Noelia García is provisional number 1 in the MIR 2024 exam. This Medicine graduate from the Autonomous University of Madrid has achieved a total of 190 hits and 10 misses in her first attempt at the MIR exam.. In a first interview with this newspaper, García revealed his preferences regarding the specialty: “I have always wanted to do Dermatology or Endocrinology and Nutrition and I am still hesitating.”. I need to talk to more residents and see what appeals to me the most.. I don't know the hospital either, but I know that I want to stay in Madrid.”

García has prepared with the MIR Asturias academy, which will have managed to train the number 1 candidate for the third consecutive year if these results are confirmed in the final lists. This doctor began preparing in the sixth year of her degree starting in December 2023, opting for the academy's 17-month intensive course. He highlights that in the simulations he obtained more than 180 net, “but at the academy they had told us not to believe it”.

THE IMPORTANCE OF REST

What have you done differently from the rest? “We all study and dedicate many hours and a lot of effort to studying, but I think that just as important as studying is to respect rest, both at night and going out to get some fresh air, do some sports, refresh the mind and not just be studying” , reflects the candidate. “If you are tired you are not going to perform the same and it is something that I have always kept in mind. Just like high-performance athletes, they spend many hours training a day, but the rest of the time what they do is rest and do everything possible to optimize their rest and give their best the next day, when preparing for an opposition like the MIR exam, same. “You have to work hard and study hard, but you have to rest so you can repeat it the next day.”

She explains that she has distant relatives in the healthcare world, both doctors and nurses, but that of her immediate family she is the first to get the bug.. “When I was in high school and they asked me what I wanted to be, I wasn't sure.. In fact, in the list I made for Evau, my first options were Medicine, Biochemistry or Economics.. But in the end, thinking a little about what job I saw myself doing for most of my life, doctor was one in which I saw myself being happy.. “There was no further reasoning, I could have chosen something else, it was not something vocational in the sense that I could only be a doctor.”

He acknowledges that the first years were quite hard with the change from high school to university and with basic subjects rather than clinical content: “You still saw yourself very far from the performance of Medicine, studying something that you were not very interested in and that you did not have many facilities”. Furthermore, during the third year, with the pandemic, he believes that the training suffered a lot, especially in the practices, “which had to be recovered at the beginning of the fourth year and in fits and starts”. However, he highlights that “all these obstacles are being overcome and I am glad that I persevered even though several times, especially in first and second year, I considered changing careers, because I didn't see that so much suffering was worth it.”

She confesses that, apart from the practices and mandatory seminars, she barely went to class, so her study has been based on notes and reference manuals: “It was more profitable for me to study it alone at home than to go to college.”. For me, being in class was a very passive way of studying, it was not profitable.. “I realized that I arrived home and it was as if I hadn't been there, I didn't remember anything, so I had to change my method.”

He chose the MIR Asturias academy because the manuals, having summaries, illustrations and test questions, seemed to be the most complete.. In addition, it highlights that it is the academy with the most simulations, “and they are longer but you have less time to do them than in the MIR exam. This overtraining makes you feel looser on the day of the MIR. Immediately after the Saturday simulation you have a 4-hour correction class, which means that the reasoning you have used is fresh.”.

IMPRESSIONS FROM THE MIR 2024 EXAM

Regarding the exam on January 20, García points out that it was “similar to others that we had done at the academy, in the sense that the questions were about familiar concepts that we had already worked on and that have appeared two or more times in previous calls [the so-called repeMIR in the jargon of the academy]”. Yes, it was longer than previous exams, although he acknowledges that he was able to finish on time because at MIR Asturias they train with tests of 225 questions and 4 hours long, compared to the 210 questions and 4 and a half hours of the official exam.

Regarding his future, he points out that he is still hesitating between two specialties that he liked since college, and in which he had the opportunity to rotate for an additional month during sixth year.. Regarding Dermatology, he highlights that “even though it is a medical-surgical surgery, the surgeries are not very complex and I like that it has something more manual, like biopsies, even though it scares me because I am a little clumsy, but I have been told that those things They train and I don't worry about that.”.

From Endocrinology he explains that the part of Clinical Nutrition catches his attention. Furthermore, he highlights both are specialties that “personally interest me and in the long term they can offer me a good quality of life.”

