Desarrollo de un curriculum de radiología para la formación médica de pregrado: experiencia de una escuela de medicina de Chile / Development of radiology curriculum in undergraduate medical education: experience of a chilean school of medicine

Existe consenso por parte de las autoridades académicas y los estudiantes de Medicina de pregrado que es necesaria la incorporación de la Imagenología a los planes de estudio de la carrera. Sin embargo, esto no se ha traducido en una participación constante de los médicos radiólogos en la formación de los futuros médicos. Nuestra Escuela de Medicina implementó un nuevo plan de estudios el año 2015 el que, entre otros aspectos, acortó la duración de la carrera de 7 a 6 años e integró la Imagenología en forma longitudinal a lo largo de la malla curricular. Para llevar a cabo este proceso de integración curricular fue necesario la decisión departamental y de la Dirección de Pregrado, para así identificar las oportunidades de incorporación de médicos radiólogos en la educación médica de pregrado.

There is wide agreement between teachers, students and authorities in the Schools of Medicine regarding the need of incorporating Medical Imaging teaching for undergraduates. Nonetheless, there is no active nor constant participation of radiologists in teaching for Medicine students. In our Medical School a new program was implemented in 2015, with a duration of 6 years (instead of 7 years, as previously), incorporating Medical Imaging teaching across the curriculum. To achieve the latter objective it was necessary to actively involve the Radiology (Medical Imaging) Department and the Undergraduate Director, identifying the opportunities to incorporate radiologists in medical teaching.

[Refractory dermatomyositis associated with chronic organizing pneumonia treated with rituximab: report of one case]. / Dermatomiositis refractaria asociada a neumonía en organización tratada con rituximab: reporte de un caso.

Chronic organizing pneumonia (COP) has often been reported as a pulmonary manifestation of collagen vascular diseases, mainly rheumatoid arthritis, but the association of COP and dermatomyositis (DM) has rarely been documented. We report a 55 year-old woman with well-documented DM and a COP. She was refractory to steroids and two other immunosuppressive agents therapy (cyclophosphamide and azathioprine). Therefore, rituximab (2 x 1 g infusions) was used for treatment. During the following weeks her strength gradually increased while creatine kinase (CK), C reactive protein and erythrocyte sedimentation rate normalized. After 6 months, she had a relapse with increased muscle enzymes, fever and moderate muscle weakness. After a second course of rituximab (2 x 1 g infusions), the patient demonstrated a remarkable clinical response as indicated by an increase in muscle strength and moderate decline in creatine kinase levels. Lung abnormalities resolved significantly on high resolution chest CT scan. Thus, B-cell depletion therapy with rituximab used alone or in combination with other immunosuppressants may be a viable option in patients with polymyositis-dermatomyositis and pneumonia refractory to current therapies.

Dermatomiositis refractaria asociada a neumonía en organización tratada con rituximab: Reporte de un caso / Refractory dermatomyositis associated with chronic organizing pneumonia treated with rituximab: Report of one case

Chronic organizing pneumonia (COP) has often been reported as a pulmonary manifestation of collagen vascular diseases, mainly rheumatoid arhritis, but the association of COP and dermatomyositis (DM) has rarely been documented. We report a 55 year-old woman with well-documented DM and a COP. She was refractory to steroids and two other immunosuppressive agents therapy (cyclophosphamide and azathioprine). Therefore, rituximab (2 x 1 g infusions) was used for treatment. During the following weeks her strength gradually increased while creatine kinase (CK), C reactive protein and erythrocyte sedimentation rate normalized. After 6 months, she had a relapse with increased muscle enzymes, fever and modérate muscle weakness. After a second course of rituximab (2 x 1 g infusions), the patient demonstrated a remarkable clinical response as indicated by an increase in muscle strength and moderate decline in creatine kinase levels. Lung abnormalities resolved significantly on high resolution chest CT sean. Thus, B-cell depletion therapy with rituximab used alone or in combination with other immunosuppressants may be a viable option in patients with polymyositis-dermatomyositis and pneumonia refractory to current therapies.

Ateroesclerosis en enfermedades reumatológicas: ¿mito o realidad? / Atherosclerosis in rheumatic diseases: myth or reality?

