Scielo RSS <![CDATA[Revista médica de Chile]]> vol. 148 num. 12 lang. es <![CDATA[SciELO Logo]]> <![CDATA[Autorización de uso de emergencia primera vacuna RNA para COVID-19 en Chile]]> <![CDATA[Análisis de sobrevida en pacientes incidentes de hemodiálisis en Chile, 2013-2019]]> Background: Renal replacement therapies, especially hemodialysis (HD) in end-stage kidney disease, avoid an inevitable death caused by the disease. However, in elderly patients with multiple comorbidities, this therapy could derive in a comparable survival than conservative management. Considering that HD represents a high cost for the health system, it is worth analyzing the effects of HD on survival. Aim: To analyze the survival and mortality of all national health security system's patients (FONASA) admitted to HD in Chile from 2013 to 2019. Material and Methods: We requested to the Ministry of Health information about all patients affiliated to the public health insurance system that started dialysis between 2013 and 2019. We evaluated the influence of age when starting HD, sex, presence of hypertension, presence of diabetes mellitus (DM), the region of residence, and year of admission on mortality. Results: A total of 24,113 patients aged 61 ± 15 years (45% women) were analyzed. Forty five percent of patients were aged &gt; 65 years. After 5 years of follow-up, the median survival in this age group was 36.1 months. Among patients who started HD at age &gt; 85 years, the median survival was 14.8 months. Diabetic patients had a median survival of 52.3 months. Advanced age and DM were associated with higher annual mortality. Also, the region of residence and year of admission were associated with higher mortality at 3 and 12 months. Conclusions: The median survival of patients on HD is dependent on age and the presence of comorbidities, among other factors. We performed an analysis to determine if starting HD in older patients with comorbidities has a real benefit over conservative management in terms of survival. <![CDATA[Reporte de los primeros 50 pacientes con COVID-19 en ventilación mecánica hospitalizados en la Unidad de Cuidados Intensivos del Complejo Asistencial Dr. Sótero del Río]]> Background: Since March, Chile experienced an exponential increase in SARS-CoV2 cases, which led to an almost full occupancy of the intensive care units (ICU). Aim: To characterize patients with SARS-CoV2 disease who required hospitalization in the ICU and invasive mechanical ventilation (IMV) in our hospital. Material and Methods: A prospective observational study was performed, which included the first 50 patients, aged 54 ± 13 years (58% men), with SARS-CoV2 disease, with ICU and IMV requirements between March 23 and June 2, 2020. Demographics, comorbidities, symptoms, laboratory and imaging, therapies performed and IMV characteristics were registered. The most relevant outcomes observed were lethality, number of days in the ICU and connection to an IMV. Results: Ninety percent of patients were overweight or obese, 46% had hypertension and many had diabetes mellitus. They had elevated inflammatory parameters and typical patterns of COVID-19 in computed tomography. Most of the patients got protective lung ventilation with a high rate of use of neuromuscular blockade (NMB) and prone position. Antibiotics, hydroxychloroquine, and lopinavir/ritonavir were administered according to the protocol of the institution. Lethality was 16% (8 cases) at the end of this study. Conclusions: The information obtained in this study provides characteristics and early outcomes of hospitalized patients with confirmed COVID-19 and IMV, admitted to the ICU of our center. <![CDATA[Manejo endovascular de la isquemia crítica distal: análisis de una serie contemporánea]]> Background: Chronic limb ischemia can lead to high rates of limb loss and mortality. Open surgery is the gold standard for treatment of distal disease. Endovascular surgery should have less complications with similar outcomes. Aim: To report a cohort of patients with distal arterial disease treated with endovascular surgery at our institution. Material and Methods: Review of angioplasty records of patients undergoing distal lower extremity endovascular procedures between 2016 and 2019. Demographics, comorbidities, form of presentation, type of intervention, perioperative complications, and length of stay were analyzed. The primary outcomes were wound healing, reinterventions and freedom from major amputation. Secondary outcomes were overall survival and amputation-free survival. Results: Forty-eight limbs of 41 patients with a mean age 75 years (78% males) were treated. Ninety-three percent had hypertension, 88% diabetes, 30% chronic kidney disease. 