Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720090001&lang= vol. 137 num. 1 lang. <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<b><i>Plagiarism in scientific publications</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000100001&lng=&nrm=iso&tlng= Similar to what occurs in ¡iterature, art and other human endeavours, every scientific repon is based in previous work done by others. The new paper should add something original but a basic law of scientific honesty demands that any mention oíideas, observations or thinking that has been previously proposed or published by others, should be acknowledgedproperly in the text andin the references. Plagiarism is identified when the authors of a scientific repon use ideas or text that belong to others and present them as original, the previous source is concealed or it is referred to in a different context. The authors of a paper that contains plagiarism have the intention to mislead the readers, pretending to be the original authors of an idea that was expressed previously by others, or to be the owners of results shown by them. Plagiarism is a dishonest behaviour and, when discovered, may have dangerous consequences because the editors of the journal may publish a notice of retraction that will be inserted by Medline in both papers: the plagiarized and the plagiarizer, to be noticed by everyone who accesses to either of them in the Internet. <![CDATA[<b><i>Adverse reactions to diphtheria-pertussis-tetanus vaccine in the Chilean Immunization Program</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000100002&lng=&nrm=iso&tlng= Background: During 2005, the surveillance system of the Chilean Immunization Program detected an increased number of adverse reaction notifications associated to diphtheria, pertussis and tetanus whole-cell vaccine (DPT), coincidentiy with a change in the vaccine manufacturer. Aim: To compare the reactogenicity of two DPT formulations (vaccines 1 and 2) in 18-month-old infants and 4-year-old children. Material and methods: Severe adverse reactions to DPT were studied at the emergency room of two hospitals of Santiago in a case-control study (110 cases and 171 controls, who consulted for other causes). Simultaneously the incidence of total adverse reactions (mild and severe) for vaccine 1 and 2 was estimated in a cohort of 1,017 children vaccinated in an ambulatory health center of the same área. The formulation of DPT received by all participants was verífied, as well as the temporal relation with consultation or symptoms referred by their caregivers. Results: There was a greater probability of consulting at the emergency rooms for severe adverse reactions among children who received vaccine 1 (odds ratio (OR) =7.1; p <0.001), being greater among 4-year-old children (OR =18.9; p <0.001). Coincidentiy, in the cohort of vaccinated children, those who received vaccine 1 had a higher risk of presenting adverse reactions (RR =2.9; p <0.001), being high fever the commonest. Conclusions: We confirmed that vaccine 1 was associated to a higher risk of adverse reactions, especially among 4-year-old children. These results allowed the sanitary authority to adopt an informed decisión. The usefulness of observational studies in vaccine adverse reactions is confirmed. <![CDATA[<b><i>Beating heart anterior descending coronary artery grafting with left internal mammary artery</i></b>: <b><i>A long term follow up experience</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000100003&lng=&nrm=iso&tlng= Background: In recent years the use of left internal mammary artery (LIMA) as a gran to anterior descending artery (DA) with the offpump technique has been associated with similar good long term results as with the on pump technique. Aún: To repon the results of LIMA to DA bypass grafting without extracorporeal circulation (EC) for isolated DA lesions. Patients and methods: Descriptive study of 80 patients subjected to coronary surgery between 1999 and 2007. Results: Mean age ofpatients was 63 + 10 years and 60 were male. There was no operative mortality or stroke. One patient with a myocardial infarction required a reoperation. Actuarial survival was 98% at 97 months. Conclusions: In this group ofpatients the use ofLIMA as a coronary bypass gran to DA with the off pump technique is a safe surgical procedure, providing a prolonged cardiac event free survival (mortality, angina, myocardial infarction, and need for a new coronary procedure). <![CDATA[<b><i>Surgery of post myocardial infarction papillary muscle rupture</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000100004&lng=&nrm=iso&tlng= Background: Papillary muscle rupture is a serious complication of myocardial infarction whose only treatment is surgery. Aim: To analyze our most recent surgical experíence with papillary muscle rupture. Patients and Methods: The datábase of our Service was reviewed for the period 1995-2005, to identify patients with