Flipped learning as an educational model in a cardiology residency program.

INTRODUCTION: Flipped learning (FL) is a model which allows students to adjust their study rhythm by taking advantage of class time to apply their knowledge. Although FL meets many of the needs of the traditional lecture-based model and the exclusively virtual model, its effectiveness in medical residency programs has not been thoroughly studied. Our study evaluates the efficacy of an FL model in a cardiology residency program based on the satisfaction and academic performance of the participants. METHOD: A prospective, observational, and descriptive study was conducted at Ignacio Chávez National Institute of Cardiology in Mexico City to evaluate the satisfaction and effectiveness of an FL model for acquiring competencies in electrocardiographic diagnosis among thirty-one first-year cardiology residents. The Advanced Electrocardiography Workshop and a virtual classroom were designed for the intervention. Four teachers taught the workshop and video classes, and ten medical specialists from the participants' areas of work performed evaluations of practical skills before and after the intervention. RESULTS: 75% of the participants rated the intervention as very favorable compared to the traditional and virtual models. The main advantages offered by the FL model were identified. An improvement of high statistical significance was observed in participants' academic performance after the intervention (P value < 0.001). CONCLUSION: The FL model has a high degree of acceptance among participants and teachers. Our study shows an improvement in academic performance after the intervention. Considering that the FL model is flexible and reproducible in other areas of medicine, it represents an excellent educational alternative that meets current needs.

Academic and professional profile of cardiology fellowship graduates of National Institute of Cardiology Ignacio Chávez from 2000 to 2015.

BACKGROUND: The Ignacio Chávez National Institute of Cardiology (NIC) has positioned itself as an international benchmark in cardiovascular medical education, standing out for its high academic standards and human quality. OBJECTIVE: This study aims to identify the employment and academic profile of cardiology fellowship graduates from the National Institute of Cardiology of Mexico (NIC). METHODS: A cross-sectional and retrospective study was conducted, involving 473 graduates from the period 2000-2015. Data was collected through an electronic survey. RESULTS: A total of 221 graduates agreed to participate, accounting for 46.7% of the total number of graduates. Among the participants, 85.2% were male. The majority of graduates (82.4%) held Mexican nationality, while the remaining individuals represented various Latin-American nationalities. Following the completion of the cardiology fellowship, 89% of graduates pursued further postgraduate degrees. Within this group, 95.4% completed at least one additional fellowship, while 4.6% pursued a master's or PhD program. The most popular fellowship program chosen was Interventional Cardiology. On average, NIC graduates dedicate 10.8 hours per day to their work, with 6.4 hours dedicated to cardiology and 4.3 hours to their other postgraduate degree. Those employed in both public and private health systems allocate 6.1 hours and 5.2 hours per day, respectively. Additionally, 75% of graduates are involved in teaching activities. Currently, 84% of graduates are employed in Mexico. CONCLUSION: The majority of NIC graduates are physicians who further their academic training by pursuing additional postgraduate programs. They work longer hours per day compared to the general Mexican population, with a significant focus on clinical cardiology. Graduates actively seek opportunities to share their expertise through various academic activities.

