Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720060009&lang= vol. 134 num. 9 lang. <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<em><b>Predictors of hospital death and prolonged hospitalization in patients with cardiac failure in Chilean hospitals</b></em>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000900001&lng=&nrm=iso&tlng= Background: Heart failure (HF) is one of the most common causes for hospital admission. Aim: To evaluate clinical predictors of mortality and prolonged hospital stay among patients admitted for HF in Chilean hospitals. Patients and Methods: Prospective registry of 14 centers. Patients admitted for HF in functional class III and IV were included. Epidemiological, clinical data, functional class, decompensation cause, electrocardiogram, echocardiogram, treatment and evolution were registered. The endpoint was hospital death and hospital stay greater than 10 days. Results: Data from 646 patients (mean age 69±13 years, 56% men) was collected. The main etiologies of HF were hypertensive in 29.6%, ischemic in 27.1% and valvular in 20%. Mean hospital stay was 10±9 days and mortality was 5.6%. Independent predictors of death and prolonged hospital stay were serum sodium <130 mEq/L at admission (odds ratio (OR) 2.6, confidence interval (CI)= 1.2-5.9), serum albumin <3 g/dL (OR 3.2, CI= 1.42-7.2) and a history of hypertension (OR 1.98, CI=1.1-3.85). The model predicted correctly the occurrence of the endpoint in 67% of cases. Conclusions: In patients admitted for worsening HF, low serum sodium, decreased serum albumin on admission and a history of hypertension increase the risk for in-hospital death and prolonged hospital stay <![CDATA[<em><b>Glucose tolerance alterations and frequency of metabolic syndrome among patients with non alcoholic fatty liver disease</b></em>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000900002&lng=&nrm=iso&tlng= Background: Non alcoholic fatty liver disease (NAFLD) is associated to diabetes mellitus, obesity, disturbances in serum lipid levels, insulin resistance and metabolic syndrome. Aim: To assess glucose tolerance and the presence of metabolic syndrome among patients with biopsy proven NAFLD. Patients and methods: Serum lipid levels, hepatic function tests were measured and an oral glucose tolerance test was performed in 46 patients (mean age 45±12 years, 36 females) without history of diabetes mellitus and with steatosis in a liver biopsy. Results: Mean body mass index of the sample was 37±12 kg/m². Seventeen percent had pure steatosis, 78% had steatohepatitis with or without fibrosis and 50% had fibrosis in the liver biopsy. Glucose intolerance and diabetes was found in 57% and 15% of cases, respectively. The presence of steatohepatitis was higher in diabetics, compared with subjects with glucose intolerance or a normal glucose response (43, 38 and 8%, respectively, p <0.0001). Ninety three percent had a metabolic syndrome and the proportion of biopsies with fibrosis was higher among subjects with more than three diagnostic criteria for metabolic syndrome compared with those with three or less criteria (59 and 46%, respectively, p <0.05). Conclusions: Glucose intolerance, diabetes and metabolic syndrome are common among patients with NAFLD, even when they are not obese <![CDATA[<em><b>Association between tumor necrosis factor-alpha promoter polymorphisms and type 2 diabetes and obesity in Chilean elderly women</b></em>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000900003&lng=&nrm=iso&tlng= Background : Tumor necrosis factor-alpha (TNF-alpha) has an increased expression in the adipose tissue of obese subjects and is involved in insulin resistance. Aim: To screen for associations between -308G/A, -238G/A, -376G/A and -163G/A genetic variants of the TNF-alpha gene, diabetes and obesity-related variables. Material and methods: A group of 263 elderly women aged 60-90 years were recruited. Among them, an oral glucose tolerance test was performed and serum lipids measured in 100 women. TNF-alpha genotypes were determined by polymerase chain reaction (PCR) and analysis of restriction fragment lenght polymorphisms. Results: No significant differences were found when comparing allele frequencies in TNF-alpha polymorphisms of normal subjects with those having impaired glucose tolerance or type 2 diabetes. After excluding patients with previous diagnosis of diabetes, no significant differences by polymorphism carrier status were found for plasma levels of lipids, glucose and insulin. Additionally, no significant differences were found for the association between variables related to adiposity and the ­308G/A polymorphisms. Conclusions: It is unlikely that polymorphisms in the promoter region of the TNF-alpha gene have a major influence in obesity and diabetes phenotypes in Chilean elderly women <![CDATA[<strong>Variantes alélicas de CYP1A1 y GSTM1 como biomarcadores de susceptibilidad a cáncer gástrico</strong>: <strong>influencia de los hábitos tabáquico y