papillary muscle rupture. Then, the clinical records and operating protocols were analyzed. Survival and functional class of patients were assessed. Results: Twelve patients (7 men), aged 52 to 89 years, had papillary muscle rupture. They represented 2.2% of all mitral procedures for mitral insufficiency and 8.8% of mitral surgeries for ischemic mitral regurgitation, during the study períod. In eight cases myocardial infarction was inferior, in three lateral and in one, anterior. In 10 patients, a mitral replacement was carried-out and in two the mitral valve was repaired. In seven patients, myocardial revascularization was performed. Mean lapse between infarction and surgery was 13.5 days (1 to 85). Two patients died in the perioperative period. Follow-up ranged from 1.7 to 120.4 months. Four patients died during follow-up, 2 due to a cardiovascular cause. Thus, at the end of follow-up 6 patients were alive. All were in functional class III. Conclusions: Papillary muscle rupture is an uncommon complication of myocardial infarction, with considerable operative and ¡ong-term mortality. However, survivors have good quality of life. <![CDATA[<b><i>Precocious pubarche</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000100005&lng=&nrm=iso&tlng= Background: Precocious pubarche (PP), defined as the development of sexual pubic hair before 8 years of age in females and before 9 years in males, is usually a benign condition but it can also be the first sign of an underlying disease. Aim: To analyze the etiology and perform a short term follow up in a cohort ofpatients with PP. Material and methods: A group of 173patients (158 females) consulted for PP with a mean age of 7.4+0.1 years. These patients were followed between 15 to 60 months. Anthropometric measurements, bone age, serum levels of total testosterone, 17 OH progesterone (17 OHP) and dehydroepiandrosterone sulphate (DHEAS) were evaluated. Results: Mean birth weight and length was 3024.1+50.5 g and 48.5+0.3 cm, respectively. Ten percent of children were small for gestational age at birth. Bone age was accelerated by 1.1+0.01 years. One hundred and twelve patients were classified as having idiopathic PP (64.7%; 105 females), 29 as central precocious puberty (16.8%; only females), 16 as exaggerated adrenarche (EA 9.2%; 13 females) and 16 as non classical adrenal hyperplasia (9.2%; 11 females). Conclusions: PP represents a common and usually benign sign. However, 26% of cases had a pathologic underlying condition. Therefore, all children with PP should be evaluated by a pediatric endocrinologist. Low birth weight was not frequent in this cohort and these patients did not show EA . <![CDATA[<b><i>Blood pressure and family history of hypertension in children from Santiago, Chile</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000100006&lng=&nrm=iso&tlng= Background: The prevalence of pediatric arterial hypertension (AHT) is approximately 1% to 2%. In the last tenyears, mean blood pressure levels (BP) have raised due to obesity and changes in lifestyles. Family history (FH) of AHT is a risk factor to develop AHT in children. Aim: To assess blood pressure, cardiovascular risk factors and family history in healthy children of Santiago. Material and methods: Blood pressure, family history of AHT, birth weight (BW), gestational age, puberal stage, blood glucose, serum lipids and ultrasensitive Reactive C Protein (usCRP) were analyzed, using data from a study of early markers of atherosclerosis in children. Results: Data of 112 children aged between 6-12 years was analyzed. Hypertension (BP >percentile 95) was detected in 2.7% and pre hypertension (BP in percentiles 90-95) in 3.6% ofthe sample. Children with abnormal BP had higher levels of usCRP (p <0.05) and a non significant tendency towards a higher body mass index. All hypertensive and one pre hypertensive children had FH of AHT. Eleven percent of parents, had high blood pressure. In no children, both parents were hypertensive. Children with a family history of hypertension had higher concentrations of total serum cholesterol (p <0.05). Conclusions: The abnormal prevalence of AHT found in this study is comparable to other studies. FH associated to higher levels of BP in children. Children with abnormal BP had a higher subclinical level of inflammation . <![CDATA[<b><i>Unwanted pregnancy and access to printed media in Peruvian women</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000100007&lng=&nrm=iso&tlng= Background: It is possible that there is a relationship between reading newspapers and magazines, watching televisión and ¡istening to the radio and unwanted pregnancies. Aim: To assess the relationship between the access to printed and audiovisual information resources and unwanted pregnancy in Peruvian women. Material and methods: A sample of 5,071 women, aged between 18 and 30 years was selected from a datábase of a Demographics and Health survey performed between 2004 and 