ANTECEDENTES: El Instituto Nacional de Cardiología Ignacio Chávez (INC) se ha posicionado como un referente internacional en la educación médica cardiológica, destacándose por su alto nivel académico y calidad humana. OBJETIVO: El objetivo de este estudio fue identificar el perfil laboral y académico actual de los egresados del Instituto Nacional de Cardiología Ignacio Chávez (INC). MÉTODOS: Se llevó a cabo un estudio transversal y retrospectivo que incluyó a 473 egresados del INC graduados entre 2000 y 2015. Se utilizó una encuesta electrónica para recopilar los datos. RESULTADOS: Un total de 221 egresados aceptaron participar en el estudio, lo que representa el 46.7% del total de egresados. El 85.2% de los participantes son hombres. La mayoría de los egresados son de nacionalidad mexicana (82.4%), mientras que el resto se distribuye en varios países de Latinoamérica. El 89% de los egresados completó otro posgrado después de cardiología. De este grupo, el 95.4% realizó al menos una alta especialidad, mientras que el 4.6% obtuvo una maestría o doctorado. La especialidad más comúnmente elegida fue Cardiología Intervencionista. Los egresados del INC trabajan en promedio 10.8 horas al día, de las cuales 6.4 horas se dedican a la cardiología clínica y 4.3 horas al otro posgrado. Aquellos que trabajan en el sector público y privado dedican 6.1 horas y 5.2 horas al día, respectivamente. Además, el 75% de los egresados desempeña actividades de enseñanza. El 84% de los egresados trabajan en México. CONCLUSIÓN: En su mayoría, los egresados del INC son médicos especialistas que continúan su formación académica a través de la realización de otros posgrados. Trabajan más horas al día en comparación con el resto de la población mexicana, y dedican la mayor parte de su tiempo al ejercicio de la cardiología clínica. También buscan transmitir sus conocimientos a través de actividades académicas y de enseñanza.

The rescue of medical education crippled by the COVID-19 pandemic.

BACKGROUND AND OBJECTIVE: The ravages caused by the COVID-19 pandemic have affected medical education by losing the tutorial teaching that we carried out in out Institution. METHOD: The strategies implemented through information and communication technologies are described in this article. RESULTS: With the strategies carried out, it was possible to continue with all the theoretical education virtually at a distance, including the daily hospital rounds, the presentation of clinical cases, the remote analysis of laboratory and cabinet methods, as well as the teaching of the physical examination and the acquisition of diagnostic aid methods. In addition, the number of attendants for the weekly academic general session of the institute increased from 100 in-person attendants to 500 virtual attendants (average), with approximately 5000 reproductions of the recorded sessions. The advantages and disadvantages of these new techniques and the challenges for the future are discussed in this manuscript. CONCLUSIONS: Undoubtedly, the pandemic has caused damage to the teaching of two generations of medical students during 2020 and 2021, and we are still afraid that, in 2022, it will persist. Therefore, in our opinion, the medical education implemented by us is not ideal, but, at least, it constitutes a good palliative for the harm that the pandemic caused to medical education.

ANTECEDENTES Y OBJETIVO: Los estragos causados por la pandemia COVID-19 alcanzaron también la educación médica perdiéndose la enseñanza tutorial que ejercíamos en nuestro Instituto. MÉTODO: Se implementaron estrategias a través de las tecnologías de la información y de la comunicación que se describen en este artículo. RESULTADOS: Con las estrategias llevadas a cabo se pudo continuar con toda la educación teórica de manera virtual a distancia, incluyendo el pase cotidiano de visita a los enfermos, la presentación de casos clínicos, el análisis a distancia de los métodos de laboratorio y gabinete, así como la enseñanza de la exploración física y la adquisición de los métodos de ayuda diagnóstica de los gabinetes. El número de asistentes a la sesión general semanaria del Instituto incremento de 100 asistentes presenciales a 500 virtuales (promedio) con reproducciones de las mismas en un promedio de 5,000. Se discuten las ventajas e inconvenientes de estas nuevas técnicas y cuáles son los desafíos para el futuro. CONCLUSIONES: Sin duda alguna, la pandemia ha causado daño a la enseñanza de dos generaciones de estudiantes de la medicina en los años 2020 y 2021 y aún seguimos temerosos de que en el 2022 persista. A nuestro juicio la educación médica implementada por nosotros no es lo ideal, pero por lo menos constituye un buen paliativo del daño que la pandemia produjo en la educación médica.

Rupture of sinus of Valsalva aneurysm to the right atrium resolved with interventionism.

We present a case of a ruptured right sinus of Valsalva aneurysm to the right atrium that developed global heart failure over the course of three months, and which was completely resolved through cardiac catheterism, placing an occlusive device at the site of the fistula. Its ethology is discussed, as well as the guidelines for clinical diagnosis and treatment.

