¹Profesora Asistente del Departamento de Inglés

²Profesora Instructora del Departamento de Inglés

³Profesor Instructor del Departamento de Inglés

RESUMEN

El programa que se imparte a los alumnos de 5to año de medicina Medically Speaking presenta textos médicos que están desactualizados, y la mayoría de estos no se ajustan a las enfermedades que se describen en las diferentes unidades, e incluso, algunos contienen contradicciones desde el punto de vista científico. Asimismo, los ejercicios que de estos textos se derivan para desarrollar la habilidad de lectura, son insuficientes e inefectivos. Por todo lo anterior fue preparado un sistema de textos médicos actualizados y tomados de diversas fuentes con su sistema de ejercicios diseñado para contribuir a mejorar la adquisición de la habilidad de lectura en los estudiantes de 5to año de medicina. Su aplicación garantizó una mejor interpretación y comprensión por parte de los estudiantes y les ayudó a incrementar sus conocimientos médicos. Además, dichos textos fueron favorablemente aceptados por alumnos y profesores.

Palabras claves: entrevista, experiencia docente, encuestas, ejercicios, textos.

ABSTRACT

The teaching-learning process comprises four main abilities: listening and understanding, speaking, reading, and writing. After teaching Medically Speaking book to 5^th-year medicine students for over six years, teachers have found non-updated medical texts, some of which have contradictions from the medical point of view and the exercises based on them are not suitable to develop this ability in our students, so a system of updated medical texts was prepared, taken from different sources to overcome this drawback. A set of exercises was also designed to improve the acquisition of the reading ability and its skills in our students.

Its implementation guaranteed a better comprehension, interpretation as well as an increase in the students’ medical knowledge. Consequently, those texts were favorably accepted by both students and teachers.

Key Words: Interviews, Teaching experience, Surveys, Exercises, Texts

INTRODUCCIÓN

El individuo cuanto más lee, más amplía el caudal de sus conocimientos; y si esta lectura se hace en idioma Inglés, no sólo está ampliando sus conocimientos, sino también lingüísticos y culturales lo cual le será de mucha utilidad en su actividad profesional futura, aún más cuando en nuestro país el campo de las ciencias médicas ha alcanzado un amplio desarrollo, y en estos momentos existe un programa de colaboración en el campo de la medicina con países de habla inglesa, especialmente con Sudáfrica.

Debido a que los textos médicos que aparecen en el libro de 5to año de medicina, así como los ejercicios derivados de ellos, no ayudan totalmente a desarrollar esta actividad en los estudiantes, planteamos el siguiente problema científico:

¿Qué debemos a hacer para ayudar a mejorar la adquisición de la habilidad en la lectura de textos médicos a través de temas actualizados que despierten el interés en los estudiantes?

Y para encontrar la solución se realizó una intensa búsqueda de textos que están actualizados y guardan relación con los temas médicos que se plantean en el libro de 5to año, así como también se preparó un sistema de ejercicios derivados de los mismos que ayudan a desarrollar esta importante habilidad.

OBJETIVO GENERAL

§ Contribuir a mejorar la adquisición y desarrollo de la habilidad de la lectura intensiva y extensiva de textos médicos en Inglés para los alumnos de 5to año de medicina.

OBJETIVOS ESPECÍFICOS

Realizar una intensa búsqueda bibliográfica de textos médicos que reúnan las siguientes características: a) que no sean muy extensos -no más de 1.5 cuartilla b) que estén en correspondencia con los temas médicos que trata el libro de 5to año Medically Speaking c) que sean novedosas e interesantes para los alumnos d) que estén actualizados e) que tengan un lenguaje claro, sencillo y asequible a los estudiantes.
Elaborar un set de ejercicios que se adapte a cualquier texto médico en Inglés.
Clasificar los ejercicios de manera que estos se adapten a los diferentes momentos de la lectura (antes, durante, y después de leerlos).

MATERIAL Y MÉTODO

La base del problema que nos condujo a desarrollar este trabajo es básicamente que los textos médicos que aparecen en cada una de las 10 unidades del libro de texto Medically Speaking que se imparte a los estudiantes de 5to año de la carrera de medicina presentan serias dificultades que frenan o impiden el desarrollo y adquisición de la habilidad de lectura -importante elemento para el aprendizaje de un idioma extranjero.

A través de la revisión de dicho libro, de la experiencia personal, del trabajo docente durante 6 cursos con ese programa, así como de la realización de consultas y entrevistas a estudiantes y profesores que han recibido o impartido clases en 5to año, las principales deficiencias radican en que:

§ la mayoría de los textos no se ajusta al tema del problema de salud que trata la unidad

§ que están totalmente obsoletos (hace más de 20 años de publicados)

§ algunos presentan contradicciones desde el punto de vista científico.

§ algunos incluyen procedimientos y exámenes que ya no se realizan porque existen técnicas mucho más avanzadas en la ciencia actual.

