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.

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

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.

Infected transcartilaginous ear piercings. A case report and review of the literature / Pericondritis del pabellón auricular por piercings. Reporte de un caso clínico y revisión de la literatura

Background: transcartilaginous perforations have become a prominent practice among adolescents and young adults in recent years,which are associated with an increased risk of complications since it is frequently performed without sterile technique and by unqualified individuals. The transgression of the integrity of the skin and cartilage of the ear favors infections such as cellulitis, chondritis, perichondritis or abscesses that can cause serious deformities. Methods: we present a clinical case compatible with a perichondritis secondary to ear perforations with three abscesses. Results: the three abscesses were drained with sterile technique and successfully managed with outpatient antibiotic treatment. In relation to the pathophysiology, the trauma in the auditory pavilion produces the extraction of the adjacent perichondrium, causing devascularization of the cartilage and microfractures, which together with the transgression of the skin, increase the susceptibility to infection. In addition, subpericardial bleeding and inflammatory reaction decrease the blood supply, which limits the immune response and the effectiveness of antibiotics. In some cases, incision and drainage are required. The signs of perichondritis include pain, swelling, and erythema of the skin. Clinically, perichondritis can be differentiated from cellulitis of the pinna, in that the first usually does not involve the earlobe. The fluctuating swelling leads us to an abscess. Conclusions: the administration of broad-spectrum antibiotics should be immediately administered and include coverage for Pseudomonas aeruginosa since it is responsible for the majority of post-perforation cartilage infections (up to 95 percent of cases). Due to the increase of post-perforation infectious complications, all physicians should be familiar with its diagnosis and treatment.(AU)

Antecedentes: las perforaciones transcartilaginosas se han convertido en una práctica destacada entre adolescentes y adultos jóvenes en los últimos años, que están asociados con un mayor riesgo de complicaciones, ya que se realiza con frecuencia sin técnica estéril y sin calificación individuos. La transgresión de la integridad de la piel y el cartílago del oído favorece infecciones como la celulitis, la condritis, la pericondritis o los abscesos que pueden causar graves deformidades. Métodos: presentamos un caso clínico compatible con una pericondritis secundaria a las perforaciones del oído con tres abscesos. Resultados: los tres abscesos se drenaron con técnica estéril y se manejaron con éxito con tratamiento antibiótico ambulatorio. En relación con la fisiopatología, el trauma en el pabellón auditivo produce la extracción. del pericondrio adyacente, causando la desvascularización del cartílago y las microfracturas, que junto con la transgresión de la piel, aumenta la susceptibilidad a la infección. Además, el sangrado subpericárdico y la reacción inflamatoria disminuyen la sangre. suministro, lo que limita la respuesta inmune y la efectividad de los antibióticos. En algunos casos, se requiere incisión y drenaje. los Los signos de pericondritis incluyen dolor, hinchazón y eritema de la piel. Clínicamente, la pericondritis puede diferenciarse de la celulitis de el pinna, ya que el primero generalmente no involucra el lóbulo de la oreja. La hinchazón fluctuante nos lleva a un absceso. Conclusiones: la administración de antibióticos de amplio espectro debe administrarse inmediatamente e incluir cobertura para Pseudomonas aeruginosa desde Es responsable de la mayoría de las infecciones de cartílago posteriores a la perforación (hasta el 95 por ciento de los casos). Debido al aumento de post-perforación complicaciones infecciosas, todos los médicos deben estar familiarizados con su diagnóstico y tratamiento...(AU)

Clinical characterization of Chilean patients with IgE-mediated food allergy. / Caracterización clínica de pacientes chilenos con alergia alimentaria mediada por IgE.

BACKGROUND: Food allergy (FA) is an entity of high and growing prevalence, which can be mediated by IgE or cellular immunity. It can have a wide range of symptoms and be triggered by multiple food antigens, which vary in different geographical areas. OBJECTIVES: To describe clinical characteristics of Chilean patients with IgE-mediated FA. PATIENTS AND METHOD: Retrospective review of patients with IgE-mediated FA treated at a tertiary healthcare center in Santiago, Chile, between 2006 and 2016. Demographic characteristics, clinical manifestations, and trigger foods were evaluated. RESULTS: A to tal of 282 patients diagnosed with IgE-mediated FA were included. 89% had FA onset before 18 years of age and most of these before one year of age (median of age: one year; range: one month-55 years). The most common clinical manifestations were hives, angioedema, dyspnea, and vomiting. 40% had symptoms compatible with anaphylaxis. The foods most frequently involved were egg, cow's milk, peanut, shellfish, walnut, tomato, wheat, avocado, fish, and legumes. Egg, cow's milk, and peanut allergies were the most frequent at pediatric age, while seafood allergy was the most frequent among adults. CONCLUSION: Foods causing IgE-mediated FA in Chile were similar to those described in other countries, although the frequency of tomato and avocado allergy, which are unusual in international series, stands out. Anaphylaxis incidence was high, emphasizing the need for epinephrine autoinjec tors in Chile.