Se presenta un caso de aneurisma del seno de Valsalva derecho roto a la aurícula derecha, que en el transcurso de tres meses desarrolló insuficiencia cardiaca global y fue resuelto del todo por medio de intervencionismo, colocando un dispositivo oclusor en el sitio de la fístula. Se discute su etología, así como las pautas para el diagnóstico clínico y el tratamiento.

Ignacio Chávez Rivera. A paradigm in Medicine.

This article summarizes the life of Ignacio Chávez Rivera, one of the six most valuable directors that the National Institute of Cardiology has had "Ignacio Chávez Sánchez," founder of the same and father of the aforementioned. His time in life left a clear example to emulate both in the scientific, academic and teaching as well as in the human, family, social and friendly, which make him in the most outstanding student of Master Chávez. His time in life at the National Academy of Medicine, the National Autonomous University of Mexico, the Interamerican Society of Cardiology, the Mexican Society of Cardiology and the Institute itself, has left an indelible mark on these Institutions. The National Institute of Cardiology bows reverently to the figure of Ignacio Chávez Rivera.

Este documento sintetiza la vida de Ignacio Chávez Rivera, uno de los seis directores más valiosos que ha tenido el Instituto Nacional de Cardiología Ignacio Chávez Sánchez, su fundador y padre del ahora aludido. Su paso por la vida dejó un claro ejemplo a emular tanto en el ámbito científico, académico y docente como en los aspectos humano, familiar y social que lo convirtieron en el alumno más destacado del maestro Chávez. Su paso por la vida en la Academia Nacional de Medicina, la Universidad Nacional Autónoma de México, la Sociedad Interamericana de Cardiología, la Sociedad Mexicana de Cardiología y el propio Instituto ha dejado huella imperecedera en estas instituciones. El instituto Nacional de Cardiología se inclina reverente ante la figura de Ignacio Chávez Rivera.

Perfil académico y profesional de los egresados de la especialidad de Cardiología de 2000 a 2015 en el Instituto Nacional de Cardiología Ignacio Chávez / Academic and professional profile of cardiology fellowship graduates of National Institute of Cardiology Ignacio Chávez from 2000 to 2015

Resumen Antecedentes: El Instituto Nacional de Cardiología Ignacio Chávez (INC) se ha posicionado como un referente internacional en la educación médica cardiológica, destacándose por su alto nivel académico y calidad humana. Objetivo: El objetivo de este estudio fue identificar el perfil laboral y académico actual de los egresados del Instituto Nacional de Cardiología Ignacio Chávez (INC). Métodos: Se llevó a cabo un estudio transversal y retrospectivo que incluyó a 473 egresados del INC graduados entre 2000 y 2015. Se utilizó una encuesta electrónica para recopilar los datos. Resultados: Un total de 221 egresados aceptaron participar en el estudio, lo que representa el 46.7% del total de egresados. El 85.2% de los participantes son hombres. La mayoría de los egresados son de nacionalidad mexicana (82.4%), mientras que el resto se distribuye en varios países de Latinoamérica. El 89% de los egresados completó otro posgrado después de cardiología. De este grupo, el 95.4% realizó al menos una alta especialidad, mientras que el 4.6% obtuvo una maestría o doctorado. La especialidad más comúnmente elegida fue Cardiología Intervencionista. Los egresados del INC trabajan en promedio 10.8 horas al día, de las cuales 6.4 horas se dedican a la cardiología clínica y 4.3 horas al otro posgrado. Aquellos que trabajan en el sector público y privado dedican 6.1 horas y 5.2 horas al día, respectivamente. Además, el 75% de los egresados desempeña actividades de enseñanza. El 84% de los egresados trabajan en México. Conclusión: En su mayoría, los egresados del INC son médicos especialistas que continúan su formación académica a través de la realización de otros posgrados. Trabajan más horas al día en comparación con el resto de la población mexicana, y dedican la mayor parte de su tiempo al ejercicio de la cardiología clínica. También buscan transmitir sus conocimientos a través de actividades académicas y de enseñanza.

