La atorvastatina no modifica el incremento agudo de los niveles de p-selectina y fibrinógeno inducido con esfuerzo físico máximo / Atovastatin does not modify the acutely increased levels of P-selectin and fibrinogen induced by maximal physical exercise

Introducción: Las estatinas han demostrado disminuir los eventos cardiovasculares en sujetos con y sin enfermedad aterosclerótica establecida. Se ha demostrado, que sus efectos benéficos no sólo dependen de la reducción del colesterol, sino que también podrían ser secundarios a otros efectos de las estatinas, como su efectos de reducción de inflamación y/ o trombogénesis entre otros. Sin embargo, no existen trabajos que demuestren que las estatinas sean capaces de frenarla activación de la cascada de inflamación y/o trombogénesis. Objetivos: Determinar el efecto de la administración oral de atorvastatina por 7 días sobre los niveles plasmáticos de proteína C- reactiva ultrasensible (PCR us), fibrinógeno y P-selectina, pre y post prueba de esfuerzo máximo inmediato y a las 24 horas de su ejecución. Métodos: Ensayo clínico en 50 hombres sanos (18 a 50 años), randomizado atorvastatina 80 mg/día - placebo por 7 días, doble ciego. Muestras tomadas en sangre para PCRus, fibrinógeno y P-selectina, perfil lipídico, creatin kinasa y transaminasas hepáticas, pre y post test de esfuerzo, y a las 24 horas. Los resultados para datos continuos se expresan como medias +/- desviación estándar, test de student para muestras independientes, ANOVA para muestras repetidas. Programa estadístico SPSS 14.0. Resultados: Un grupo de 44 sujetos completaron el estudio: atorvastatina 80 mg (n=24) o placebo (n=20). En el grupo atorvastatina, después de una semana de tratamiento, los niveles de LDLc disminuyeron en 38 por ciento (LDL basal: 97 +/- 27 mg/dL vs LDL post: 62 +/- 31 mg/dL, p < 0.001). Sin embargo, no se observaron cambios en ese mismo período en los niveles de PCRus, fibrinógeno y P-selectina con respecto a placebo. Los niveles de fibrinógeno se elevaron 8 por ciento entre la etapa pre y post ejercicio inmediato (341 +/- 56 mg/dL vs 368 +/- 65 mg/dL, p<0.001), retornando a los niveles basales a las 24 horas; no hubo diferencias entre atorvastatina - placebo...

Background: Chronic statin therapy is known to decrease ínflammation and platelet aggregation. However, little data exist regarding acute effect of statins upon these variables. Exercise can be used to induce ínflammation and platelet aggregation. Aim: to determine the acute effect of atorvastatin upon plasma levels of ultra sensitive C reactive protein (US-PCR), fibrinogen and P selectin before, immediately after and 24 hr following a maximal exercise test in healthy subjects. Methods: This was a double blind, randomized prospective study Fifty healthy male subjects (aged 18to 50years) received atorvastatin 80 mg or placebo daily for 7 days. US-PCR, fibrinogen, P-selectin, blood lipids, total creatin-kinase (CK) and transaminases were determined pre and immediately after maximal treadmill exercise. Repeat determinations were performed 24 following the test. Results were analyzed using the SPSS statistical package, and are expressed as mean +/- SD. Student's t and repeated measures ANOVA were used as appropriate. Results: 44 subjects completed the study (atorvastatin =24; placebo= 20). LDL cholesterol decreased from 97 +/- 27 to 62 +/- 31 mg/dl in the atorvastatin group (p<0.001). US-PCR, After 1 week, Fibrinogen and P-selectin were not significantly modified from baseline, and no differences were observed between groups (atorvastatin vs. control). However, fibrinogen increased 8 percent from baseline to immediately post exercise (341 +/- 6 vs. 368 +/- 65mg/dl (95 percent CI. 21/.3 - 33.6). 24hr after exercise, fibrinogen levels returned to baseline. Similar changes were observed for P-selectin (25 +/- 5, 28 +/- 1.7 ng/dl, baseline and post exercise respectively p<0.01), again returning to baseline 24hr after exercise. No significant changes were observed for US-PCR after exercise in neither group. CK increased 43 percent in the atorvastatin group and 12 percent in controls (NS). Conclusion: Atorvastatin...

Psychometric analyses and internal consistency of the PHEEM questionnaire to measure the clinical learning environment in the clerkship of a Medical School in Chile.

BACKGROUND AND AIMS: The Spanish version of the Postgraduate Hospital Educational Environment Measure (PHEEM) was evaluated in this study to determine its psychometric properties, validity and internal consistency to measure the clinical learning environment in the hospital setting of Pontificia Universidad Católica de Chile Medical School's Internship. METHODS: The 40-item PHEEM questionnaire was translated from English to Spanish and retranslated to English. Content validity was tested by a focus group and minor differences in meaning were adjusted. The PHEEM was administered to clerks in years 6 and 7. Construct validity was carried out using exploratory factor analysis followed by a Varimax rotation. Internal consistency was measured using Cronbach's alpha. RESULTS: A total of 125 out of 220 students responded to the PHEEM. The overall response rate was 56.8% and compliances with each item ranged from 99.2% to 100%. Analyses indicate that five factors instrument accounting for 58% of the variance and internal consistency of the 40-item questionnaire is 0.955 (Cronbach's alpha). The 40-item questionnaire had a mean score of 98.21 +/- 21.2 (maximum score of 160). CONCLUSIONS: The Spanish version of PHEEM is a multidimensional, valid and highly reliable instrument measuring the educational environment among undergraduate medical students working in hospital-based clerkships.

Ambiente educacional y calidad de la docencia en la escuela de medicina / Eucational environment and quality of teaching in our school of medicine

El ambiente educacional es un concepto que cada vez cobra mayor relevancia en la educación médica por su impacto en el proceso de enseñanza, aprendizaje y posterior vida laboral. Existen numerosos instrumentos para evaluar el ambiente, según el ciclo de formación o el tipo de rotación. En la Escuela de Medicina de la Pontificia Universidad Católica de Chile se han utilizado las encuestas DREEM y PHEEM, que se complementan con otros instrumentos aplicados a los estudiantes, generados por el Centro de Educación Médica y la American Association of Medical Colleges (AAMC) en el contexto del proceso de la evaluación de la Escuela de Medicina. Todos estos confirman que el ambiente educacional en general es adecuado. Las fortalezas detectadas están relacionadas con el ambiente académico y la calidad de los profesores. Los aspectos deficitarios están relacionados con la retroalimentación, el proceso de evaluación y áreas de desarrollo social. La constante medición del ambiente educacional dentro de la Escuela de Medicina nos permitirá a futuro detectar las fortalezas, mejorar las áreas deficitarias y evaluar el impacto de las modificaciones curriculares.

The Educational Environment has increased its relevance in medical education due to the impact in the process of teaching and learning and later professional work. There are numerous instruments to evaluate the environment, according to the cycle of formation or the kind of rotation. In the Medical School of Pontificia Universidad Católica de Chile it has been used the DREEM and PHEEM questionnaires, which complement with other instruments applied to the students, developed by the Center of Medical Education and the American Association of Medical Colleges (AAMC) in the context of the School of Medicine evaluation. All these instruments confirm that the educational environment in general is good. The strengths are related to the academic atmosphere and the quality of teachers. The weaknesses are related to feedback, evaluation and areas related to social development. The measurement of the educational climate within the Medical School will allow in the future detecting the strengths, in order to improve the deficit areas and to evaluate the impact of curricular changes.