2005. Using the information obtained in the survey, the association between unwanted pregnancies and reading newspapers and magazines, was analyzed. Results: Twenty six percent of women had at least an unwanted child (n =1,327). Radio and televisión were the media mostly used by these women. Seventy five percent of women almost never read newspapers and magazines. The lack of reading and the reliance in televisión and radio as sources of information were all associated with unwanted pregnancy (p & lt;0.001). Conclusions: In this sample of women, there is a negligible interest for reading and a high preference for radio and televisión. This explains the poor knowledge on sexual and reproductive health and the lack of impact of printed materials used in educational campaigns. <![CDATA[<b><i>Possible role of psychological and environmental factors in the genesis of chilhood vitiligo</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000100008&lng=&nrm=iso&tlng= Background: The exposure to stressing situations may play a role in the appearance of vitiligo. Patients with the disease have a greater sensitivity to environmental stress and a lower threshold to generate catecholamine mediated responses. Aim: To evaluate the temperament and character of patients with vitiligo and explore the relationship of the disease with negative life events and life quality impairment. Material and methods: The study population were 21 patients with vitiligo aged 5 to 12years, and two control groups (Gl and G2). Gl was composed by 14 healthy siblings of vitiligo patients. G2 was composed by 21 age and gender matched healthy students from two schools in Santiago, Chile. The Júnior Temperament and Character Inventory (JTCI), the Qualitative Psychosocial Development Survey (QPDS), the Life Event Checklist (LEC) and the Childrens Life Quality índex (CDLQI) were applied (LEC only to vitiligo patients). Resulte: On the temperament dimensions, vitiligo patients scoredhigh on the "harm avoidance" scale in comparison to G2 (13.7 v/s 10.6). Compared with Gl, QPDS showed in vitiligo patients a higher frequency offear to strangers (71% and 36%, respectively) and a predominant feeling offear and shyness in response to changes in a cióse relative (80% and 8%, respectively). There was a negatíve correlation (protective factor) between the character dimensión "self-directedness" and CDLQI score (r =-0.703). Conclusions: In this group of patients, we found a possible relationship between a specific temperament dimensión, vitiligo and its impact on life quality. <![CDATA[<b><i>lnterleukin-1 genetic polymorphism</i></b>: <b><i>Association with gastric cancer in the high-risk Central-Western population of Venezuela</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000100009&lng=&nrm=iso&tlng= Background: Genetic predisposition may playa role in the prevalence of gastric cancer (GC). Aim: To investígate the relationship between selected interleukin-1 (IL-1) loci polymorphisms and gastric cancer risk in the Central-Western región of Venezuela, where gastric cancer represents the first cause of cancer-related deaths. Material and methods: In a case-control study we compared the frequencies of IL-1B-511 and IL-1B+3954 biallelic polymorphism, and the pentallelic VNTR of IL-IRN in 84 gastric adenocarcinoma parafñn-embedded biopsies and 84 endoscopic biopsies from cancer-free controls. Results: No significant increase in genotypic frequencies in gastric cancer was observed for any ofthe IL-1B-511 allelic combinations. However, in a logistic regression analysis, a significant association emerged for the IL-1B+3954C carrier genotype (odds ratio (OR): 6.2; 95% confidence intervals (CI) 1.3-28.8). On the other hand, a significantly higherrisk was evidenced for the IL-IRN*2/*2genotype (OR: 7.0; 95% CI2.3-21.5). Onlypatients with a well/moderately-differentiated adenocarcinoma that were homozygotes for the E-IRN*2/*2 genotype, liad a higher risk than the complete gastric cancer group (OR: 8.1, 95% CI 2.5-26.8). Some genotype combinations among IL-1B-511, IL-1B+3954 and IL-IRN showed an increased risk for developing gastric cancer and well/moderate differentiated adenocarcinoma, that was dependent ofthe presence of IL-IRN*2/*2 genotype. Conclusions: IL-IRN*2/*2 genotype is associated with increased risk of gastric cancer in the Venezuelan population. <![CDATA[<b><i>Molecular subtyping of Salmonella enterica serotype Enteritidis in a post epidemic period</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000100010&lng=&nrm=iso&tlng= Background: In the last two decades, Salmonella enterica serotype Enteritidis has become one of the main agents causing food borne diseases worldwide. This agent is transmitted mainly by contaminated meat and poultry. Aim: To determine the genetic subtypes of Salmonella enterica serotype Enteritidis, circulating in Chile between 2001 and 2003, a post epidemc period. Material and methods: One hundred ninety