alcohólico</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000900004&lng=&nrm=iso&tlng= Background: Gastric cancer (GaC) is the second cause of death by cancer in the world and one of the first causes in Chile. However, the burden of this disease shows remarkable worldwide variation probably explained by environmental and genetic factors. The role of susceptibility low penetrance genes and environmental and dietary factors in the etiology of gastric cancer is not well-known. Aim: To analyze the possible association between CaG susceptibility, genetic (CYP1A1 and GSTM1 polymorphisms) and environmental (tobacco and alcohol) factors. Patients and Methods: In a case-control study, we included 73 patients with a pathologically diagnosed GaC and 263 controls. DNA was extracted from peripheral blood to detect allele variants for CYP1A1 and GSTM1, using polymerase chain reactions and digestion with restriction enzymes. Results: There was a clear association of smoking and alcohol ingestion with GaC with odds ratios (OR) of 2.54 (95% confidence intervals (CI) of 1.45-4.46 and OR of 3.36 (95% CI 1.76-6.41), respectively. Polymorphic variants of CYP1A1 and GSTM1 had no association with GaC. However, the m2 variant of CYP1A1 significantly modifies the risk induced by tobacco or alcohol (OR 13.65; 95% CI 3.15-59.05 y 8.37; 95% CI 1.86-37.64, respectively). Conclusions: Subjects that carry the m2 allelic variant of CYP1A1 and are exposed to tobacco smoke or alcohol have a significantly higher risk of developing gastric cancer <![CDATA[<em><b>Genetic markers in four Chilean families with familial Creutzfeldt-Jakob disease</b></em>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000900005&lng=&nrm=iso&tlng= Background: Creutzfeldt-Jakob disease (CJD) is a form of transmissible spongiform encephalopathy, in which a prion protein (PrP Sc) accumulates in the brain of affected individuals. Chile has a prevalence of CJD that is more than twice than in the rest of the world and has the highest rate of familial forms. These later forms are associated with the heterozygocity of codon 200 of PrP protein gene. Aim: To search susceptibility genetic markers of CJD in members of families affected by CJD. Material and methods: A blood sample was obtained from 50 individuals pertaining to four families affected by CJD. DNA from peripheral mononuclear cells was amplified by polymerase chain reaction and sequenced for the gene that codifies PrP protein. Results: In family A, 21 of 23 members were homozygotes for codon 129 (Met/Met) and eight were simultaneously heterozygotes for codon 200 (Glu/Lys). In family B, six of nine members were homozygotes for codon 129, five were heterozygotes for codon 200 and four had both mutations. In family C, the four analyzed subjects were homozygotes for codon 129 and two were simultaneously heterozygotes for codon 200. In family D, nine of 14 members were homozygotes for codon 129 and two were simultaneously homozygotes for codon 200. No family had polymorphisms for codon 219. Conclusions: Thirty two percent of analyzed subjects were homozygotes for codon 129 and heterozygotes for codon 200, condition that defines the genetic susceptibility to acquire CJD. The dominant tendency of these genotypes could explain the higher incidence of CJF in Chile <![CDATA[<em><b>Assessment of androgenic decline in the elderly</b></em>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000900006&lng=&nrm=iso&tlng= Background:The gold standard to assess androgenic status is the measurement of free testosterone by equilibrium dialysis. However, the estimation of free testosterone using formulas based on the law of mass action can be an adequate standard. Aim: To assess androgenic decline in the elderly by different methods. Material and methods: Free testosterone by radioimmunoassay, total testosterone and steroid binding globulin (SHBG) by automated chemiluminiscence system and estradiol by automated electrochemiluminiscence system were measured in 30 male aged 64±5 years (range 60-70), and 25 males aged between 20 and 30 years, as control group; devoid of diseases or drugs that could cause hypogonadism. Free androgen index, free testosterone, biavailable testosterone, and free estradiol were calculated using a formula based on the law of mass action. Results: Fifty seven percent of elderly subjects had hypogonadism, according to calculated free testosterone values. Their total testosterone was on average, 152 nd/dl lower than in young adults, figure that represents a 3.8 ng/dl decline per year. According to total testosterone values, 27% of elderly males had gonadal incompetence. The correlations between calculated free testosterone and total testosterone was 0,95 and between calculated free testosterone and measured free testosterone was 0,67. The methods employed overestimated (76.7% of hypogonadism when using the free androgen index) or underestimated (27 and 3% of hypogonadism, considering total or free testosterone, respectively) the ondrogen