The first cause of morbidity and mortality among patients with Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA) is atherosclerotic vascular disease. This has been demonstrated in several epidemiological, clinical and mortality studies. Compared with the general population, these patients have a greater number of clinical events (myocardial ischemia, angina pectoris and cerebrovascular events), more subclinical vascular diseases (detected by carotid ultrasound, stress thallium scans, echocardiograms and vascular stiffness) and a higher rate of standardized mortality ratios. Framingham oe traditional cardiovascular risk factors do not seem to be wholly responsible for the increased vascular risk. Current evidence indicates that atherosclerosis is an inflammatory disease that may be initiated by endothelial injury. A prolonged inflammatory response is characteristic of SLE and RA, and may actually be an important facilitator of atherogenesis in these patients. High levels of circulating C-reactive protein, inflammatory cytokines (ICAM-1, CCAM-1, E-selectins and IL-6), antibodies, complement-fixing immune complexes, clonal expansion of certain types of lymphocytes and others that could be the source of endothelial injury in these patients are described. This article reviews the literature relating to the epidemiology of vascular disease, related risk factors and the suggested management strategies.

Neumonía cavitada por Rhodococcus equi en paciente inmunocomprometido no infectado por virus de inmunodeficiencia humana: Caso clínico y revisión / Necrotizing pneumonia due to Rhodococcus equi in non HIV immunocompromised host: Case report and review

Rhodococcus equi, es un bacilo grampositivo intracelular que causa infecciones mayoritariamente en pacientes inmunodeprimidos. Reportamos el caso de una mujer de 52 años, en tratamiento de lupus eritematoso sistémico, con historia progresiva de 10 meses de evolución caracterizada por tos, disnea progresiva, expectoración muco-purulenta, ocasionalmente hemoptoica, fiebre intermitente, y pérdida de peso del 10 por ciento. Tuvo respuesta parcial a diversos cursos de tratamiento antimicrobiano y el seguimiento radiológico evidenció la aparición de múltiples focos de consolidación bilaterales, algunos de ellos nodulares. El estudio microbiológico de un lavado broncoalveolar y de una biopsia pulmonar percutánea permitió la identificación de R. equi y la histología de la biopsia pulmonar fue compatible. Recibió tratamiento antimicrobiano bi-asociado prolongado con buena respuesta clínica y radiológica. Se debe considerar este agente en el estudio de pacientes inmunocomprometidos que cursan con neumonías de evolución prolongada.

Manifestaciones clínicas de la granulomatosis de Wegener y la poliangeítis microscópica en Santiago-Chile, 1990-2001 / Clinical features of Wegener granulomatosis and microscopic polyangiitis in Chilean patients

Background: Systemic vasculitis are a group of heterogeneous diseases characterized by inflammation and necrosis of blood vessel walls. The etiology is not known, but geographic and environmental factors are implicated. Aim: To describe the clinical features of microscopic polyangiitis (MPA) and Wegener's granulomatosis (WG) in a Chilean cohort of patients. Patients and methods: Retrospective review of the medical records of 123 patients with the diagnosis of systemic vasculitis (65 MPA and 58 WG), seen from 1990 to 2001. The diagnosis were made based on the American College of Rheumatology and Chapel Hill criteria. Results: The mean follow-up for MPA was 15 months (1-120) and for WG, 20 months (1-120). The median age (years) at diagnosis for MPA was 61 (19-82) and WG 50 (20-82). Gender distribution was similar in both groups (male: 68percent and 57percent respectively).The main clinical features in the MPA group were renal involvement (68percent), peripheral nervous system involvement (57percent), pulmonary hemorrhage (28percent), and skin disease (32percent). In the WG group were alveolar hemorrhage (62percent), renal involvement (78percent), paranasal sinus involvement (57percent), and ocular disease (26percent). In both, creatinine levels above 2.0 mg/dl were associated with a higher mortality (p< 0.01). ANCA by immunofluorescence was performed in 56 MPA patients (75percent had pANCA, 4percent had cANCA and 21percent were ANCA negative) and in 55 WG patients (17percent had pANCA, 79percent had cANCA and 4percent were ANCA negative). Global mortality was 18percent and 17percent respectively, and the most common causes of death were infections. Conclusions: The clinical features of our patients are similar to other published data. In our WG and MPA patients the main predictor for death was a serum creatinine above 2 mg/dl.