three isolates coming from human samples, prepared foods and animal products for human consumption, were analyzed bypulsed field electrophoresis, using PulseNet standardized protocol. Results: Thirteen subtypes of Salmonella enterica serotype Enteritidis were identified, that had between 0 and 13 bands. A predominant subtype was identified in 172 strains (88%) that carne from human isolates, prepared foods and animal producís for human consumption. Other four subtypes, found in prepared foods and animal products for human consumption, were also found in human isolales. Most subtypes were lighlly inlerrelaled Subtypes II, VIII and XI were also found in the 1994 epidemic. Conclusions: Subtyping of baclerial slrains by pulsed field electrophoresis is useful for the surveillance of food borne diseases. <![CDATA[<b><i>Discordance between nutritional status and self perception of weight among adults from Talca, Chile</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000100011&lng=&nrm=iso&tlng= Background: Obesity is related to underestimation of one 's own weight. Aim: To determine the agreement between nutritional status and self perception ofweight status in apparently healthy adults from Talca. Subjects and methods: Data were obtained from a survey applied at 1007 randomly selected subjects, aged 18-74 years old (66% women). The survey identified age, gender, educational level and socioeconomic status. Self-perception of weight was estimated with pictures representing the four nutritional status categories: underweight, normal, overweight and obese. Body Mass index (BMI, kg/m²) was calculated to determine nutritional status. Statistical analysis included kappa índex, Bowman s symmetry test and a logistic regression model to calculate the odds ratio in different variables related to underestimation of weight. Results: Seventy three percent of subjects were overweight or obese and 44% underestimated their nutritional status. Sixty percent ofsubjects with a BMI between 25 and 26 kg/m², perceived themselves as normal. A higher underestimation was observed in obese subjects (odds ratio (OR) 17.2 95% confidence intervals (CI) 10.9-27.1), in overweight individuals (OR 3.5 95% CI 2.3-5.3), in men (OR 1.5 95% CI 1.1-2.1) and in people aged from 45 to 59 years (OR 1.7 95% CI 1.0-2.7). Conclusion: Almost half of studied population had an erroneous self-perception ofweight, mainly due to underestimation. Obese subjects, males and people older than 45years were those with the higher degree of underestimation. <![CDATA[<b><i>Colusion tumor consisting in a metastatic adenocarcinoma ano follicular lymphoma in the same lymph node</i></b>: <b><i>Report of one case</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000100012&lng=&nrm=iso&tlng= Colusion tumors are defined as the simultaneous presence of two adjacent but histologically distinct tumor types artsing in the same organ or site. The occurrence of these tumors is rare. We report a 52 year-old woman with a colusión tumor consisting of metastatic adenocarcinoma and follicular lymphoma present in the same lymph node, excised from the left supraclavicular space. The patient died four weeks after the diagnosis was made. <![CDATA[<b><i>Refractory dermatomyositis associated with chronic organizing pneumonia treated with rituximab</i></b>: <b><i>Report of one case</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000100013&lng=&nrm=iso&tlng= Chronic organizing pneumonia (COP) has often been reported as a pulmonary manifestation of collagen vascular diseases, mainly rheumatoid arhritis, but the association of COP and dermatomyositis (DM) has rarely been documented. We report a 55 year-old woman with well-documented DM and a COP. She was refractory to steroids and two other immunosuppressive agents therapy (cyclophosphamide and azathioprine). Therefore, rituximab (2 x 1 g infusions) was used for treatment. During the following weeks her strength gradually increased while creatine kinase (CK), C reactive protein and erythrocyte sedimentation rate normalized. After 6 months, she had a relapse with increased muscle enzymes, fever and modérate muscle weakness. After a second course of rituximab (2 x 1 g infusions), the patient demonstrated a remarkable clinical response as indicated by an increase in muscle strength and moderate decline in creatine kinase levels. Lung abnormalities resolved significantly on high resolution chest CT sean. Thus, B-cell depletion therapy with rituximab used alone or in combination with other immunosuppressants may be a viable option in patients with polymyositis-dermatomyositis and pneumonia refractory to current therapies. <![CDATA[<b>Down-Syndrome associated with MBL-deficiency, IgG-deficiency, vasculitis and mutated prothrombin</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000100014&lng=&nrm=iso&tlng= The association of Down syndrome with mannose-binding lectin (MBL)-deficiency, recurrent infections and vasculitis has not been reponed. We repon a 30 year-old female with Down-syndrome associated with MBL-deficiency with the genotype LXA/HYD, IgG-deficiency, recurrent uro-genital infections, cutaneous vasculitis, G20.210A prothrombin mutation, deep venous thrombosis, and pulmonary embolism. MBL-deficiency in combination with IgG deficiency might have favored the development of recurrent uro-genital infections. Immunodeficiency might be also involved in the pathogenesis of cutaneous vasculitis. Deep venous thrombosis and pulmonary embolism were attributed to the genetically determined prothrombotic state and intake of oral contraceptives.