Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720090010&lang= vol. 137 num. 10 lang. <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<b><i>Estimation of coronary heart disease risk in Chilean subjects based on adapted Framingham equations</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001000001&lng=&nrm=iso&tlng= Background: Cardiovascular disease is the leading cause of morbidity and mortality in Chile and worldwide. Framingham functions were developed to calculate overall coronary heart disease risk However these functions overestimate the risk in some countries ¡ike Chile. Aim To develop Chilean risk tables to assess the overall 10-year risk of coronary heart disease. Material and methods: The Framingham function was adapted for a population aged 35 to 74 years, based on an estimate of Chilean incidence of coronary heart disease and the prevalence of coronary heart disease risk factors such as age, sex, total cholesterol, high-density lipoprotein cholesterol, blood pressure, diabetes and smoking. Results: The 10-year incidence of coronary heart disease in Chile (2.7% in men, 1.096 in women) was lower than the incidence in the United States (10.096/3.896) and Spain (4.996/2.296), but higher than China (1.196/0.496). Framingham tables have more than 50% of cells in the risk category of 10% or greater. In contrast, Chilean tables have less than 10% of cells in the same risk category. Conclusions: Adapted tables use local information to calculate overall coronary heart disease risk. A validation study should be conducted to assess their predictive power. <![CDATA[<b><i>Management of community acquired pneumonia in adults following clinical guidelines at a rural hospital</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001000002&lng=&nrm=iso&tlng= Background: A National Consensus Guideline published in 2005 established the basis for the diagnostic, severity assessment and treatment of community acquired pneumonia (CAP) in the adult population. The compliance with pneumonia clinical guidelines has been associated to a reduction in hospital stay healthcare-related costs, morbidity and mortality. Aim To describe the management and outcome of non-severe CAP in hospitalized adult patients treated in a rural hospital, based on the national clinical guidelines. Patients and methods: Ninety six patients aged 74 ± 13 years (50 males) hospitalized with non-severe pneumonia (group 3) at a community-based primary care center between January 1, 2006, and March 31, 2007, were evaluated. Results: Eighty percent of patients had concomitant diseases such as hypertension in 49%, diabetes in 23% and chronic obstructive pulmonary disease in 18%. All were treated with a third generation cephalosporin (ceftriaxone 1-2 g/day TV) as empirical therapy. Only 9% of patients also received a macrolide. Early switch to oral antimicrobial therapy was successful in two third of cases. Mean hospital length of stay was 5.0 ± 2.5 days, and 30-day mortality was 6.3%. Conclusions: Following the recommendations of the national clinical guidelines, most of these patients had a favorable response to monotherapy with a B-lactam antimicrobial. Early switch therapy to oral antibiotic was effective and safe, reducing significantly hospital length of stay as compared to previous national clinical studies. <![CDATA[<b><i>Modeling the academic performance of medical students in basic sciences and pre-clinical courses</i></b>: <b><i>A longitudinal study</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001000003&lng=&nrm=iso&tlng= Background: The study of predictors of academic performance is relevant for medical education. Most studies of academic performance use global ratings as outcome measure, and do not evaluate the influence of the assessment methods. Aim: To model by multivariate analysis, the academic performance of medical considering, besides academic and demographic variables, the methods used to assess students' learning and their preferred modes of information processing. Material and methods: Two hundred seventy two students admitted to the medical school of the Pontificia Universidad Católica de Chile from 2000 to 2003. Six groups of variables were studied to model the students' performance in five basic science courses (Anatomy, Biology, Calculus, Chemistry and Physics) and two pre-clinical courses (Integrated Medical Clinic I and IT). The assessment methods examined were multiple choice question tests, Objective Structured Clinical Examination and tutor appraisal. Results: The results of the university admission tests (high school grades, mathematics and biology tests), the assessment methods used, the curricular year and previous application to medical school, were predictors of academic performance. The information processing modes influenced academic performance, but only in interaction with other variables. Perception (abstract or concrete) interacted with the assessment methods, and information use (active or reflexive), with sex. The correlation between the real and predicted grades was 0.7. Conclusions: In addition to the academic results obtained prior to university entrance, the methods of assessment used in the university and the information processing modes influence the academic performance of