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Papers by Nancy Solís
Las Redes Sociales Digitales (RSD) son herramientas ampliamente utilizados por los jovenes estudi... more Las Redes Sociales Digitales (RSD) son herramientas ampliamente utilizados por los jovenes estudiantes. Ellos las utilizan como un medio de comunicacion efectivo, mas que de aprendizaje. Es aqui, el momento de los profesores de aprovechar este medio de comunicacion para orientar su uso hacia el aprendizaje individual y posteriormente al aprendizaje colaborativo. Las RSD potencializan las formas de aprendizaje mas no las garantizan, por lo que es importante la implementacion de estrategias de aprendizaje colaborativas. En este articulo se presenta una definicion de las RSD, su evolucion y como se relacionan con los ambientes virtuales de aprendizaje. Ademas se establece la relacion entre las RSD y la teoria de aprendizaje constructivista. Finalmente, se propone un modelo de diseno instruccional y un conjunto de estrategias de aprendizaje colaborativas aplicables a las RSD, entre ellas: a) el metodo de la solucion de problemas, b) el metodo de proyectos individuales, c) el metodo del ...
Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease, 2020
et al., Chemical hypoxia induces pro-inflammatory signals in fat-laden hepatocytes and contribute... more et al., Chemical hypoxia induces pro-inflammatory signals in fat-laden hepatocytes and contributes to cellular crosstalk with Kupffer cells through extracellular vesicles, BBA-Molecular Basis of Disease(2020),
Annals of Hepatology, 2006
Background: Non-alcoholic steatohepatitis (NASH) is a metabolic disorder of the liver, which may ... more Background: Non-alcoholic steatohepatitis (NASH) is a metabolic disorder of the liver, which may evolve to fibrosis or cirrhosis. Pentoxifylline (PTX) has been postulated to act as an antifibrogenic agent able to inhibit hepatic stellate cell proliferation and collagen synthesis in vitro. Short-term studies suggest beneficial effects of PTX in experimental models of NASH. Aim: To study whether PTX can influence liver fibrogenesis in an animal model of NASH. Methods: To induce NASH, a choline-deficient diet (CDD) was given to Sprague-Dawley rats for 8 weeks. Rats were allocated to two experimental groups one receiving PTX (9 mg/kg/day) in drinking water. Control rats received a choline-supplemented diet. Biochemical and histological evaluation of fatty liver was performed by conventional techniques. In addition, mRNA levels of Pro-collagen I and transforming growth factor beta-1 were assessed by semi-quantitative RT-PCR and stellate cell activation by α α α α α-actin immunofluorescence stain. Results: After 8 weeks CDD induced a marked elevation of serum aminotransferases, a marked decrease in both hepatic and
Annals of Hepatology, 2011
Background. The plasminogen activator inhibitor type-1 (PAI-1) has been implicated in the regulat... more Background. The plasminogen activator inhibitor type-1 (PAI-1) has been implicated in the regulation of fibrinolysis and extracellular matrix components. The single base pair guanine insertion/deletion polymorphism (4G/5G) within the promoter region of the PAI-1 gene influences PAI-1 synthesis and may modulate hepatic fibrogenesis. Aim. To evaluate the influence of PAI-1 serum levels and 4G/5G polymorphism on the risk of liver fibrosis associated to non-alcoholic fatty liver disease (NAFLD) in morbidly obese patients. Material and methods. Case-control study of 50 obese patients undergoing bariatric surgery and 71 non-obese subjects matched by age and sex. Anthropometric and biochemical measurements were performed, including PAI-1 serum levels. Genomic DNA was obtained to assess the presence of 4G/5G polymorphism. Results. BMI, insulinemia, triglycerides, HOMA-IR, hypertension and diabetes were significantly higher in obese patients compared to control subjects. PAI-1 serum levels observed in obese patients were significantly lower (10.63 ± 4.82) compared to controls (14.26 ± 11.4; p < 0.05). No differences were observed in the PAI-1 4G/5G promoter genotypes frequencies (p = 0.12). No differences were observed in PAI-1 plasma levels among obese patients with liver fibrosis (10.64 ± 4.35) compared to patients without liver fibrosis (10.61 ± 5.2; p = 0.985). PAI-1 4G/5G promoter genotypes frequencies were similar in patients with or without liver fibrosis associated to NASH (p = 0.6). Conclusions. Morbidly obese patients had significantly lower PAI-1 serum levels with similar PAI-1 4G/5G genotypes frequencies compared to non-obese subjects. The frequency of 4G/5G genotypes in Chilean Hispanic healthy subjects was similar to that described in other populations. No association was found between PAI-1 serum levels or 4G/5G genotype with liver fibrosis in obese patients.
Annals of Hepatology, 2014
Background. Bile acid sequestration (BAS) with resins has shown antidiabetic effects in both huma... more Background. Bile acid sequestration (BAS) with resins has shown antidiabetic effects in both humans and animals. Since hepatic steatosis is commonly associated with type 2 diabetes mellitus and the effects of BAS on steatosis have not been explored in detail, we evaluated the effects of cholestyramine (CTM) administration on fatty liver development in the leptin-deficient obese mice. Aim. To study the effects of BAS on fatty liver development in obese (ob/ob) mice. Material and methods. 4 week-old ob/ob mice (B6.V-Lepob/J, n = 4-6 per group) were fed with or without CTM (control group) during 8 weeks. Serum and biliary parameters, glucose tolerance test (GTT), hepatic triglyceride content, liver histology and hepatic gene expression of relevant genes related to bile secretion, lipid and glucose metabolism were assessed. Results. Control 12-week-old mice exhibited marked obesity and hepatic steatosis. CTM administration expectedly determined a marked de-repression of 7-α-hydroxylase and decreased biliary bile acid secretion as well as improved GTT. CTM feeding showed no effects on hepatic triglyceride content or in the degree of steatosis on liver histology. CTM was associated with increased levels of serum alanine-aminotransferase. Conclusion. Although CTM administration positively affects glucose tolerance it does not prevent hepatic steatosis development in obese mice. Moreover, CTM feeding was associated to liver enzyme elevation in this model of NAFLD. Thus, the effects BAS on NAFLD need to be specifically addressed since this therapy might not be beneficial for this condition.
