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Rev. méd. Chile ; 147(6): 790-798, jun. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1020728


Background: A portfolio is a compilation of academic work that demonstrates student's knowledge, reflection and critical thinking. Aim: To describe the development and implementation of an undergraduate portfolio in the School of Medicine at the Pontificia Universidad Católica de Chile, its temporal evolution and its educational impact after 10 years of experience. Material and Methods: The development and implementation of a portfolio for 4th-year undergraduate medical student was analyzed. Its design, teaching and learning methodologies, results and perceptions of students and teachers were assessed. The educational impact was measured using Kirkpatrick's levels. Results: A total of 1,320 students participated between 2007 and 2017, supported by six teachers and 190 assistant-students. The portfolio included clinical cases, narrative medicine, palliative care and evidence-based medicine (EBM). The overall student's perception was positive, highlighting the development of critical analysis, clinical reasoning and professionalism. The delivery of feedback and learning assessment, allowed students to obtain excellent grades. There were only two cases of plagiarism reported. Fifteen EBM articles and two books with 52 narrative medicine essays were published. The greatest organizational impact of this teaching innovation, was that it evolved to become an established and continuous assessment instrument in 10 consecutive years. Conclusions: This portfolio is a project with a high educational impact, with a favorable perception by students and tutors, excellent results related to grades, stimulating both scientific writing and reflective practice.

Humans , Education, Medical, Undergraduate/methods , Educational Measurement/methods , Students, Medical , Time Factors , Chile , Surveys and Questionnaires , Learning
Rev. chil. ortop. traumatol ; 56(3): 45-51, sept.-dic.2015. ilus, tab
Article in Spanish | LILACS | ID: lil-795842


La artrosis de rodilla (OA) es uno de los principales problemas de salud a nivel mundial debido a su alta prevalencia y costos asociados. Los conocimientos disponibles demuestran que el componente inflamatorio es fundamental en el desarrollo de esta condición, abandonándose el concepto de que la OA es una enfermedad puramente degenerativa. En el presente escrito revisaremos, basándonos en la literatura disponible, la epidemiología y los factores de riesgo involucrados, los nuevos conocimientos fisiopatológicos, el enfrentamiento clínico y los tratamientos disponibles tanto médicos como quirúrgicos de esta condición...

Knee osteoarthritis (OA) is one of the major public health problems worldwide, due to its high prevalence and associated costs. The available knowledge shows that the inflammatory component is critical in the development of this condition, abandoning the concept that OA is only a degenerative disease. A review is presented in this article, based on the available literature, on the epidemiology and risk factors involved, recent knowledge about the pathophysiological and clinical management, and the medical and surgical treatments available for this condition...

Humans , Osteoarthritis, Knee/diagnosis , Osteoarthritis, Knee/therapy , Osteoarthritis, Knee/classification , Osteoarthritis, Knee/epidemiology , Osteoarthritis, Knee/physiopathology , Risk Factors
Rev. méd. Chile ; 143(9): 1097-1104, set. 2015. ilus, tab
Article in Spanish | LILACS | ID: lil-762679


Background: Plasma high density lipoproteins (HDL) are involved in reverse cholesterol transport mediated by the scavenger receptor class B type I (SR-BI). Nicotinic acid increases HDL cholesterol levels, even though its specific impact on SR-BI dependent-cellular cholesterol transport remains unknown. Aim: To determine the effect of nicotinic acid on HDL particle functionality in cholesterol efflux and uptake mediated by SR-BI in cultured cells in hypoalphalipoproteinemic patients. Material and Methods: In a pilot study, eight patients with low HDL (≤ 40 mg/dL) were treated with extended release nicotinic acid. HDL cholesterol and phospholipid levels, HDL2 and HDL3 fractions and HDL particle sizes were measured at baseline and post-therapy. Before and after nicotinic acid treatment, HDL particles were used for cholesterol transport studies in cells transfected with SR-BI. Results: Nicotinic acid treatment raised total HDL cholesterol and phospholipids, HDL2 levels as well as HDL particle size. Nicotinic acid significantly increased HDL cholesterol efflux and uptake capacity mediated by SR-BI in cultured cells. Conclusions: Nicotinic acid therapy increases SR-BI-dependent HDL cholesterol transport in cultured cells, establishing a new cellular mechanism by which this lipid-lowering drug appears to modulate HDL metabolism in patients with hypoalphalipoproteinemia.