§ son muy densas y se circunscriben a problemas más bien locales, e.g., en Inglaterra en los años 70; y por lo tanto no motivan a nuestros estudiantes

§ que los ejercicios que de cada texto se derivan son insuficientes para desarrollar la habilidad de lectura

Por todo esto decidimos darle solución a este problema en dos vertientes fundamentales:

1. La realización de una intensa búsqueda de textos en distintas fuentes de información tales como revistas médicas, libros de reciente adquisición, correo electrónico, reprints, etc., y de estos textos seleccionamos los más actualizados y cuyos temas están en correspondencia con las unidades del libro de texto, pero que además resultasen interesantes, con un vocabulario fácil de comprender por los estudiantes y que encierran conocimientos y tecnologías nuevas.

2. El diseño de un set o sistema de ejercicios derivados de los textos que van a ayudar al desarrollo de esta habilidad. Estos ejercicios se clasificaron para ser aplicados en diferentes momentos de la lectura e.g. para la motivación, antes de la lectura del texto, durante la lectura, y después de la lectura. De manera tal que puedan adaptarse a cualquier tipo de lectura.

Consideramos este trabajo de gran utilidad para mejorar la enseñanza del Inglés médico porque les ofrecemos a los profesores actividades útiles para desarrollar la habilidad de lectura en sus estudiantes independientemente de que el texto pueda cambiar. Estas actividades sugeridas incluyen:

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Pregunta No. 2 ¿Le gustaría sustituirlas?

A) Sí b) No

¿Por qué razones?

La mayoría de los profesores entrevistados plantean que están obsoletas, densas, que los enfoques en cuanto a tratamiento y procedimientos diagnóstico de las enfermedades han variado. Además, opinan que los alumnos no muestran interés por los mismos y que los ejercicios que plantea el libro en las clases de lectura no son suficientes ni adecuadas para ayudar al desarrollo de esta habilidad ni a la integración con las demás habilidades del idioma.

Pregunta No. 3. ¿Cuál es la valoración en relación con los textos?

La valoración de los 3 profesores que respondieron a esta interrogante fue positiva en relación con los textos que utilizaron sustituyendo a los del libro y consideraron que para próximos cursos tanto los estos como los ejercicios derivados de ellos deben extenderse y por consiguiente aplicarse en todas las unidades y a todos los alumnos de 5to año.

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A continuación se incluyen los textos médicos que sustituyeron a los del libro y su sistema de ejercicios. (Anexo 2)

ANEXO 2 : Textos médicos incluidos en el programa

Unit 3: LACTATION AND BIRTH SPACING

In many developing countries where birth control is not widely practiced there is, nonetheless, a form of natural birth-spacing related to amenorrhea and lactation. One of the methods of fertility control that has received very little attention in the Western world was the birth effect of breast feeding, mainly because the majority of married couples are prepared to use a contraceptive method. However, the situation in the developing world is entirely different. Very populous countries like India and Pakistan, for example, will have very small percentages of women using contraception, and this is where breast-feeding comes into its own and becomes extremely important. In fact, in developing countries breast-feeding prevents more pregnancies than all other forms of contraception put together.

The Medical Research Council Unit of Reproductive Biology, in Edinburgh, had as its remits to investigate any method of fertility control, and their study was concerned not only with developing countries, but also with women in Britain.

They look at a number of British women in great detail to find out how the mother suckled, that is, how frequently and how long she kept the baby at the breast, and the relationship between her breast-feeding practice, the endocrine changes such as the prolactin release and whether or not her ovaries were working to the extend that she was ovulating and capable of becoming pregnant . Even in these women there was absolutely no doubt that breast feeding suppressed the ovaries and rendered the mother infertile for quite a large number of months, and in some cases the infertile time lasted for 18 months post-delivery.

There had been some questions raised of whether malnutrition might be causing the reduced fertility in developing countries. There is conflicting evidence on this. Some of the studies suggest that mothers who are malnourished have a longer period of amenorrhea compared with others who are well-nourished. On the other hand, the problem is that poorly nourished mothers also tend to suckle their babies more frequently, so it is difficult to tell whether the longer amenorrhea is due to the malnourishment or to the longer suckling. It is possible that both of these factors have an effect and more work is needed before this can be cleared up.

In a nutshell, findings about the specific effects of suckling on birth-spacing and amenorrhea and fertility have shown that the more mother suckles the more prolactin she releases and the greater the suppression of her ovarian activity and the longer the period of amenorrhea after delivery. One of the other points that came out is that, when a mother is fully feeding her baby, giving it no alternative form of nourishment, the suckling frequency and the length of time she suckles her baby everyday remain quite high and really quite constant. But as soon as she introduces an alternative form of feeding whether it be an extra bottle of formula milk or solid food, then the baby suckles either less often or, if it does suckle, it suckles for a shorter period of time. This means that the prolactin level falls, the suppression of the ovarian activity is less secure and she is more likely to ovulate and therefore more likely to get pregnant. So this obvious practical implication of this is that when there is a trend to encourage mothers to use the breast milk substitutes, this tendency undermines suckling and it will undermine the contraceptive effect.