<hr/>La asociación de síndrome de Down con deficiencia de lectina de unión a manosa, infecciones recurrentes y vasculitis no ha sido informada. Presentamos una mujer de 30 años de edad con síndrome de Down asociado a deficiencia de lectina de unión a mañosa, con el genotipo LXA/HYD, deficiencia de IgG, infecciones urogenitales recurrentes, vasculitis cutánea, mutación de protrombina G20.210A, trombosis venosa profunda y embolia pulmonar. La deficiencia de lectina de unión a manosa combinada con la deficiencia de IgG puede haber favorecido las infecciones urogenitales recurrentes. La inmunodeficiencia puede también tener relación con la patogenia de la vasculitis cutánea. La trombosis venosa profunda y la embolia pulmonar pueden deberse al estado protrombótico derivado de la mutación de protrombina y el uso de contraceptivos orales. <![CDATA[<b><i>Acute type A aortic dissection in pregnant patient with Marfan syndrome</i></b>: <b><i>Report of one case</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000100015&lng=&nrm=iso&tlng= Aortic dissection is a life-threatening disease that requires immediate surgical intervention. Marfan syndrome is a hereditary disease with an autosomal dominant transmission, which affects the connective tissue, with skeletal, cardiovascular and ocular involvement. It is one of the most prevalent connective tissue disorders, presenting a rísk of aortic dissection of approximately 1% even without dilatation of the aorta. When dissection occurs during pregnancy and requires surgical intervention (type A dissection), maternal mortality is high (2096-30%). We report a 38 year-old woman with Marfan syndrome that had an acute type A aortic dissection and severe aortic regurgitation at 37 weeks of gestation. The patient underwent a cesarean section and delivered a healthy baby. Afterwards, aortic valve repair and ascending aortic replacement was successfully performed under circulatory arrest with deep hypothermia. Additionally mitral valve repair for degenerative disease with posterior, autologous pericardium mitral valve ring was performed. <![CDATA[<b><i>The relevance of environmental health and the scope of pediatric environmental health specialty units</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000100016&lng=&nrm=iso&tlng= In the last decades there has been an important decrease in infant mobidity and mortality, but these achievements are not equally distributed across the whole population. Children are one of the most susceptible groups due to their unique vulnerabilities to environmental factors. Unhealthy environments, indoor pollution, poor drainage, inadequate waste disposal, and many others, are significant environmental risk factors to children. Currently, Chile is experiencing an advanced demographical transition, a situation that requires a precise approach to guarantee that the population has an adequate health status. It is important to take care of children, since their present health status will condition their health as adults. Pediatric Environmental Health Specialty Units are structures specialized in pediatric conditions related to the environment, formed by an interdisciplinary and highly specialized team. These centers provide assistance, information and treatment, promote research, edúcate health care providers or the public, and report problems to authoríties. Health authoríties should emphasize the importance ofhavíng a safe environment for children and encourage efforts to reduce exposure to environmentalhazards promoting healthy behaviors, education and awareness at all levéis of society . <![CDATA[<b><i>Atypical antipsychotic induced weight gain and metabolic disorders</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000100017&lng=&nrm=iso&tlng= The advent of new antipsychotic drugs has improved the treatment of schizophrenic patients as well as those suffering from other severe psychiatric disorders. Its widespread use, however, has been associated to the development of obesity and metabolic disturbances such as diabetes mellitus, dyslipidemia and increased coronary risk. This has caused a serious concern, due to the high cardiovascular mortality that prematurely affects these patients. The etiology of these abnormalities is still a matter of debate, although it is generally believed that the