Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720200007&lang=es vol. 148 num. 7 lang. es <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[Corticoides para el tratamiento de COVID-19]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000700893&lng=es&nrm=iso&tlng=es <![CDATA[Estudio de prevalencia de síndrome de apneas obstructivas del sueño en la población adulta chilena. Subestudio de la Encuesta Nacional de Salud, 2016/17]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000700895&lng=es&nrm=iso&tlng=es Background: Obstructive sleep apnea syndrome (OSAS) affects approximately 10%-20% of adults and is associated with obesity, hypertension and metabolic syndrome. Aim: To assess the prevalence and risk factors associated with OSAS in Chilean adults. Material and Methods: A standardized sleep questionnaire and respiratory polygraphy at home were conducted on adults aged 18 years or more, residing in the Metropolitan Region and enrolled in the 2016/17 National Health Survey. Results: Two-hundred and five people between 18 and 84 years old (46% men, mean age 50 years) underwent overnight respiratory polygraphy at home. The estimated obstructive sleep apnea prevalence was 49% (62% men, 31% women) considering an apnea-hypopnea index ≥ 5 respiratory events/hour, and 16% (21% men, 13% women) considering an apnea–hypopnea index ≥ 15 respiratory events/hour. The prevalence of obstructive sleep apnea continuously increased along with age for men and women, with a later onset for women. Age, gender, body mass index, cervical and waist circumference, snoring, reporting of apnea by proxies, self-reported cardiovascular and metabolic diseases such as hypertension, diabetes and dyslipidemia, were significantly associated with OSAS. No association was found with insomnia and daytime sleepiness. Conclusions: The prevalence and risk factors associated to obstructive sleep apnea syndrome were high among these adults. <![CDATA[Consumo de azúcares totales y su asociación con obesidad en población chilena - Resultados del estudio GENADIO]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000700906&lng=es&nrm=iso&tlng=es Background: Sugar intake is a risk factor for the development of obesity. Aim: To investigate the association between total sugar intake and obesity markers in Chilean adults. Material and Methods: This cross-sectional study included 396 participants of the GENADIO study. Anthropometric measurements (body weight, body mass index (BMI), waist circumference (WC), hip circumference (HC), waist-to-hip ratio, and % body fat) were measured through standardized protocols. Total sugar intake was determined from a 7-days weighted food daily. Sugar intake expressed in g/day was categorized into quartiles. Results: Higher sugar intake was associated with a higher BMI, WC and HC but not with body fat %. One quartile increment in sugar intake was associated with 1.50 kg [95% confidence interval (CI): 0.49; 2.50] higher body weight, 0.34 kg/m2 [95% CI: 0.01; 0.69] higher BMI, 1.23 cm [95% CI: 0.11; 2.34] higher WC, 1.39 cm [95% CI: 0.28; 2.50] higher HC and 0.02 the waist-to-hip ratio [95% C: 0.01; 0.02]. Conclusions: Total sugar intake was associated with higher adiposity levels in these Chilean adults. <![CDATA[Incidencia de síndrome de Stevens-Johnson y necrólisis epidérmica tóxica en Chile años 2001-2015 y su asociación con latitud]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000700915&lng=es&nrm=iso&tlng=es Background: Stevens-Johnson Syndrome (SSJ) and Toxic Epidermal Necrolysis (NET) are infrequent and life-threatening mucocutaneous diseases, which occur predominantly as adverse drug reactions. Aim: To describe the frequency of SSJ and NET diagnoses at a national level, estimate their incidence and describe their distribution among the different regions of the country. Material and Methods: Analysis of hospital discharge databases available at the website of the Chilean Ministry of Health searching for the tenth version of the International Classification of Diseases (ICD 10) codes for SSJ or NET, between 2001 and 2015. Results: We analyzed 24,521,796 hospital discharges nationwide. SSJ caused 855 discharges, with a lethality of 2%. NET caused 128 discharges with a lethality of 16%. The global cumulative incidence was 3.87 cases per million inhabitants per year nationwide, with a trend line to increase incidence towards the regions of higher latitude. Conclusions: SSJ and NET are dermatological emergencies with high mortality. The increase in incidence towards regions at higher latitudes may suggest an association between these conditions and lower levels of vitamin D, correlated with latitude and exposure to UV radiation. <![CDATA[Hábitos alimentarios, obesidad y calidad de vida relacionada con la salud en adolescentes chilenos]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000700921&lng=es&nrm=iso&tlng=es Background: Adolescence is considered a nutritionally vulnerable period of life, since their eating habits are influenced by factors that can promote the consumption of non-nutritious food. Aim: To analyze the relation between eating habits, obesity, and the perception of Health-Related Quality of Life in school-aged adolescents. Material and Methods: A cross-sectional study of 550 adolescents aged 16 ± 1 years (60% women) attending a