Aged , Female , Humans , Male , Middle Aged , Cholesterol, HDL/metabolism , Hypoalphalipoproteinemias/metabolism , Hypolipidemic Agents/pharmacology , Lipoproteins, HDL/metabolism , Niacin/pharmacology , Biological Transport , Cholesterol, HDL/drug effects , Pilot Projects , Phospholipids/blood , Scavenger Receptors, Class B/metabolism
Rev. méd. Chile ; 143(2): 175-182, feb. 2015. tab
Article in Spanish | LILACS | ID: lil-742568


Background: In 2007, a Clinical-Case-Portfolio (CCP) was introduced as a new assessment instrument for fourth grade undergraduate medical students. Since then, several changes have been implemented such as reduction on the number of clinical cases, peer review and the introduction of virtual patient to the portfolio. Aim: To describe the virtual patient model incorporated to the CCP and assess the perception of this change and its effects on the performance of undergraduate students. Material and Methods: Virtual patients were implemented based on prototype clinical cases with specific syndromes. Students’ perceptions about CCP before and after the introduction of virtual patients were evaluated using a validated questionnaire that was answered voluntarily and anonymously. Results: Overall perception of CCP significantly improved after the incorporation of virtual patients (97.1 ± 24.9 and 111.3 ± 25.7 points; 57.8 and 66.2% respectively). The same improvements were observed for the domains “Student Learning”, “Organization and Evaluation”, “Teaching Methodology” and “Integration”. In both years, students obtained high grades in CCP evaluations. However CCP grades were not significantly correlated with integrated final grades. Conclusions: The incorporation of virtual patients improved undergraduate students’ perception of CCP.

Animals , Mice , Apoptosis , Axin Protein/metabolism , Enzyme Activation , Poly(ADP-ribose) Polymerases/metabolism , Protein Serine-Threonine Kinases/antagonists & inhibitors , Aurora Kinases , Adenosine Triphosphate/metabolism , Apoptosis Inducing Factor/genetics , Apoptosis Inducing Factor/metabolism , Cell Line , Cell Membrane/metabolism , Cell Membrane/physiology , Mitochondria/metabolism , Protein Kinase Inhibitors/pharmacology , RNA Interference , Time-Lapse Imaging
Rev. méd. Chile ; 142(9): 1193-1199, set. 2014. ilus, graf, tab
Article in Spanish | LILACS | ID: lil-730290


Background: Formative evaluation is a range of formal assessment employed by professors during the teaching process in order to modify curriculum activities, to improve student attainment. For students, it is helpful to evaluate their learning process. Although recommended, it is seldom used. Aim: To evaluate the perception and performance of medical students subjected to formative assessments during an integrative clinical course. Material and Methods: Fourth year medical students that participated in a multiple choice formative assessment, similar to the final exam during 2007 and 2008, responded a survey about the usefulness and quality of such assessment. Student achievement was expressed as the percentage of correct answers of the tests. Results: The formative assessment was answered by 99% of students. In 2007 97% of students considered the experience as excellent or very good and 92% evaluated it as useful or very useful. During 2008 the figures were 89% and 79%. The students outlined that this assessment oriented their study, allowed them to discover their weaknesses and have a perception of the degree of difficulty of the final exam. Over 90% of students that took the formative evaluation, improved their academic achievement. Conclusions: Formative assessments are well evaluated by medical students and improve their academic achievement.

