Exercise modulates the expression of IL-1ß and IL-10 in the articular cartilage of normal and osteoarthritis-induced rats.

After a joint lesion, high-impact exercise is a risk factor for the development of osteoarthritis (OA). The degradation of articular cartilage in OA has been associated with the activation of inflammatory cytokine signaling pathways. However, differences in cytokine expression in healthy and injured cartilage after exercise have not yet been analyzed. We used immunofluorescence and Western blot to study the expression of IL-1ß and IL-10 in the articular cartilage of normal (N), sham-operated (S), and menisectomized (OA) rats subjected or not to high-impact exercise (E) for 3, 6, and 10 days (N, NE, S, SE, and OA groups). Cartilage integrity and proteoglycan content were only affected in the OA groups. Exercise increased the amount of IL-1ß and IL-10 positive chondrocytes in NE and SE groups compared with non-exercised groups (N and S). The expression of IL-1ß was up-regulated over time in the NE and OA groups, although in the late stages the increase was higher in the OA groups. In contrast, the expression of anti-inflammatory IL-10 was low in the OA group, whereas in the NE groups expression levels were higher at each time point analyzed. These results suggest that anti- and pro-inflammatory molecules in the cartilage might be tightly regulated to maintain the integrity of the tissue and that when this equilibrium is broken (when the meniscus is removed), the pro-inflammatory cytokines take over and OA develops.

[Correlations between the dimensions of clinical learning environments from the perspective of medical residents]. / Correlaciones entre las dimensiones de los ambientes clínicos de aprendizaje desde la percepción de los médicos residentes.

OBJECTIVES: The aim of the present study was to establish correlations between the dimensions of clinical learning environments (ACA) considering variables like: health institutions, hospital offices, specialty, and year of residency. METHODS: 4,189 doctors were evaluated through an online survey in 2012. RESULTS: The results revealed that the dimension of "educational processes" correlated best with others; specialties with the best ACA from the view of the medical residents were Internal Medicine and Surgery; and the third year residents had less favorable perceptions of their ACA. CONCLUSIONS: The pursuance of the academic program is relevant to physicians in training and teachers play an important role in the educational process.

[Construction, validation and use of an instrument developed to assess learning clinical environments in medical specialties]. / Construcción y validación de un instrumento para evaluar ambientes clínicos de aprendizaje en las especialidades médicas.

INTRODUCTION: Clinical education is an essential component of medical training and takes place in relatively adequate learning environments. OBJECTIVE: Build and validate an instrument specific for the assessment of factors influencing a clinical learning environment. MATERIAL AND METHODS: A Likert-type questionnaire was designed and its content was validated, while statistical trials were applied to it to determine its psychometric properties. The instrument was refined and assessed twice (a pilot of 122 cases on October 2011 and the study of 4,189 PUEM residents on March 2012). It consists of 28 items, distributed in four dimensions: interpersonal relations (IR), teaching processes (TP), institutional culture (IC), and service dynamics (SD). RESULTS: Cronbach's α of the whole pilot questionnaire after item refinement and 4,189 case study was 0.94 and 0.96, respectively. The percentage of total variance explained by the first component was 48 and 46%, respectively. CONCLUSIONS: The reliability and validity of the whole questionnaire and by dimension was adjusted to assess clinical learning environments in Mexican contexts and allows ranking specialized medical departments.

Las actividades docentes de los profesores clínicos del PUEM desde la perspectiva de sus residentes / PUEM's clinical professors' teaching activities from their residents' perspective