public education institution in Valparaíso, Chile. The Global School-based Student Health Survey (GSHS) for eating habits and the KIDSCREEN-27 survey for health-related quality of life were self-administered online. The answers were anonymous. A logistic regression analysis was conducted to evaluate the relationship between the variables, which was adjusted for age and sex. Results: Ten percent of men and 6% of women were obese. Those with an inadequate consumption of fruits had a worst perception of their physical well-being, autonomy and relationship with their parents. Psychological well-being and school environment were perceived worst among those that did not consume breakfast. Obese respondents also reported a poorest physical health. Conclusions: Inadequate eating habits and obesity have a negative effect of health-related quality of life among adolescents. <![CDATA[Cómo definen los pacientes a un buen médico, y cómo definen los médicos a un buen paciente]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000700930&lng=es&nrm=iso&tlng=es ABSTRACT Background: From a patient's point of view, an ‘ideal’ doctor could be defined as one having personal qualities for interpersonal relationships, technical skills and good intentions. However, doctors' opinions about what it means to be a ‘good’ patient have not been systematically investigated. Aim: To explore how patients define the characteristics of a ‘good’ and a ‘bad’ doctor, and how doctors define a ‘good’ and a ‘bad’ patient. Material and Methods: We surveyed a cohort of 107 consecutive patients attending a community teaching hospital in February 2019, who were asked to define the desirable characteristics of a good/bad doctor. Additionally, a cohort of 115 physicians working at the same hospital was asked to define the desirable characteristics of a good/bad patient. Responses were subjected to content analysis. Simultaneously, an algorithm in Python was used to automatically categorize responses throughout text-mining. Results: The predominant patients' perspective alluded to desirable personal qualities more importantly than proficiency in knowledge and technical skills. Doctors would be satisfied if patients manifested positive personality characteristics, were prone to avoid decisional and personal conflicts, had a high adherence to treatment, and trusted the doctor. The text-mining algorithm was accurate to classify individuals' opinions. Conclusions: Ideally, fusing the skills of the scientist to the reflective capabilities of the medical humanist will fulfill the archetype of what patients consider to be a ‘good’ doctor. Doctors' preferences reveal a “paternalistic” style, and his/her opinions should be managed carefully to avoid stigmatizing certain patients' behaviors.<hr/> Antecedentes: Desde la perspectiva del paciente, un médico “ideal” podría definirse como aquel que tiene cualidades para las relaciones interpersonales, habilidades técnicas y buenas intenciones. Sin embargo, las opiniones de los médicos sobre lo que significa ser un “buen” paciente no se han investigado sistemáticamente. Objetivo: Explorar cómo los pacientes definen las características de un “buen” y “mal” médico, y cómo los médicos definen un “buen” y “mal” paciente. Material y Métodos: Encuestamos a una cohorte de 107 pacientes consecutivos que asistieron a un hospital comunitario en febrero de 2019, a quienes se les pidió que definieran las características deseables de un médico bueno/malo. Además, se pidió a una cohorte de 115 médicos que trabajaban en el mismo hospital que definieran las características deseables de un paciente bueno/malo. Las respuestas se sometieron a un análisis de contenido. Simultáneamente, se utilizó un algoritmo en Python para clasificar automáticamente las respuestas mediante minería de texto. Resultados: Los pacientes aludieron que las cualidades personales del médico eran más importantes que la competencia en conocimiento y las habilidades técnicas. Los médicos estarían satisfechos si los pacientes mostraran características positivas de personalidad, fueran propensos a evitar conflictos, tuvieran una alta adherencia al tratamiento y confiaran en el médico. El algoritmo de minería de texto clasificó las opiniones de los encuestados en forma precisa. Conclusiones: Idealmente, fusionar las habilidades del científico con las capacidades reflexivas del médico humanista cumplirá con el arquetipo de lo que los pacientes consideran un “buen” médico. Las preferencias de los médicos revelan un estilo “paternalista”, y sus opiniones deben manejarse con cuidado para evitar estigmatizar los comportamientos de ciertos pacientes. <![CDATA[Tabaquismo en el adulto mayor: un freno al envejecimiento saludable en la población chilena]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000700939&lng=es&nrm=iso&tlng=es Background: Smoking is one of the main causes of death among adults worldwide. Aim: To characterize smoking among Chilean older people, according to sociodemographic and clinical variables. Material and Methods: Secondary analysis of data obtained during the National Health Survey 2009-10, selecting individuals aged 60 years and older. Expansion factors were used due to the complex design of the sample. Prevalence and characteristics of smoking were calculated, according to age, sex, educational