Abstract Introduction: To ensure a good medical preparation and reduce the risk of mistakes, different methods and techniques for the development of clinical practice are used; cardiac examination skills decrease along the time. For this purpose simulation is implemented on the teaching process, and the impact of it on performance of cardiac auscultation should be assessed. Objective: We aimed to compare 4th-year med students’ performance and diagnostic accuracy during the cardiac examination, before and after training. Method: The sample comprised forty-six 4th year med students randomized into two groups. One group was trained with cardiac simulators and the other with patients exclusively. We assessed their ability to perform a cardiac examination and the diagnostic accuracy by using a standardized assessment checklist for a cardiac examination and then performed a statistic test to compare both groups’ performance. Results: There was a difference between both groups’ initial scores of 2 decimals (7.1 and 7.3 on a 0-10 scale). After training, we found that the patients’ trained group had an average score of 8.6 while the simulators trained group had an average score of 8.8 and higher diagnosis accuracy. Conclusions: Clinical simulation and patient training are two different ways of achieving the same goal. There are many reports that claim simulation is best to train medical students, but in this report, we did not observe a statistical difference among them. This is not however, a disadvantage. Clinical simulation offers better learning experience, shown as a tendency in the scores and better diagnostic accuracy. The lack of significant difference between the simulator/patient groups can be explained by a small sample size.

Resumen Introducción: Para asegurar una buena preparación médica y reducir el riesgo de errores, se utilizan diferentes métodos y técnicas para el desarrollo de la práctica clínica. Las habilidades de exploración cardiaca disminuyen con el tiempo, por lo cual se ha implementado la simulación en el proceso de enseñanza y debe evaluarse su impacto en el rendimiento de la auscultación cardiaca. Objetivo: Nuestro objetivo fue comparar el rendimiento y la precisión diagnóstica de los estudiantes de medicina de cuarto año durante el examen cardiaco, antes y después del entrenamiento. Método: La muestra estuvo compuesta por cuarenta y cinco estudiantes de medicina de cuarto año asignados al azar en dos grupos. Un grupo se entrenó con simuladores cardiacos y el otro exclusivamente con pacientes. En las diferentes pruebas, evaluamos su capacidad para realizar un examen cardiaco y la precisión del diagnóstico mediante el uso de una lista de verificación de evaluación estandarizada para un examen cardiaco. Luego realizamos una prueba estadística para comparar el desempeño de ambos grupos. Resultados: Hubo una diferencia entre las puntuaciones iniciales de ambos grupos de 2 decimales (7.1 y 7.3 en una escala de 0 a 10). Después del entrenamiento, encontramos que el grupo entrenado de pacientes tenía una puntuación media de 8.6, mientras que el grupo entrenado con simuladores tenía una puntuación media de 8.8 y una precisión diagnóstica más alta. Conclusiones: La simulación clínica y el entrenamiento del paciente son dos formas diferentes de lograr el mismo objetivo. Hay muchos informes de que la simulación de reclamos es mejor para capacitar a los estudiantes de medicina, pero en este informe no observamos una diferencia estadística entre ellos. Sin embargo, esto no es una desventaja. La simulación clínica ofrece una mejor experiencia de aprendizaje, que se muestra como una tendencia en los puntajes y una mejor precisión diagnóstica. La falta de diferencia significativa entre los grupos de simulador/pacientes puede explicarse por un tamaño de muestra pequeño.

Resumen: La diabetes mellitus es una de las principales causas de morbilidad y mortalidad a nivel mundial. Este grupo de pacientes generalmente representa una población con alto o muy alto riesgo cardiovascular, razón por la cual se realiza una estratificación precoz del riesgo, buscando enfocarse objetivamente en el abordaje farmacológico y no farmacológico con una estrategia intensiva. La enfermedad cardiovascular representa la principal causa de mortalidad, pero en los últimos años se han producido avances en la terapéutica que han demostrado reducir los eventos cardiovasculares mayores. Este artículo revisa la interacción entre diabetes, enfermedades cardiovasculares y su tratamiento.

Summary: Diabetes mellitus is one of the main causes of morbidity and mortality worldwide. This group of patients generally represents a population with high or very high cardiovascular risk, that is the reason for an early stratification of risk, seeking to objectively focus on pharmacological and non-pharmacological approach with an intensive strategy. Cardiovascular disease represents the main cause of mortality, but in recent years there have been advances in therapeutics that have been shown to reduce major cardiovascular events. This article reviews the interaction between diabetes, cardiovascular diseases and their treatment.

Resumo: A diabetes mellitus é uma das principais causas de morbimortalidade em todo o mundo. Esse grupo de pacientes geralmente representa uma população com alto ou muito alto risco cardiovascular, razão pela qual se estratifica precocemente o risco, buscando enfocar objetivamente a abordagem farmacológica e não farmacológica com estratégia intensiva. A doença cardiovascular representa a principal causa de mortalidade, mas nos últimos anos houve avanços na terapêutica que mostraram reduzir os eventos cardiovasculares maiores. Este artigo analisa a interação entre diabetes, doenças cardiovasculares e seu tratamento.