Humans , Education, Medical, Undergraduate , Educational Measurement/methods , Students, Medical , Educational Measurement/statistics & numerical data , Surveys and Questionnaires
Univ. med ; 50(4): 444-451, oct.-dic. 2009. tab
Article in Spanish | LILACS | ID: lil-601551


La rapidez, eficacia y oportunidad del diagnóstico de influenza facilita el manejo de casos confirmados a nivel terapéutico más aun considerándose el estado actual del virus pandémico H1N1/2009. Objetivo: Analizar la concordancia de cuatro pruebas rápidas para la detección de Influenza A en Bogotá. Métodos: En este estudio descriptivo de corte transversal fueron comparadas cuatro pruebas rápidas para la detección de Influenza A (Quick Vue Influenza A+B; Directigen Ez Flu A+B®; SD Bioline Influenza Antigen® y Clearview Exact Influenza A and B®) en un grupo de 57 hisopados nasofaríngeos de pacientes sospechosos del virus pandémico H1N1/2009, los cuales fueron analizados previamente por PCR en tiempo real y clasificados como positivos o negativos para Influenza A. Resultados: El comportamiento de las pruebas rápidas valorado por su concordancia global con la prueba de referencia fluctuó entre 68,19% y 74,47%, sin evidencias de diferencias estadísticamente significativa entre ellas (c2=0,35; p=0,95). Tampoco se encontró un comportamiento diferencial estadísticamente significativo al valorar la proporción de concordancia entre los positivos de cada una de las pruebas rápidas con la prueba de referencia. Conclusión: Existen varios trabajos a favor y en contra de las pruebas rápidas para influenza, y algunos destacan su baja sensibilidad y especificidad comparadas con otras metodologías, como inmunofluorescencia directa, cultivo viral y RT-PCR. Sin embargo,ante la emergencia que actualmente se vive por la pandemia viral H1N1/2009, diferentes estrategias de vigilancia en salud pública, incluidas los estudios centinela y de conglomerados, pudieran ser implementados y las pruebas rápidas influenza (sin importar la casa comercial) serían útiles por sus características operativas, bajo costo y la posibilidad de lograr mayores coberturas de identificación de casos nuevos, descongestión de servicio y ajuste rápido de medidas en salud pública.

Rapidity, effectiveness and opportunity of influenza diagnosis make easy confirmed cases handling at therapeutic level most of all considering actual state of pandemic virus A H1N1/2009. Objective: To analyze agreement of four quick tests for Influenza A detection of in Bogotá. Methods: In a cross sectional fashion it was compared four quick tests designed for influenza detection (Quick Vue Influenza A + B; Directigen Ez Flu A + B®; SD Bioline Influenza Antigen® and Clearview Exact Influenza A and B®) in 57 nasopharynxeal hyssoped examples of suspicious patients of pandemic A H1N1/2009 virus, all of them were previously analyzed by real-time PCR and classified as positive for that virus. Results: Behavior of fast tests valued by its global agreement against test of reference fluctuated between 68.19% and 74,47%, without significant statistical differences among them (p=0,95). Neither significant statistical differences were found upon valuing proportion of agreement among positives each one of fast tests with reference test. Conclusions: There are some works on behalf or against of influenza rapid tests, and some of them emphasizes their low sensibility and specificity against other techniques, like direct inmunofluorescence inmunofluorescence, viral culture and RT-PCR. Nevertheless, in order to face the actual viral AH1N1/2009 pandemic, different strategies of public health surviellance, (including sentinel and conglomerate studies), could be implemented. Influenze Rapid tests (making exclusion of trade mark) would be serviceable by their operative characteristics, low cost and high possibility of identify new cases and by that way, it would possible emergence services decongestion and fast adjustment of measures in Public Health.

