecen inalterados. Ambas fracciones de luz son captadas por un fotodetector y son procesadas para proporcionar una medida del flujo sanguíneo. Esto nos permite conocer una serie de datos hasta ahora no bien conocidos sobre los fenómenos que se producen a nivel microcirculatorio. Al tratarse de una técnica no invasiva que proporciona datos a tiempo real, ha encontrado aplicaciones en una gran variedad de disciplinas experimentales y clínicas. Destacan las aplicaciones dentro del campo de la neurocirugía, dermatología, cirugía digestiva, cirugía cardiaca, oftalmología, cirugía maxilofacial y cirugía plástica. Nosotros nos centraremos en las aplicaciones dentro del área bucal y maxilofacial, recordando los principios básicos de la circulación a nivel de los maxilares, de los dientes, ligamento periodontal y encía, los cambios.que se producen durante la inflamación, las características principales de este instrumento y las consideraciones a tener en cuenta durante su utilización

Iron Deficiency and Obesity - Are we Diagnosing with Appropriate Indicators?

INTRODUCTION: We aim to define the iron deficiency prevalence and eventual differences between obese patients with and without metabolic syndrome. MATERIAL AND METHODS: Analysis of patients evaluated at multidisciplinary consultation of obesity in our institution between 2013 and 2015 (n = 260). Iron deficiency: ferritin levels < 15 ng/mL. EXCLUSION CRITERIA: prior bariatric surgery; lack of ferritin or hemoglobin determinations. RESULTS: We analyzed data from 215 patients (84.2% female) with a mean age of 42.0 ± 10.3 years. The median body mass index was 42.5 (40.0 - 46.8) kg/m2 and 52.1% had metabolic syndrome. Iron deficiency was present in 7.0%, with no differences between genders or between patients with or without metabolic syndrome. Hypertension was associated with lower prevalence of iron deficiency. Type 2 diabetes and hypertension patients had higher levels of ferritin. The multivariate analysis showed that metabolic syndrome and increasing body mass index were predictive of higher risk of iron deficiency while hypertension predicted lower odds of iron deficiency. DISCUSSION: The prevalence of iron deficiency was similar in other published studies. Iron deficiency may be underdiagnosed if based only on ferritin concentrations. In our study, diabetes and hypertension appear to contribute to the increase in ferritin levels described in obesity. CONCLUSION: Ferritin may not be a reliable index for evaluating iron stores in obese patients, particularly when associated with comorbidities such as type 2 diabetes and hypertension. Further studies are needed to guide the diagnosis and iron supplementation in these patients.info:eu-repo/semantics/publishedVersio

Aprendre a emprendre en el sector audiovisual. El MOOC com a eina per millorar l’empleabilitat.

Es presenta la posada en marxa d’una acció d’innovació docent, promoguda des de l'ensenyament de Comunicació Audiovisual de la Facultat de Biblioteconomia i Documentació de la UB, i portada a terme pel Grup Consolidat d’Innovació Docent GIDC-CAV. Aquesta té com a objectius generals crear continguts i recursos digitals sobre l’emprenedoria en l'àmbit de la comunicació audiovisual en format MOOC i el desenvolupament i l’aplicació d’eines de seguiment del procés d’avaluació i d’aprenentatge.Programa de Millora i Innovació Docent de la Universitat de Barcelona - Vicerectorat de Política Docen

Differential sensitivities to lactate transport inhibitors of breast cancer cell lines

This is linked to the online version of the paper at: http://dx.doi.org/10.1530/ERC-13-0132.The tumour microenvironment is known to be acidic due to high glycolytic rates of tumour cells. Monocarboxylate transporters (MCTs) play a role in extracellular acidification, which is widely known to be involved in tumour progression. Recently, we have described the upregulation of MCT1 in breast carcinomas and its association with poor prognostic variables. Thus, we aimed to evaluate the effect of lactate transport inhibition in human breast cancer cell lines. The effects of a-cyano-4-hydroxycinnamate, quercetin and lonidamine on cell viability, metabolism, proliferation, apoptosis, migration and invasion were assessed in a panel of different breast cancer cell lines. MCT1, MCT4 and CD147 were differently expressed among the breast cancer cell lines and, as expected, different sensitivities were observed for the three inhibitors. Interestingly, in the most sensitive cell lines, lactate transport inhibition induced a decrease in cell proliferation, migration and invasion, as well as an increase in cell death. Results were validated by silencing MCT1 expression using siRNA. The results obtained here support targeting of lactate transport as a strategy to treat breast cancer, with a special emphasis on the basal-like subtype, which so far does not have a specific molecular therapy.This work was supported by the Fundação para a Ciência e a Tecnologia (FCT) grant ref. PTDC/SAU-FCF/104347/2008, under the scope of ‘Programa Operacional Temático Factores de Competitividade’ (COMPETE) of ‘Quadro Comunitário de Apoio III’ and co-financed by the Fundo Europeu De Desenvolvimento Regional (FEDER)

Directrices académico-docentes en el grado de CAV: Un estudio exploratorio multifuente

En este artículo se presenta una experiencia de investigación en el marco de los estudios de Comunicación Audiovisual de la Universidad de Barcelona. El objetivo ha sido diseñar las directrices académico-docentes de la materia Proyectos del Grado de Comunicación Audiovisual. Durante los meses de octubre y noviembre de 2012, se realizó un estudio cualitativo descriptivo, de carácter exploratorio y con metodología multifuente para identificar aquellos aspectos que permiten el desarrollo de una propuesta didáctica caracterizada por el desarrollo de las competencias del estudiante. Se optó por realizar dos seminarios prospectivos como técnica de recogida de datos. Esta metodología es considerada especialmente útil para estudiar la generación de representaciones sociales, dado que a partir del debate grupal emerge el significado compartido acerca del tema de discusión. Los informantes fueron identificados como clave por el hecho de ser docentes, egresados y/o empleadores de Comunicación Audiovisual. El análisis de contenido muestra un cierto grado de consenso entre profesores, profesionales y egresados con respecto a los conocimientos/habilidades requeridos por los estudiantes y docentes para el desarrollo de un proyecto audiovisual. Se evidencia la conceptualización del proyecto como un proceso y un producto que requiere la puesta en práctica de conocimientos y habilidades, así como el papel relevante que estudiantes y profesores tienen frente a los empleadores. Así mismo se observa el gap existente entre las competencias descritas en la titulación y las expresadas en los seminarios prospectivos