Regarding the reliability of breast feeding as a contraceptive, in those communities where the mothers suckle their babies frequently, it is in fact very reliable. With this pattern of suckling, it has been calculated that the pregnancy rate in the first six months postpartum was about 1 per 100 woman years, a contraceptive effect-efficiency similar to that of the pill. But when taking the efficiency in a country like the United Kingdom or the United States, the position changes quite remarkably. In these countries mothers suckle much less frequently, their desire is to give up the night feed as quickly as possible and this means that the stimulation to release prolactin is much less strong so that in developed countries it is a much less reliable method of contraception, not for any biological reason but because of the different social patterns of infant feeding.

Understanding these factors is very important especially as people seek more natural methods of birth control, and there could be clinical implications for the developed countries, but this would apply only to a minority of women. There are a number of women who are very anxious to do everything as naturally as possible in their reproductive lives and when they have understood what is involved in breast-feeding and its contraceptive effect, they have been perfectly prepared to take a small chance that they might become pregnant inadvertently. But it is important to stress that these women have been wanting to space out their children, not to have an indefinite method of contraception, and what they have done is take on the idea of feeding their babies much more frequently. They sleep with their baby at night and they have tried to copy the traditional method, and these women have actually adopted this method very enthusiastically.

Breast-feeding should be put on the menu of contraceptive methods and as long as the women understand that it is not 100 % reliable they should be left to make up their own minds about it.

Source: Adapted from an interview with Professor Peter Howie of the Department of Obstetrics and Gynecology in the Ninewells Hospital, Dundee, Scotland; in Auditorium, Vol. 10 No. 3, 1983.

A. Pre-Reading Activity:

What is the importance of breast-feeding?

B. While-Reading

1. Where does breast-feeding become extremely important?

a) In the western world b) All over the world c) In populous countries of the developing world.

2. What can be the cause of the reduced fertility in developing countries?

a) Malnutrition b) The longer suckling period in poorly nourished mothers

b) Both factors

3. When in the ovarial activity less secure?

a) when a mother is fully feeding her baby, giving him no alternative form of nourishment b) When she introduces an alternative way of feeding

C. Answer the following questions from paragraphs 4 and 5.

What are the findings about the specific effects of suckling on birth-spacing and amenorrhoea and fertility?
What happens introduces an alternative form of feeding?
How is the reliability of breast-feeding as a contraceptive in communities where mother suckle their babies very frequently?
What is the efficiency of this natural contraceptive method in the United Kingdom and the USA? Why?

D Post Listening Activities

1- Find the English equivalents of the following words or phrases

a- Sin embargo (paragraph 1)

b-Lactancia materna (paragraph1)

c- Países en vía de desarrollo (paragraph 1)

d-Investigar (paragraph 2)

e-Liberar (paragraph 2)

f- Período de tiempo infértil (paragraph 2)

g-Bien nutrida (paragraph2)

h-Frecuencia de lactancia (paragraph 4)

i- Forma alternativa de alimentación (paragraph 4)

j- Probable (paragraph 4)

k-Tendencia (paragraph 4)

l- Socava (paragraph 4)

m-Confiabilidad (paragraph 5)

n-Amamantar (paragraph 5)

o-Suspender(paragraph 5)

p-Método anticonceptivo (paragraph 5)

2-The students will work with paragraph number 6.Versions should be checked at the end of the activity

3-Write a Summary of the text beginning with the following idea.

“Breast-feeding should be put on the menu of contraceptive methods.....”

At the end some versions should be checked.

Myocardial Infarction by Alan D. Guerci

More than one million acute myocardial infarction occur each year in the United States. In the industrialized West, the acute and chronic manifestations of myocardial infarction account for more deaths than any other single disease entity. Full discussion of the pathophysiology and treatment of acute myocardial infarction is beyond the scope of this text, and this chapter will focus on diagnostic and therapeutic problems related to the patient’s presentation.

The majority of myocardial infarctions are caused by thrombosis of severely atherosclerosed coronary arteries. Coronary spasm is an unusual cause of acute myocardial infarction and coronary artery embolism, congenital anomalies of the coronary circulation, and inflammatory arteritides are rare causes of myocardial infarction. Necrosis is determined by the duration and intensity of ischemia. Available data suggest that most myocardial infarction are complete in four to six hours.

Patients with acute myocardial infarction typically complain of squeezing or crushing retrosternal discomfort, often to radiation to the neck, jaw, or left arm. Radiation to the right arm or back is less common. In some cases the discomfort is episgrastic and may be mistaken for indigestion. Still other patients present not with pain but with symptoms of disordered electrical or mechanical activities such as syncope or shortness of breath.

Electrocardiography remains the single most useful diagnostic test in the initial face of myocardial infarction. Although fallible electrocardiography usually offers insight into the location, sites, age, and consequently the prognosis of an infarct.