Caracterización clínica de pacientes chilenos con alergia alimentaria mediada por IgE / Clinical characterization of Chilean patients with IgE-mediated food allergy

INTRODUCCIÓN: La alergia alimentaria (AA) es una entidad de elevada y creciente prevalencia, pudiendo ser mediada por IgE o inmunidad celular. Puede presentar amplia sintomatología y ser gatillada por múltiples antígenos alimentarios, lo que varía en diversas zonas geográficas. OBJETIVO: Describir las características clínicas de pacientes chilenos con AA IgE-mediada. PACIENTES Y MÉTODO: Revisión retrospectiva de pacientes con AA IgE-mediada atendidos en un centro terciario de salud de Santiago, Chile entre los años 2006 y 2016. Se evaluaron características demográficas, manifestaciones clínicas y alimentos gatillantes. RESULTADOS: Se incluyeron 282 pacientes con diagnóstico de AA IgE-mediada. El 89% debutó con AA antes de los 18 años de edad y de estos, la mayoría antes del año (mediana: 1 año; rango: 1 mes - 55 años). Las manifestaciones clínicas más frecuentes fueron urticaria, angioedema, disnea y vómitos. Un 40% tenía historia compatible con anafilaxia. Los alimentos más frecuentes fueron huevo, leche de vaca, maní, mariscos, nuez, tomate, trigo, palta, pescados y legumbres. Alergia a huevo, leche de vaca y maní fueron más frecuentes en edad pediátrica, mientras que en adultos fueron los mariscos. CONCLUSIONES: Los alimentos causantes de AA IgE-mediada en Chile fueron similares a los descritos en otros países, aunque destaca la elevada frecuencia de alergia a tomate y palta, poco habituales en series internacionales. La incidencia de anafilaxia fue alta, lo que instala la necesidad de contar con autoinyectores de adrenalina a nivel nacional.

BACKGROUND: Food allergy (FA) is an entity of high and growing prevalence, which can be mediated by IgE or cellular immunity. It can have a wide range of symptoms and be triggered by multiple food antigens, which vary in different geographical areas. OBJECTIVES: To describe clinical characteristics of Chilean patients with IgE-mediated FA. Patients and Method: Retrospective review of patients with IgE-mediated FA treated at a tertiary healthcare center in Santiago, Chile, between 2006 and 2016. Demographic characteristics, clinical manifestations, and trigger foods were evaluated. RESULTS: A to tal of 282 patients diagnosed with IgE-mediated FA were included. 89% had FA onset before 18 years of age and most of these before one year of age (median of age: one year; range: one month-55 years). The most common clinical manifestations were hives, angioedema, dyspnea, and vomiting. 40% had symptoms compatible with anaphylaxis. The foods most frequently involved were egg, cow's milk, peanut, shellfish, walnut, tomato, wheat, avocado, fish, and legumes. Egg, cow's milk, and peanut allergies were the most frequent at pediatric age, while seafood allergy was the most frequent among adults. CONCLUSION: Foods causing IgE-mediated FA in Chile were similar to those described in other countries, although the frequency of tomato and avocado allergy, which are unusual in international series, stands out. Anaphylaxis incidence was high, emphasizing the need for epinephrine autoinjec tors in Chile.