![Research paper thumbnail of [Undergraduate student's perception of clinical simulation workshops: assessment of an instrument]](https://attachments.academia-assets.com/103307464/thumbnails/1.jpg)
](Revista medica de Chile, 2018
Simulation is a useful training tool for undergraduate medical students. A valid instrument is ne... more Simulation is a useful training tool for undergraduate medical students. A valid instrument is needed to assess students' perception of simulation workshops. To adapt and validate an instrument to assess the undergraduate medical student's perception of simulation workshops of clinical procedures. Delphi Methodology was used to adapt the instrument. Exploratory and confirmatory analyses were performed to determine the construct validity and Cronbach's Alpha (0 to 1) for internal consistency of the instrument. A Delphi panel of 10 experts adapted a seven-item questionnaire (Likert scale 1-5; ranging from 7 to 35) and four open-questions. After 3-delphi-rounds, the instrument was administered to 210 students in six simulation training programs (Paracentesis, Cardiopulmonary Resuscitation, Airway management, Sutures, Thoracentesis and Nursing Procedures). The instrument was considered unidimensional in the factorial analysis. The overall median (Q1-Q3) score was 34 ranging ...
International journal of molecular sciences, Jan 2, 2018
Somatotropic axis dysfunction associated with non-alcoholic fatty liver disease (NAFLD) has poten... more Somatotropic axis dysfunction associated with non-alcoholic fatty liver disease (NAFLD) has potential multisystemic detrimental effects. Here, we analysed the effects of growth hormone (GH) and insulin growth factor-1 (IGF-1) supplementation on liver histology, adipokine profile and muscle function in an NAFLD model. C57BL/6 mice were fed with a high fat diet (HFD) for 12 weeks and were separated into three groups treated for 4 weeks with: (1) High fat diet (HFD) ( = 10); (2) HFD + GH 9 μg/g/d ( = 10); (3) HFD + IGF-1 0.02 µg/g/d ( = 9). A control group fed a chow diet was included ( = 6). Liver histology, liver triglycerides content, serum alanine aminotransferase (ALT) activity, adiponectin and leptin serum levels, in vivo muscle strength, tetanic force and muscle fibre cross-sectional area (CSA) were measured. HFD + GH and HFD + IGF-1 groups showed significantly lower ALT activity compared to HFD ( < 0.01). Liver triglyceride content in HFD + GH was decreased compared...
Scientific reports, Jan 14, 2017
Therapy for nonalcoholic steatohepatitis (NASH) is limited. Andrographolide (ANDRO), a botanical ... more Therapy for nonalcoholic steatohepatitis (NASH) is limited. Andrographolide (ANDRO), a botanical compound, has a potent anti-inflammatory activity due to its ability to inhibit NF-κB. ANDRO has been also shown to inhibit the NLRP3 inflammasome, a relevant pathway in NASH. Our aim was to evaluate the effects of ANDRO in NASH and its influence on inflammasome activation in this setting. Thus, mice were fed a choline-deficient-amino-acid-defined (CDAA) diet with/without concomitant ANDRO administration (1 mg/kg, 3-times/week). Also, we assessed serum levels of alanine-aminotransferase (ALT), liver histology, hepatic triglyceride content (HTC) and hepatic expression of pro-inflammatory, pro-fibrotic and inflammasome genes. Inflammasome activation was also evaluated in fat-laden HepG2 cells. Our results showed that ANDRO administration decreased HTC and attenuated hepatic inflammation and fibrosis in CDAA-fed mice. ANDRO treatment determined a strong reduction in hepatic macrophage infil...
Academic Radiology, 2016
Rationale and Objectives: Radiology teachers are well trained in their specialty; however, when w... more Rationale and Objectives: Radiology teachers are well trained in their specialty; however, when working in academic institutions, faculty development and promotion through the education pathway tends to be based on their teaching knowledge and skills. The aim of this study is to assess psychometric properties of the Medicina Universidad Católica-Radiology 32 items (MEDUC-RX32), an instrument designed to evaluate the performance of postgraduate radiology teachers and to identify the best teachers. Materials and Methods: Mixed methodology was used, including qualitative and quantitative phases. The psychometric properties of the MEDUC-RX32 survey were performed by factor analysis (validity), Cronbach alpha coefficient, and G coefficient (reliability). The residents assessed their teachers and simultaneously voted for the "best teacher," which was used as a gold standard for the receiver operating characteristic curves construction comparing their votes with the global score. Results: A total of 28 residents answered 164 surveys. The global score was 6.23 ± 0.8 (scale from 1 to 7). The factor analysis showed six domains of the resident's perception: (1) tutorial teaching, feedback, and independent learning; (2) communication and teamwork; (3) learning objectives; (4) respectful behavior; (5) radiological report; and (6) teaching and care support. The tutor's strengths were related with respectful behavior and teamwork. The instrument is highly reliable with a Cronbach alpha of 0.937 and a G coefficient of 0.831 (with a minimum of 8 residents). The MEDUC-RX32 instrument has a sensitivity of 91.7% and specificity of 83.3% to identify tutors as best teachers with at least one vote with an area under the receiver operating characteristic curve of 0.931 with a cutoff of 5.94. Conclusions: The MEDC-RX32 instrument is a multidimensional, valid, and highly reliable method to evaluate radiology teachers, identifying teachers with excellence in tutorial teaching in a postgraduate radiology program.