Abstract Background: The Ignacio Chávez National Institute of Cardiology (NIC) has positioned itself as an international benchmark in cardiovascular medical education, standing out for its high academic standards and human quality. Objective: This study aims to identify the employment and academic profile of cardiology fellowship graduates from the National Institute of Cardiology of Mexico (NIC). Methods: A cross-sectional and retrospective study was conducted, involving 473 graduates from the period 2000-2015. Data was collected through an electronic survey. Results: A total of 221 graduates agreed to participate, accounting for 46.7% of the total number of graduates. Among the participants, 85.2% were male. The majority of graduates (82.4%) held Mexican nationality, while the remaining individuals represented various Latin-American nationalities. Following the completion of the cardiology fellowship, 89% of graduates pursued further postgraduate degrees. Within this group, 95.4% completed at least one additional fellowship, while 4.6% pursued a master's or PhD program. The most popular fellowship program chosen was Interventional Cardiology. On average, NIC graduates dedicate 10.8 hours per day to their work, with 6.4 hours dedicated to cardiology and 4.3 hours to their other postgraduate degree. Those employed in both public and private health systems allocate 6.1 hours and 5.2 hours per day, respectively. Additionally, 75% of graduates are involved in teaching activities. Currently, 84% of graduates are employed in Mexico. Conclusion: The majority of NIC graduates are physicians who further their academic training by pursuing additional postgraduate programs. They work longer hours per day compared to the general Mexican population, with a significant focus on clinical cardiology. Graduates actively seek opportunities to share their expertise through various academic activities.

Aneurisma del seno de Valsalva roto a la aurícula derecha resuelto con intervencionismo / Rupture of sinus of Valsalva aneurysm to the right atrium resolved with interventionism

Resumen Se presenta un caso de aneurisma del seno de Valsalva derecho roto a la aurícula derecha, que en el transcurso de tres meses desarrolló insuficiencia cardiaca global y fue resuelto del todo por medio de intervencionismo, colocando un dispositivo oclusor en el sitio de la fístula. Se discute su etología, así como las pautas para el diagnóstico clínico y el tratamiento.

Abstract We present a case of a ruptured right sinus of Valsalva aneurysm to the right atrium that developed global heart failure over the course of three months, and which was completely resolved through cardiac catheterism, placing an occlusive device at the site of the fistula. Its ethology is discussed, as well as the guidelines for clinical diagnosis and treatment.

[Severe myocardial disease in a case of Barlow's syndrome]. / Daño miocárdico grave en un case de síndrome de Barlow.

The Barlow's syndrome is a disease characterized by the presence of mitral valve prolapse and a wide range of signs and symptoms. We know that its manifestations has a great variety existing cases with little clinical expression as those seen frequently in daily practice or the other side opposite completely in which, the syndrome is so complex getting to the patient to present many symptoms secondary to hemodynamics alterations that reduce by much its quality of life and even modify its prognosis.The case that we present is a female patient of 25 years old with Barlow's syndrome and functional class II-III of NewYork Heart Association as a result of the alterations in the contractility function of the heart that finally caused her death.

Pharmacogenetic Variation in Over 100 Genes in Patients Receiving Acenocumarol.

Coumarins are widely prescribed worldwide, and in Mexico acenocumarol is the preferred form. It is well known that despite its efficacy, coumarins show a high variability for dose requirements. We investigated the pharmacogenetic variation of 110 genes in patients receiving acenocumarol using a targeted NGS approach. We report relevant population differentiation for variants on CYP2C8, CYP2C19, CYP4F11, CYP4F2, PROS, and GGCX, VKORC1, CYP2C18, NQO1. A higher proportion of novel-to-known variants for 10 genes was identified on 41 core pharmacogenomics genes related to the PK (29), PD (3), of coumarins, and coagulation proteins (9) including, CYP1A1, CYP3A4, CYP3A5, and F8, and a low proportion of novel-to-known variants on CYP2E1, VKORC1, and SULT1A1/2. Using a Bayesian approach, we identified variants influencing acenocumarol dosing on, VKORC1 (2), SULT1A1 (1), and CYP2D8P (1) explaining 40-55% of dose variability. A collection of pharmacogenetic variation on 110 genes related to the PK/PD of coumarins is also presented. Our results offer an initial insight into the use of a targeted NGS approach in the pharmacogenomics of coumarins in Mexican Mestizos.