73% presented with major wounds. Plain balloon and drug coated balloon angioplasties were carried out in 65 and 31% of procedures respectively, with no difference in results. In 46% of the cases, only chronic total occlusions were treated. Wound healing was achieved in 85% of procedures and 90% of patients were free from amputation at one year of follow up. Complications were observed in 18% of procedures, perioperative mortality was 2% and one-year survival was 76%. Conclusions: Endovascular therapy achieves high rates of wound healing and freedom from amputation with low perioperative mortality and moderate complication rates. <![CDATA[Relación entre la condición física, índices antropométricos y parámetros de laboratorio en mujeres adultas mayores]]> ABSTRACT Background: Aging causes an involution of anthropometric and health indices that can affect physical fitness. Aim: To determine the influence of anthropometric and health indices on the physical fitness of elderly women. Material and Methods: Anthropometric parameters, serum lipids, blood glucose and physical fitness evaluated using Senior Fitness Test, were assessed in 140 women aged 70 ± 5 years. The association between parameters was analyzed using Pearson's correlation coefficient and multiple regression models. Results: In the regression models serum lipids and the suprailiac skinfold were significant predictors of the up and go test (R2= 0.48). HDL cholesterol and the level of physical activity were predictors of the two minutes step test (R2= 0.31). Serum lipids, suprailiac skinfold and age were predictors of the back-scratch test (R2= 0.41). Fasting blood glucose and HDL cholesterol were predictors of the chair sit and reach test (R2= 0.24). Serum lipids and body mass index were predictors of the arm curl test (R2= 0.37). Body mass index and serum lipids were predictors of the chair stand test (R2= 0.49). Conclusions: Anthropometric variables, serum lipid levels and blood glucose were predictors of different physical fitness parameters in these women.<hr/> Antecedentes: El envejecimiento causa involución de indices antropométricos y de salud, los cuales pueden afectar la condición física. Objetivo: Determinar la influencia de indices antropométricos y de salud sobre la condición física de mujeres mayores. Material y Métodos: Se evaluaron parámetros antropométricos, lípidos séricos y la condición física mediante el “senior fitness test” en 140 mujeres de 70 ± 5 años. La asociación entre variables se evaluó mediante correlaciones simples y modelos de regresión múltiple. Resultados: En los modelos de regresión múltiple, los lípidos séricos y pliegue suprailíaco fueron predictores significativos de la prueba de levantarse, caminar y volver a sentarse (R2 = 0,48). El colesterol HDL y el nivel de actividad física fueron predictores de la prueba de dos minutos de marcha (R2 = 0,310). Los lípidos séricos, el pliegue suprailíaco y la edad fueron predictores de la prueba de juntar las manos tras la espalda (R2 = 0,41). La glicemia en ayunas y el colesterol HDL fueron predictores de la prueba de flexión del tronco en silla (R2 = 0,24). El índice de masa corporal y los lípidos séricos fueron predictores de la prueba de flexo-extensión de codo (R2= 0,37). El índice de masa corporal y los lípidos séricos fueron predictores de la prueba de sentarse y levantarse de una silla (R2 = 0,49). Conclusiones: Las variables antropométricas, los lípidos séricos y la glicemia fueron predictores de diversas pruebas de capacidad física en mujeres mayores. <![CDATA[<em>Fitness</em> cardiorrespiratorio estimado mediante ecuación y su caracterización sociodemográfica en población chilena: Resultados de la Encuesta Nacional de Salud 2016-2017]]> Background: Cardiorespiratory fitness is a strong predictor of mortality and chronic diseases. However, its estimation is costly and time consuming which may limit it broad use in population-based studies. Aim: To estimate the cardiorespiratory fitness of the Chilean population by using equations and to characterize fitness levels of the Chilean population by sociodemographic factors. Material and Methods: This cross-sectional study included 5,958 adults from the Chilean Health Survey conducted between 2016 and 2017. Cardiorespiratory fitness was estimated from sex-specific equations for men and women and expressed as METs (Energy Metabolic Equivalent). Fitness levels were characterized by sociodemographics factors (age, sex, education, income and area of residency). Results: Fitness levels were higher in men (9.01 METs) than in women (6.76 METs) and in average decrease by 0.59 and 0.34 METs per each year increment in age for men and women, respectively. Fitness levels were 12.7 METs and 7.8 METs for 20-year-old men and women, respectively. However, fitness levels decreased to 7.8 METs and 4.3 METs in 90-year-old men and women, respectively. Fitness levels were also higher in individuals living in urban setting, those with higher education or income levels and lean individuals. Conclusions: This study reports fitness levels in a nationally representative sample of Chile. Fitness levels were higher in men than women however, its decline with age was more pronounce in men than women. <![CDATA[Factores asociados a una baja calidad de vida en adultos chilenos durante la cuarentena por COVID-19]]> Background: The quarantine