Diagnosis/analysis , Epitopes/analysis
Rev. chil. cardiol ; 26(4): 437-443, 2007. ilus, tab
Article in Spanish | LILACS | ID: lil-499074


Introducción: El receptor scavenger clase B tipo I (SR-BI) es un elemento clave en el metabolismo de las HDL, donde su expresión ejerce un importante efecto anti-aterogénico controlando la fase hepática del transporte reverso de colesterol. Así, el estudio de la modulación de la expresión de SR-BI permitiría el desarrollo de nuevas alternativas farmacológicas para el tratamiento de la ateroesclerosis. Objetivo: La meta de nuestro estudio fue determinar el efecto de la triiodotironina (T3) y el glucagón sobre el metabolismo del colesterol HDL y la expresión hepática de SR-BI en el ratón, evaluando simultáneamente su impacto sobre el colesterol total y lipoproteico plasmático y la secreción biliar de colesterol. Métodos: Se utilizaron ratones C57BL/6 tratados con T3 (30 nmol/kg/día) o glucagón (80 µg/día) más los respectivos grupos controles. Después del tratamiento, los animales se anestesiaron para recolección de bilis, plasma y tejido hepático. Los niveles totales de colesterol plasmático y biliar fueron medidos por métodos enzimáticos. El colesterol lipoproteico plasmático se evaluó por fraccionamiento cromatográfico del plasma y medición enzimática del colesterol en cada fracción. La expresión hepática de SR-BI se cuantificó mediante western blot. Resultados: El uso de T3 o glucagón disminuyeron significativamente el colesterol plasmático total y aumentaron el colesterol biliar con respecto al grupo control correspondiente. Las fracciones de colesterol VLDL, LDL y HDL disminuyeron en ambos grupos tratados, con un mayor efecto observado en la fracción HDL. La administración de ambas hormonas aumentaron significativamente los niveles hepáticos de SR-BI. Conclusión: Los resultados establecen que T3 y glucagón disminuyen el colesterol plasmático, predominantemente de tipo HDL, y aumentan la secreción de colesterol biliar en el ratón, probablemente como consecuencia del incremento en la expresión hepática...

Introduction: The scavenger receptor class B type I (SR-BI) plays a key role in the metabolism of high-density lipoprotein (HDL) cholesterol. Its expression has an important anti-atherogenic effect by controlling the hepatic phase of the reverse cholesterol transport pathway in vivo. Thus, the study of the modulation of SR-BI expression may allow the development of new pharmacologic approaches for treatment of atherosclerotic cardiovascular disease. Objective: The goal of this study was to determine the effect of triiodothyronine (T3) and glucagon on HDL metabolism and hepatic expression of SR-BI in mice, evaluating also the impact in total and lipoprotein cholesterol as well as biliary cholesterol secretion. Methods: C57BL/6 mice were treated with T3 (30 nmol/kg/día) or glucagon (80 µg/día) in comparison to appropriate control groups. After treatment, bile, plasma and hepatic tissue were collected for analysis. Total plasma and biliary cholesterol levels were measured by enzymatic methods. Lipoprotein cholesterol was also measured enzymatically after chromatographic separation of plasma samples. The hepatic expression of SR-BI protein was quantified by western blotting. Results: The use of T3 or glucagon significantly decreased total plasma cholesterol levels and increased of biliary cholesterol concentrations compared to control groups. Levels of VLDL, LDL and HDL cholesterol were reduced in both treatment groups, with a more important effect observed in the HDL fraction. Both treatments increased hepatic SR-BI protein levels. Conclusions: These results show that T3 and glucagon decrease plasma cholesterol levels, particularly in HDL, and increase biliary cholesterol secretion in mice, probably as a consecuence of higher hepatic expression of SR-BI, which may have led to facilitated HDL cholesterol transport from plasma into bile.

Animals , Mice , Cholesterol, HDL/metabolism , Glucagon/pharmacology , Liver/metabolism , Scavenger Receptors, Class B , Triiodothyronine/pharmacology , Blotting, Western , Bile/chemistry , Cholesterol, HDL/analysis , Cholesterol/analysis , Fluorescent Antibody Technique , Glucagon/administration & dosage , Liver , Receptors, Lipoprotein , Triiodothyronine/administration & dosage