ST segment is the ECG hallmark of acute transmural ischemia involving the anterior, inferior, and lateral walls of the left ventricle. When viewed from above, the ST segment elevation often has a convex shape, as opposed to the concave upward appearance of the ST elevation of pericarditis and early repolarization. In some cases hyperacute T waves, defined as greater than 1.0-mV-high T waves may be the earliest and only ECG evidence of infarction. Deep (usually more than 0.2 mV) horizontal, or slowly upsloping ST segment depressions in the precordial leads may be the only evidence of transmural ischemia involving the posterior wall of the left ventricle. These segments depression are actually the reciprocal representation of the ST elevations, as may be appreciated by turning the ECG over and viewing it against a source of light. The development of Q waves and loss of R waves occur in parallel and indicate necrosis. Like the infarction itself, these ECG processes are ordinarily complete in four to six hours. Indeed, when chest pain and ST segment elevations persist for more than three or four hours without R waves loss or the development of Q waves, it is appropriate to consider the possibility of preservation of myocardium due to abundance collateral blood flow to the ischemic region or nonischemic causes of ST segment elevation.

The differential diagnosis of acute myocardial infarction includes aortic dissection, pulmonary embolism, pericarditis, and a variety of disorders involving the chest wall and upper gastrointestinal tract. The pain of aortic dissection ordinarily radiates to the back and is usually described in terms more severe that of myocardial infarction.

Although the dissection may involve the aortic root , occlude a coronary artery, and cause an acute myocardial infarction, most aortic dissection do not cause infarction and, in addition, do not cause changes in the ECG. This latter feature may be a useful point in differential diagnosis.

Like myocardial infarction, pulmonary embolism may cause severe chest pain and shortness of breast. Pulmonary embolism may also cause T waves inversion or a manor non specific ST and T waves abnormalities, which lack diagnostic utility. Alternatively, the ECG may be normal or minimally abnormal in massive pulmonary embolism. Excluding acute ischemic mitral regurgitation, this is not true of myocardial infarction causing hemodynamic compromise, that is, although the ECG may be normal in small myocardial infarctions, is grossly normal when infarction is large enough to cause hypotention or respiratory distress.

The pain of pericarditis is almost pleuritic, whereas that of the initial phase of myocardial infarction is rarely, if ever, pleuritic. Several other clinical and ECG features of the pericarditis are also distinctive.

Esophageal spasm may cause pain which is indistinguishable from that of acute myocardial infarction, but that does not cause ST segment or T waves abnormalities. Cholecystitis and pancreatitis more commonly caused confusion, for both may cause minor, nonspecific ST-T wave inversions, and the pain of acute myocardial infarction may be epigastric. Physical examination, that is, demonstration of right upper quadrant or epigastric tenderness, is usually sufficient to establish the correct diagnosis.

Source : Manual of Clinical Problems in Internal Med. 4^th edition.

Pre-Reading Activity

Teacher reads aloud paragraph 1 and asks the students what it is about.

While-Reading

A. Answer the following questions about the text.

1. How many MI occur per year in the USA?

2. What is the main objective of study of this chapter?

3. What is the major cause of MI?

4. Which causes are rare?

5. How long dose an MI need to be completed?

6. What do patients with an MI complain of?

7. What symptoms may be mistaken for indigestion?

8. What is the most useful diagnostic test?

9. What specific data does it offer?

Post-Reading Activity

1. Translate paragraph from line 65 to 75 into Spanish.

2. Summarize the text from line 31 to 64.

3. Be ready to give your opinion and discuss the last paragraph.

II Ulcerative colitis: Reading Practice Activities for Unit 5 Colitis.

A. Before-Reading Activity

Objective: To give the purpose for reading. Write the following questions on the board.

What is the disease described in the reading?
Within what group of diseases is it classified?

B. While-Reading Activity. (Skim reading: quick reading for specific points)

The condition presents with a change in..................... ........................, particularly with .................................... .
The stools often being.......................... and........................... containing

.................................. .

Severe diarrhea may lead to........................... and.....................; bleeding may lead to............................
Simple granular proctitis occasionally presents a.................. or................... in old age. It is not associated with........................... in the.............................. .

Activity 3 While-Reading

A) Answer the following questions on the reading:

1. What are the most frequent inflammatory bowel diseases that can appear in the elderly?

2. What are he main clinical manifestations?

3. Is granular proctitis associated with melena? Explain.

4. What can a sigmoidoscopy show in granular proctitis?

5. How would you manage a patient with this disease?

6. How often would you apply the treatment?

7. What other methods can help o carry out these procedures?

C. After-Reading Activity

1. Translate into Spanish paragraph No 3.

2. Summarize the last paragraph in not more than 40 words.

Reading: ULCERATIVE COLITIS

Ulcerative Colitis is now known to occur quite commonly for the first time in advanced age and must always be considered in the diagnosis of disorders of the lower bowel in the elderly. The condition presents with the change in the bowel habit, particularly with diarrhea, the stool often being blood-stained and mucus-containing. Severe diarrhea may lead to dehydration and collapse; bleeding may lead to anemia. The diagnosis and management of this condition is the same in old age as it is in younger people. Treatment may involve the use of sulphasalazine, steroids or surgery.