and social distancing implemented during COVID 19 pandemic may hamper the quality of life of the population. Aim: To determine the factors associated with a low quality of life during COVID 19 quarantine in Chilean adults. Material and Methods: The SF-36 survey about quality of life was answered by 1,082 Chilean adults aged between 18 and 60 years, who were quarantined by the COVID-19 health alert. Other variables studied were sociodemographic background, nutritional status, lifestyles, level of physical activity, sedentary behavior and sleep hours. Risk factors associated with low quality of life were identified by logistic regression analysis for each of the 8 dimensions evaluated in the SF-36 questionnaire. Results: The factors that increased the probability of having a lower general health perception were being female (Odds ratio (OR) = 1.29; p = 0.05), being physically inactive (OR = 2.76 p &lt; 0.01), unhealthy hours of sleep (OR = 1.58, p &lt; 0.01), smoking (OR = 1.59, p &lt; 0.01) and eating junk food (OR = 2.26; p &lt; 0.01). For the other dimensions of quality of life, the most frequently repeated factors were being female, junk food consumption, and being physically inactive and sedentary. Conclusions: There are factors associated with a low quality of life during the quarantine of the COVID-19 pandemic in the Chilean population. Their identification could reinforce remedial actions at the government level to benefit the health of the population during this health emergency. <![CDATA[Virtudes del médico: ¿qué importancia le atribuyen los pacientes?]]> Background: Theoretically, the exercise of good medicine requires physicians who possess and practice virtues. There are good reasons to believe that virtue ethics would be highly appreciated by patients. Aim: To determine the importance that patients attribute to the possession virtues among physicians. Material and Methods: Patients hospitalized in a private and a public hospital were invited to answer a three-question survey. The questions were: first, what do you expect of a good physician? Second, please evaluate, in a scale from 1 to 5, the importance of physician virtues to consider him a good doctor (fidelity to trust given by the patient, benevolence, postponement of self-interests, compassion, intellectual honesty, justice and prudence). Third, among the seven former virtues, select the three more important, and then the most important of all. Results: Most patients responded that they valued that a good physician should have good communication skills, a cordial relationship, commitment to the patient and knowledge. All virtues studied were considered important or very important by almost all patients. The virtues considered the most important were intellectual honesty and fidelity to trust given by the patient. Conclusions: These results support the theoretical argument that, for patients, the practice of virtue ethics is essential for a good medical practice. <![CDATA[Estudio descriptivo de mortalidad en sobrevivientes de tortura y prisión política en el período de la dictadura militar en Chile, 1973-1990]]> Background: Studies on the long-term consequences of torture in survivors in Chile have only addressed the consequences for mental health, leaving aside the physical consequences. Aim: To report the causes of death in the universe of victims of the Chilean civic-military dictatorship recognized by the Reports of the National Commission for Political Prison and Torture (CNPPT) and the Advisory Commission for the qualification of Disappeared Detainees, Politically Executed individuals and Victims of Political Prison and Torture. Material and Methods: The causes of death, age at the time of death, sex, political context of death and opportunity of repair up to June 2016 are described in 38,254 victims of the Chilean civic-military dictatorship. Results: Of the universe of 38,254 victims, 9,152 (23.9%) died until June 2016. The median age at death was 68 years. The main causes of death were malignant tumors in 28%, cardiovascular diseases in 27%, respiratory diseases in 10%, digestive diseases in 9% and external causes in 8%. Conclusions: These results can inform prevention and treatment strategies for victims of the Chilean dictatorship. <![CDATA[Frecuencia y características de hipoacusia en osteogénesis imperfecta]]> ABSTRACT Background: Osteogenesis imperfecta (OI) is a rare group of genetic disorders affecting connective tissue, with consequent bone fragility, frequent fractures and skeletal deformity. Depending on the type, patients can have blue sclera, dentinogenesis imperfecta, and hearing loss. Aim: To determine the frequency, type and audiometric characteristics of hearing loss in a group of patients with OI. Material and Methods: A prospective cohort study was completed. A clinical and diagnostic hearing evaluation with tympanometry, acoustic stapedial reflex, pure-tone and speech audiometry were performed. Results: Thirty patients completed the study; mean age of 22 years (range 6-63 years). Sixty seven percent had a type I OI. Overall, nine (30%) patients had hearing loss (15/60 ears). Of these, six had bilateral hearing loss. Of the 15 affected ears, six showed conductive hearing loss, five sensorineural hearing loss, and four mixed hearing loss. Patients with hearing loss were older than patients with normal hearing. Only one pediatric patient developed hearing loss. Of the ears without hearing loss, 13% did not have an acoustic stapedial reflex. Conclusions: In this group of patients with OI, 30% had hearing loss and among those ears with normal hearing, 13% did not have an acoustic stapedial reflex. Patients with OI should be monitored for hearing loss.