Abstract SARS-CoV-2 virus has been identified as the causative agent of the COVID-19 pandemic. Even when no standard treatment is available, antivirals such as remdesivir and other drugs such as chloroquine and ivermectin, which interfere with viral replication, have been assayed. Some strategies aimed to reduce immune mechanisms, such as the use of tocilizumab and natural antioxidants, have also been tested. The use of drugs related to the renin-angiotensin system has been controversial. Pathogenicity mechanisms, as well as controlled treatments, still have to be studied in detail in order to propose a viable therapeutic option that prevents the entry and replication of the virus or enhances the host immune system.

Resumen El virus SARS-CoV-2 ha sido identificado como el agente patológico causante de la pandemia de COVID-19. Aun cuando no se cuenta con un tratamiento estándar, se han probado antivirales como remdesivir y otros fármacos como cloroquina e ivermectina, que interfieren con la replicación del virus. También se han intentado algunas estrategias encaminadas a disminuir los mecanismos inmunitarios, como el uso de tocilizumab y antioxidantes naturales. Los fármacos relacionados con el sistema renina-angiotensina han resultado controversiales. Aún se debe estudiar con detalle los mecanismos de patogenicidad, así como los tratamientos controlados para proponer alguna opción terapéutica viable que evite la entrada y replicación del virus o que aumente los sistemas inmunitarios del huésped.

ABSTRACT In Aggregatibacter actinomycetemcomitans, different serotypes have been described based on LPS antigenicity. Recently, our research group has reported a differential immunogenicity when T lymphocytes were stimulated with these different serotypes. In particular, it was demonstrated that the serotype b of A. actinomycetemcomitans has a stronger capacity to trigger Th1- and Th17-type cytokine production. Objective This study aimed to quantify the expression of different CC chemokines (CCLs) and receptors (CCRs) in T lymphocytes stimulated with the different A. actinomycetemcomitans serotypes. In addition, the expression of the transcription factors T-bet, GATA-3, RORC2, and Foxp3, master-switch genes implied in the Th1, Th2, Th17, and T-regulatory differentiation, respectively, was analyzed in order to determine T-cell phenotype-specific patterns of CCL and CCR expression upon A. actinomycetemcomitans stimulation. Material and Methods Human naïve CD4+ T lymphocytes were obtained from healthy subjects and stimulated with autologous dendritic cells primed with the different A. actinomycetemcomitans serotypes. The expression levels for the chemokines CCL1, CCL2, CCL3, CCL5, CCL11, CCL17, CCL20, CCL21, CCL25, and CCL28, as well as the chemokine receptors CCR1, CCR2, CCR3, CCR4, CCR5, CCR6, CCR7, CCR8, CCR9, and CCR10 were quantified by qPCR. Similarly, the expression levels for the transcription factors T-bet, GATA-3, RORC2, and Foxp3 were quantified and correlated with the CCL and CCR expression levels. Results Higher expression levels of CCL2, CCL3, CCL5, CCL20, CCL21, CCL28, CCR1, CCR2, CCR5, CCR6, CCR7, and CCR9 were detected in T lymphocytes stimulated with the serotype b of A. actinomycetemcomitans compared with the other serotypes. In addition, these higher expression levels of CCLs and CCRs positively correlated with the increased levels of T-bet and RORC2 when T lymphocytes were stimulated with the serotype b. Conclusion A T-lymphocyte response biased towards a Th1- and Th17-pattern of CCL and CCR expression was detected under stimulation with the serotype b of A. actinomycetemcomitans.

In Aggregatibacter actinomycetemcomitans, different serotypes have been described based on LPS antigenicity. Recently, our research group has reported a differential immunogenicity when T lymphocytes were stimulated with these different serotypes. In particular, it was demonstrated that the serotype b of A. actinomycetemcomitans has a stronger capacity to trigger Th1- and Th17-type cytokine production. Objective This study aimed to quantify the expression of different CC chemokines (CCLs) and receptors (CCRs) in T lymphocytes stimulated with the different A. actinomycetemcomitans serotypes. In addition, the expression of the transcription factors T-bet, GATA-3, RORC2, and Foxp3, master-switch genes implied in the Th1, Th2, Th17, and T-regulatory differentiation, respectively, was analysed in order to determine T-cell phenotype-specific patterns of CCL and CCR expression upon A. actinomycetemcomitans stimulation. Material and Methods Human naïve CD4+ T lymphocytes were obtained from healthy subjects and stimulated with autologous dendritic cells primed with the different A. actinomycetemcomitans serotypes. The expression levels for the chemokines CCL1, CCL2, CCL3, CCL5, CCL11, CCL17, CCL20, CCL21, CCL25, and CCL28, as well as the chemokine receptors CCR1, CCR2, CCR3, CCR4, CCR5, CCR6, CCR7, CCR8, CCR9, and CCR10 were quantified by qPCR. Similarly, the expression levels for the transcription factors T-bet, GATA-3, RORC2, and Foxp3 were quantified and correlated with the CCL and CCR expression levels. Results Higher expression levels of CCL2, CCL3, CCL5, CCL20, CCL21, CCL28, CCR1, CCR2, CCR5, CCR6, CCR7, and CCR9 were detected in T lymphocytes stimulated with the serotype b of A. actinomycetemcomitans compared with the other serotypes. In addition, these higher expression levels of CCLs and CCRs positively correlated with the increased levels of T-bet and RORC2 when T lymphocytes were stimulated with the serotype b. Conclusion A T-lymphocyte response biased towards a Th1- and Th17-pattern of CCL and CCR expression was detected under stimulation with the serotype b of A. actinomycetemcomitans.