A less severe, simple granular proctitis occasionally presents as diarrhea or fecal incontinence in old age. It is not associated with blood in the stool and sigmoidoscopy shows a uniform hyperemic velvety appearance of the rectal mucosa. This condition is usually treated very successfully by a series of retention enemas of hydrocortisone hemisuccinate given once or twice a day. Retention of the enema is sometimes aided by given a dose of propantheline half an hour before the enema and also by elevating the foot of the bed.

Crown’s disease: A second peak in the incidence of this disease occurs in the 70-year-age group. Crohn´s disease in the old is the only one of the colonic diseases likely also to affect the anus. Barium enema may show the typical ‘sting sign’ indicating involvement of discrete localized areas. Treatment usually requires hospital admission and ease by steroids or surgery.

Colonic ectasias (small sub-mucous arteriovenous aneurysms) have become recognized in the past few years as a source of both acute and chronic hemorrhage. They increase with advancing age and are thought to be due to occlusion of small veins as they pass from the colonic mucosa through the circular muscles, the long continued contraction of muscle causing the obstruction. They can be recognized by colonoscopy or arteriography.

Source : from Geriatric Medicine For Students, p. 147.

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Reading activities about Mammography: Benefits and Risks.

Team1: Answer the following questions on paragraph.

1. What is the most recommendable screening for breast?

2. What is important to notice in these cases?

3. Do X-rays produce any side effects?

4. In what period of women's life is the breast more sensitive to radiation?

5. What is the percent of risk?

6. Is there any risk rate for annual mammographies?

7. Who is Dr. Epstein?

8. What is the most recent concern about beast cancer risk?

Team 2

Translate into Spanish this paragraph.

Team 3

Comment and give your personal opinion about this paragraph.

Team 4: Answer these questions on paragraphs 4 and 5.

1. What is the experts’ opinion about breast self-examination?

2. What is Dr. Epstein’s point on this matter?

3. What is the author’s opinion about mammography?

4. Which are the newest methods for breast cancer detection?

5. What is AMAS? What is it based on?

6. What is the importance of AMA?

Reading : MAMMOGRAPHY: BENEFITS AND RISKS

While the use of mammography is commonly recommended to detect breast cancer, it is important that its drawbacks be noted, as well. First, X-rays can cause cancer. There is clear evidence that the breast, particularly in menopausal women is highly sensitive to radiation, with estimates of increase risk of 1 percent for every RAD (radiation absorbed dose) units of x-ray exposure. “Even for low dosage of exposure of two RADs or less, this exposure can add up quickly for women having annual mammographies,” notes Samuel Epstain, M.D. Professor of Occupational and Environmental Medicine at the University of Illinois School of Public Health. “More recent concern come from evidence that one percent of women or over one million women in the United States alone, carry a gene that increases their breast cancer risk from radiation fourfold.”

Secondly, mammography provides false tumor reports between 5 and 15 percent of the time. False positive results cause women to be responsed to additional x-rays and create an environment of further stress even possible leading to unneeded surgery. “Furthermore,” says Dr. Epstain, “while there is a general consensus that mammography improves early cancer detection and survival in postmenopausal women no such benefits is demonstrable for younger women. “Still, the American Cancer Society recommends annual mammography for old women aging forty to fifty-five.

In addition, mammography may also fail to detect advanced tumors measuring less than two centimeters in diameter. Yet, a tumor can be felt manually when it reaches about one centimeter (approximately one half inch) in diameter, and with training in self-examination, women can detect even smaller tumors. In view of this, women should take self-examination all the more seriously.

Many experts believe that early detection through manual examination provides the best all-round results, as well.

“It is certainly the safest, least expensive, and least invasive preventive action available to women,” Dr. Epstain points out. “It also enables women to become familiar with their breast tissue, natural lumps and all, and to report early on any noticeable changes.”

For the time being, mammography’s place in breast cancer detection is secure. But it is a passing technology, which will soon be replaced by safer testing methods. Two such methods available include Transillumination with infrared light scanning, and the Antimalignant Antibody in Serum (AMAS) test. Transillumination is based on the concept that light will shine through most breast issue but will be blocked by lumps. Its advantage is that it does not use radiation. The AMAS test measures serum levels of AMA, an antibody found to be elevated in most patients in the early stages of active non-terminal malignancies.

Source: Golberg Group B, Alternative Medicine, 1993: 570.