Simulación en Otorrinolaringología: una herramienta de enseñanza y entrenamiento / Simulation in Otolaryngology: a teaching and training tool

La simulación en los procesos educativos de la medicina constituye un método de enseñanza y de aprendizaje efectivo. Permite estandarizar los procesos de aprendizaje y enseñar sin poner en riesgo al paciente. En Otorrinolaringología existen diferentes tipos de simulación en las distintas áreas de la especialidad. Se han desarrollado modelos tipo fantoma, paciente-maniquí, modelos virtuales y también se utilizan modelos animales para poder enseñar y practicar diferentes habilidades. Cada modelo tiene sus ventajas y desventajas, donde la realidad virtual se posiciona como un modelo emergente y con un futuro prometedor. Sin embargo, aún falta mayor desarrollo de la simulación en el área de Otorrinolaringología (AU)

Simulation in medical education is an effective method of teaching and learning, allowing standardisation of the learning and teaching processes without compromising the patient. Different types of simulation exist within subspecialty areas of Otolaryngology. Models that have been developed include phantom imaging, dummy patients, virtual models and animal models that are used to teach and practice different skills. Each model has advantages and disadvantages, where virtual reality is an emerging model with a promising future. However, there is still a need for further development of simulation in the area of Otolaryngology (AU)

Simulation in Otolaryngology: A teaching and training tool. / Simulación en Otorrinolaringología: una herramienta de enseñanza y entrenamiento.

Simulation in medical education is an effective method of teaching and learning, allowing standardisation of the learning and teaching processes without compromising the patient. Different types of simulation exist within subspecialty areas of Otolaryngology. Models that have been developed include phantom imaging, dummy patients, virtual models and animal models that are used to teach and practice different skills. Each model has advantages and disadvantages, where virtual reality is an emerging model with a promising future. However, there is still a need for further development of simulation in the area of Otolaryngology.

[Curriculum reform at the Pontificia Universidad Católica de Chile School of Medicine]. / Reforma curricular de la carrera de Medicina de la Pontificia Universidad Católica de Chile.

The career of Medicine at the Pontificia Universidad Católica de Chile was established from the beginning (1929), with a classical Flexner curriculum design. In seven years, the career is divided in three cycles: basic sciences, clinics and internship. It obtained Chilean accreditation and fulfilled American Association of Medical Colleges accreditation requirements. Changes in the Chilean epidemiological profile and health system, and new teaching methods in medicine, stimulated a process of deep curricular analysis, identifying strengths and weaknesses of the medical career. The curricular strengths were well-developed scientific and clinical components, fully committed students and faculties, well defined learning objectives and excellent clinical campuses. Curricular weaknesses included a poor vertical and horizontal integration, few student centered methodologies and a weak emphasis concerning doctor’s professionalism. Subsequently, the whole community of teachers, students and medical educators worked on the design of a new curriculum, establishing a new graduate profile and designed it oriented by learning objectives, of six years of duration, with an optimized course sequence that melds basic science and clinical concepts, with strong emphasis on humanities and professionalism. It prioritizes an early contact with patients from the first year and expands teaching methods. The main objective of this process was to achieve a new curriculum with an integrative structure. This was implemented in 2015 with an approved protocol to evaluate the outcomes.

[Constrictive pericarditis as a serious and rare presentation of systemic lupus erythematosus: Report of one case]. / Pericarditis constrictiva como presentación grave e infrecuente de lupus eritematoso sistémico: reporte de un caso y revisión de la literatura.

Constrictive Pericarditis (CP) is an unusual disease. Its most common causes are idiopathic or secondary to cardiac surgery. Less frequently it is caused by connective tissue diseases. We report a 30 years old woman hospitalized due to progressive dyspnea, chest pain and signs of right sided heart failure. During her stay, a Systemic Lupus Erythematosus (SLE) was diagnosed. The echocardiogram suggested a CP and the diagnosis was confirmed by cardiac catheterization. Pericardiectomy was successfully performed. The biopsy confirmed a nonspecific chronic pericarditis, with extensive fibrosis and absence of caseating granulomas. The patient had a satisfactory recovery.

Pericarditis constrictiva como presentación grave e infrecuente de lupus eritematoso sistémico: reporte de un caso y revisión de la literatura / Constrictive pericarditis as a serious and rare presentation of systemic lupus erythematosus: Report of one case

Constrictive Pericarditis (CP) is an unusual disease. Its most common causes are idiopathic or secondary to cardiac surgery. Less frequently it is caused by connective tissue diseases. We report a 30 years old woman hospitalized due to progressive dyspnea, chest pain and signs of right sided heart failure. During her stay, a Systemic Lupus Erythematosus (SLE) was diagnosed. The echocardiogram suggested a CP and the diagnosis was confirmed by cardiac catheterization. Pericardiectomy was successfully performed. The biopsy confirmed a nonspecific chronic pericarditis, with extensive fibrosis and absence of caseating granulomas. The patient had a satisfactory recovery.