Descripción de los Procesos de Evaluación en la Escuela de Medicina de la Pontificia Universidad Católica de Chile: Experiencia de 10 años / Description of Assessment Processes at the Medical School of the Pontificia Universidad Católica de Chile: A Ten year experience

Globalization of health care seems to be irreversible and beyond cultural differences and local realities; consequently, medical education needs to have a common set of core principles or standards that may be applied worldwide. The aim of participating in assessment processes is to guarantee that medical education takes place in a sufficiently rich environment to promote extensive academic purposes. The Medical School of the Pontificia Universidad Católica de Chile (PUC) participated in three assessment processes that included three stages: internal assessment, external assessment, and accreditation judgment. Two of these assessments were voluntarily carried out following the standards set by the Liaison Committee on Medical Education-LCME, and they took place in 1997 and 2007. The other assessment was based on standards set by the Chilean accrediting organism, the National Committee for Undergraduate Program Accreditation (Comité Nacional de Acreditación de Pregrado-CNAP) and took place in the year 2001. In all three experiences, internal assessment was the most enriching stage, stimulating refections among students and teachers in order to recognize areas of strengths and weaknesses. External assessment processes, especially those based on international standards, are very important for the institutional and program development of Medical Schools. The PUC Medical School on its whole learnt how to carry out an assessment process and was able to improve several weaknesses without pressure, moving from quality assurance to quality enhancement. The present paper analyzes the major challenges involved in an external assessment process.

Médicos -Centíficos en Chile: ¿Una especie en extinción? / Physicians in biomedical research in Chile: A species under risk of extinction?

Several studies have reported a progressive reduction in the number of grant applications and research projects approved by medical doctors (MD) in the United States. The overall trend and current situation of MDs actively involved in biomedical research in Chile has not been defined. Thus, we analyzed the professional profile of the principal investigators (PI) that have led research grants approved by the Technology and Medical Sciences study groups of the Fondo Nacional de Desarrollo Científico y Tecnológico (FONDECYT), during the last 20 years. The results show that the projects led by MDs corresponded to 80percent in 1984, decreasing to 50percent in 2003, with further reduction projected for the next years. We think that the physician doing biomedical research represents a human resource indispensable to preserve a genuine academic environment within medical schools; thus, it is necessary to design and apply strategies to reverse this worrying trend of less MDs actively involved in research in Chile. Among these, we consider important to stimulate research activities at both the undergraduate and postgraduate levels of MD training particularly increasing the flexibility of the postgraduate fellowship programs. In addition, it is necessary to support both in terms of money and spare time those physicians who are beginning an academic career involved in biomedical research. Finally, we consider important that non-academic institutions (e.g., pharmaceutical companies, health medical organizations, and philanthropic foundations) should also support academic development and biomedical research in our medical schools.

Medicina en televisión: ¿un problema ético? / Medicine in television: an ethical problem?

Television programs where medical procedures are shown with progressive realism generate problems that physicians need to know and analyze. The authors analyze this issue, based on the respect to patient's dignity and the principles of bioethics. Medical programs on TV present specific problems to the different agents involved in them: TV media, physicians, health organization, public and patients or relatives that are exposed. Physicians have the responsibility to educate the society using the most efficient methods of public communication, including television. The problem is not how much can be shown but how to do it, making sure that the dignity of patients, the privacy of their stories and their own and their relative's feelings are always strictly cherished. The respect towards the patient is accomplished through a valid informed consent, the reverence to his face as an expression of his personhood, and the way in which his body is exposed. The authors conclude that TV programs on health and medical subjects are valuable methods to educate society and that physicians, in their function of social educators, should take part in them truly reassuring the respect to patient's dignity and to the bioethical principles of beneficence, autonomy and justice.