[Extreme aortic coarctaction, severe aortic regurgitation and heart failure relieved immediately after stent aortoplasty, and complete resolution through Bental/de Bono surgical repair]. / Alivio inmediato de la insuficiencia cardíaca en la coartación de la aorta posterior a la aortoplastía con stent, y mejoría absoluta, posterior a la operación de Bentall y de Bono. (Presentación de un caso).

When aneurysm of the root of aorta, bicuspid aorta valve and coarctation coexist, surgical repair involves technical problems. We present the case of a patient in whom initial correction of the coarctation was made by means of interventional treatment, with an impressive and practically immediate resolution of heart failure. In a second intervartional, the aortic root pathology was corrected through the Bentall and de Bono's surgical technique. We present the short- and mid-term results. In addition this case demostrates the little well-know fact, that the patients with bicuspid aorta also have cystic media degeneration of the wall of the aorta.

Ignacio Chávez Rivera. A paradigm in medicine / Ignacio Chávez Rivera. Un paradigma en la medicina

Abstract This article summarizes the life of Ignacio Chávez Rivera, one of the six most valuable directors that the National Institute of Cardiology has had "Ignacio Chávez Sánchez," founder of the same and father of the aforementioned. His time in life left a clear example to emulate both in the scientific, academic and teaching as well as in the human, family, social and friendly, which make him in the most outstanding student of Master Chávez. His time in life at the National Academy of Medicine, the National Autonomous University of Mexico, the Interamerican Society of Cardiology, the Mexican Society of Cardiology and the Institute itself, has left an indelible mark on these Institutions. The National Institute of Cardiology bows reverently to the figure of Ignacio Chávez Rivera.

Resumen Este documento sintetiza la vida de Ignacio Chávez Rivera, uno de los seis directores más valiosos que ha tenido el Instituto Nacional de Cardiología Ignacio Chávez Sánchez, su fundador y padre del ahora aludido. Su paso por la vida dejó un claro ejemplo a emular tanto en el ámbito científico, académico y docente como en los aspectos humano, familiar y social que lo convirtieron en el alumno más destacado del maestro Chávez. Su paso por la vida en la Academia Nacional de Medicina, la Universidad Nacional Autónoma de México, la Sociedad Interamericana de Cardiología, la Sociedad Mexicana de Cardiología y el propio Instituto ha dejado huella imperecedera en estas instituciones. El instituto Nacional de Cardiología se inclina reverente ante la figura de Ignacio Chávez Rivera.

[The heart in hypertension. Cardiac protection and cardiac repair]. / El corazón en la hipertensión. Cardioprotección y cardiorreparación.

Studies performed in the last five years have led to the knowledge of new mechanisms by which the hypertensive process produces hypertrophy and cardiac fibrosis, at the same time, favoring development of the atheroesclerotic plaque. The Renin-Angiotensin-Aldosterone axis is relevant by involved in the physiopathology of these alterations, not only by producing hyperplasia and hypertrophy of vascular smooth muscle cells or by increasing protein and DNA syntheses, mediated by Angiotensin II (by itself a potent Growth factor) but also through inflammatory processes exerted upon the vascular smooth muscle cells. These alterations (hypertrophy, fibrosis, inflammation, and destabilization of the atherosclerotic plaque) can now be counteracted by blocking the Angiotensin-Converting enzyme or its AT1 receptors with the consequent improvement in ventricular diastolic functions.

[Inflammation in atherosclerosis]. / Inflamación en aterosclerosis.