decline of the elderly. Among the elderly, 16 or 30% of subjects had an absolute hypoestrogenism, based on estradiol or calculated free estradiol values, respectively. On average there was a 20 and 30% reduction of estradiol and calculated free estradiol values in the elderly. Conclusions: Calculated free or bioavailable testosterone values should be used to assess androgen decline in elderly men <![CDATA[<em><b>Effect of flour folic acid fortification on the incidence of cranio encephalic congenital defects</b></em>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000900007&lng=&nrm=iso&tlng= Background: In Chile, flour is fortified with folic acid since 2000, and the incidence of neural tube defects has decreased. Cranio-encephalic congenital defects (CECD) have a wider clinical scope, includind classical neural tube defects (NTD) such as anencephalia and acrania, but also incorporating other defects. Therefore, the effects of folic acid fortification on the incidence of CECD could be different. Aim: To study the effect of folic acid fortification on the incidence of CECD. Material and methods: All prenatal diagnoses of CECD and cases registered locally in the Latin American Collaborative Study of Congenital Malformations (ECLAMC) were reviewed. The obtained data were crossed with all death certificates of newborns or stillborns of more than 500 g in the Sixth Region, in Central Chile. All cases were classified again in four subtypes, according to their phenotype. The incidences of all subtypes prior (1996-2000) and after folic acid supplementation (2001-2004), were compared. Results: Between 1996 and 2004, there were 64 cases of CEDC among 109,176 infants born alive. The global rate was 8.86 per 10,000 born alive in the period prior to fortification and 3.03 per 10,000 born alive after fortification. Comparing both periods, there was a 66% reduction in all CECD and a 77 and 100% reduction in subtypes A and B of CECD, respectively (p <0.05). No significant reductions in type C and D CECD, were observed. Conclusions: After the start of flour folic acid fortification, there was a global reduction in the incidence of CECD. However, only types A and B CECD, supposedly more responsive to folic acid, were reduced <![CDATA[<em><b>Cardiac tumors in children and adults</b></em>: <em><b>A retrospective study</b></em>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000900008&lng=&nrm=iso&tlng= Background: Cardiac tumors are very uncommon at all ages. There are important clinical differences between children and adults in the behavior of these tumors. Aim: To compare the behavior of primary and secondary cardiac tumors, from fetal age to adults. Patients and Method: Multicentric retrospective analysis of 38 children and adults with cardiac tumors, evaluated with echocardiography between January 1995 and August 2001. Medical records, echocardiographic and radiological examinations, surgical protocols and pathologic examinations were reviewed. Follow-up was obtained through data on medical records or calling patients by telephone. Results: Tumors were diagnosed in 38 patients (13 children and 25 adults), from a total of 31.800 echocardiograms. In children the diagnosis was made by fetal, transthoracic or transesophageal echocardiography in 23.6% and 8% of cases, respectively. Eighty five percent were primary (10 benign and 1 malignant) and 15%, secondary tumors. Fifty four percent were rhabdomyomas and 75% regressed spontaneously. Seventy seven percent were symptomatic and 31% were treated with surgery. During a follow up of 44±35 months, 31% of patients died. In adults, 76% of tumors were diagnosed by transthoracic and 20% by transesophageal echocardiography. Seventy six percent were primary (18 benign and 1 malignant) and 24% secondary tumors. Fifty six percent were myxomas. Ninety two percent were symptomatic and 84% were treated surgically. Twenty percent of patients died in the early postoperative period. No adult patients had a follow-up. Conclusions: Rhabdomyomas were solely found in children. In adults, myxomas are the predominat cardiac tumors. Primary and metastasic malignant tumors are observed both in children and in adults <![CDATA[<em><b>Fasting glucose versus oral glucose tolerance test for detection of glucose intolerance in obese children</b></em>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000900009&lng=&nrm=iso&tlng= Background: Recently, the cut-off point for normal fasting glucose (FG) level, was decreased to 100 mg/dl. Aim: To determine the frequency of abnormal carbohydrate abnormalities in children with obesity and evaluate if the fasting glucose level is a useful tool for the screening of glucose intolerance (GI). Patients and methods: Children and adolescents, referred for evaluation of obesity were evaluated with an oral glucose tolerance test (OGTT) and FG. The sensitivity of FG for detection of GI, using the 100 and 110 mg/dl cut-off point, was evaluated. Results: We studied 186 patients (125 females) aged 12.1 (range: 5.4-19.3) years with a body mass index (BMI) of 29.9 (18.3-44.6) kg/mt² and a BMI Z score of 2.1 (1.7-3.2). Seven patients (3.8%) had abnormalities in the carbohydrate metabolism. The sensitivity of FG for the detection of GI using the 100 and 110 mg/dl cut-off values was 42.9 and 14.3%, respectively. Receiver operating characteristic (ROC) curves showed that the optimal diagnostic level for FG corresponds to 80 mg/dl (sensitivity: 85.7% and specificity of 74.9%). Conclusions: An abnormal carbohydrate metabolism was detected in 3.8% of the obese children and adolescents in this sample. FG of 100 mg/dl does not detect 57.1% of the patients with glucose intolerance. These data suggest that FG is not a useful screening tool for glucose intolerance in young patients <![CDATA[<em><b>Low concordance between early clinical suspicion of dengue and its serological confirmation</b></em>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000900010&lng=&nrm=iso&tlng= Background:Early detection of dengue could help to prevent its complications. The usefulness of clinical criteria for diagnosis of the disease must be ascertained. Aims: To assess the correlation between laboratory and clinical diagnosis of dengue, done during the first consultation in the emergency room. To estimate the impact of clinical diagnosis on the initial medical treatment. Patients and Methods: Patients older than 5 years with an acute febrile syndrome that consulted during the first 72 hours of disease, during 2004, at an emergency room in Bucaramanga, Colombia, were studied. Symptoms and the clinical diagnosis of the initial evaluation were registered. Paired serum samples for dengue specific ELISA-IgM test and viral isolation were obtained. The association of the initial clinical diagnosis with early symptoms, initial medical treatment and laboratory diagnosis was evaluated. Results: One hundred sixty eight patients were enrolled (54 with confirmed dengue infection). Clinical diagnosis of dengue was associated to a higher request of complete blood counts (p =0.01) and greater use of intravenous fluids (p =0.02). However, clinical diagnosis was not correlated with the laboratory diagnosis (p =0.15). The percentage of agreement was less than would be expected by chance (Kappa =-0.1). Headache was associated to the initial clinical diagnosis of dengue (p =0.03), and only metrorrhagia was associated with confirmed dengue infection (p =0.04). Conclusions: The early clinical suspicion of dengue has a low concordance with the laboratory confirmation of the disease <![CDATA[<em><b>Osteonecrosis associated with the use of biphosphonates</b></em>: <em><b>Case report</b></em>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000900011&lng=&nrm=iso&tlng= Biphosphonates reduce the risk of skeletal events and are currently part of standards of therapy in myeloma. Recently, zoledronate and pamidronate have been linked to osteonecrosis of the jaw, specially after surgical dental procedures. We report a 84 year-old man with multiple myeloma who developed spontaneous osteonecrosis of both jaws, after 36 months of therapy with zoledronate with a cumulative dose of 136 mg. We discuss the pathogenic mechanisms, and review the recommendations on prevention and management of this new complication for neoplastic patients under prolonged therapy with biphosphonates <![CDATA[<em><b>Occult breast cancer</b></em>: <em><b>Report of two cases</b></em>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000900012&lng=&nrm=iso&tlng= Occult breast cancer is expressed as a metastatic axillary lymph node without clinical or imaging evidence of a primary tumor in the breast. The old concept involved non palpable tumors. Its incidence is low, representing only 0.3 to 1% of all breast cancer cases. The search for the primary tumors is performed with mammography, whose sensitivity is low, ranging from 0 to 56%. Several studies have shown a higher sensitivity of magnetic resonance imaging, ranging from 85 to 100%, to detect occult lesions. The treatment of isolated axillary metastases of breast cancer is controversial. An axillary dissection is recommended. If there is a suspicious image, a radiosurgical or stereotaxic biopsy should be done. However, in patients without radiological lesions in the breast, the tendency is not to perform a radical mastectomy as previously recommended, since the primary tumor will not be found in the surgical specimen in two thirds of cases. A superior and external quadrantectomy or exclusive radiotherapy should suffice. An expecting behavior is not recommended as a therapeutic alternative. Treatment should be complemented with hormonal therapy or chemotherapy. The literature suggests that prognosis is better than stage II, with a ten years survival ranging from 50 to 71%. We report two patients with a well defined occult breast cancer and based on them, a review of the subject is attempted. Considering its prognosis, physicians should be aware of this uncommon and difficult to