Cuadernos de Antropología, 2014
Resumen: Partiendo del concepto de economía popular, este trabajo pretende acercar al lector a la... more Resumen: Partiendo del concepto de economía popular, este trabajo pretende acercar al lector a la cotidianidad de los vendedores y vendedoras ambulantes josefinos, esbozando el ambiente de la venta ambulante y definiendo las estructuras organizadas alrededor de esta actividad. La convivencia, la recolección de relatos y una revisión de su memoria histórica permitieron concluir que las ventas ambulantes no son solamente una alternativa de sustento ante las condiciones excluyentes de la formalidad. Es un oficio heredado que se disfruta muchas veces y permanece a pesar de las duras circunstancias en las calles del San José caóticamente ordenado.
Educación Médica, 2015
Students' perceptions of their educational environment (EE) have been studied in undergraduate an... more Students' perceptions of their educational environment (EE) have been studied in undergraduate and postgraduate curricula. The Ambulatory Care Learning Educational Environment Measure (ACLEEM) is an inventory that was recently developed to measure the EE in postgraduate ambulatory settings. The aim of this study was to assess the psychometric properties of the inventory. Methods: A mixed methodology was used to develop the ACLEEM including: Grounded theory (8 focus groups); a two-round Delphi technique to identify consensus; and a pilot study. The inlarge cohort of clerks and residents in Chile during 2010-2011. Psychometric measurements included factor analysis followed by Varimax rotation for construct validity, Cronbach's alpha co-Results: Four-hundred and eleven students responded: 151 clerks (83.9% of the target population) and 260 residents (74% of the target population) from 31 postgraduate programs. The factor analyses showed an eight factor instrument. ACLEEM was found highly reliable with a Cronbach's alpha of 0.94 and D-study revealed a reliable outcome for residency programs with at positive without differences between groups: 152.52 ± 23.36 (76.26%) and 150.61 ± 24.62 (75.30%), respectively (p=0.761). 132 A. Riquelme et al. The 50-item ACLEEM inventory is a multidimensional and valid instrument requiring only 15 respondents for reliable results. We recommend using it to measure the EE in the ambulatory postgraduate Spanish-speaking programs.
Revista médica de Chile, 2015
Development of MEDUC-PG14 survey to assess postgraduate teaching in medical specialties Backgroun... more Development of MEDUC-PG14 survey to assess postgraduate teaching in medical specialties Background: Feedback is one of the most important tools to improve teaching in medical education. Aim: To develop an instrument to assess the performance of clinical postgraduate teachers in medical specialties. Material and Methods: A qualitative methodology consisting in interviews and focus-groups followed by a quantitative methodology to generate consensus, was employed. After generating the instrument, psychometric tests were performed to assess the construct validity (factor analysis) and reliability (Cronbach's alpha). Results: Experts in medical education, teachers and residents of a medical school participated in interviews and focus groups. With this information, 26 categories (79 items) were proposed and reduced to 14 items (Likert scale 1-5) by an expert's Delphi panel, generating the MEDUC-PG14 survey, which was answered by 123 residents from different programs of medical specialties. Construct validity was carried out. Factor analysis showed three domains: Teaching and evaluation, respectful behavior towards patients and health care team, and providing feedback. The global score was 4.46 ± 0.94 (89% of the maximum). One teachers' strength, as evaluated by their residents was "respectful behavior" with 4.85 ± 0.42 (97% of the maximum). "Providing feedback" obtained 4.09 ± 1.0 points (81.8% of the maximum). MEDUC-PG14 survey had a Cronbach's alpha coefficient of 0.947. Conclusions: MEDUC-PG14 survey is a useful and reliable guide for teacher evaluation in medical specialty programs. Also provides feedback to improve educational skills of postgraduate clinical teachers.
Revista médica de Chile, 2015
Introduction of virtual patients to clinical case portfolios for undergraduate medical students B... more Introduction of virtual patients to clinical case portfolios for undergraduate medical students Background: In 2007, a Clinical-Case-Portfolio (CCP) was introduced as a new assessment instrument for fourth grade undergraduate medical students. Since then, several changes have been implemented such as reduction on the number of clinical cases, peer review and the introduction of virtual patient to the portfolio. Aim: To describe the virtual patient model incorporated to the CCP and assess the perception of this change and its effects on the performance of undergraduate students. Material and Methods: Virtual patients were implemented based on prototype clinical cases with specific syndromes. Students' perceptions about CCP before and after the introduction of virtual patients were evaluated using a validated questionnaire that was answered voluntarily and anonymously. Results: Overall perception of CCP significantly improved after the incorporation of virtual patients (97.1 ± 24.9 and 111.3 ± 25.7 points; 57.8 and 66.2% respectively). The same improvements were observed for the domains "Student Learning", "Organization and Evaluation", "Teaching Methodology" and "Integration". In both years, students obtained high grades in CCP evaluations. However CCP grades were not significantly correlated with integrated final grades. Conclusions: The incorporation of virtual patients improved undergraduate students' perception of CCP.
