Evaluación del valor responsabilidad en estudiantes de Medicina y sus profesores / Assessment of the responsibility as moral values in Medical students and their professors

Se realizó una investigación aplicada, observacional, descriptiva, longitudinal y prospectiva en el período correspondiente al curso escolar 2008- 2009, que incluyó como muestra al universo de los estudiantes de Medicina, 11 de primer año y de segundo año, para un total de 22 y sus 24 profesores de la Carrera de Medicina, pertenecientes al Policlínico Universitario "Hermanos Cruz" de Pinar del Río. Los datos necesarios se obtuvieron previo consentimiento informado de los estudiantes incluidos en la investigación y sus profesores, a los que se les aplicaron instrumentos que permitieron determinar el estado en que se encuentran con relación al valor responsabilidad en actividades del proceso docente. Los profesores y alumnos fueron sometidos a una entrevista y observación de clases. Los datos recogidos fueron procesados por el método de estadística descriptiva empleándose frecuencias absolutas y relativas (%). Se obtuvo como principales resultados las carencias y dificultades en la formación del valor responsabilidad en los estudiantes de primero y segundo año de la Carrera de Medicina, fundamentalmente: deporte, cultura e investigación, persisten en los profesores aspectos insuficientes para lograr conformar el soporte apropiado que permita fortalecer el valor responsabilidad debido fundamentalmente a que son claustros jóvenes. Estos resultados permitieron elaborar una intervención que contribuirá a la formación del valor responsabilidad en todas las Universidades. Palabras clave: valores sociales, enseñanza, clínica de pacientes externos, universidades. ABSTRACT An applied, observation, descriptive, longitudinal and prospective research was conducted during the academic course 2008-2009, which included as a sample the universe of the Medical students, 11 from the first and second academic years (22 the total) and their 24 professors of the Medical Major enrolled at "Hermanos Cruz" University Outpatient Clinic, Pinar del Rio. The necessary data were obtained by means of an informed consent of those students and professors included into the research, applying instruments to determine the state of the moral values of responsibility in the teaching-learning process. Professors and students were called to an interview and lecture's observation. Data were collected and processed using the descriptive statistics with absolute and relative frequencies (%). The main results showed lack and difficulties in the formation of the responsibility as moral values, principally in: sports, culture and research, persisting in professors insufficient aspects to achieve, in this young staff, the appropriate support to reinforce the moral values of responsibility. These results allowed to elaborate an intervention that will contribute to the reinforcement of the responsibility in all the universities. Key words: social values, teaching, outpatient clinic, universities

Tocilizumab in refractory Caucasian Takayasu's arteritis: a multicenter study of 54 patients and literature review

Objective: To assess the efficacy and safety of tocilizumab (TCZ) in Caucasian patients with refractory Takayasu's arteritis (TAK) in clinical practice. Methods: A multicenter study of Caucasian patients with refractory TAK who received TCZ. The outcome variables were remission, glucocorticoid-sparing effect, improvement in imaging techniques, and adverse events. A comparative study between patients who received TCZ as monotherapy (TCZMONO) and combined with conventional disease modifying anti-rheumatic drugs (cDMARDs) (TCZCOMBO) was performed. Results: The study comprised 54 patients (46 women/8 men) with a median [interquartile range (IQR)] age of 42.0 (32.5-50.5) years. TCZ was started after a median (IQR) of 12.0 (3.0-31.5) months since TAK diagnosis. Remission was achieved in 12/54 (22.2%), 19/49 (38.8%), 23/44 (52.3%), and 27/36 (75%) patients at 1, 3, 6, and 12 months, respectively. The prednisone dose was reduced from 30.0 mg/day (12.5-50.0) to 5.0 (0.0-5.6) mg/day at 12 months. An improvement in imaging findings was reported in 28 (73.7%) patients after a median (IQR) of 9.0 (6.0-14.0) months. Twenty-three (42.6%) patients were on TCZMONO and 31 (57.4%) on TCZCOMBO: MTX (n = 28), cyclosporine A (n = 2), azathioprine (n = 1). Patients on TCZCOMBO were younger [38.0 (27.0-46.0) versus 45.0 (38.0-57.0)] years; difference (diff) [95% confidence interval (CI) = -7.0 (-17.9, -0.56] with a trend to longer TAK duration [21.0 (6.0-38.0) versus 6.0 (1.0-23.0)] months; diff 95% CI = 15 (-8.9, 35.5), and higher c-reactive protein [2.4 (0.7-5.6) versus 1.3 (0.3-3.3)] mg/dl; diff 95% CI = 1.1 (-0.26, 2.99). Despite these differences, similar outcomes were observed in both groups (log rank p = 0.862). Relevant adverse events were reported in six (11.1%) patients, but only three developed severe events that required TCZ withdrawal. Conclusion: TCZ in monotherapy, or combined with cDMARDs, is effective and safe in patients with refractory TAK of Caucasian origin.Funding: This work was partially supported by RETICS Programs, RD08/0075 (RIER), RD12/0009/0013 and RD16/0012 from “Instituto de Salud Carlos III” (ISCIII) (Spain)

Tocilizumab in refractory Caucasian Takayasu's arteritis : a multicenter study of 54 patients and literature review

Objective: To assess the efficacy and safety of tocilizumab (TCZ) in Caucasian patients with refractory Takayasu's arteritis (TAK) in clinical practice. Methods: A multicenter study of Caucasian patients with refractory TAK who received TCZ. The outcome variables were remission, glucocorticoid-sparing effect, improvement in imaging techniques, and adverse events. A comparative study between patients who received TCZ as monotherapy (TCZ) and combined with conventional disease modifying anti-rheumatic drugs (cDMARDs) (TCZ) was performed. Results: The study comprised 54 patients (46 women/8 men) with a median [interquartile range (IQR)] age of 42.0 (32.5-50.5) years. TCZ was started after a median (IQR) of 12.0 (3.0-31.5) months since TAK diagnosis. Remission was achieved in 12/54 (22.2%), 19/49 (38.8%), 23/44 (52.3%), and 27/36 (75%) patients at 1, 3, 6, and 12 months, respectively. The prednisone dose was reduced from 30.0 mg/day (12.5-50.0) to 5.0 (0.0-5.6) mg/day at 12 months. An improvement in imaging findings was reported in 28 (73.7%) patients after a median (IQR) of 9.0 (6.0-14.0) months. Twenty-three (42.6%) patients were on TCZ and 31 (57.4%) on TCZ: MTX (n = 28), cyclosporine A (n = 2), azathioprine (n = 1). Patients on TCZ were younger [38.0 (27.0-46.0) versus 45.0 (38.0-57.0)] years; difference (diff) [95% confidence interval (CI) = -7.0 (-17.9, -0.56] with a trend to longer TAK duration [21.0 (6.0-38.0) versus 6.0 (1.0-23.0)] months; diff 95% CI = 15 (-8.9, 35.5), and higher c-reactive protein [2.4 (0.7-5.6) versus 1.3 (0.3-3.3)] mg/dl; diff 95% CI = 1.1 (-0.26, 2.99). Despite these differences, similar outcomes were observed in both groups (log rank p = 0.862). Relevant adverse events were reported in six (11.1%) patients, but only three developed severe events that required TCZ withdrawal. Conclusion: TCZ in monotherapy, or combined with cDMARDs, is effective and safe in patients with refractory TAK of Caucasian origin