La tecnología en el proceso enseñanza –aprendizaje de las ciencias médicas.

El desafío planteado en este tema, abarca diferentes puntos de vista, por un lado, involucra a la historia de la medicina y por otro, concierne todo lo relacionado con la enseñanza de esta ciencia. Al referirnos a la historia de la medicina, debemos remontarnos a la humanidad en diferentes culturas y civilizaciones, donde observamos rastros de pacientes, con probables patologías traumáticas, infecciosas y hasta signos de procedimientos quirúrgicos, realizados hace más de cinco mil años. En ese momento, es muy probable, que aquellos tratamientos que hayan tenido buenos resultados, basados en rezos, uso de plantas medicinales, sacrificios, hayan sido transmitidos a las siguientes generaciones, como modelos terapéuticos, dando origen a la enseñanza de la medicina personalizada, centrada en el análisis y resolución del problema

Un nuevo escenario al final de una carrera de posgrado

En un posgrado, y como toda nueva etapa de estudio, uno avizora que obtendrá nuevos conocimientos, contactos, relaciones, que permitan potenciar lo adquirido en grado; avizora que la nueva etapa de estudio elegida, incorporara en mi saber y en mí hacer, destrezas, competencias, cualidades dispuestas a ser utilizadas en un mundo, un entorno, una población, diferente a la que este año encontraron al momento de graduarse. Durante el año 2019, cada uno de ustedes, fue culminando su carrera, y mientras transitaban las últimas etapas y exámenes, me imagino, planificaban de qué manera aplicarían su nuevo saber en su entorno

Perspectivas Ignacianas para ser un buen docente en la Universidad

Existe el concepto social que “saber” transforma al experto en un buen docente, peroprobablemente “saber” es la condición básica para ejercer la docencia. El objetivo de este trabajo es analizarlas características que superan al conocimiento para transformarse en un buen docente enriquecido por laVisión Ignaciana de esta actividad.MATERIAL Y MÉTODO: Para elaborar este informe se trabajó sobre tres documentos de alto impacto ennuestro hacer: 1) el paradigma Paradigma Ledesma – Kolvenbach; 2) Constitución apostólica sobre lasUniversidades Católicas de SS Juan Pablo II y 3) La pedagogía Ignaciana.DISCUSIÓN Y CONCLUSIÓN: Ser buen docente, parte del saber especifico, pero es mucho más quesimplemente saber, implica compromiso con la realidad y la capacidad de crear espacios, que favorecen laapropiación crítica del conocimiento y la actitud de búsqueda permanente por parte de la comunidadestudianti

La inteligencia artificial en la educación médica y la predicción en salud

La inteligencia artificial tiene el potencial de transformar la forma en que se brinda la atención médica. Puede respaldar mejoras en los resultados y aumentar la productividad y la eficiencia de la prestación de los servicios. En servicios de las diferentes especialidades los avances realizados a nivel hardware deben desarrollarse en paralelo con los métodos de aprendizaje automático, aspectos que la inteligencia artificial contribuye para promover un cambio de paradigma significativo en las más diversas áreas de la medicina. Es importante en la educación médica como eje para el conocimiento y en la toma de decisiones que pueden mejorar el desempeño de los profesionales. Los estudiantes de medicina de nueva generación pueden adaptarse perfectamente a los nuevos métodos digitalizados en un contexto médico globalizado, incluida la inteligencia artificial. Por ello es importante tener como objetivos a implementar en los planes de estudio e introducir programas educativos representativos de esta tecnología. Es fundamental que todas las áreas del Sistema de Salud tengan confianza en los sistemas informáticos específicamente en el aprendizaje profundo, no solo por la información concreta y objetiva que de él se deriva sino también por la posibilidad de predecir eventos futuros, brindando alta certeza en cuanto al diagnóstico y tratamiento de enfermedades

Blood pressure-lowering effects of nifedipine/candesartan combinations in high-risk individuals: Subgroup analysis of the DISTINCT randomised trial

The DISTINCT study (reDefining Intervention with Studies Testing Innovative Nifedipine GITS - Candesartan Therapy) investigated the efficacy and safety of nifedipine GITS/candesartan cilexetil combinations vs respective monotherapies and placebo in patients with hypertension. This descriptive sub-analysis examined blood pressure (BP)-lowering effects in high-risk participants, including those with renal impairment (estimated glomerular filtration rate<90 ml min-1, n=422), type 2 diabetes mellitus (n=202), hypercholesterolaemia (n=206) and cardiovascular (CV) risk factors (n=971), as well as the impact of gender, age and body mass index (BMI). Participants with grade I/II hypertension were randomised to treatment with nifedipine GITS (N) 20, 30, 60 mg and/or candesartan cilexetil (C) 4, 8, 16, 32 mg or placebo for 8 weeks. Mean systolic BP and diastolic BP reductions after treatment in high-risk participants were greater, overall, with N/C combinations vs respective monotherapies or placebo, with indicators of a dose-response effect. Highest rates of BP control (ESH/ESC 2013 guideline criteria) were also achieved with highest doses of N/C combinations in each high-risk subgroup. The benefits of combination therapy vs monotherapy were additionally observed in patient subgroups categorised by gender, age or BMI. All high-risk participants reported fewer vasodilatory adverse events in the pooled N/C combination therapy than the N monotherapy group. In conclusion, consistent with the DISTINCT main study outcomes, high-risk participants showed greater reductions in BP and higher control rates with N/C combinations compared with respective monotherapies and lesser vasodilatory side-effects compared with N monotherapy

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure &lt; 100 mmHg (n = 1127), estimated glomerular filtration rate &lt; 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Antihypertensive efficacy of amlodipine and losartan after two 'missed' doses in patients with mild to moderate essential hypertension

We compared the effects of amlodipine (5 - 10 mg, n = 94) and losartan (50 100 mg, n = 94) on the lowering of blood pressure (BP) at steady state and after two missed doses, as well as on tolerability. This was a randomized, double-blind study of 12 weeks of active treatment followed by 2 days of placebo treatment. Twenty-four-hour ambulatory blood pressure monitoring and office BP measurements were performed at baseline, week 12 and after the 2-day drug holiday. After 12 weeks, amlodipine was significantly more effective than losartan in reducing both 24-h systolic blood pressure (SBP) (-18.0 versus -10.8 mmHg) and diastolic blood pressure (DBP) (-10.6 versus -8.0 mmHg). While mean SBP and DBP for both treatments increased comparably during the drug holiday, BP values remained significantly lower than baseline for both treatments. The superior BP-lowering effect of amlodipine compared with losartan was maintained during the drug holiday.Hosp Rim & Hipertensao, Escola Paulista Med, Sao Paulo, BrazilPoliclin Bancario, Div Cardiol, Ctr Hipertens Arterial, Ciudad de Buenos Aires, ArgentinaHosp Santojanni, Serv Cardiol, Ciudad de Buenos Aires, ArgentinaClin Medellin, Medellin, ColombiaCtr Med Docente La Trinidad, Caracas, VenezuelaGen Hosp Durango, Durango, MexicoCtr Med Alemania, Quito, EcuadorRio de Janeiro Sch Med, Rio De Janeiro, BrazilUniv Sao Paulo, Sch Med, Sao Paulo, BrazilHosp Rim & Hipertensao, Escola Paulista Med, Sao Paulo, BrazilWeb of Scienc