<hr/> Antecedentes: La osteogénesis imperfecta (OI) es un grupo raro de trastornos genéticos que afectan al tejido conectivo, con la consiguiente fragilidad ósea, fracturas frecuentes y deformidad esquelética. Según el tipo, los pacientes pueden presentar escleras azules, dentinogénesis imperfecta e hipoacusia. Objetivos: Determinar la frecuencia, tipo y características audiométricas de la hipoacusia en un grupo de pacientes con OI. Material y Métodos: Se completó un estudio de cohorte prospectivo. Se realizó una evaluación clínica, y de la audición con timpanometría, reflejo estapedial, audiometría tonal y logoaudiometría. Resultados: Treinta pacientes completaron el estudio; edad media de 22 años (rango 6-63 años). El 67% tenía una OI tipo I. Nueve pacientes (30%) tuvieron hipoacusia (15/60 oídos). De estos, seis tenían hipoacusia bilateral. De los 15 oídos afectados, seis tenían hipoacusia de conducción, cinco hipoacusia neurosensorial y cuatro hipoacusia mixta. Los pacientes con hipoacusia eran mayores que los pacientes con audición conservada. Sólo un paciente pediátrico desarrolló hipoacusia. De los oídos sin hipoacusia, el 13% tenía un reflejo estapedial ausente. Conclusiones: En este grupo de pacientes con OI, el 30% tenía hipoacusia. Además, el 13% de los oídos con audición normal no tenía reflejo acústico estapedial. Los pacientes con OI deben ser monitoreados para detectar hipoacusia. <![CDATA[Definición de fragilidad social en personas mayores: una revisión bibliográfica]]> Social frailty is a seldom explored concept in older people. There is dissent if it should be considered a multidimensional syndrome or it should be limited to the physical sphere. We conducted a review aiming to develop a concept of social frailty in older people using PubMed, BVS and CINAHL databases. We found ten articles. One exposes the concept of social frailty, nine operationalize social frailty using questions or items on social behavior and two use scales or measuring instruments to classify older people as “socially frail”. It is concluded that social frailty is a new concept in gerontology: there are divergences as to whether it should be considered as another dimension of frailty or as an independent concept with a predictive capacity by itself to detect risk among older people. <![CDATA[Hipopituitarismo postraumatismo encefalocraneano: revisión de la literatura y algoritmo de estudio y abordaje terapéutico]]> Hypopituitarism after moderate or severe traumatic brain injury (TBI) is usually underdiagnosed and therefore undertreated. Its course can be divided in an acute phase during the first 14 days after TBI with 50 to 80% risk of hypopituitarism, and a chronic phase, beginning three months after the event, with a prevalence of hypopituitarism that ranges from 2 to 70%. Its pathophysiology has been addressed in several studies, suggesting that a vascular injury to the pituitary tissue is the most important mechanism during the acute phase, and an autoimmune one during chronic stages. In the acute phase, there are difficulties to correctly interpret pituitary axes. Hence, we propose a simple and cost-effective algorithm to detect and treat a potential hypothalamic-pituitary-adrenal axis impairment and alterations of sodium homeostasis, both of which can be life-threatening. In the chronic phase, post-concussion syndrome is the most important differential diagnosis. Given the high prevalence of hypopituitarism, we suggest that all pituitary axes should be assessed in all patients with moderate to severe TBI, between 3 to 6 months after the event, and then repeated at 12 months after trauma by a specialized team in pituitary disease. <![CDATA[Embarazo en enfermedad inflamatoria intestinal: no solo 9 meses de cuidado]]> The prevalence of inflammatory bowel disease (IBD) increased in the last decades. Thus, the number of pregnant women with the condition is also increasing. Given that active disease itself is the main risk factor for complications during pregnancy, it is necessary to achieve a complete remission before planning a pregnancy. Also, pregnant women with IBD must be monitored noninvasively and be treated proactively, including escalated therapies, if needed, to prevent potential flares during pregnancy. Patients can undergo vaginal delivery in most forms of IBD. However, cesarean delivery is still preferable in