Utilidad del ecocardiograma y de marcadores séricos en la estratificación de riesgo en pacientes cursando con embolia pulmonar submasiva / Utility of echocardiogram and serum markers in the risk stratification in patients attending with submassive pulmonary embolism

Los pacientes que cursan tromboembolismo, dependiendo de su severidad, pueden recibir variados tratamientos no exentos de efectos adversos. Existe, por lo tanto, la necesidad de estratificar riesgo -magnitud- mortalidad con criterios que le permitan al clínico tomar las mejores decisiones. En este artículo se pretende establecer un sistema de aproximación al tromboembolismo pulmonar de acuerdo a la información hasta ahora disponible.

Inyección intramuscular de toxina botulínica con fines dermocosmiátricos / Intramuscular injection of botulin toxin for dermocosmetic use

La toxina botulínica producida por el Clostridium botulinum es un potente inhibidor neuromuscular local, altamente específico, que actúa mediante bloqueo de la liberación de acetilcolina en la placa neuromuscular, traduciéndose clínicamente en una parálisis fláccida del músculo tratado. El uso de la toxina botulínica se ha visto incrementado en los últimos años, tanto en clínica como en ciencias básicas, existiendo numerosos estudios que avalan su utilización con fines terapéuticos y de investigación. El propósito de esta revisión es analizar los usos e indicaciones actuales de la toxina botulínica, su aplicación en dermocosmiatría, las diversas técnicas empleadas, precauciones, contraindicaciones y eventuales complicaciones

Disminución del volumen plasmático y cambios en hormonas vasoactivas en embarazadas de bajo peso / Reduced plasma volume and changes in vasoactive hormones in underweight pregnant women

Background: Pregnant women with low weight/height (wt/ht) have lower plasma volume and reduced birth weight than women with normal wt/ht. Aim: To explore the hormonal mechanisms involved in these alterations. Patients and methods: Plasma volume, and several hormones related to plasma volume regulation were determined in 24 near term pregnant women with low wt/ht and in 30 with normal wt/ht. Results: Newborns's weight, height and ponderal index were reduced in the low wt/ht group. Plasma volume (3042 ñ 101 vs 3631 ñ 101 ml, p< 0.001); plasma renin activity (7.5 ñ 0.9 vs 11.1 ñ 0.9 ng/ml/h, p< 0.01) and aldosterone (428 ñ 47 vs 710 ñ 58 pg/ml, p< 0.001) were significantly reduced in the low wt/ht group. Similar reductions were observed in serum estradiol and progesterone levels. Urinary kallikrein activity (354 ñ 112 vs 824 ñ 134 nmoles/24 h, p< 0.05), 6-keto-prostaglandin F1a (561 ñ 90 vs 1121 ñ 165 ng/24 h, p< 0.05) and thromboxane B2 (110 ñ 29 vs 280 ñ 29 ng/24 h, p< 0.05) were also reduced in low wt/ht women. Conclusions: We postulate that the reduced levels of vasoactive hormones observed in pregnant women with low wt/ht may interfere with plasma volume expansion and, in turn, cause low birth weight

Problemas éticos en los proyectos de investigación biomédica, presentados al Comité de Etica de la Escuela de Medicina de la Pontificia Universidad Católica de Chile / Ethical problems of research proposals submitted to an ethics committee

All research proposals involving humans, submitted within a two years period to the ethics commitee of the School of Medicine of the Catholic University, were retrospectively reviewed. "Ethical problem" was defined as any explicit disagreement with the ethical principles and guidelines for the protection of human subjects involved in biomedical research, according to the Helsinki declaration. In 20 of 44 reviewed projects, an ethical problem was identified. The most commont problems were the absence or inadequacy of the informed consent, the justification of the use of placebo and problems related to the methodological aspects of the research, particularly the lack of an adequate control group when the potential benefits of a new drug were evaluated. According to the Nuremberg code, the Helsinki declaration and the International Principle of Ethics in Biomedical Research, we analyse ethical problems and suggest judgement elements for them