new antipsychotic drugs have a control stimulating effect on appetite, and their use is associated to an increased level of cortisol and to an insulin-resistance state. In addition, there is an increase in inflammatory mediator and cytokine production, induced by the pathophysiology of the schizophrenic process itself and also caused by the direct action of the antipsichotic drugs. In spite of the mounting evidence, the metabolic management of these patients is still deñcient. A cióse follow-up in the initial stages of the antipsychotic treatment is recommended, as well as giving advice about diet and physical exercise. Finally, when obesity or other conditions associated to metabolic syndrome appear, the recommendation is to switch to drugs with less secondary effects or to add adjuvant medications to improve the overall evolution of these patients. <![CDATA[<b><i>General aspects of homeopathy</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000100018&lng=&nrm=iso&tlng= Homeopathic medicine is a type of therapy that appeared in Europe at the end of the eighteenth century. At the present time, it is widely accepted in developed countries as a form of alternative medicine. In Chile, health regulation includes homeopathy as pharmaceutical producís and homeopathy is also considered a form of complementary medicine, that is well accepted by the public. The scientific rationale of homeopathy is based on an empine type of thought that goes from the general to the particular. The symptoms that are valued are those that are particular to each sick individual. It uses diluted solutions of plants, minerals, animáis and even venoms. There are basically two hypotheses to explain its mechanisms ofaction: The "immunological memory" and the "memory of water" or the transmission of electromagnetic information of the water. There still is needed to perform new studies to scientifically assess homeopathy and its usefulness, as an accepted alternative therapy . <![CDATA[<b><i>Create or copy... Which is the difference?</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000100019&lng=&nrm=iso&tlng= Creating and copying are two different processes; we must not confuse creativity with plagiarism. However, this distinction is problematic, because there is no possibility of creating from scratch, this implies that any creative act necessarily arises from accumulative experience, inevitably producing a continuity between oíd and new. Even so it is necessary to establish clearly the difference between creating and copying. It is not desirable that a matter of such importance remains in the nébula or that the relationship between creativity and ethics is kept unaware. There are many cases of plagiarism, but this cannot be a consolation. There is no gain when the existence of a plagiarism is ignored or concealed and less when it is unjustified. <![CDATA[<b>Hepatitis Viral</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000100020&lng=&nrm=iso&tlng= Creating and copying are two different processes; we must not confuse creativity with plagiarism. However, this distinction is problematic, because there is no possibility of creating from scratch, this implies that any creative act necessarily arises from accumulative experience, inevitably producing a continuity between oíd and new. Even so it is necessary to establish clearly the difference between creating and copying. It is not desirable that a matter of such importance remains in the nébula or that the relationship between creativity and ethics is kept unaware. There are many cases of plagiarism, but this cannot be a consolation. There is no gain when the existence of a plagiarism is ignored or concealed and less when it is unjustified. <![CDATA[<b>Reunión del Comité de Jefes de Servicios de Medicina, durante el XXX Congreso de Medicina Interna de la Sociedad Médica de Santiago -Sociedad Chilena de Medicina Interna</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000100021&lng=&nrm=iso&tlng= Creating and copying are two different processes; we must not confuse creativity with plagiarism. However, this distinction is problematic, because there is no possibility of creating from scratch, this implies that any creative act necessarily arises from accumulative experience, inevitably producing a continuity between oíd and new. Even so it is necessary to establish clearly the difference between creating and copying. It is not desirable that a matter of such importance remains in the nébula or that the relationship between creativity and ethics is kept unaware. There are many cases of plagiarism, but this cannot be a consolation. There is no gain when the existence of a plagiarism is ignored or concealed and less when it is unjustified. <![CDATA[<b>Curso</b>: <b>Salud en las Américas</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000100022&lng=&nrm=iso&tlng= Creating and copying are two different processes; we must not confuse creativity with