Liver International, 2015
Background-Therapeutic options to treat Non-alcoholic steatohepatitis (NASH) are limited. Mineral... more Background-Therapeutic options to treat Non-alcoholic steatohepatitis (NASH) are limited. Mineralocorticoid receptor (MR) activation could play a role in hepatic fibrogenesis and its modulation could be beneficial for NASH. Aim-To investigate whether eplerenone, a specific MR antagonist, ameliorates liver damage in experimental NASH. Methods-C57bl6 mice were fed a choline-deficient-amino-acid-defined (CDAA) diet for 22 weeks with or without eplerenone supplementation. Serum levels of aminotransferases and aldosterone were measured and hepatic steatosis, inflammation, and fibrosis scored histologically. Hepatic triglyceride content (HTC) and hepatic mRNA levels of pro-inflammatory pro-fibrotic, oxidative stress-associated genes and of MR were also assessed.
Revista médica de Chile, 2013
Serum levels of alanine aminotransferase in Chilean population: analysis of results of the nation... more Serum levels of alanine aminotransferase in Chilean population: analysis of results of the national health survey 2009-2010 Background: Determination of Alanine aminotransferase serum levels ([ALT] s) is a sensitive and reliable test for liver diseases.
Revista médica de Chile, 2013
Identifying the main training needs of postgraduate medical program managers Background: Training... more Identifying the main training needs of postgraduate medical program managers Background: Training of postgraduate medical specialty program managers (PMSPM) is essential for the proper development of their programs. Aim: To identify the main training needs of PMSPM at a medical school. Material and Methods: A mixed-methodology approach was implemented including focus group/interviews and the administration of the Program Managers Training Needs Assessment Questionnaire (PROMANAQ) developed by an expert panel with 59 items (with two sections: relevance/performance-selfperception). Higher priority was assigned to items with high relevance and low performance. Results: Forty five PMSPM completed the PROMANAQ (81.8% response rate). Both sections of PROMANAQ were highly reliable (Cronbach alpha of 0.95/0.97 for relevance/performance-self-perception, respectively). The items with higher priority value were evaluation of clinical educators, evaluation of teaching programs and accreditation of programs. Ten PMSPM were included in the focus group (18.2% of the universe). The findings of the qualitative component were concordant with the areas explored in the questionnaire. Conclusions: The PROMANAQ is valid and reliable to identify the training needs of PMSPM. The views of PMSPM must be taken into account for faculty development planning.
Revista médica de Chile, 2012
Evaluation of the educational environment in medical specialty programs Background: The Postgradu... more Evaluation of the educational environment in medical specialty programs Background: The Postgraduate Hospital Education Environment Measure (PHEEM) questionnaire, is a valid and reliable instrument to measure the educational environment (EE) in postgraduate medical education. Aim: To evaluate the EE perceived by the residents of a postgraduate training program using the PHEEM. Material and Methods: The PHEEM was applied in 2010-2011 in 35 specialty programs. We calculated their individual results and compared means of both global and individual domain scores of the PHEEM, by gender, university of origin and nationality. Cronbach's alpha coefficients and D study (Generalizability theory) were performed for reliability. Results: Three hundred eighteen residents were surveyed (75.7% of the total universe). The mean score of the PHEEM was 105.09 ± 22.46 (65.7% of the maximal score) which is considered a positive EE. The instrument is highly reliable (Cronbach´s alpha = 0.934). The D study found that 15 subjects are required to obtain reliable results (G coefficient = 0.813). There were no significant differences between gender and university of origin. Foreigners evaluated better the EE than Chileans and racism was not perceived. The programs showed a safe physical environment and teachers with good clinical skills. The negative aspects perceived were a lack of information about working hours, insufficient academic counseling, and scanty time left for extracurricular activities. Conclusions: This questionnaire allowed us to identify positive aspects of the EE, and areas to be improved in the specialty programs. The PHEEM is a useful instrument to evaluate the EE in Spanish-speaking participants of medical specialty programs.
Obesity Surgery, 2010
Background Reduced serum levels of adiponectin have been associated with insulin resistance and n... more Background Reduced serum levels of adiponectin have been associated with insulin resistance and non-alcoholic fatty liver disease (NAFLD). However, the relationship between serum adiponectin levels and hepatic histology in NAFLD is controversial. The aim of this study was to
Medical Teacher, 2012
Background: Students' perceptions of their educational environment (EE) have been studied in unde... more Background: Students' perceptions of their educational environment (EE) have been studied in undergraduate and postgraduate curricula. Postgraduate EE has been measured in hospital settings. However, there are no instruments available to measure the EE in postgraduate ambulatory settings. Aim: The aim of this study was to develop the ''Ambulatory Care Learning Education Environment Measure'' (ACLEEM). Methods: A mixed methodology was used including three stages: (1) Grounded theory (focus groups); (2) Delphi technique to identify consensus; and (3) Pilot study. Results: Three quota samples of approximately 60 stakeholders were formed, one as Focus Groups and two as Delphi panels. Eight focus groups were carried out including 58 residents (Latin-American Spanish speakers). The results were analysed and 173 items were offered to a National Delphi panel (61 residents and teachers). They reduced in two rounds the number of important items to 54. The 54-item questionnaire was then piloted with 63 residents and refined to the final version of the ACLEEM with 50 items and three domains. Conclusions: The 50-item inventory is a valid instrument to measure the EE in postgraduate ambulatory setting in Chile. Largescale administration of the ACLEEM questionnaire to evaluate its construct validity and reliability are the next steps to test the psychometric properties of the instrument.