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Reading activities about: Surgical Complications in Solitary Pancreas

and Combined Pancreas-Kidney Transplantation

Paragraph 1:

1. What factors have influenced on allograph survival rates?

2. What is the result of these techniques?

3. How many pancreas transplantations were performed in 1991?

4. How many hospitals have made these transplants?

5. Have these pancreas transplants been performed along with other organs? Which ones?

6. What patients have received the least percent of transplants?

Paragraph 2

1. What do they need to prevent rejection?

2. Is transplantation appropriate to type I diabetic patients?

3. What is the other problem of PT?

4. In what cases have the procedure been on effective therapeutic option?

Paragraph 3

1. What was the patient’s age range?

2. Which group is the most affected?

Paragraph 4

1. What factors were taken into consideration to perform these transplantations?

2. What measures were taken before such transplants?

3. What was the survival rate after 34- month follow-up?

4. What were the main complications for the patients?

Paragraph 5 and 6

1. Translate both into Spanish.

2. Summarize the whole article in about 100 words.

SURGICAL COMPLICATIONS IN SOLITARY PANCREAS AND COMBINED PANCREAS-KIDNEY TRANSPLANTATION.

With improvement in organ retrieval technology, refinement in surgical techniques and advances in clinical immunosupression, allograft survival rates have improved dramatically, which has resulted in an increase interest in vascularized pancreas transplantation (PT). In 1991, 537 PTs were performed among about 60 different transplant centers in the United States. Approximately 8 % of PTs have been performed in conjunction with a simultaneous kidney transplant, whereas the remaining 20 % have been divided between nonnumeric patients could receive a pancreas transplant alone and diabetic patients with a functioning kidney transplant who then received a solitary pancreas after kidney (PAK) transplant.

Since immunosupression is necessary to prevent allograph rejection, wide spread application of PT to the type I diabetic population is not appropriate at this time. Another major problem of PT is the morbidity associated with an operative procedure. However, as PT has involved, technical problems have been overcome, and the procedure has emerged as an effective therapeutic option in carefully selected insulin-dependent type I diabetic patients.

The age of patients range was 24 to 44 years, and the severity of type I diabetic was assessed by the mean duration, daily insulin dose, and glycerol and or autonomic neuropathy.

Patients were selected for transplantation based on ABO blood type compatibility, length of time on the waiting list, a negative T-lymphocytoxic cross-match, and medical urgency. All patients underwent preoperative selective bowel preparation and antibiotic bowel preparation (oral clindamycin and neomycin).

For the entire group, overall pancreas allograph survival was 80% after a main follow-up of 34 months. Ten pancreas allographs were lost (1 death, 1 rejection, 3 thrombosis, and 5 peripancreatic infections with pancreatitis) .

The incidence of rejection and the overall level of immunosupression were similar in patients with and without operative complications. However, the development of allograph pancreatitis, specially with infection usually resulted in surgical morbidity.

A number of recent innovations have enhanced the safety and the reliability of PT. In contrast with other solid organ transplanted, the pancreas is susceptible to a unique set of complications because of its exocrine element and low blood flow. Allograph pancreatitis has become less a problem.

Source: Nyhus Ll. M, Mastery of Surgery, 1992.

Reading Activities: Malaria: Hopes and Fears

I. Pre-Reading Activity.

A) The teacher will suggest the students expand the following idea, so that they begin to think about the topic they are going to read.

Malaria is a disease................................

Versions should be checked orally and the theme will be introduced to the students: Malaria: Hopes and Fears.

B) Students will be asked what they think the text states according to its title.

II. While-Reading Activity

Firstly, the students will be working on paragraphs 1-4 with a listening activity. Secondly, answers will be checked orally.

a) Write TRUE or FALSE

1. By the 1950s there was a confidence about the effects of the synthetic drug chloroquine.

2. One of the unpleasant surprises in the 1960s was the development of chloroquine resistance in South America and South East Asia.

3. Mosquitoes can be eradicated in sufficient numbers using present techniques.

4. In the severe cerebral malaria the patient may die within a few days if there is no rapid assistance.

5. Qin Thao Xi is a herbal medicine with a potent anti-malarial action.

6. It hasn’t been clinically evaluated yet.

Paragraph 5 (Looking for specific items to widen vocabulary)

Procedure: The teacher reads the paragraph twice or thrice for the students to fill in the blanks and checks the activity at the end.

1. So there is some................. for the future, thanks to the ancient Chinese ........................

2. There is growing ........................... that a .................... might soon be ........................... to protect millions of people.

3. Professor John Playfair and his colleagues at Middle Essex Hospital in London have discovered that the ...................... may prove to be one of the most ................ ........................ against plasmodium.

III. Post-Reading Activity

Work Group

A) The students will be asked to summarize the text.

B) Another variant is that one member of the group will talk about the text.

C) Translation of paragraphs 6,9, and 10 into Spanish will be assigned as teamwork. Each team is to translate one paragraph.

Malaria: Hopes and Fears

By the 1950s the synthetic drug chloroquine was so effective and easily available for the treatment of malaria that there was confidence, complacency even that malaria could be overcome. This feeling was boosted by apparent success of mosquito eradication campaigns in many places. But, as Dr White explains, there were some unpleasant surprises in a store.

" There were several jolts in the 1960s. The first was the development of chloroquine resistance, almost simultaneously is South America and South-East Asia and the second was the realization that the goal of malaria eradication was perhaps attainable".