medical students in basic and preclinical courses. <![CDATA[<b><i>Thelarche and nutritional status</i></b>: <b><i>An epidemiológical study of two ethnic groups</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001000004&lng=&nrm=iso&tlng= Background: Improvements in environmental conditions may result in an earlier onset of thelarche. However, its onset is not homogeneous among different population groups. Aim: To assess the relationship between nutritional status, ethnicity and age of thelarche. Material and methods: Cross-sectional study of girls in second through sixth grade, attending 165 schools located in Chile's Araucania region. Of these, 231 girls who presented thelarche (breast button) were selected. The girls' surnames were used to identify their ethncity: indigenous had three or four last names of Mapuche indigenous origin (n =113), while non-indigenous were those who only had Chilean-Spanish last names (n =118). Weight, height, waist circumference and skinfold thicknesses were measured and socio-economic background information was collected through a home interview. Results: The median age of thelarche was 10 years and 4 months, regardless of ethnic group. Multivariant models showed that an increase of one z score unit of body mass index (BMI) decreased the median age of thelarche by 5.6 months (CI: -7.24 to -3.90), controlling for the effect of different covariables. A decrease in one z score of height retards the median age of thelarche by 5.5 months (CI: 4.02 to 6.98). Ethnicity did not influence the age of thelarche. Conclusions: The age of thelarche found by us is similar to that reported in international studies, it comes earlier as weight increases, is delayed as height decreases and is not related to ethnicity. <![CDATA[<b><i>Antimicrobial susceptibility of Helicobacter pylori strains isolated in Colombia</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001000005&lng=&nrm=iso&tlng= Background: Helicobacter pylori antimicrobial resistance rates differ among countries and even between different areas of a country. In Colombia, the most commonly used antimicrobials for the treatment of H pylori infection are amoxicillin, clarithromycin and metronidazole. Aim: To determine antimicrobial susceptibility of H pylori strains isolated in Colombia. Materials and methods: Eighty eight strains of H pylori were isolated and identified by microbiological methods and confirmed with polymerase chain reaction (PCR). The detection of antimicrobial resistance to amoxicillin, clarithromycin, metronidazole and tetraclycline, was conducted by the Etest method. Mutations in the 23S rDNA, involved in resistance to clarithromycin, were detected using PCR and restriction fragment lenght polymorphism. Results: Eighty eight and 2.2% of the strains were resistant to metronidazole and clarithromycin, respectively. No isolate was simultaneously resistant to amoxicillin or tetracycline. The two clarithromycin resistant strains were homozygous for the A2143G mutation. No mutations were found in the remaining 86 susceptible strains. Conclusions: The high rate of metronidazole resistance in our population precludes the use of this drug for the empirical treatment of Hpylori infection. <![CDATA[<b><i>Effects of periodontal therapy on markers of systemic inflammation in patients with coronary heart disease risk</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001000006&lng=&nrm=iso&tlng= Background- Studies investigating effects of periodontal treatment (PT) on markers of inflammation in healthy subjects show conflicting results. Few studies have investigated the effects ofPT among subjects with coronary heart disease (CHD) risk factors. Aim: To report the results of a pilot prospective study on the effects of periodontal treatment on markers of inflammation among subjects with CHD risk factors. Material and methods: Seventy three patients aged 53±6 years (25% males) with chronic periodontitis, dyslipidemia and other CHD risk factors were subjected to PT consisting on root planning and oral metronidazol and amoxicillin for 7 days. Periodontal clinical parameters, serum C-reactive protein (CRP), fibrinogen levels and erythrocyte sedimentation rate (ESR) were assessed before and at 6 weeks añerPT. Polymorphisms at the ILlA-889 andIL1B+3954genes were also genotyped. Results: After the treatment period, CRP levels significantly increased from 3.6±3.7 mg/ L to 5.4±5.7 mg/L (p =0.001). No significant changes were observed in fibrinogen levels and ESR. Higher post-treatment CRP levels were significantly associated with the composite polymorphic genotype at the ILlA-889 and IL1B+3954 genes (p =0.0001), and extensive periodontitis (p =0.005). Moderate alcohol consumption appeared as a protective factor for CRP elevation (p =0.029). Conclusions: The increase of the CRP levels after PT in patients with CVD risk factors appeared associated with IL-1 gene polymorphisms and extensive periodontitis. <![CDATA[<b><i>Effects of incorporating group visits on the metabolic control of type 2 diabetic patients</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001000007&lng=&nrm=iso&tlng= Background: A better metabolic control is an important objective of health care in diabetes mellitus. This objective has been achieved