level, marital status, healthcare insurance system and comorbidities. Results: Nineteen percent of older people were actual smokers, and 85% of these smokers were aged between 60 and 69 years. Forty-five percent were highly dependent to nicotine and 73% reported their intention to quit smoking. Conclusions: There is a high prevalence of tobacco smoking among Chilean older people. Prevention measures are needed. <![CDATA[Diagnóstico médico de depresión se asocia a sospecha de deterioro cognitivo en adultos mayores]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000700947&lng=es&nrm=iso&tlng=es Background: Depression has been previously associated with cognitive impairment in high income country populations. However, its association in the Chilean population has not been investigated. Aim: To investigate the association between depression and cognitive impairment. Material and Methods: Data from 1384 Chilean adults aged &gt; 60 years, participating in the National Health Survey 2009-2010 was analyzed. Cognitive impairment was assessed using the Mini Mental Examination score. The medical diagnosis of depression was self-reported. The association between depression and cognitive impairment was assessed using a logistic regression. Results: Depression was positively associated with cognitive impairment. However, the magnitude of the association was higher in men (Odds ratio (OR) = 4.02 [95% confidence intervals (CI): 1.44; 6.61], p &lt; 0.01]) than in women (OR = 2.23 [95%CI: 1.03; 3.43], p = 0.04). Older adults who were diagnosed for the first time with depression after 65 years of age, showed a stronger association with cognitive impairment (OR = 6.65 [95% CI: 2.39; 10.9], p &lt; 0.01) than those diagnosed before 55 years. Conclusions: Our study confirms the association between depression and cognitive impairment. Further research is needed to elucidate the nature and potential mechanisms that link depression with cognitive impairment. <![CDATA[Epidemiología de la sífilis con enfoque territorial: caso del Hospital de La Serena, años 2015-2017]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000700956&lng=es&nrm=iso&tlng=es Background: Syphilis continues to be a common sexually transmitted disease. Aim: To describe the epidemiologic features of patients with syphilis consulting in a Chilean sexually transmitted diseases clinic. Material and Methods: Review of medical records of patients with positive serology for syphilis, who attended a unit of sexually transmitted diseases between 2015 and 2017. Results: Of 266 cases, 61% were male and 74% were aged between 20 and 49 years. The highest incidence was observed in males aged between 20 and 30 years. Eighty five percent of cases were diagnosed in latent phases, 10% of the cases had a co-infection with HIV and 18%, a history of other sexually transmitted disease. The rate of coinfection was significantly higher in men than in women (78 and 28%, respectively; p &lt; 0.01). Only 6.4% reported always using a condom. Men used it with higher frequency than women (72 and 28% respectively; p &lt; 0.01). A low adherence to treatment and faulty follow-up and treatment of sexual contacts was observed. Twenty five percent of women diagnosed with syphilis were pregnant and 27% of them had a premature birth, with one neonatal death. Conclusions: A high incidence of syphilis was observed, especially in men of younger ages. The diagnosis is delayed, the treatment of sexual contacts and the use of condoms are uncommon. Although the treatment of pregnant women is appropriated, some perinatal complications are observed. <![CDATA[Distribución de la COVID-19 y tuberculosis en la Región Metropolitana de Chile: diferentes enfermedades, similares desigualdades]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000700963&lng=es&nrm=iso&tlng=es Background: Poor living conditions promote the spread of communicable diseases. It happened with Tuberculosis (TB) and is happening with COVID-19. Due to its dynamic nature, this group of diseases must be studied in the context of the social determinants of health. Aim: To describe the epidemiological behavior of COVID-19 in response to the control strategies implemented by the Chilean Ministry of Health and its similarities with the socio-economic distribution of TB in the Metropolitan Region (MR) of Chile. Material and Methods: The 2018 Tuberculosis rates and average income of districts belonging to the MR were described, as well as the incidence rates of COVID-19. A Pearson correlation analysis was applied between the rates of both diseases, to assess similarities in the epidemiological distribution patterns. Results: The RM accounts for over 50% of the total national cases of COVID-19. After the implementation of selective quarantines, only four districts in the RM managed to control the outbreak (those with the highest incomes). In the rest, a clear increase in cases was observed. The districts with the highest increase in cases were the most disadvantaged, and those with the highest TB rates during 2018, with a correlation coefficient of 0.6. Conclusions: Control policies cannot deepen health inequalities. If vulnerable groups, as well as the factors that determine their health, are not properly identified, the consequences of the current pandemic could be even more