Liver Transplantation, 2003
Las Redes Sociales Digitales (RSD) son herramientas ampliamente utilizados por los jovenes estudi... more Las Redes Sociales Digitales (RSD) son herramientas ampliamente utilizados por los jovenes estudiantes. Ellos las utilizan como un medio de comunicacion efectivo, mas que de aprendizaje. Es aqui, el momento de los profesores de aprovechar este medio de comunicacion para orientar su uso hacia el aprendizaje individual y posteriormente al aprendizaje colaborativo. Las RSD potencializan las formas de aprendizaje mas no las garantizan, por lo que es importante la implementacion de estrategias de aprendizaje colaborativas. En este articulo se presenta una definicion de las RSD, su evolucion y como se relacionan con los ambientes virtuales de aprendizaje. Ademas se establece la relacion entre las RSD y la teoria de aprendizaje constructivista. Finalmente, se propone un modelo de diseno instruccional y un conjunto de estrategias de aprendizaje colaborativas aplicables a las RSD, entre ellas: a) el metodo de la solucion de problemas, b) el metodo de proyectos individuales, c) el metodo del ...
Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease, 2020
et al., Chemical hypoxia induces pro-inflammatory signals in fat-laden hepatocytes and contribute... more et al., Chemical hypoxia induces pro-inflammatory signals in fat-laden hepatocytes and contributes to cellular crosstalk with Kupffer cells through extracellular vesicles, BBA-Molecular Basis of Disease(2020),
Annals of Hepatology, 2006
Background: Non-alcoholic steatohepatitis (NASH) is a metabolic disorder of the liver, which may ... more Background: Non-alcoholic steatohepatitis (NASH) is a metabolic disorder of the liver, which may evolve to fibrosis or cirrhosis. Pentoxifylline (PTX) has been postulated to act as an antifibrogenic agent able to inhibit hepatic stellate cell proliferation and collagen synthesis in vitro. Short-term studies suggest beneficial effects of PTX in experimental models of NASH. Aim: To study whether PTX can influence liver fibrogenesis in an animal model of NASH. Methods: To induce NASH, a choline-deficient diet (CDD) was given to Sprague-Dawley rats for 8 weeks. Rats were allocated to two experimental groups one receiving PTX (9 mg/kg/day) in drinking water. Control rats received a choline-supplemented diet. Biochemical and histological evaluation of fatty liver was performed by conventional techniques. In addition, mRNA levels of Pro-collagen I and transforming growth factor beta-1 were assessed by semi-quantitative RT-PCR and stellate cell activation by α α α α α-actin immunofluorescence stain. Results: After 8 weeks CDD induced a marked elevation of serum aminotransferases, a marked decrease in both hepatic and
Annals of Hepatology, 2011
Background. The plasminogen activator inhibitor type-1 (PAI-1) has been implicated in the regulat... more Background. The plasminogen activator inhibitor type-1 (PAI-1) has been implicated in the regulation of fibrinolysis and extracellular matrix components. The single base pair guanine insertion/deletion polymorphism (4G/5G) within the promoter region of the PAI-1 gene influences PAI-1 synthesis and may modulate hepatic fibrogenesis. Aim. To evaluate the influence of PAI-1 serum levels and 4G/5G polymorphism on the risk of liver fibrosis associated to non-alcoholic fatty liver disease (NAFLD) in morbidly obese patients. Material and methods. Case-control study of 50 obese patients undergoing bariatric surgery and 71 non-obese subjects matched by age and sex. Anthropometric and biochemical measurements were performed, including PAI-1 serum levels. Genomic DNA was obtained to assess the presence of 4G/5G polymorphism. Results. BMI, insulinemia, triglycerides, HOMA-IR, hypertension and diabetes were significantly higher in obese patients compared to control subjects. PAI-1 serum levels observed in obese patients were significantly lower (10.63 ± 4.82) compared to controls (14.26 ± 11.4; p < 0.05). No differences were observed in the PAI-1 4G/5G promoter genotypes frequencies (p = 0.12). No differences were observed in PAI-1 plasma levels among obese patients with liver fibrosis (10.64 ± 4.35) compared to patients without liver fibrosis (10.61 ± 5.2; p = 0.985). PAI-1 4G/5G promoter genotypes frequencies were similar in patients with or without liver fibrosis associated to NASH (p = 0.6). Conclusions. Morbidly obese patients had significantly lower PAI-1 serum levels with similar PAI-1 4G/5G genotypes frequencies compared to non-obese subjects. The frequency of 4G/5G genotypes in Chilean Hispanic healthy subjects was similar to that described in other populations. No association was found between PAI-1 serum levels or 4G/5G genotype with liver fibrosis in obese patients.