elsewhere, incorporating group visits to the usual care of diabetic patients. Aim: To evaluate the effects of a primary care group visit model after 9 and 15 months of implementation, on the metabolic control of diabetic patients. Material and methods: Two cohorts of type 2 diabetic patients, matched by sex, age and fasting plasma glucose (FPG) were studied. Group visits (monthly medical consultation and one hour sessions with group interaction on the same day) were implemented in 600 patients and routine visits (monthly one-to-one medical consultation) were implemented in 601 patients. The evolution on FPG, cholesterol, systolic (SBP) and diastolic blood pressure (DBF) and body mass index (BMI) were compared. Results: At 15 months of follow up, mean FPG was lower in patients with group visits compared to those in usual individual care (155.3 ± 59.5 and 175.7 ± 67.7 mg/dL respectively, p <0.01). SBP and DBF were also lower in patients on group visits (123.6 ± 13.4 and 127.5 ±12.8 mmHg, respectively for systolic pressure, p <0.01 and 73.5 ±8.5 and 79.4 ±6.3 mmHg, respectively for diastolic pressure, p <0.01). No differences between groups were observed for blood cholesterol or BMI. Conclusions: Incorporation of group visits in type 2 diabetic patients improved metabolic control and blood pressure, compared to the usual individual care model. <![CDATA[<b><i>Retrospective review of 44</i></b>: <b><i>Chilean patients with Behçet disease</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001000008&lng=&nrm=iso&tlng= Background: Behget's disease (BD) is a rare multisystemic inflammatory disease that is potentially disabling and may cause death. Aim: To describe the characteristics of BD patients from two Chilean centers. Patients and method: Retrospective review of the clinical records of patients with BD attended in two rheumatology services between 1985 and 2007. The "Behget's Disease Research Committee of Japan" (BDCJ) and the "International Study Group for Behget's Disease" (ISG) diagnostic criteria were applied. Results: We found 44 cases (25 males), diagnosed as BD. The mean age at the onset of symptoms was 26± 12 years. According to BDCJ criteria, 13 patients had complete BD, 24 had incomplete BD and 7 had a suspected BD. Thirty two patients fulfilled the ISG criteria. Forty two patients (95%) had oral ulcers, 33 (75%) had genital ulcers and 29 (66%) had ophthalmological involvement. Eleven and three patients had symptoms of central and peripheral nervous system involvement, respectively. No gender differences were detected. Conclusions: The clinical characteristics of these patients were similar to those described abroad, except for a higher frequency of peripheral nervous system involvement and a lower rate of arthritis. <![CDATA[<b><i>Adenocarcinoma and intestinal duplication of the ileum</i></b>: <b><i>Report of one case</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001000009&lng=&nrm=iso&tlng= Gastrointestinal duplications are uncommon developmental abnormalities that occur anywhere along the gastrointestinal tract. We report a 36 year-old female admitted to the emergency room due to abdominal pain. Computed abdominal tomography demonstrated small bowel ¡oops surrounding a tubular cystic structure and peritoneal free fluid. The surgical exploration revealed multiple malignant implants covering the visceral and parietal peritoneum and infiltrating completely the omentum. At the Heal mesentery we found a tubular cystic whitish tumor measuring 12 cm of diameter and 15 cm on length. A complete resection of the tumor was not considered an option due to the extensive peritoneal dissemination. Thirty-four days after the operation the patient died. The histopathology of the cystic wall was compatible with the architecture of intestinal wall extensively infiltrated by a moderately differentiated mucinous adenocarcinoma; a mucosal lining in parts atrophic and in parts infiltrated or replaced by adenocarcinoma was observed. A well structured muscular layer was recognized, and the myenteric plexus was identified. <![CDATA[<b><i>Complete repair in a single period of circulatory arrest of a ruptured atherosclerotic aortic arch aneurysm</i></b>: <b><i>Report of one case</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001000010&lng=&nrm=iso&tlng= The aortic arch aneurysm is a complex disease with a growing incidence in our population. We report a 64 year-old female with an atherosclerotic aortic arch aneurysm with a maximum diameter of 9.4 cm and evidence of contained rupture. We performed a complete aortic arch replacement in a single period of 100 minutes of circulatory arrest with deep hypothermia and brain protection with anterograde cerebral perfusión through the right axillary artery. The patient had a complete recovery without evidence of neurological damage and was extubated on the next morning. One year later, the patient is asymptomatic and the peri-aortic haematoma was completely reabsorbed. <![CDATA[<b><i>Prolonged prone position ventilation for severe respiratory distress syndrome post-pneumonectomy</i></b>: <b><i>Report of one case</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001000011&lng=&nrm=iso&tlng= Management of patients with severe respiratory failure is mainly supportive, and