Síndrome hipertensivo del embarazo: estudio caso control de la incidencia y recurrencia / Hypertension syndrome in pregnancy: case-control study of the incidence and recurrence

En un estudio caso-control retrospectivo, analizamos la incidencia, resultado perinatal y riesgo de recurrencia del síndrome hipertensivo del embarazo (SHE) en un grupo de nulíparas que tuvieron su parto en el Hospital Clínico de la Universidad Católica durante los años 1988-1990. SHE se observó en 328/3127 (10.5 por ciento) de los partos. El 45 por ciento correspondió a hipertensión transitoria (HT), 49 por ciento tuvo preeciampsia (PE), 3.5 por ciento hipertensión crónica y 2.5 por ciento fueron hipertensas crónicas con PE sobreagregada. Los resultados perinatales de las madres con HT fueron semejantes a los observados en el grupo control, mientras que las con PE tuvieron un riesgo aumentado de parto prematuro, recién nacidos pequeños para la edad gestacional y con Apgar bajos. Hubo un 36 por ciento de recurrencia de SHE, comparado con un 2.2 por ciento de SHE observado en las mujeres que estuvieron normotensas en la primera gestación. El OR para PE fue de 16 [CI 1,9-363] si en el primer embarazo también hubo PE

Rol de la infección por el virus hepatitis C en algunas afecciones dermatológicas / Role of hepatitis C virus infection in some dermatological diseases

El objetivo de este artículo es poner al día el rol de la infección por el Virus Hepatitis C (VHC) en algunas afecciones dermatológicas; incluyendo algunas Vasculitis, Poliarteritis Nodosa, Porfiria Cutánea Tarda, Liquen Plano y en alteraciones de las glándulas salivales (Sialoadenitis Linfocítica). Además, se describen las características principales de la biología molecular, las vías de transmisión y el compromiso hepático producido por el Virus Hepatitis C

Superoxide dismutase from Trichuris ovis, inhibiton by benzimidazoles and pyrimidine derivatives

Three superoxide dismutase isoenzymes of different cellular location were detected in an homogenate of Thrichuris ovis. Each of these molecular forms was purified by differential centrifugation and precipitation with ammonium sulphate, followed by chromatography on DEAE-cellulose and Sephadex G-75 columns. The activity levels of the two molecular forms detected in the mitochondrial (one cyanide sensitive Cu-Zn-SOD and the other cyanide intensitive Mn-Sod were higher than that of the superoxide dismutase detected in the cytoplasmic fraction (cyanid sensitive Cu-Zn-SOD). All the mollecular forms present evident differences to the SODs contained in the host liver. Molecular mass and some of the physical and chemical aproperties of the enzyme was determined for all three molecular forms. An inhibitory effect on the SOD of the parasite an the host was detected with a series of compounds, some of wich markedly inhibited parasite ensyme but not host enzyme

Evaluacion local del programa de salud del nino y del adolescente. / Local evaluation of health programs for children and adolescents

Se evaluo el cumplimiento de tres objetivos especificos del Programa de Salud del Nino y del Adolescente a nivel local, en el consultorio M. Montt del Servicio de Salud Metropolitano Oriente. En una muestra al azar de la cohorte de recien nacidos que ingresaron a control al consultorio M. Montt en 1980, se estudio en 116 ninos lactancia materna, estado nutricional y cumplimiento del calendario de vacunaciones. Un 46% de los lactantes de 4 meses de edad recibe lactancia materna exclusiva y la meta fijada es de 70%.La prevalencia de desnutricion a los 6 meses es de 8,0% y a los 12 meses es de 7,7%, siendo un 1,7% desnutricion grado 2. La meta fijada es de menos de 2% para desnutricion grado dos y tres. El cumplimiento del calendario de vacunas, al ano de edad, fue de un 82,7% y la meta es de 90%. La evaluacion sistematica del cumplimiento de objectivos del Programa, permitira mejorar la eficiencia y eficacia de la atencion medica