Drugs to treat erectile dysfunction, including Viagra, may be associated with a lower risk of Alzheimer's disease, a study of nearly 270,000 men with the disorder revealed.. The study, published by Neurology, does not prove that these drugs reduce the probability of Alzheimer's, it only indicates an observed association, as its authors make clear.

Although the association ends in nothing, the mere possibility that there are already drugs with potential benefit for Alzheimer's disease is an “encouraging result and justifies more research,” says the author of the work Ruth Brauer, from University College London, in the United Kingdom. , who highlights that “we desperately need treatments that can prevent or delay the development of Alzheimer's disease.”

If the suggested association is finally demonstrated, phosphodiesterase type 5 inhibitors, drugs that constitute a pillar in the treatment of erectile dysfunction, could also be used in the neurodegenerative disease. These medications work by dilating blood vessels to allow more blood to flow.

It would not be the first therapeutic repositioning of these drugs: sildenafil, the active ingredient in Viagra, was originally developed for pulmonary arterial hypertension and angina pectoris.. The notable side effect detected in the patients who received it marked the new direction of this pill, which we all already know.

However, before reaching that point, as Ruth Brauer points out, “more research is needed to confirm these findings, learn more about the possible benefits and mechanisms of these medications, and analyze the optimal dosage.”. Therefore, it justifies conducting “a randomized controlled trial with male and female participants to determine whether these findings would also apply to women.”

WHAT IS THE IMPACT OF THE USE OF DRUGS ON THE DEVELOPMENT OF ALZHEIMER'S?

The association between these drugs and a lower risk of Alzheimer's was seen by reviewing the medical records of 269,725 male participants with a mean age of 59 years who had recently been diagnosed with erectile dysfunction; The men did not have any memory or cognition problems at the beginning of the study. They were followed for an average of five years, in which 55% of participants who were prescribed ED medications were compared to 45% who had no prescriptions.. During the study, 1,119 people developed Alzheimer's disease.

Among participants who took the drugs, 749 developed the disease, corresponding to a rate of 8.1 cases per 10,000 person-years (person-years represent both the number of people in the study and the amount of time that each person is followed in the study). Among those who did not take the medications, 370 were diagnosed with Alzheimer's, corresponding to a rate of 9.7 cases per 10,000 person-years.

The research adjusted for other factors that could affect the rate of Alzheimer's disease, such as age, smoking and alcohol consumption.. They found that people who took erectile dysfunction medications were 18% less likely to develop Alzheimer's than people who did not.

The association was stronger in those who wrote more prescriptions during the study period. One of the limitations of the work is that it is based on prescription records, but the researchers are not certain about the participants' use of those prescriptions, a fact highlighted by Ivan Koychev, principal clinical investigator of the UK Dementia Platform, from the University of Oxford: “The study is limited by the challenge of establishing causal relationships in epidemiological studies. “In addition, these types of drugs are often taken as needed, so it is difficult to know how much was actually taken and how often.”

The researcher, however, points out to SMC of the United Kingdom that the reduction in the risk of Alzheimer's is greater as there are more prescriptions, and also “in people with risk factors for heart disease (high blood pressure, diabetes), which suggests “that the effect may be due to neuroprotection through vascular mechanisms.”

The evaluations of other experts collected by SMC of the United Kingdom also indicate that although there is no conclusive evidence that relates the drugs to a lower risk of Alzheimer's, the results do support more research.. “These types of drugs are worth continuing to study in the future,” says Tara Spiers-Jones, president of the British Neuroscience Association and professor at the UK Dementia Research Institute at the University of Edinburgh.

WHAT IS THE ROLE OF NITRIC OXIDE?

Another of these experts, Francesco Tamagnini, a neurophysiologist at the School of Pharmacy at the University of Reading, introduces nitric oxide into the hypothesis, whose role “in the consolidation, encoding and retrieval of memory has been known for some years.”

“Nitric oxide intervenes both peripherally in erectile function (by mediating vasodilation) and centrally in cognition, by modulating neuronal function. For example, it has been observed that nitric oxide-dependent transmission is necessary for perirhinal cortex-dependent visual recognition memory,” as shown in some of their published research.