plagiarism. However, this distinction is problematic, because there is no possibility of creating from scratch, this implies that any creative act necessarily arises from accumulative experience, inevitably producing a continuity between oíd and new. Even so it is necessary to establish clearly the difference between creating and copying. It is not desirable that a matter of such importance remains in the nébula or that the relationship between creativity and ethics is kept unaware. There are many cases of plagiarism, but this cannot be a consolation. There is no gain when the existence of a plagiarism is ignored or concealed and less when it is unjustified. <![CDATA[<b>Curso</b>: <b>Diabetes mellitus en atención primaria</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000100023&lng=&nrm=iso&tlng= Creating and copying are two different processes; we must not confuse creativity with plagiarism. However, this distinction is problematic, because there is no possibility of creating from scratch, this implies that any creative act necessarily arises from accumulative experience, inevitably producing a continuity between oíd and new. Even so it is necessary to establish clearly the difference between creating and copying. It is not desirable that a matter of such importance remains in the nébula or that the relationship between creativity and ethics is kept unaware. There are many cases of plagiarism, but this cannot be a consolation. There is no gain when the existence of a plagiarism is ignored or concealed and less when it is unjustified. <![CDATA[<b><i>LIVER TRANSPLANTATION IN PEDIATRIC CANDIDATES</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000100024&lng=&nrm=iso&tlng= Creating and copying are two different processes; we must not confuse creativity with plagiarism. However, this distinction is problematic, because there is no possibility of creating from scratch, this implies that any creative act necessarily arises from accumulative experience, inevitably producing a continuity between oíd and new. Even so it is necessary to establish clearly the difference between creating and copying. It is not desirable that a matter of such importance remains in the nébula or that the relationship between creativity and ethics is kept unaware. There are many cases of plagiarism, but this cannot be a consolation. There is no gain when the existence of a plagiarism is ignored or concealed and less when it is unjustified. <![CDATA[<b><i>Liaison psychiatry</i></b>: <b><i>Referrals in a University Clinic in Colombia</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000100025&lng=&nrm=iso&tlng= Creating and copying are two different processes; we must not confuse creativity with plagiarism. However, this distinction is problematic, because there is no possibility of creating from scratch, this implies that any creative act necessarily arises from accumulative experience, inevitably producing a continuity between oíd and new. Even so it is necessary to establish clearly the difference between creating and copying. It is not desirable that a matter of such importance remains in the nébula or that the relationship between creativity and ethics is kept unaware. There are many cases of plagiarism, but this cannot be a consolation. There is no gain when the existence of a plagiarism is ignored or concealed and less when it is unjustified. <![CDATA[<b><i>Clinical guidelines on identitication, management and complications of chronic kidney disease</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009000100026&lng=&nrm=iso&tlng= The key messages of these guidel ines on chronic kidney disease are: • Chronic kidney disease (CKD) is a public health problem due to its wide distribution, high rate of complications and cost. • CKD is a common condition, its prevalence being about 10%, and is treatable if it is detected on time. • A patient with CKD has a higher risk of cardiovascular mortality than of progression of its underlying renal disease. • A new definition of CKD, based on estimated Glomerular Filtration Rate (eGFR) and kidney damage, facilitates its detection and management. • CKD is detected with three simple tests: 1) Blood pressure measurement, 2) Detection of proteinuria or albuminuria in an isolated urine sample, and 3) Estimation of renal function (eGFR), based on serum creatinine, age, gender and race. • The CKD risk groups are individuáis with diabetes, hypertension and a family history of renal disease. • The most cost-effective measures are to detect and treat diabetic and hypertensive patients in the community. • Therapy must emphasize the maximal reduction of cardiovascular risk. • The complications of CKD such as anemia and renal osteodystrophy can be identified and treated on time. • Most patients with chronic kidney disease are detected in the community, therefore their initial care must be organized at the level of primary care, along with programs for hypertension and diabetes.