Introduction: Without underestimating the primary role of the professional tutor and academic tutor in the monitoring and evaluation of clinical practices made by our students, there is no doubt that Moodle offers a number of tools that can be a training support for the student and that are of great help in the system of continuous and competency-based assessment of this course. Objectives: To evaluate the use of the platform with the implementation of applications such as the reflective journal, the creation of a glossary and the evaluation of satisfaction meant to support in the monitoring and evaluation of clinical practices, and developing proposals for improvement. Material and methods: cross sectional study. Study subjects: the diploma students who have completed supervised clinical practice during the academic year 2010 to 2011. Scope: School of Nursing Fundación Jiménez Díaz-Universidad Autónoma de Madrid. Tools: ad-hoc questionnaire and conducted qualitative and quantitative analysis of the various resources used in monitoring and evaluation of clinical practice. Results: 98% of participants believe that the glossary has greatly contributed to their learning,, 86.1% of participants feel the same about the reflective journal, with respect to clinical practice, 94% feel very satisfied, and finally, over 80% of students from the three courses believe Moodle should be extended to all subjects. Conclusions: Moodle has been welcomed by students and tutors for monitoring and evaluation of the supervised clinical practice, and it is crucial in monitoring the tasks used to evaluate skills in this subject. The organization of the material, control in the delivery of the various tasks and the easy assignment and qualification of these are undoubtedly a key advantage.

Introducción: Sin olvidar el papel primordial del tutor profesional y tutor académico en el seguimiento y evaluación de las prácticas clínicas que realizan nuestros estudiantes, Moodle ofrece una serie de herramientas que supone un soporte formativo para el estudiante y ayudan en el sistema de evaluación continuada y por competencias de esta asignatura. Objetivos: Evaluar la utilización de la plataforma en la implantación de recursos tales como: diario reflexivo, creación de un glosario y consulta de satisfacción como herramientas de apoyo en el seguimiento y evaluación de las prácticas clínicas. Material y métodos: estudio descriptivo transversal. Sujetos de estudio: alumnos de la diplomatura que han realizado prácticas clínicas supervisadas durante el curso académico 2010- 2011. Ámbito: Escuela de Enfermería Fundación Jiménez Díaz-Universidad Autónoma de Madrid. Herramientas: cuestionario realizado ad-hoc y análisis cualitativo y cuantitativo de los distintos recursos utilizados en el seguimiento y evaluación de las prácticas clínicas. Resultados: El 98% de los participantes consideran que el glosario ha contribuido mucho a su aprendizaje, un 86,1% de los participantes opinan lo mismo sobre el diario reflexivo, respecto a las prácticas clínicas, un 94% se siente muy satisfecho y, finalmente, más de un 80% de los alumnos de los tres cursos consideran que Moodle debería ampliarse a todas las asignaturas. Conclusiones: Moodle ha sido bien acogida por alumnos y tutores para el seguimiento y evaluación de la asignatura "Prácticas clínicas tuteladas", y está resultando clave en el seguimiento de las tareas con las que se evalúan competencias de esta asignatura. La organización del material, el control en la entrega de las distintas tareas y la fácil asignación y calificación de las mismas son, sin duda, una ventaja clave.

Purpose: This article describes the use of a custom-made implant for cranial reconstruction. Clinical case: In a patient with a traumatic cranial defect, a custom-made implant of Polyetheretherketone (PEEK Optima-LT, Synthes) was used for reconstruction. Results: Intraoperative implant adjustments were not required. No rejection reactions, infections or implant exposure occurred in the postoperative period (3 months follow-up). The patient's preoperative symptoms diminished and the cranial contour improved notably. Conclusion: Custom-made implants are proposed as a feasible method for the reconstruction of severe skull defects. Factors such as cost, surgical procedure, and long-term results, must be evaluated.

Objetivo: Este artículo describe el uso de un implante hecho a la medida para la reconstrucción de un defecto craneal. Caso clínico: Un paciente con defecto craneal producto de traumatismo craneoencefálico. Se utilizó un implante a medida del paciente de polieteretercetona (PEEK Optima-LT, Synthes). Resultados: No hubo necesidad de ajuste transquirúrgico del implante, ni se presentaron reacciones de rechazo, infección o exposición del implante en el periodo posoperatorio (3 meses de seguimiento). El paciente disminuyó la sintomatología reportada previa a la reconstrucción, y la mejoría del contorno craneal fue notoria. Conclusión: Los implantes hechos a medida se presentan como un método razonable para la reconstrucción de defectos craneales graves. Deben evaluarse diversos factores, tales como el costo, el procedimiento quirúrgico y los resultados a largo plazo.

Human localized cutaneous leishmaniasis (LCL), induced by Leishmania braziliensis, ranges from a clinically mild, self-healing disease with localized cutaneous lesions to severe forms which can present secondary metastatic lesions. The T cell-mediated immune response is extremely important to define the outcome of the disease; however, the underlying mechanisms involved are not fully understood. A flow cytometric analysis of incorporation of 7-amino actinomycin D and CD4+ or CD8+ T cell surface phenotyping was used to determine whether different frequencies of early apoptosis or accidental cell death occur at different stages of LCL lesions. When all cells obtained from a biopsy sample were analyzed, larger numbers of early apoptotic and dead cells were observed in lesions from patients with active disease (mean = 39.5 ± 2.7%) as compared with lesions undergoing spontaneous healing (mean = 17.8 ± 2.2%). Cells displaying normal viability patterns obtained from active LCL lesions showed higher numbers of early apoptotic events among CD8+ than among CD4+ T cells (mean = 28.5 ± 3.8 and 15.3 ± 3.0%, respectively). The higher frequency of cell death events in CD8+ T cells from patients with LCL may be associated with an active form of the disease. In addition, low frequencies of early apoptotic events among the CD8+ T cells were observed in two patients with self-healing lesions. Although the number of patients in the latter group was small, it is possible to speculate that, during the immune response, differences in apoptotic events in CD4+ and CD8+ T cell subsets could be responsible for controlling the CD4/CD8 ratio, thus leading to healing or maintenance of disease.

Patients with American cutaneous leishmaniasis were studied before therapy (active lesion) and at the end of therapy (cured patients). Assays of lymphocyte proliferative responses of peripheral blood mononuclear cells induced in vitro by Leishmania braziliensis promastigote antigens (Lb) were performed. Antigen-stimulated cells were harvested for CD4 and CD8 phenotype analysis and the levels of gamma interferon (IFN-<FONT FACE="Symbol">g</font>) and interleukin 4 (IL-4) produced were also determined in the culture supernatants. Two different patterns of Lb-induced T cell responses were observed: a) predominance of responding CD4+ cells and mixed type 1 and type 2 cytokine production (IFN-<FONT FACE="Symbol">g</font> and IL-4) during the active disease, and b) similar proportions of responding CD4+ and CD8+ cells, and type 1 cytokine production (presence of IFN-<FONT FACE="Symbol">g</font> and very low IL-4) at the end of therapy (healed lesions). This last pattern is probably associated with a beneficial T cell response