Annals of Hepatology, 2014
Background. Bile acid sequestration (BAS) with resins has shown antidiabetic effects in both huma... more Background. Bile acid sequestration (BAS) with resins has shown antidiabetic effects in both humans and animals. Since hepatic steatosis is commonly associated with type 2 diabetes mellitus and the effects of BAS on steatosis have not been explored in detail, we evaluated the effects of cholestyramine (CTM) administration on fatty liver development in the leptin-deficient obese mice. Aim. To study the effects of BAS on fatty liver development in obese (ob/ob) mice. Material and methods. 4 week-old ob/ob mice (B6.V-Lepob/J, n = 4-6 per group) were fed with or without CTM (control group) during 8 weeks. Serum and biliary parameters, glucose tolerance test (GTT), hepatic triglyceride content, liver histology and hepatic gene expression of relevant genes related to bile secretion, lipid and glucose metabolism were assessed. Results. Control 12-week-old mice exhibited marked obesity and hepatic steatosis. CTM administration expectedly determined a marked de-repression of 7-α-hydroxylase and decreased biliary bile acid secretion as well as improved GTT. CTM feeding showed no effects on hepatic triglyceride content or in the degree of steatosis on liver histology. CTM was associated with increased levels of serum alanine-aminotransferase. Conclusion. Although CTM administration positively affects glucose tolerance it does not prevent hepatic steatosis development in obese mice. Moreover, CTM feeding was associated to liver enzyme elevation in this model of NAFLD. Thus, the effects BAS on NAFLD need to be specifically addressed since this therapy might not be beneficial for this condition.
Revista medica de Chile, 2018
Simulation is a useful training tool for undergraduate medical students. A valid instrument is ne... more Simulation is a useful training tool for undergraduate medical students. A valid instrument is needed to assess students' perception of simulation workshops. To adapt and validate an instrument to assess the undergraduate medical student's perception of simulation workshops of clinical procedures. Delphi Methodology was used to adapt the instrument. Exploratory and confirmatory analyses were performed to determine the construct validity and Cronbach's Alpha (0 to 1) for internal consistency of the instrument. A Delphi panel of 10 experts adapted a seven-item questionnaire (Likert scale 1-5; ranging from 7 to 35) and four open-questions. After 3-delphi-rounds, the instrument was administered to 210 students in six simulation training programs (Paracentesis, Cardiopulmonary Resuscitation, Airway management, Sutures, Thoracentesis and Nursing Procedures). The instrument was considered unidimensional in the factorial analysis. The overall median (Q1-Q3) score was 34 ranging ...
International journal of molecular sciences, Jan 2, 2018
Somatotropic axis dysfunction associated with non-alcoholic fatty liver disease (NAFLD) has poten... more Somatotropic axis dysfunction associated with non-alcoholic fatty liver disease (NAFLD) has potential multisystemic detrimental effects. Here, we analysed the effects of growth hormone (GH) and insulin growth factor-1 (IGF-1) supplementation on liver histology, adipokine profile and muscle function in an NAFLD model. C57BL/6 mice were fed with a high fat diet (HFD) for 12 weeks and were separated into three groups treated for 4 weeks with: (1) High fat diet (HFD) ( = 10); (2) HFD + GH 9 μg/g/d ( = 10); (3) HFD + IGF-1 0.02 µg/g/d ( = 9). A control group fed a chow diet was included ( = 6). Liver histology, liver triglycerides content, serum alanine aminotransferase (ALT) activity, adiponectin and leptin serum levels, in vivo muscle strength, tetanic force and muscle fibre cross-sectional area (CSA) were measured. HFD + GH and HFD + IGF-1 groups showed significantly lower ALT activity compared to HFD ( < 0.01). Liver triglyceride content in HFD + GH was decreased compared...
Scientific reports, Jan 14, 2017
Therapy for nonalcoholic steatohepatitis (NASH) is limited. Andrographolide (ANDRO), a botanical ... more Therapy for nonalcoholic steatohepatitis (NASH) is limited. Andrographolide (ANDRO), a botanical compound, has a potent anti-inflammatory activity due to its ability to inhibit NF-κB. ANDRO has been also shown to inhibit the NLRP3 inflammasome, a relevant pathway in NASH. Our aim was to evaluate the effects of ANDRO in NASH and its influence on inflammasome activation in this setting. Thus, mice were fed a choline-deficient-amino-acid-defined (CDAA) diet with/without concomitant ANDRO administration (1 mg/kg, 3-times/week). Also, we assessed serum levels of alanine-aminotransferase (ALT), liver histology, hepatic triglyceride content (HTC) and hepatic expression of pro-inflammatory, pro-fibrotic and inflammasome genes. Inflammasome activation was also evaluated in fat-laden HepG2 cells. Our results showed that ANDRO administration decreased HTC and attenuated hepatic inflammation and fibrosis in CDAA-fed mice. ANDRO treatment determined a strong reduction in hepatic macrophage infil...
Academic Radiology, 2016
Rationale and Objectives: Radiology teachers are well trained in their specialty; however, when w... more Rationale and Objectives: Radiology teachers are well trained in their specialty; however, when working in academic institutions, faculty development and promotion through the education pathway tends to be based on their teaching knowledge and skills. The aim of this study is to assess psychometric properties of the Medicina Universidad Católica-Radiology 32 items (MEDUC-RX32), an instrument designed to evaluate the performance of postgraduate radiology teachers and to identify the best teachers. Materials and Methods: Mixed methodology was used, including qualitative and quantitative phases. The psychometric properties of the MEDUC-RX32 survey were performed by factor analysis (validity), Cronbach alpha coefficient, and G coefficient (reliability). The residents assessed their teachers and simultaneously voted for the "best teacher," which was used as a gold standard for the receiver operating characteristic curves construction comparing their votes with the global score. Results: A total of 28 residents answered 164 surveys. The global score was 6.23 ± 0.8 (scale from 1 to 7). The factor analysis showed six domains of the resident's perception: (1) tutorial teaching, feedback, and independent learning; (2) communication and teamwork; (3) learning objectives; (4) respectful behavior; (5) radiological report; and (6) teaching and care support. The tutor's strengths were related with respectful behavior and teamwork. The instrument is highly reliable with a Cronbach alpha of 0.937 and a G coefficient of 0.831 (with a minimum of 8 residents). The MEDUC-RX32 instrument has a sensitivity of 91.7% and specificity of 83.3% to identify tutors as best teachers with at least one vote with an area under the receiver operating characteristic curve of 0.931 with a cutoff of 5.94. Conclusions: The MEDC-RX32 instrument is a multidimensional, valid, and highly reliable method to evaluate radiology teachers, identifying teachers with excellence in tutorial teaching in a postgraduate radiology program.