devastating. <![CDATA[Actualización general de inmunoterapia en cáncer]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000700970&lng=es&nrm=iso&tlng=es Cancer is one of the leading causes of death worldwide. The success rate of conventional anticancer therapeutic approaches such as chemotherapy is limited by the non-specific toxicity and low specificity towards specific tumors, which are highly dependent on the mutational burden present on each patient. Similarly, targeted therapies have proven to induce resistance in numerous malignancies. Therefore, immunotherapy has emerged as a better approach to discriminate between “the own” and “the non-own”, which occurs through two types of mechanisms, innate and acquired immunity. Acquired immunity is one of the targets for new immunotherapeutic treatments, unleashing the power of antigen-specific T cells as a potential therapeutic weapon for cancer treatment. Thus, immunotherapy modifies the own immune system to increase the recognition and elimination of cancer cells by identifying these cancer antigens. One of the advantages of immunotherapy, when compared to conventional anticancer approaches, is the generation of long-term immunity (immunological memory). Currently, there are different potential types of immunotherapy in cancer to promote the modulation of the immune response. Among them, the use of cytokines, vaccines, viruses, monoclonal antibodies, and the generation of adaptive immune response cells have achieved successful results in some types of cancer. <![CDATA[Osteonecrosis de los maxilares asociada a medicamentos: revisión de la literatura y propuesta para la prevención y manejo]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000700983&lng=es&nrm=iso&tlng=es Medication-related osteonecrosis of the jaw is a disease where there is necrotic bone exposed or that can be explored by means of a fistula in the maxillofacial region. It has been associated with the use Biphosphonates and denosumab for osteoporosis. Although its etiology is unclear, it may be related to a decrease in bone turnover produced by these drugs, rendering the bone more prone to generate cell necrosis during invasive dental procedures, especially in the posterior region of the jaw. There is no consensus about the prevention and treatment of this condition. The aim of this paper is to present a review of the literature with the main characteristics of osteonecrosis of the jaws associated with drugs, together with a proposal for prevention and treatment for these patients. <![CDATA[Herramientas para la interpretación de informes endoscópicos: clasificaciones y escalas en endoscopía digestiva]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000700992&lng=es&nrm=iso&tlng=es Interpretation and description of findings detected in upper-endoscopy and colonoscopy are qualitative processes which depend on the experience and skills of the endoscopist performing the procedure. This explains the high variability of endoscopic reports, hampering their interpretation, specially by general practitioners. Classifications, scores and scales give a quantitative support to these qualitative processes. The aim of this review is to describe the classifications, scores and scales most frequently reported in digestive endoscopy, specially those with the highest methodological support in terms of validation and reproducibility. These tools facilitate the description of findings related to gastroesophageal reflux, Barrett's esophagus, gastroesophageal varices, stigmas related to non-variceal gastrointestinal bleeding, advanced and incipient neoplasms, bowel preparation for colonoscopy and severity scores of inflammatory bowel diseases. In summary, these tools enable to standardize endoscopic reports, simplifying their interpretation. <![CDATA[Consideraciones culturales y etimológicas sobre el origen del concepto <em>fobos</em> y su utilización en el contexto clínico y social]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000701004&lng=es&nrm=iso&tlng=es The concept of phobia, coming from the Hellenic language, is today widely spread. However, its clinical and social use has significant differences that distort it and induce an erroneous interpretation. Originally associated with fear, it has now become related to hatred. To illustrate this misunderstanding, the case of homophobia is presented. This paper reviews the etymology of the term and its subsequent inclusion in the clinical and social area. With Greek language as parameter, this article proposes terms that describe in a correct and accurate way what is meant to be expressed. The correct use of language is the best manner to investigate, understand and deal with this phenomenon. <![CDATA[Formación científica en el pregrado de medicina en Chile: ¿dónde estamos? y ¿hacia dónde vamos?]