diagnose disease <![CDATA[<em><b>Spontaneous bacterial peritonitis caused by Listeria in a patient with cirrhosis</b></em>: <em><b>Case report</b></em>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000900013&lng=&nrm=iso&tlng= Infections caused by Listeria monocytogenes are usually found in cattle and occasionally appear in humans, particularly pregnant women and immunocompromised individuals. Peritonitis by Listeria monocytogenes is a rare but dangerous condition that must be recognized early, since it requires a specific treatment. We report a 31 year-old male with alcoholic cirrhosis that developed ascites with abdominal pain and fever. The peritoneal fluid culture yielded Listeria monocytogenes. The patients was initially treated with cefotaxim and later with ampicillin and levofloxacin. The patient voluntarily abandoned treatment and died at home two weeks later <![CDATA[<em><b>BAFF</b></em>: <em><b>A regulatory cytokine of B lymphocytes involved in autoimmunity and lymphoid cancer</b></em>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000900014&lng=&nrm=iso&tlng= BAFF (B cell activating factor belonging to the TNF family) is a cytokine implicated in the survival and maturation of peripheral B lymphocytes and T and B cell activation. BAFF binds to three different receptors: TACI, BCMA and BAFF-R, whose expression is restricted to B and T lymphocytes. BAFF and BAFF-R-deficient mice show a dramatic loss of peripheral B lymphocytes and a severely reduced immune response. In contrast, an enhanced BAFF expression leads to B cell hyperplasia and autoimmunity in mice. In vivo, administration of soluble decoy receptors for BAFF effectively decreases disease progression in various autoimmune mouse models. These evidences render BAFF as a potentially new therapeutic target. Elevated BAFF levels have been detected in the serum of patients with autoimmune diseases, such as Systemic Lupus Erythematosus, rheumatoid arthitis, Sjögren's syndrome, lymphoid cancers and HIV infection. In addition to BAFF receptors, malignant B cells abnormally express BAFF, which attenuates apoptosis through both autocrine and paracrine pathways. The data suggest that an increase in the expression of BAFF induces an enhanced B and T cell activation and the survival of pathologically active B cells. In this article, we review and discuss the participation of BAFF and its receptors in the immune response and its involvement in immunodeficiency, autoimmunity, infections and lymphoid cancers as well as the currently investigated therapies using BAFF antagonists in the treatment of these diseases <![CDATA[<em><b>The relationship between the ozone layer and skin cancer</b></em>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000900015&lng=&nrm=iso&tlng= In the recent decades, a sustained increase in the worldwide incidence of skin cancer has been observed and Chile is not the exception. The most important risk factor is the exaggerated and repeated exposure to ultraviolet radiation coming from the sun. The ozone layer restricts the transmission of type B and C ultraviolet light. Since 1980, a sustained depletion of stratospheric ozone levels is occurring, specially in middle latitudes (-30 to ­60). Along with this depletion, the amount of ultraviolet light that reaches the earth surface is increasing. This article reviews some basic concepts about the ozone layer and the association between its depletion and skin cancer. The general population should be informed about the risks of inadequate and exaggerated exposure to sunlight <![CDATA[<b>Quality of Mortality statistics in Chile, 1997-2003</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000900016&lng=&nrm=iso&tlng= Background: Death certification is the basis for the study of mortality patterns and the identification of leading causes of death. These data are used for planning health policies and prevention programs. Aim: To evaluate the quality of mortality statistics in Chile from 1997 and 2003. Material and methods: Mortality data from 1997 to 2003 available at the Chilean Ministry of Health was used. Quality of information was evaluated using the percentage of certifications done by physicians and ill-defined causes of death according to rural or urban residence, medical services, age and gender. Results: Death certification done by physicians increased from 97.6% to 99.0% in the studied period. The greatest increase was observed in rural areas, from 89.9% to 94,8%. There was a steady reduction in the percentage of ill-defined causes of deaths, from 4.7% in 1997 to 2.8% in 2003. The percentage of ill-defined causes had a great variation among the different medical services. The variation went from 1.5% in Magallanes to 13.7% in Araucania Sur. There was an inverse linear correlation between death certification by physicians and ill-defined conditions. Conclusions: Quality of Chilean mortality statistics has improved over time. Nevertheless, there is still space for enhancement for the appropriate use of