Mosquitoes simply can't be eradicated in sufficient numbers using present techniques ant there is not much prospect of doing better in the future. Dr. White and his colleagues are particularly interested in severe cerebral malaria in which the patient become comatose and may die within a few days without speedy intervention. In such places it is vital to know how much of the standard medications, chloroquine and quinine, can be used safely. But because of increasing resistance to all anti-malarials he's also investigating the Chinese herbal remedy called Qin Hao Xu.

" This is an exciting advance. Its discovery by the Chinese that a plant product, a product of the, of Artemisia annua, has potent anti-malarial action. The original plant extract was found to be very effective in treating malaria in China and the Chinese have done a lot of work on this drug and they´ve identified the active structure, synthesized derivates and a water-soluble derivates of Qin Hao Xu, called artesunate looks to be very promising drug for the treatment of severe malaria. It's rapidly effective and it's been shown to be clinically effective in a very large number of patients in China. We hope that we can evaluate this promising drug in cerebral malaria to see how it compares with quinine, our established treatment and to try and find again the best dose regimen for giving it to severely ill patients.

So there is some hope for the future, thanks to ancient Chinese herbalists. Moving back front-line of the battle against malaria, there's growing optimism that a vaccine might soon be mass-produced to protect millions of people. The current hopes are based on the huge growth of gene cloning and monoclonal antibodies techniques, which have made possible to mass-produce a whole range of medically useful substances quite cheaply. There are several different promising lines of approach to developing a malaria vaccine.

Professor John Playfair and his colleagues at the Middlesex Hospital in London have discovered that the body's cell-mediated immune system may prove to be one of the most effective weapons against Plasmodium.

"We became interested in cell-mediated immunity in malaria as a result of experiments with mouse malaria in which we vaccinated mice against various species of malaria parasites and looked to see what immune response correlated with protection. And were quite surprised to find protection seemed to correlate better with cell-mediated immunity, that´s to say with the activation of T-cells than with the production of antibodies. So we then looked at the ways in which T-cells mediated immunity might lead to effective protection against blood-stage malaria. It has been shown that malaria parasites are susceptible to killing by a number of factors that can be secreted by macrophages, particularly macrophages that have been activated and perhaps attracted to the relevant side by the T-cells, so this seemed to us a pathway worth investigating."

And investigate it they did. The chain of events which leads to macrophages attacking malarial parasites must begin somehow with the assistance of special antigens on the parasite.”These mobilise the T-cells system and this sets off the macrophages. A vaccine based on the parasites antigens could soon be made,” says Professor Playfair.

"In the past this has been rather difficult because there hasn't been a simple technique for studying the result of T-cells to individual antigens, but I think this is going to be proved in the next few years by the development of T-cell cloning. In a world it's now possible to make large population of T-cell derived from a simple precursor, in much the same way as has already been done for the B-cells in the production of monoclonal antibodies which has been so important in identifying protective antigens in malaria and other parasites. Now we hope that producing T-cell clones, that's to say populations of T-cells with restrictive specificities responding to single antigens from the parasite, we shall then be able to transfer these cells into animals or perhaps their effects in the test-tube and identify which antigens are the most potent in stimulating this type of immunity. Of course those could be the source of antigens one would like to incorporate into a vaccine."

But until such a vaccine is made, doctors like Nicholas White are putting their main hopes upon drugs. So what is the world picture of drug resistance in malaria?

"Chloroquine resistance in the early 60s was succeeded by the development of resistance to the pyramethamine-sulphonamide combinations in the 70s and certainly in Thailand quinine resistance is progressing apace which really leaves us nothing in the pharmacy cupboard so to speak, other than perhaps Qin Hao Xu, with which to combat sever infections. This pattern of development of resistance in probably at its worst in South-East Asia but it certainly seem elsewhere. The Americas have produced some modifications of the quiniline series, probably the most important of these is mefloquine, which is certainly a very effective drug in the treatment of chloroquine resistant Plasmodium falciparum infections and is also effective in some patients with quinine resistance strains, but unfortunately this drug cannot be given parenterally so although it may be very effective treatment for uncomplicated infections it's of no use to the patient who's severely ill."

So, does that mean that Dr. White and other malaria workers are fighting a losing battle?

"Yes, I think you could say that we're losing at the moment. It's never wise to rely on any single anti-microbial agent -the natural history of bacterial infections over the last 20 or 30 years has taught us that. We certainly need a new and effective anti-malarial and I think We need it quickly. Whether Qin Hao Xu is going to do that I don't know. I would like to predict at the present time but there's no room for complacency."

Speaker: Dr. Nicholas White and Professor Playfair

Source: Auditorium vol. 10 No. 6 (1984)

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Reading Activities about Adult Children of Alcoholics Reading

A) Complete the following paragraph with the words from the list below:

1. Genetic 2. Risk 3. Strong 4. Demonstrated 5. Younger 6. Levels 7. Less

7. Environmental 9. Multiple 10. Generations 11. Power 12. Roles

Family studies have .................that alcoholism has a ........... familial association, often with ........... family member being affected in multiple ......................... Family studies do not have the ........... to separate ............. from familial .......................... factors. However, adoption studies have demonstrated strong ............ influence in alcoholism. ( Cloninger et al., 1981; Goodwin et al., 1974 ). The separate .............of family environmental influence in increasing the ....... ... of alcoholism in ............ family members is ..... clear.