women with a history of ileal pouch-anal anastomoses (IPAA) or active perianal disease. <![CDATA[Hepatitis aguda por virus C: reporte de siete casos en centro de referencia en Chile]]> Hepatitis C virus infection is a major global public health problem. Treatment with direct-acting antivirals is intended to eradicate the chronic form of this infection by 2030. Although uncommon, the acute form of presentation is increasingly recognized, especially in some high-risk populations, such as men who have sex with men without protection. Its virological and serological diagnosis is not standardized, so clinical suspicion is essential. Its early detection allows a timely treatment. We report seven cases of acute HCV hepatitis in a national reference center, its presentation, diagnosis and treatment. We discuss populations at risk and the change in therapeutics with the use of direct-acting antiviral drugs. <![CDATA[Implementación del Primer Examen Clínico Objetivo Estructurado (ECOE) para la Certificación de la Especialidad en Anestesiología en Chile]]> Anesthesiology became the first Chilean medical specialty certification board to incorporate an objective structured clinical examination (OSCE) into its certification system. The main reason for the introduction of an OSCE is to include an evaluation that allow candidates to demonstrate what they really “do” in clinical practice domains. Inherent in this justification is that the OSCE detects competences that are not well evaluated in current written and oral exams. This article describes the process of implementing an OSCE in Anesthesiology certification and a description of its application after one year of operation. <![CDATA[Investigación en pregrado de las escuelas de medicina de Chile: Motivación y participación de estudiantes de medicina asistentes al Congreso Chileno de Estudiantes de Medicina (COCEM)]]> Background: The participation of medical students in research generates professional, scientific, and personal benefits for the student. Aim: To evaluate the interest and opportunities for medical students in Chile to participate in scientific research and their perceptions about factors influencing research. Material and Methods: All students attending the 2018 Chilean Congress for Medical Students were invited to answer a 44 questions survey about interest and opportunities to participate in research. Results: The survey was answered by 489 of the 538 students attending the congress. Eighty five percent referred interest in conducting scientific research, but only 47% had the opportunity to actively participate in a research project. The main research area providing opportunities was epidemiology and the main form to access a research project was through direct contact with a medical professor or researcher. Seventy seven percent of respondents had courses of scientific investigation in their medical curriculum and 92% had a scientific society for medical students in their university. Conclusions: Respondents showed a great deal of interest in participating in scientific research. However, there is a gap between this interest and the available opportunities. Medical professors should promote and facilitate the participation of their students in research. <![CDATA[Trombosis venosa profunda y agenesia de vena cava inferior: presentación típica en una anomalía poco frecuente. Caso clínico]]> Abnormalities of the inferior vena cava are rare. Its embryological development occurs between the sixth and eighth week of gestation and depends on the persistence or regression of three pairs of veins: the posterior cardinal veins, the subcardinal veins and the supracardinal veins. The type of congenital alteration depends on the moment that embryogenesis is altered. The most frequent clinical presentation is deep vein thrombosis, which occurs mainly in young men. We report a 16-year-old male presenting with edema of the left leg. No risk factor for thrombosis was recorded. A Doppler ultrasound confirmed the presence of a deep femoro-popliteal vein thrombosis. An abdominal CAT scan showed an agenesis of the supra and infra-adrenal inferior vena cava, with multiple collaterals. The study for thrombophilia was negative. The patient was treated with vitamin K antagonists with a good clinical response. <![CDATA[Metahemoglobinemia, una entidad de diagnóstico complejo. Reporte de un caso]]> Methemoglobinemia is a rare condition with serious consequences if not diagnosed. We report the case of a 64-year-old woman with a history of allergy to sulfa drugs and a recent diagnosis of a small vessel vasculitis (ANCA-p) who started induction therapy with corticosteroids and rituximab. Due to the need for infectious prophylaxis, and considering her history, dapsone was administered instead of cotrimoxazole after ruling out glucose-6-phosphate dehydrogenase deficiency. During the admission to the hospital for her second dose of rituximab, and while being asymptomatic, she persistently presented a pulse oximetry ≪ 90% despite the administration of