Cuadernos de Antropología, 2014
Resumen: Partiendo del concepto de economía popular, este trabajo pretende acercar al lector a la... more Resumen: Partiendo del concepto de economía popular, este trabajo pretende acercar al lector a la cotidianidad de los vendedores y vendedoras ambulantes josefinos, esbozando el ambiente de la venta ambulante y definiendo las estructuras organizadas alrededor de esta actividad. La convivencia, la recolección de relatos y una revisión de su memoria histórica permitieron concluir que las ventas ambulantes no son solamente una alternativa de sustento ante las condiciones excluyentes de la formalidad. Es un oficio heredado que se disfruta muchas veces y permanece a pesar de las duras circunstancias en las calles del San José caóticamente ordenado.
Educación Médica, 2015
Students' perceptions of their educational environment (EE) have been studied in undergraduate an... more Students' perceptions of their educational environment (EE) have been studied in undergraduate and postgraduate curricula. The Ambulatory Care Learning Educational Environment Measure (ACLEEM) is an inventory that was recently developed to measure the EE in postgraduate ambulatory settings. The aim of this study was to assess the psychometric properties of the inventory. Methods: A mixed methodology was used to develop the ACLEEM including: Grounded theory (8 focus groups); a two-round Delphi technique to identify consensus; and a pilot study. The inlarge cohort of clerks and residents in Chile during 2010-2011. Psychometric measurements included factor analysis followed by Varimax rotation for construct validity, Cronbach's alpha co-Results: Four-hundred and eleven students responded: 151 clerks (83.9% of the target population) and 260 residents (74% of the target population) from 31 postgraduate programs. The factor analyses showed an eight factor instrument. ACLEEM was found highly reliable with a Cronbach's alpha of 0.94 and D-study revealed a reliable outcome for residency programs with at positive without differences between groups: 152.52 ± 23.36 (76.26%) and 150.61 ± 24.62 (75.30%), respectively (p=0.761). 132 A. Riquelme et al. The 50-item ACLEEM inventory is a multidimensional and valid instrument requiring only 15 respondents for reliable results. We recommend using it to measure the EE in the ambulatory postgraduate Spanish-speaking programs.
Revista médica de Chile, 2015
Development of MEDUC-PG14 survey to assess postgraduate teaching in medical specialties Backgroun... more Development of MEDUC-PG14 survey to assess postgraduate teaching in medical specialties Background: Feedback is one of the most important tools to improve teaching in medical education. Aim: To develop an instrument to assess the performance of clinical postgraduate teachers in medical specialties. Material and Methods: A qualitative methodology consisting in interviews and focus-groups followed by a quantitative methodology to generate consensus, was employed. After generating the instrument, psychometric tests were performed to assess the construct validity (factor analysis) and reliability (Cronbach's alpha). Results: Experts in medical education, teachers and residents of a medical school participated in interviews and focus groups. With this information, 26 categories (79 items) were proposed and reduced to 14 items (Likert scale 1-5) by an expert's Delphi panel, generating the MEDUC-PG14 survey, which was answered by 123 residents from different programs of medical specialties. Construct validity was carried out. Factor analysis showed three domains: Teaching and evaluation, respectful behavior towards patients and health care team, and providing feedback. The global score was 4.46 ± 0.94 (89% of the maximum). One teachers' strength, as evaluated by their residents was "respectful behavior" with 4.85 ± 0.42 (97% of the maximum). "Providing feedback" obtained 4.09 ± 1.0 points (81.8% of the maximum). MEDUC-PG14 survey had a Cronbach's alpha coefficient of 0.947. Conclusions: MEDUC-PG14 survey is a useful and reliable guide for teacher evaluation in medical specialty programs. Also provides feedback to improve educational skills of postgraduate clinical teachers.
Revista médica de Chile, 2015
Introduction of virtual patients to clinical case portfolios for undergraduate medical students B... more Introduction of virtual patients to clinical case portfolios for undergraduate medical students Background: In 2007, a Clinical-Case-Portfolio (CCP) was introduced as a new assessment instrument for fourth grade undergraduate medical students. Since then, several changes have been implemented such as reduction on the number of clinical cases, peer review and the introduction of virtual patient to the portfolio. Aim: To describe the virtual patient model incorporated to the CCP and assess the perception of this change and its effects on the performance of undergraduate students. Material and Methods: Virtual patients were implemented based on prototype clinical cases with specific syndromes. Students' perceptions about CCP before and after the introduction of virtual patients were evaluated using a validated questionnaire that was answered voluntarily and anonymously. Results: Overall perception of CCP significantly improved after the incorporation of virtual patients (97.1 ± 24.9 and 111.3 ± 25.7 points; 57.8 and 66.2% respectively). The same improvements were observed for the domains "Student Learning", "Organization and Evaluation", "Teaching Methodology" and "Integration". In both years, students obtained high grades in CCP evaluations. However CCP grades were not significantly correlated with integrated final grades. Conclusions: The incorporation of virtual patients improved undergraduate students' perception of CCP.