B) Translate lines 1-15 into Spanish.

C) Summarize lines 17-46.

D) Answer the following questions on the reading lines 40-65.

1. What do Miller and Tuckfield suggest?

2. What is Hibbard’s opinion?

3. What is the role of diagnostic categories? Why?

4. What factors do doctors evaluate to determine specific treatment group?

5. What prediction did they make?

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Reading: ADULT CHILDREN OF ALCOHOLICS

Family studies have demonstrated that alcoholism has a strong familial association, often with multiple family member being affected in multiple generations. Family studies do not have the power to separate generic from familial and environmental factors, however, adoption studies have demonstrated strong generic influence in alcoholism. ( Cloninger et al., 1981; Goodwin et al., 1974). The separate roles of family environmental influence in increasing the risk of alcoholism in younger family members is less clear.

Nevertheless, many clinical treatment personnel and programs have assumed a major familial environmental influence and developed programs for alcoholics coming from homes with a history of parental alcoholism. These programs assumed the childhood traumas are an important cause of alcoholism and require understanding and treatment to improve the patient’s alcohol problems.

“Children of Alcoholics” (COA) has become a popular term used by some psychologists, social workers, counselors, and physicians to denote a diagnostic group with purported shared developmental experiences and adult personality and interpersonal deficiencies. The COA movement focuses on understanding the effects of being raised in a home with at least one parent impaired by alcoholic abuse. Some COA studies state that more 10 % of the U.S. population has had exposure to an alcoholic home life (Ackerman, 1983).

Krisberg (1985) proposes the evolution of diverse family systems due to the stresses of an alcoholic environment. The early home and social environment of COAs have been found to have increase marital strife, parental-child conflict, and physical abuse (Reich et al, 1988), with these detrimental childhood experiences, an impaired adult is predicted to emerge with a multiplicity of complex psychological problems. Sometimes these problems are manifested as alcoholic or substance abuse tendencies (Parker and Hartford, 1988), although the theory predicts that the adult COA may be impaired in multiple ways affecting personality, psychopathology, and life adjustment abilities. A home life laden with the unpredictable behaviors of an alcoholic no doubt serious hazards to children.

Miller and Tuckfeld (1986) suggest that, due to the lack appropriate parenting, adult COAs have been denied a healthy base for life and often present clinically with unique problems that they have acquired in their deleterious childhoods; adult COAs often lack the skills to deal with reality, have learned complex mechanisms of mistrust, and have strong need to control others. Hibbard (1987) states that many COAs display a wide spectrum of disorders that begin in childhood and follow into adult life.

Although the adverse effects of childhood with an alcoholic parent are undeniable, the categorization, of these COA group for treatment purposes has little research support. Clinically subgroups based on specific phenomenology, etiology, or treatment outcome ( Robins and Guze, 1970). To determine whether the adult COA designation defines specific treatment group, we evaluated subjects in treatment for evidence of clinical specificity by comparing sociodemographic factors, personality, and psychiatric features between alcohol/drugs abusers, with and without having been exposed to an alcoholic environment in childhood.

We predicted that, if the adult COA concept is valid, the COA group, because of their common negative background, should always display more personality and psychiatric psychopathology and a more severe substance abuse pattern than abusers without a parent with alcohol problems.

Source: Ivy F.A. Journal of Nervous and Mental Diseases, 199

Correspondencia: Lic. Marlene Cabrera Pérez, Facultad de Ciencias Médicas de Holguín. E_mail. marlene@cristal.hlg.sld.cu

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ABSTRACT

OBJETIVOS ESPECÍFICOS

MATERIAL Y MÉTODO

Dentro de los ejercicios sugeridos para buscar información precisa y concreta y a la vez resumir lo leído se encuentran:

a) predecir

b) anticipar

c) buscar

d) profundizar

e) Buscar sinónimos

f) Buscar antónimos

g) Completar cuadros

h) Completar ideas

i) Completar preguntas

j) Responder ejercicios de verdadero o falso

k) Hacer resúmenes

l) Hacer comentarios sobre lo leído

m) Dar diferentes versiones

n) Traducir a otros idiomas.

En el caso de los grupos de control se trabajó con los mismos textos que aparecen en el libro de texto de los alumnos y se aplicó un grupo de ejercicios preparados por los autores. En el caso de los grupos experimentales se aplicaron los siguientes textos:

a) ejercicios de verdadero o falso (antes de leer el texto escrito)

b) ejercicios de vocabulario i.e. sinónimos, antónimos, cazar (durante la

lectura)

c) traducción al español de diferentes párrafos (después de leer)

d) preguntas sobre el texto (durante la lectura)

e) dar opiniones sobre lo leído (después de leer)

f) hacer resúmenes del texto leído (después de leer).

ANEXO # 1