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000701011&lng=es&nrm=iso&tlng=es For more than a century the training of medical professionals has been organized according to the Flexnerian model, which comprises three cycles: basic, clinical and clerkship. On the other hand, the accelerated development of biomedical sciences modified the competences of the first cycle. Additionally, new skills required for medical practice, such as teamwork and innovation as a tool to solve health problems, challenged in recent years the classic paradigm of medical education. Therefore, the medical schools have developed multiple strategies to deal with it, such as curricular integration using competency-based education models, incorporating basic and clinical sciences in parallel during the curriculum, ensuring a relevant and applicable scientific knowledge throughout the training process. Although in Chile the Flexner prototype is still followed, the basic sciences are taught as single or integrated courses or using a systems approach. In this article we report a diagnosis about the local integration of fundamental sciences in medical training. We also compare our schools with those of Canada, Europe and Latin America. Recommendations aimed at modernizing medical school curricula are made. <![CDATA[Oportunidad en la salud digital: una respuesta al control de las demencias]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000701018&lng=es&nrm=iso&tlng=es The increase of the elderly population with a significant load of non-communicable diseases, accelerates pathological aging and increases the risk of dementia, generating a huge health, social and economic cost for any country. Dementia does not have an effective treatment yet, therefore, the focus must remain on prevention and early diagnosis. The early stages of dementia are known as mild cognitive impairment; at this stage is still possible to mitigate the progression of the disease, however, health systems worldwide face difficulties to provide universal access to health services, due to a lack of specialists and geographical distances, interfering with the access to healthcare centers. In this scenario, WHO urged countries to implement strategies to democratize and to expand the reach of health institutions. In this document, we briefly review the global and local situation of dementias and discuss some attempts to control their progression by using revolutionary digital tools. We believe the focus should be on the population that is just beginning to show cognitive impairment. <![CDATA[Metástasis pancreática como debut de carcinoma papilar de tiroides. Caso clínico y revisión del perfil clínico patológico y molecular]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000701025&lng=es&nrm=iso&tlng=es Pancreatic metastases of papillary thyroid carcinoma (PTC) are exceptional. We report a 80-year-old man consulting for obstructive jaundice and dysphonia. Abdominal ultrasonography showed biliary dilation and abdominal magnetic resonance imaging (MRI) showed a pancreatic head mass of 36 mm. A left vocal cord paralysis was confirmed and cervical computed tomography (CT) showed multiple thyroid nodules of up to 35 mm associated with bilateral cervical lymph nodes (LN). Positron emission tomography ( 18 F-FDG PET/CT) evidenced hyper-metabolic activity in bilateral cervical LN, lungs, pancreas and left intercostal soft tissue, as well as left gluteus. Thyroid biopsy reported a tall-cell variant of PTC, and endoscopic ultrasound guided fine needle aspiration (EUS-FNA) of pancreatic mass confirmed PTC metastasis. The molecular study was positive for BRAFV600E. Pancreatic metastasis from PTC can be accurately diagnosed with 18 F-FDG PET/CT and EUS-FNA, which is consistent with a predominant expression of BRAFV600E mutation and, thus, an aggressive presentation with poor short-term survival. <![CDATA[Miastenia gravis refractaria con buena respuesta a rituximab. Caso clínico]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000701031&lng=es&nrm=iso&tlng=es Myasthenia gravis (MG) is a heterogeneous disease, and there is no unique therapeutic approach for all patients. In 2013 the Myasthenia Gravis American Foundation (MGFA) panel of experts defined refractory MG as the lack of change or deterioration after the use of corticosteroids and two immunosuppressive agents, in adequate doses and time. We report a 51-years-old female with MG of bulbar predominance, who presented four myasthenic crises in 17 months despite the use of corticosteroids, azathioprine and mycophenolate. The high costs associated with her hospitalizations, as well as severe caloric - protein malnutrition, the need for tracheostomy and gastrostomy support, led us to use rituximab. The patient evolved with an excellent response, free of crises after 30 months. She gained 12 kg of weight, without tracheostomy and gastrostomy, only using pyridostigmine support 4 times a day. <![CDATA[Hiperactividad simpática paroxística: una entidad subdiagnosticada. Caso clínico]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000701034&lng=es&nrm=iso&tlng=es Paroxysmal sympathetic hyperactivity may appear after brain injury. Its clinical manifestations are sporadic and self-limited crisis of arterial hypertension, hyperthermia, tachycardia, hyperhidrosis, muscle tension, sialorrhea and mydriasis. These subside with the administration of morphine and beta-blockers. It may be caused by a dysautonomia leading to increased levels of catecholamines due to the lack of brain regulation. We report a 19 years-old man with a history of illicit drug and alcohol consumption, with a secondary axonal injury due to a cranioencephalic trauma. During hospitalization, he had recurrent, self-limited episodes of dysautonomia. An infectious cause was discarded. When morphine was administrated suspecting the