O2. Therefore, the infusion was postponed to study the patient. The arterial gasometric study by direct potentiometry revealed an O2 saturation of 98%, with a saturation gap &gt; 5%. Considering the use of dapsone, a methemoglobinemia was suspected and confirmed by co-oximetry (methemoglobinemia 9%). Dapsone was suspended and one week later, her methemoglobinemia was absent. <![CDATA[La brucelosis en el diagnóstico diferencial de las meningitis asépticas: a propósito de un caso]]> Aseptic meningitis represents a diagnostic challenge for the clinician. Cytological and chemical parameters are key in the differential diagnosis. Hypoglycorrhachia is a strong predictor of a bacterial origin for aseptic meningitis. We report a 44-year-old male with a history of recurrent febrile headaches admitted with fever and delirium. The initial cerebrospinal fluid (CSF) analysis showed low glucose levels. Magnetic resonance imaging did not show abnormalities. The patient was discharged but was admitted again three weeks later with fever, headache and a stiff neck. The CSF was inflammatory with low glucose levels. Serology for brucellosis was positive. The patient was treated with ceftriaxone and rifampicin with a good clinical response. <![CDATA[Paciente de 30 años con infarto agudo al miocardio e infección por SARS-CoV-2, presentación inhabitual de Covid-19. Caso clínico]]> Isolated cardiac involvement of COVID-19 is an infrequent presentation, and myocardial infarction is even less common. We report a 30-year-old man presenting with retrosternal pain of insidious onset whose intensity increases suddenly. On admission, the patient had tachycardia and an EKG showed a 1 mm ST-elevation and diffuse PQ segment depression. Troponin was 26.9 ng/ml (normal value [NV] &lt; 0.03), inflammatory parameters were elevated, and SARS-CoV 2 PCR was positive. He was hospitalized with the diagnosis of myopericarditis secondary to SARS-CoV 2. He progressed favorably without pain during the hospital stay and with decreasing troponin values. A Cardiac Magnetic Resonance Imaging (MRI) was compatible with an infero-lateral transmural infarction. A coronary angiography showed a distal occlusion of the circumflex artery. Consequently, anticoagulation and double platelet anti-aggregation were started. The patient evolved favorably, with a decreasing troponin curve (last at discharge 0.49 ng/ml) and a control EKG with pathological Q in DIII and AvF, and symmetrically inverted T in DII, DIII, AvF, V4, V5, and V6. <![CDATA[Las políticas de salud reproductiva en Estados Unidos y Chile]]> This work addresses the controverted reproductive health policies in the last fifty years in the United States and in the last thirty years in Chile, since the return of democracy. They range from the inclusion of sex education programs in school curricula to the voluntary interruption of pregnancy and the recent emergence of institutional conscientious objection. The author provides a comparative analysis of the latter in both countries, considering the current political context in the United States and the constituent process development in Chile. <![CDATA[Programa de Profilaxis Pre-exposición contra el VIH (PreP) del Ministerio de Salud en Chile]]> This work addresses the controverted reproductive health policies in the last fifty years in the United States and in the last thirty years in Chile, since the return of democracy. They range from the inclusion of sex education programs in school curricula to the voluntary interruption of pregnancy and the recent emergence of institutional conscientious objection. The author provides a comparative analysis of the latter in both countries, considering the current political context in the United States and the constituent process development in Chile. <![CDATA[Autonomía y dignidad de los adultos mayores en Chile]]> This work addresses the controverted reproductive health policies in the last fifty years in the United States and in the last thirty years in Chile, since the return of democracy. They range from the inclusion of sex education programs in school curricula to the voluntary interruption of pregnancy and the recent emergence of institutional conscientious objection. The author provides a comparative analysis of the latter in both countries, considering the current political context in the United States and the constituent process development in Chile. <![CDATA[Una dieta antiinflamatoria disminuiría el riesgo de mortalidad por todas las causas]]> This work addresses the controverted reproductive health policies in the last fifty years in the United States and in the last thirty years in Chile, since the return of democracy. They range from the inclusion of sex education programs in school curricula to the voluntary interruption of pregnancy and the recent emergence of institutional conscientious objection. The author provides a comparative analysis of the latter in both countries, considering the current political context in the United States and the constituent process development in Chile.