“Theoretically, it is possible that promoting nitrergic transmission could improve memory function, but the question remains whether the observed association is describing a direct effect.”. This is a great study, but more strong evidence is needed to prove a mechanism of action. “It could be that it exerts a therapeutic effect by directly affecting neurons (if the drug is able to cross the blood-brain barrier) and/or by increasing blood flow, but both hypotheses must be tested.”

Cars have “gained” an average of 250 kilos in the last three decades. And they continue to grow length, height and width, at a rate of one centimeter every two years, according to a recent study by Transport & Environment (T&E).. SUVs, a motorized version of the American “Super Size Me”, have set out to conquer European cities precisely in the era of sustainable mobility.

Paris has rebelled against the trend and has decided to lead “the fight against self-obesity”, in the words of the environmental councilor Frédéric Badina-Serpette, who has criticized “the inexorable increase in the weight and size of the vehicles that circulate on the cities”.

Parisians have voted in favor of tripling the parking fees for these cars that weigh more than 2,500 kilos in their most cumbersome versions, which are considered the second cause of the increase in CO2 emissions in the last decade and which pose serious problems of occupation of public space and road safety.

The controversial measure was approved on February 4 in a referendum that had a low turnout (5%) and was very tight, with the support of 54.55% of the votes.. But the idea went ahead, promoted by the mayor of the capital Anne Hidalgo, as part of a series of initiatives to reduce traffic and make a city “more livable.”. Last year, after another popular consultation, electric scooters were eliminated in Paris.

18 euros per hour of parking

Starting in September, visitors entering the city with a car weighing more than 1.6 tons (two tons in the case of electric ones) will have to pay 18 euros per hour to park in Paris and 12 euros if they do so in Paris. the peripheral districts. According to the city council, this supplementary pricing will affect 10% of vehicles and will provide around 35 million euros of extra income for municipal coffers.

The Parisian example will be followed by the Lyon city council, led by Grégory Doucet, a prominent member of Europe Ecology. Starting in June, the third largest French city introduces new tariff sections (something like “parking by weight”) in order to “better share public space.”

The mayor of London, Sadiq Khan, in the midst of a crusade against pollution in the British capital, has warned that he will verify the “effectiveness” of the Paris measure and would be willing to copy it if it works. “SUVs take up a lot of space, they also generate road safety and emissions problems,” acknowledged Khan, who however lacks the powers to implement a similar measure throughout the city.

Khan has, however, referred to the steps in that direction that districts such as Westminster are taking, which have decided to review street parking rates based on vehicle emissions.. “SUVs should have no place in our cities and it is very sensible to take a toll for having these “monsters” stored on our streets,” declared Caroline Russell, representative of the Green Party in the London Assembly.

The situation in Spain

In Spain, sales of SUVs surpassed those of conventional cars for the first time in 2020 and today they occupy 60% of the market. Given the ubiquity in the cities of the heirs of all-terrain vehicles and 4x4s, in 2021 the General Directorate of Traffic sent the city councils an update on the width, height and length of the vehicles, so that they could establish rates. parking in restricted areas based on the space they occupy (and not just the label on the windshield).

No Spanish city has so far taken a step comparable to that of Paris. In some cities, such as Madrid, different rates are applied depending on the level of pollution, which can increase up to 100%, but the increase in rates does not take into account the size of the vehicles.

According to a recent study by the Walking Cities Network, 68% of public space on our streets is occupied by cars, compared to 32% for pedestrians.. “The trend is to recommend that the right to park in a public space be progressively avoided,” warns Ana Montalbán, technical secretary of the network that already brings together more than 80 cities.

From his point of view, “motorized mobility and sustainability run in opposite directions.. Cities have undertaken a detoxification process, and this trend collides with the development of increasingly voluminous cars due to market logic, of creating new needs based on a supposed version of comfort,” emphasizes Ana Montalbán.

“People are driving almost “armored” in these vehicles designed more for work in the countryside or risky sports than for urban mobility,” says the architect and urban planner.. “Their vision creates an impression of power and feelings of threat to people walking or cycling.”

The NGO WWF considers that SUVs are “an aberration” for global warming, as they are heavier and more voluminous than a normal car.. Greenpeace warns that the SUV boom is serving to neutralize all the progress on climate change by car manufacturers that had opted for electrification.