presence of pain, the crisis subsided, which helped to establish the diagnosis of paroxysmal sympathetic hyperactivity. <![CDATA[Tofacitinib en el tratamiento de la colitis ulcerosa: casos clínicos]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000701039&lng=es&nrm=iso&tlng=es Biological therapy dramatically changed the management of Ulcerative Colitis (UC). However, a significant number of these patients fail to respond or have secondary loss of response to this strategy. In this clinical situation, the options include intensification of anti-TNF therapy, the use of a second anti-TNF or being switched to another drug class. Among the later, tofacitinib, an oral small molecule directed against the JAK/STAT pathway, is safe and effective in inducing and maintaining remission in patients with moderate-severe UC. We report two patients with UC refractory to conventional treatment and biological therapy, who responded successfully to the use of tofacitinib. <![CDATA[La Virtud de la Humildad en la Práctica del Médico]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000701044&lng=es&nrm=iso&tlng=es Biological therapy dramatically changed the management of Ulcerative Colitis (UC). However, a significant number of these patients fail to respond or have secondary loss of response to this strategy. In this clinical situation, the options include intensification of anti-TNF therapy, the use of a second anti-TNF or being switched to another drug class. Among the later, tofacitinib, an oral small molecule directed against the JAK/STAT pathway, is safe and effective in inducing and maintaining remission in patients with moderate-severe UC. We report two patients with UC refractory to conventional treatment and biological therapy, who responded successfully to the use of tofacitinib. <![CDATA[Sospecha de demencia en la atención primaria: la pieza clave del programa de Garantías Explícitas en Salud (GES) de Alzheimer y otras demencias]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000701045&lng=es&nrm=iso&tlng=es Biological therapy dramatically changed the management of Ulcerative Colitis (UC). However, a significant number of these patients fail to respond or have secondary loss of response to this strategy. In this clinical situation, the options include intensification of anti-TNF therapy, the use of a second anti-TNF or being switched to another drug class. Among the later, tofacitinib, an oral small molecule directed against the JAK/STAT pathway, is safe and effective in inducing and maintaining remission in patients with moderate-severe UC. We report two patients with UC refractory to conventional treatment and biological therapy, who responded successfully to the use of tofacitinib. <![CDATA[Vitamina C y Cáncer ¿amigos o enemigos?]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000701047&lng=es&nrm=iso&tlng=es Biological therapy dramatically changed the management of Ulcerative Colitis (UC). However, a significant number of these patients fail to respond or have secondary loss of response to this strategy. In this clinical situation, the options include intensification of anti-TNF therapy, the use of a second anti-TNF or being switched to another drug class. Among the later, tofacitinib, an oral small molecule directed against the JAK/STAT pathway, is safe and effective in inducing and maintaining remission in patients with moderate-severe UC. We report two patients with UC refractory to conventional treatment and biological therapy, who responded successfully to the use of tofacitinib. <![CDATA[<em>Virtual Ward:</em> una alternativa para brindar apoyo sanitario a la comunidad y en particular a las personas mayores]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000701049&lng=es&nrm=iso&tlng=es Biological therapy dramatically changed the management of Ulcerative Colitis (UC). However, a significant number of these patients fail to respond or have secondary loss of response to this strategy. In this clinical situation, the options include intensification of anti-TNF therapy, the use of a second anti-TNF or being switched to another drug class. Among the later, tofacitinib, an oral small molecule directed against the JAK/STAT pathway, is safe and effective in inducing and maintaining remission in patients with moderate-severe UC. We report two patients with UC refractory to conventional treatment and biological therapy, who responded successfully to the use of tofacitinib. <![CDATA[Nuevas directrices americanas para la prevención de cáncer: su relevancia en el contexto chileno]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872020000701050&lng=es&nrm=iso&tlng=es Biological therapy dramatically changed the management of Ulcerative Colitis (UC). However, a significant number of these patients fail to respond or have secondary loss of response to this strategy. In this clinical situation, the options include intensification of anti-TNF therapy, the use of a second anti-TNF or being switched to another drug class. Among the later, tofacitinib, an oral small molecule directed against the JAK/STAT pathway, is safe and effective in inducing and maintaining remission in patients with moderate-severe UC. We report two patients with UC refractory to conventional treatment and biological therapy, who responded successfully to the use of tofacitinib.