protective mechanical ventilation is the pivotal treatment. When conventional therapy is insufficient to improve oxygenation without deleterious effects, other strategies should be considered. We report a 53 year-old male who presented a severe respiratory failure refractory to conventional management after pneumonectomy. Prone position ventilation was used for 36 hours. Respiratory variables improved and he did not show hemodynamic instability. He was returned to the supine position without worsening of oxygenation parameters. Extended prone position ventilation could be considered in patients presenting with unresponsive severe respiratory failure after pulmonary resection. <![CDATA[<b><i>Cardiogenic shock secondary to acute myocardial infarction managed with high volume hemofiltration</i></b>: <b><i>Report of a case</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001000012&lng=&nrm=iso&tlng= Cardiogenic shock secondary to acute myocardial infarction unveils a systemic inflammatory response with elevation of cytokines that contribute to hypoperfusion. High volume hemofiltration may remove cytokines in patients with septic shock resulting in hemodynamic improvement and reducing the requirements of norepinephrine. We report a 48 year-old male with cardiogenic shock secondary to acute myocardial infarction who presented a systemic inflammatory response characterized by fever and hemodynamic collapse, without evidence of infection. Its hemodynamic profile was stabilized with high volume hemofiltration. <![CDATA[<b><i>Bridge to lung transplantation with a novel pumpless lung assist device</i></b>: <b><i>Report of one case</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001000013&lng=&nrm=iso&tlng= Devices such as Novalung® can be used as a bridge to lung transplantation while waiting for a suitable donor. We report a 50 year-old male with a terminal pulmonary fibrosis and candidate for lung transplantation. He was admitted to the hospital due to a severe deterioration of his respiratory condition, with the presence of severe respiratory acidosis despite conventional invasive respiratory support. Respiratory support with Novalung® was started, resulting in a progressive reduction ofpCOz that became normal ten hours after the installation of the device. Five days later a successful lung transplantation wasperformed. <![CDATA[<b><i>Infections in patients with systemic lupus erythematosus</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001000014&lng=&nrm=iso&tlng= Despite the availability of newer therapeutic interventions to improve clinical outcome in patients with Systemic Lupus Erythematosus (SLE), the incidence of infections as a cause of morbidity and mortality has not changed over the past 30 years. SLE itself increases the risk of infection, due to genetic (complement deficiencies) and acquired factors such as functional asplenia (humoral immunodepression) and the use of immunosuppressive drugs. These medications increase the risk of opportunistic infections that are associated with an altered cellular immune response. The main etiologic infectious agents in SLE patients are common bacterial pathogens, especially capsulated ones. The most common sites are lung, skin, bladder, brain and systemic infections. The main risk factor for infection is the history of a previous one. The clinical approach to SLE patients with suspected infectious diseases must consider the possibility of a flare up of the underlying disease, posing an additional problem to the clinician. <![CDATA[<b><i>Pathophysiology of diabetic retinopathy and nephropathy</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001000015&lng=&nrm=iso&tlng= Despite the availability of multiple therapeutic approaches, diabetes mellitus with chronic hyperglycemia remains as the main cause of new cases of blindness and chronic renal failure in the western hemisphere. We herein review the molecular mechanisms by which chronic hyperglycemia causes retinopathy and nephropathy in type I and type 2 diabetic patients. Diabetic retinopathy develops silently along years or decades, producing symptoms only in its very ¡ate stages. Its slow development starts with the activation of aldose reducíase, shortly followed by the destruction of the retinal pericyte cells, and ends in sudden blindness when vitreous hemorrhage ensues. Nephropathy, on the other hand, centers its pathophysiology in the mesangial cell, that starts as a modified smooth-muscle cell, and turns itself into a myo-fibroblast, produces such amounts of cytoplasm and extracellular protein that strangulates the glomerular capillaries and causes renal failure. After a detailed review of the molecular mechanisms of the aforementioned complications, we conclude that, apart from directing our attention to the emerging medications that are being developed to block these molecular pathways, we should never abandon the struggle for improving the glycemic control of our diabetic patients. <![CDATA[<b><i>Hospital Medicine</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001000016&lng=&nrm=iso&tlng= Hospital medicine was created over 10 years ago aiming to provide an integral care to hospitalized patients. Hospital specialists are physicians mainly devoted to the global care of hospitalized