Implementación de la reforma curricular de la Escuela de Medicina de la Pontificia Universidad Católica de Chile: analizando la experiencia / Implementation of curricular changes at a medical school

The accelerated scientific, technological, and social advances in recent years have posed new challenges for professional training institutions, where universities play a leading role. Medical schools have not been oblivious to this process. This is how Pontificia Universidad Católica de Chile implemented in 2015 a curricular reform derived from the joint work of academics, students and graduates. For this purpose, a model consisting of stages was followed, including the identification of the problem, general assessment of needs, definition of purpose and learning objectives. We worked with surveys, focus groups and committees of academics and students to identify and map content within the mesh, review terminal learning objectives while creating and reviewing courses for the vertically and horizontally integrated delivery of content and competencies. The first cohort of the new curriculum entered in 2015, consisting of 126 students. The implementation required constant follow-up and monitoring, establishing changes and adjustments according to educational needs and unforeseen conditions such as the COVID-19 pandemic. The implementation process of the new curriculum has been positive, adjusting to the defined strategic planning and responding to unexpected events.

Protocolo de resonancia magnética de manos en diagnóstico precoz de artritis reumatoide: ¿por qué? ¿cómo? ¿para qué?

Conventional radiography of hands has been the imaging technique used for the early diagnosis of rheumatoid arthritis, considering its easy access and ability to reveal structural damage. However, it does not provide information about inflammatory activity or prognosis of this disease. On the other hand, magnetic resonance imaging is becoming the technique of choice for the early diagnosis of this disease and for the assessment of treatment response. It has a better sensitivity for the detection of inflammatory findings that cannot be identified with physical examination, analytical and conventional imaging techniques. This article reports the imaging protocol for magnetic resonance of the hands used at our institution for the diagnosis and follow-up of patients with rheumatoid arthritis. We also review the main imaging findings of the disease.

Contribution of dendritic cell/T cell interactions to triggering and maintaining autoimmunity

Under healthy conditions, there is a balance between tolerance to self-tissue constituents and immunity against foreign antigens. Autoimmunity diseases (AD) take place when that equilibrium is disrupted and the immune response is directed to self-antigens, leading to injury or destruction of host tissues. The mechanisms conducing to the loss of immune tolerance remain largely unknown. The recent appearance of biological therapies has contributed to significant reduction in morbidity. However, currently available therapies are associated with important side effects and work only as palliative treatments. Dendritic cells (DCs) have emerged as key players in developing and maintaining adaptive immunity due to their capacity to prime and modulate T cell function. Therefore, because DCs work as central modulators of immune tolerance, it is likely that alterations in their function can lead to the onset of autoimmune-inflammatory diseases. By modulating DC function, novel pathways in antigen-specific tolerance could be established. In this article, the possible contribution of altered DC-T cell interactions to the onset of autoimmunity are discussed. In addition, we expand on the notion that some of the functions of these cells could be relevant targets for intervening therapies aimed to restore the balance or even prevent the loss of tolerance.

Multiple imputation procedures allow the rescue of missing data: An application to determine serum tumor necrosis factor (TNF) concentration values during the treatment of rheumatoid arthritis patients with anti-TNF therapy

Longitudinal studies aimed at evaluating patients clinical response to specific therapeutic treatments are frequently summarized in incomplete datasets due to missing data. Multivariate statistical procedures use only complete cases, deleting any case with missing data. MI and MIANALYZE procedures of the SAS software perform multiple imputations based on the Markov Chain Monte Carlo method to replace each missing value with a plausible value and to evaluate the efficiency of such missing data treatment. The objective of this work was to compare the evaluation of differences in the increase of serum TNF concentrations depending on the ¡308 TNF promoter genotype of rheumatoid arthritis (RA) patients receiving anti-TNF therapy with and without multiple imputations of missing data based on mixed models for repeated measures. Our results indicate that the relative efficiency of our multiple imputation model is greater than 98 percent and that the related inference was significant (p-value < 0.001). We established that under both approaches serum TNF levels in RA patients bearing the G/A ¡308 TNF promoter genotype displayed a significantly (p-value < 0.0001) increased ability to produce TNF over time than the G/G patient group, as they received successively doses of anti-TNF therapy.

Arteritis de celulas gigantes: clásicos y novedades que vale la pena recordar / Giant cells arteritis: classics and innovations for remember

La Arteritis de Células Gigantes (ACG) es una vasculitis frecuente que ocurre en personas mayores y que afecta principalmente vasos craneanos. Generalmente se acompaña de síntomas sistémicos, claudicación mandibular y alteraciones visuales. La Polimialgia Reumática (PMR) se caracteriza por dolor y rigidez de cintura escapular y pelviana que presenta síntomas constitucionales y reacciones sistémicas. En los últimos años, ha aparecido evidencia que relaciona ambas entidades como componentes de una misma enfermedad. En este artículo se revisan aspectos nuevos en diagnóstico, terapia y etiopatogenia de la ACG y sus relaciones con PMR.

The Giant cell arteritis (GCA) is a common vasculitic syndrome occurring in older persons and it preferentially affects cranial arteries. Generally accompanied by constitutional symptoms and typical findings like jaw claudication and vision disorder.Polymyalgia Rheumatica (PMR) is caracterized by pain and stiffness involving shoulder and pelvic girdless with constitutional symptoms and findings of a systemic reaction. In recents years, evidence linking both conditions as components of asingle disease process has been accumulated. In the present article, we review new aspects of the diagnosis, therapy and pathogenesis of the GCA, and their relationship.

Infecciones intrahospitalarias: resistencia antibiótica / Intrahospital infections: antibiotic resistance

Los mecanismos moleculares de resistencia antibiótica en bacilos gram negativos (BGN) asociados a IIH han sido poco explorados en nuestro país. Esta publicación presenta resultados preliminares de un trabajoconjunto destinado a identificar fenotípica y genéticamente mecanismos de resistencia prevalentes ante antibióticos beta lactámicos en un conjunto de aislamientos de Pseudomonas aeruginosa y de Klebsiella pneumoniae. El estudio mediante determinación de concentraciones inhibitorias mínimas, construcción de perfiles de resistencia y comparación contra perfiles conocidos de resistencia asociados a beta lactamasas específicas, identificó para P. aeruginosa diferentes niveles de producción de AmpC, una beta lactamasa cromosomal, como el mecanismo más probable de multiresistencia observado. En contraste, la multiresistencia ante beta lactámicos en K. pneumoniae parece ser explicada por la presencia casi ubicua de beta lactamasas de espectro extendido en estos aislamientos, la mayor parte de ellas del tipo SHV. Estudios complementarios en una muestra de aislamientos de K. pneumoniae demostraron la presencia de integrones, aunque el tamaño de los cassettes genéticos insertados (1 Kb) no sugiere la inserción de un número importante de genes en su interior