Liver International, 2015
Background-Therapeutic options to treat Non-alcoholic steatohepatitis (NASH) are limited. Mineral... more Background-Therapeutic options to treat Non-alcoholic steatohepatitis (NASH) are limited. Mineralocorticoid receptor (MR) activation could play a role in hepatic fibrogenesis and its modulation could be beneficial for NASH. Aim-To investigate whether eplerenone, a specific MR antagonist, ameliorates liver damage in experimental NASH. Methods-C57bl6 mice were fed a choline-deficient-amino-acid-defined (CDAA) diet for 22 weeks with or without eplerenone supplementation. Serum levels of aminotransferases and aldosterone were measured and hepatic steatosis, inflammation, and fibrosis scored histologically. Hepatic triglyceride content (HTC) and hepatic mRNA levels of pro-inflammatory pro-fibrotic, oxidative stress-associated genes and of MR were also assessed.
Revista médica de Chile, 2013
Serum levels of alanine aminotransferase in Chilean population: analysis of results of the nation... more Serum levels of alanine aminotransferase in Chilean population: analysis of results of the national health survey 2009-2010 Background: Determination of Alanine aminotransferase serum levels ([ALT] s) is a sensitive and reliable test for liver diseases.
Revista médica de Chile, 2013
Identifying the main training needs of postgraduate medical program managers Background: Training... more Identifying the main training needs of postgraduate medical program managers Background: Training of postgraduate medical specialty program managers (PMSPM) is essential for the proper development of their programs. Aim: To identify the main training needs of PMSPM at a medical school. Material and Methods: A mixed-methodology approach was implemented including focus group/interviews and the administration of the Program Managers Training Needs Assessment Questionnaire (PROMANAQ) developed by an expert panel with 59 items (with two sections: relevance/performance-selfperception). Higher priority was assigned to items with high relevance and low performance. Results: Forty five PMSPM completed the PROMANAQ (81.8% response rate). Both sections of PROMANAQ were highly reliable (Cronbach alpha of 0.95/0.97 for relevance/performance-self-perception, respectively). The items with higher priority value were evaluation of clinical educators, evaluation of teaching programs and accreditation of programs. Ten PMSPM were included in the focus group (18.2% of the universe). The findings of the qualitative component were concordant with the areas explored in the questionnaire. Conclusions: The PROMANAQ is valid and reliable to identify the training needs of PMSPM. The views of PMSPM must be taken into account for faculty development planning.
Revista médica de Chile, 2012
Evaluation of the educational environment in medical specialty programs Background: The Postgradu... more Evaluation of the educational environment in medical specialty programs Background: The Postgraduate Hospital Education Environment Measure (PHEEM) questionnaire, is a valid and reliable instrument to measure the educational environment (EE) in postgraduate medical education. Aim: To evaluate the EE perceived by the residents of a postgraduate training program using the PHEEM. Material and Methods: The PHEEM was applied in 2010-2011 in 35 specialty programs. We calculated their individual results and compared means of both global and individual domain scores of the PHEEM, by gender, university of origin and nationality. Cronbach's alpha coefficients and D study (Generalizability theory) were performed for reliability. Results: Three hundred eighteen residents were surveyed (75.7% of the total universe). The mean score of the PHEEM was 105.09 ± 22.46 (65.7% of the maximal score) which is considered a positive EE. The instrument is highly reliable (Cronbach´s alpha = 0.934). The D study found that 15 subjects are required to obtain reliable results (G coefficient = 0.813). There were no significant differences between gender and university of origin. Foreigners evaluated better the EE than Chileans and racism was not perceived. The programs showed a safe physical environment and teachers with good clinical skills. The negative aspects perceived were a lack of information about working hours, insufficient academic counseling, and scanty time left for extracurricular activities. Conclusions: This questionnaire allowed us to identify positive aspects of the EE, and areas to be improved in the specialty programs. The PHEEM is a useful instrument to evaluate the EE in Spanish-speaking participants of medical specialty programs.
Obesity Surgery, 2010
Background Reduced serum levels of adiponectin have been associated with insulin resistance and n... more Background Reduced serum levels of adiponectin have been associated with insulin resistance and non-alcoholic fatty liver disease (NAFLD). However, the relationship between serum adiponectin levels and hepatic histology in NAFLD is controversial. The aim of this study was to
Medical Teacher, 2012
Background: Students' perceptions of their educational environment (EE) have been studied in unde... more Background: Students' perceptions of their educational environment (EE) have been studied in undergraduate and postgraduate curricula. Postgraduate EE has been measured in hospital settings. However, there are no instruments available to measure the EE in postgraduate ambulatory settings. Aim: The aim of this study was to develop the ''Ambulatory Care Learning Education Environment Measure'' (ACLEEM). Methods: A mixed methodology was used including three stages: (1) Grounded theory (focus groups); (2) Delphi technique to identify consensus; and (3) Pilot study. Results: Three quota samples of approximately 60 stakeholders were formed, one as Focus Groups and two as Delphi panels. Eight focus groups were carried out including 58 residents (Latin-American Spanish speakers). The results were analysed and 173 items were offered to a National Delphi panel (61 residents and teachers). They reduced in two rounds the number of important items to 54. The 54-item questionnaire was then piloted with 63 residents and refined to the final version of the ACLEEM with 50 items and three domains. Conclusions: The 50-item inventory is a valid instrument to measure the EE in postgraduate ambulatory setting in Chile. Largescale administration of the ACLEEM questionnaire to evaluate its construct validity and reliability are the next steps to test the psychometric properties of the instrument.
Liver Transplantation, 2003