Traditional risk factors for atherosclerosis are well known and their control decreases importantly the appearance of the disease. These factors are the genetic charge, dyslipidemia, smoking, systemic arterial hypertension, diabetes, obesity, gender, age, stress, estrogen levels in women, and life style. However, in the last decade, new risk factors have been identified especially for coronary and cerebrovascular atherosclerosis. Among these factors, the inflammatory process has been pointed out in which acute stage reactants participate, such as C-reactive protein, leukocyte count, globular sedimentation, multiple cytokines, alpha tumor necrosis factor, vascular and cellular adhesion molecules, some metalloproteinases, pregnancy-associated plasma protein A, lipoprotein-associated phospholipase A2, angiotensin II, and very probably infection. This article discusses the mechanism by which these markers participate in the atherosclerotic process and their value as predictors of future coronary events, as well as to what extent current therapeutics can contribute to decrease these events and to improve patient care.

Estar ahí / Be there

ESTAR AHÍ, cuando a uno le necesitan; tomando siempre como referencia las palabras del Dr. Ignacio Chávez, la mística Institucional, que es la de superarse y estudiar siempre, convencidas que su saber es prenda de eficacia en su trabajo y garantía de salud para sus enfermos; de protegerlos con amor y consagrarse a ellos, con tanto interés cuanto más grandes sean su dolor y su angustia; y el mismo Dr. Chávez lo decía en el juramento que escribió para ellas: "… si se poner mi vida a la altura de mi empeño, que en recompensa me sea dado recibir el día que la enfermedad me doble una ayuda inteligente solicita y cordial como la que yo me empeñe en ofrecer"

[Predictive value of multi-sliced computed tomography to evaluate obstructive coronary vessel, in the preoperative assessment of non-coronary cardiac surgery]. / Valor predictivo de la tomografía multicorte para evaluar lesiones obstructivas coronarias, en el preoperatorio de cirugía cardiaca no coronaria.

INTRODUCTION: Significant Coronary Artery Disease (CAD>50%) it can easily detected with Multislice Computed Tomography (MSCT), nevertheless if MSCT may replace Invasive Coronary Angiography (ICA) in the preoperative assessment of the patient undergoing to non-coronary cardiac surgery is not well defined. The objective of this study was to know if the MSCT can replace ICA in the preoperative valuation of patients who go to cardiac surgery METHOD: 64 consecutive patients in Class I recommendation of American College of Cardiology / American Heart Association (ACC/AHA) guidelines for preoperative ICA were evaluated. Patients with angina, contrast medium allergy, serum creatinine up to 2.0 mg/dL, previous coronary cardiac surgery or coronary angioplasty and supraventricular arrhythmias were excluded. Both, Coronary artery calcium (CAC) and coronary angiography were evaluated. RESULTS: The prevalence of significant (>50%) CAD was 12.5%. The Sensitivity of MSCT to detect significant CAD was 87.5%, its Specificity of 92.8%, Predictive Negative Value was 98.1% and Area Under the Curve (ROC analysis) = 0.90. Anyone with Rheumatic Valvular Disease had significant CAD or CAC>400 UA (RR = 0.80, IC95% 0.69-0.94). Degenerative Aortic Valve Stenosis had a major probability of significant CAD (RR of 9.0; IC 95% 1.64-49.80). Logistic Regression Analysis showed than CAC>400 UA (Coef ß 0,351, t = 4.402 p = 0.000) and male gender (Coef ß 0,179, t = 2.445, p = 0.017), were the best predicting variables of CAD. This study shows different populations in patients undergoing to non-coronary cardiac surgery. CONCLUSIONS: Gender, CAC> 400 UA and type of cardiac disease previously surgery may be useful for triage to MSCT or ICA in the preoperative assessment. This study shows that ICA may be necessarily indicated in some patients in assessment of non-coronary cardiac surgery but not absolutely indicated in all patients that Guidelines of ACC/AHA have recommended.