“The shift towards heavier and less efficient vehicles is behind the increase in oil consumption and emissions,” warned the International Energy Agency in a devastating report in 2023. If the more than 330 million SUVs in circulation were a country, they would rank sixth in the world for emissions close to 1,000 million tons of CO2 in a year.

The latest wave of climate activism is precisely the group Tire Extinguishers, spread across a dozen European countries and Canada. The “Tire Extinguishers” have already acted in some Spanish cities, with radical actions to “deflate” SUVs, in protest of their environmental impact and the space they occupy on the streets.

It was a tactile resurrection. «When one of the researchers placed the sensor on his own body, I was able to feel the heat of another person again with my phantom hand, it was a very strong emotion, like reactivating a connection with someone». It is told by Fabrizio, a 57-year-old resident of Pistoya (Italy), with an amputated hand.

Thanks to a sensorized prosthesis, Fabrizio has once again felt his lost touch, a bionic touch, with which he was able to manually discriminate and classify objects at different temperatures and different materials with his eyes covered.. But also to feel the bodily contact of other humans again.

This is the first time in history that scientists have managed to incorporate natural temperature sensations into an artificial limb.. A technology designed by the Sant'Anna School of Advanced Studies in Pisa (Italy) and the École Polytechnique Fédérale de Lausanne (EPFL), in Switzerland, whose scientific results have just been published by the journal Med (Cell Press).

«Temperature is one of the last frontiers to return the sense of touch to robotic hands. And for the first time we are very close to returning the full palette of sensations to amputees,” says Professor Silvestro Micera, from the Sant'Anna School of Advanced Studies and EPFL, and co-lead author of the study.

Sensory feedback is one of the most important steps in allowing people with an amputation to interact with their environment. Building on previous findings about phantom thermal sensations, researchers have developed a device they have named MiniTouch, which allows amputees to perceive temperature, transmitting thermal information from the fingertip of the prosthetic hand to the amputee's residual arm.

And the most curious thing is that the device uses electronic components available to anyone on the market, and that its installation does not require surgery.. “This is a very simple idea that can be easily integrated into commercial prostheses,” adds Silvestro Micera.

“By adding information about temperature, touch is more similar to that of a human,” says Dr.. Solaiman Shokur, from the École Polytechnique Fédérale de Lausanne. “Having the ability to feel it will enhance the amputees' embodiment: the feeling that this hand is truly mine.”

Until now, thermal sensations have been ignored in neuroprosthetics research, although there is increasing evidence of their importance for everyday life. “We believe that amputees could recover temperature sensations that go far beyond the detection of hot or cold objects,” says Jonathan Muheim, researcher and doctoral student at EPFL.

The test phase was carried out at the Inail Prosthetic Center in Vigorso di Budrio (Bologna) with the collaboration of Dr. Emanuele Gruppioni (INAIL) and his team. The device was simply integrated into the patient's prosthesis, and fixed to a point on the stump itself, producing thermal sensations in the person's phantom index finger.

Using the MiniTouch, Fabrizio was able to discriminate between three visually indistinguishable bottles containing cold water, two of them, and hot, a third, with an accuracy of 100%, whereas, without the device, his accuracy was only 33%.. The MiniTouch device also improved its ability to accurately and quickly sort metal cubes of different temperatures.. “It's true that you need a certain level of dexterity with robotic hands to reach their full potential,” says Solaiman Shokur.

The device also improved Fabrizio's ability to distinguish between human arms and prosthetics blindfolded: from 60% without the device to 80% with the device.. Several amputees who participated in the initial trials confessed that the ability to rediscover bodily contact with another person was undoubtedly the most important benefit of the system.

“Our goal now is to develop a multimodal system that integrates sensations of touch, perception and temperature,” says Shokur.. “So people can tell you, 'this is soft and hot,' or 'this is hard and cold.'”. A technology that is already being tested in the laboratory. The team has been working since 2014 to add benefits to the prostheses.

The next step will be to prepare the device for home use, and integrate thermal information from multiple points of the phantom limb to allow people to differentiate thermal and tactile sensations in the index finger and thumb to help them grip a hot drink; while with the sensor on the back of the hand they could feel when another person touches their hand.