Introducción: Se busca describir las actividades docentes en el ámbito clínico desde la perspectiva de los residentes del PUEM. Objetivos: 1) Identificar la frecuencia con que los profesores clínicos realizan actividades educativas en 4 áreas: docencia, supervisión, organización y relaciones interpersonales, 2) distinguir por especialidad el desempeño de los instructores, 3) indagar diferencias en la evaluación del docente según el grado académico de los residentes. Material y métodos: La "Encuesta de Alumnos del PUEM 2010" incluyó en la sección del desempeño docente 13 preguntas de frecuencia y 2 de valoración. Se consideraron actividades educativas de las 4 áreas mencionadas en 10 especialidades. La muestra fue de 1816 casos y se buscaron asociaciones significativas (p < 0.05) entre las variables. Resultados: En las opciones de respuesta "siempre" y "casi siempre", las relaciones interpersonales fueron las mejor valoradas (> 80%), la organización continua de actividades académicas y asistenciales fue mencionada en más de 2 terceras partes de las respuestas. La frecuencia de actividades docentes vinculadas a la estructura curricular, y la supervisión se ubicaron en promedio por debajo de la media. Las mejores calificaciones fueron para los profesores de Medicina Familiar y las más bajas para Ortopedia. Por grado académico, R1 y R5 consideraron que la labor docente fue más constante y los R2 menos. Discusión: La relación personal entre profesores y residentes es adecuada y los estudiantes se perciben integrados a sus servicios; no obstante, el apego a los programas académicos y la supervisión no sucede con suficiente frecuencia.

Introduction: The aim is to describe the teaching activities in the clinical context from the residents' perspective. Objectives: 1) To determine how frequently clinical professors perform teaching activities in the four areas: teaching, supervision, organization and interpersonal relationships, 2) to distinguish professors' performance by specialty 3) To inquire differences in the evaluation of professors according the residents' academic year. Materials and methods: The "Survey among PUEM's Students 2010" included 13 frequency questions and 2 of valuation in the section of teaching performance. Teaching activities from the four previously mentioned areas in ten specialties were considered. The sample was 1816 cases; significant associations (p <0.05) among variables were assessed. Results: In the answer choices: "always" and "almost always", interpersonal relationships obtained the highest score (>80%), the regular organization of academic and healthcare activities was mentioned in more than 2/3 of the answers. The frequency of teaching activities related to the curricular structure, and supervision were situated below average. The highest scores were for family medicine professors and the lowest for orthopedia. By academic grade, first and fifth year residents considered that teaching activities were more constant; while second year students considered them the least constant. Discussion: Personal relationships between clinical professors and residents are adequate. Students perceive themselves integrated to their wards; however the fulfillment of academic programs and supervision are not frequent enough.

[Pedagogic implementation in medical education.]

The purpose of this study was to provide elements to consider the use and relevance of pedagogic instruments and strategies in medical education with a constructivist approach.Any teaching process should be supported by a plan, having a theoretical approach such as the curriculum, as well as teaching-learning strategies, pedagogic resources and evaluation instruments relevant to each learning process. In order to select a teaching-learning strategy, a professor should consider the following: learning objectives and goals, students' learning styles and available didactic resources. Evaluation should be appropriate to teaching principles and practices. Professors should keep in mind the availability of valid and reliable evaluation instruments that assess students' gained knowledge through authentic, real-life situations. Finally, because competences are a set of multidimensional and interrelated attributes (knowledge, clinical skills, techniques, attitudes), their appropriate evaluation is a challenge that will require several types of instruments.

Retinopatía secundaria a la administración de cloroquina en pacientes con enfermedades reumáticas autoinmunes / Choroquine retinopathy in patients with autoimmune rheumatic disease

Introducción. El presente trabajo es un reporte de cuatro pacientes con enfermedad reumática autoinmune que presentaron retinopatía secundaria al uso de cloroquina. Casos clínicos. Dos pacientes con artritis reumatoide juvenil desarrollaron esta compliación tardíamente, es decir después de 14 y 20 meses de tratamiento. En constraste, dos pacientes con lupus eritomatoso sistémico la desarrollaron a los tres y seis meses. Conclusiones. Ambos pacientes con lupus inciaron el cuadro clínico con manifestaciones a nivel de sistema nervioso central lo que pudiera ser un factor predisponente para el desarrollo de retinopatía secundaria al uso de cloroquina