this information <![CDATA[<em><b>Acute abdominal pain of difficult diagnosis</b></em>: <em><b>Report of one case and reflections about evidence based medicine</b></em>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000900017&lng=&nrm=iso&tlng= Evidence based medicine is strongly positioned in medical practice. However we must remember that it should be just a part of our knowledge and skills and that a close relationship with our patients is essential. I report a 52 years old male that presented with abdominal pain in the right upper quadrant lasting seven days, that started after participating in a celebration dinner. Abdominal ultrasound was normal and biochemical tests were within normal limits. An upper gastrointestinal endoscopy showed a toothpick that was perforating the gastric wall. The toothpick was withdrawn and the pain subsided. The patient was discharged asymptomatic three days later <![CDATA[<em><b>Systemic inflammatory response syndrome</b></em>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000900018&lng=&nrm=iso&tlng= Evidence based medicine is strongly positioned in medical practice. However we must remember that it should be just a part of our knowledge and skills and that a close relationship with our patients is essential. I report a 52 years old male that presented with abdominal pain in the right upper quadrant lasting seven days, that started after participating in a celebration dinner. Abdominal ultrasound was normal and biochemical tests were within normal limits. An upper gastrointestinal endoscopy showed a toothpick that was perforating the gastric wall. The toothpick was withdrawn and the pain subsided. The patient was discharged asymptomatic three days later <![CDATA[<strong>Coexistence of myasthenia gravis and systemic lupus erythematosus</strong>: <strong>Is it more frequent than we thought?</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000900019&lng=&nrm=iso&tlng= Evidence based medicine is strongly positioned in medical practice. However we must remember that it should be just a part of our knowledge and skills and that a close relationship with our patients is essential. I report a 52 years old male that presented with abdominal pain in the right upper quadrant lasting seven days, that started after participating in a celebration dinner. Abdominal ultrasound was normal and biochemical tests were within normal limits. An upper gastrointestinal endoscopy showed a toothpick that was perforating the gastric wall. The toothpick was withdrawn and the pain subsided. The patient was discharged asymptomatic three days later <![CDATA[<strong>"PSIQUIATRÍA DEL ADOLESCENTE"</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000900020&lng=&nrm=iso&tlng= Evidence based medicine is strongly positioned in medical practice. However we must remember that it should be just a part of our knowledge and skills and that a close relationship with our patients is essential. I report a 52 years old male that presented with abdominal pain in the right upper quadrant lasting seven days, that started after participating in a celebration dinner. Abdominal ultrasound was normal and biochemical tests were within normal limits. An upper gastrointestinal endoscopy showed a toothpick that was perforating the gastric wall. The toothpick was withdrawn and the pain subsided. The patient was discharged asymptomatic three days later <![CDATA[<strong><i>In Memoriam</i></strong><strong>: José S. Barzelatto, M.D. (1926-2006)</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000900021&lng=&nrm=iso&tlng= Evidence based medicine is strongly positioned in medical practice. However we must remember that it should be just a part of our knowledge and skills and that a close relationship with our patients is essential. I report a 52 years old male that presented with abdominal pain in the right upper quadrant lasting seven days, that started after participating in a celebration dinner. Abdominal ultrasound was normal and biochemical tests were within normal limits. An upper gastrointestinal endoscopy showed a toothpick that was perforating the gastric wall. The toothpick was withdrawn and the pain subsided. The patient was discharged asymptomatic three days later <![CDATA[<strong>Fe de erratum</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872006000900022&lng=&nrm=iso&tlng= Evidence based medicine is strongly positioned in medical practice. However we must remember that it should be just a part of our knowledge and skills and that a close relationship with our patients is essential. I report a 52 years old male that presented with abdominal pain in the right upper quadrant lasting seven days, that started after participating in a celebration dinner. Abdominal ultrasound was normal and biochemical tests were within normal limits. An upper gastrointestinal endoscopy showed a toothpick that was perforating the gastric wall. The toothpick was withdrawn and the pain subsided. The patient was discharged asymptomatic three days later