patients. Their professional functions include patient care, teaching, clinical research and managing activities. The main difference with other specialties is their exclusive dedication to hospital work. The impact of this specialty on patient care has been demonstrated by a significant reduction in the hospitalization days and costs and higher level of patient satisfaction. In clinical hospitals, the presence of tutors during the complete working day, has resulted in better pre and postgraduate teaching activities and a higher availability of supervisors for trainees. Four years ago, hospital medicine was established as a discipline at the Clinical Hospital of Pontificia Universidad Católica de Chile. In this period, these specialists became essential for student training and an integral part of the faculty staff. <![CDATA[<b><i>Benefits from the exercise of autonomy and informed consent</i></b>: <b><i>The example of Jehovah's Witnesses</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001000017&lng=&nrm=iso&tlng= The respect for self-determination has represented a great challenge for the medical community. This debate has resulted in laws, codes of ethics, international treaties, and administrative guidelines, all with the purpose of protecting such right. In the medical field, the "Convention for the Protection of Human Rights and Dignity of the Human Being with Regard to the Application of Biology and Medicine: Convention on Human Rights and Biomedicine", known as the Oviedo Convention plays a crucial role. The doctrine of Informed Consent (IC) exists to enforce it. This principle is considered as ¡aw in some countries. In Chile, the IC is considered in the legal ordinance and in documents that are used as guidelines in the field of ethics. Jehovah s Witnesses invoke such precepts when they demand respect for their decisions. The present article outlines their position regarding blood transfusions and their contribution to the practice of bloodless medicine and surgery, which promotes the respect for patient's self determination. The experience of Jehovah's Witnesses has lead to a dignified treatment of the patient and has promoted a better participation in decision-making, focusing on the patient. All these benefits can be conveyed to other patients, resulting in the protection of the dignity of the individual. <![CDATA[<b><i>Clinical usefulness of toxicology testing</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001000018&lng=&nrm=iso&tlng= A toxicology testing is the search by the laboratory of the possible etiologic agents that can cause poisoning. Given the wide variety of substances that can poison a person, the laboratories should work coordinated with the emergency wards in order to determine the appropriate tests menu and the required turn around time according to the most frequent causes of intoxication in the local population. Toxicology laboratories should provide two tiers of drug testing: selected drug tests in blood/urine and comprehensive or broad-spectrum toxicological testing in the same or other samples. The medical order must always include the suspected diagnosis, which is responsibility of the physician requesting the test. A most important issue in the study of a poisoned patient is the opportunity when the samples are drawn, which should be at the emergency room since a delay in sample collection implies losing unrecoverable information. Samples should be sent to the laboratory for either immediate analysis or later comprehensive toxicological tests, so that laboratories must have procedures for the proper storage and preservation of samples. Poison control centers provide assistance to clinicians in considering certain drugs etiologies and in selecting specific tests.<hr/>Un estudio toxicológico es ¡a búsqueda por parte del laboratorio de ¡os posibles agentes etiológicos de un cuadro clínico de intoxicación. Dada la gran variedad de sustancias con que se puede intoxicar un individuo, los laboratorios deben trabajar coordinadamente con los Servicios de Urgencia para consensuar los exámenes necesarios en esta área y sus tiempos de respuesta, de acuerdo al tipo de población y las causas de intoxicaciones más frecuentes en su medio local. Los laboratorios toxicológicos deben proveer dos niveles de exámenes: los análisis específicos de drogas en sangre/orina y los estudios toxicológicos avanzados o ampliados en estas mismas muestras u otras. La orden médica siempre debe incluir ¡a sospecha diagnóstica, ¡o cual es responsabüidad del médico que solicita el examen. Lo más importante para el estudio de un paciente intoxicado es el momento de la obtención de las muestras, que debe ser al ingreso en el Servicio de Urgencia, ya que un retraso en tomarlas implicaría la pérdida de una información irrecuperable. Las muestras deben ser enviadas al laboratorio, ya sea para su análisis inmediato o para estudios toxicológicos ampliados posteriores, por lo que los laboratorios deben tener procedimientos para el correcto almacenamiento y preservación de las muestras. Los Centros de Información Toxicológica colaboran con el clínico orientándolo en la solicitud de exámenes, como también entregándole información acerca de las posibles drogas involucradas en una intoxicación <![CDATA[<b><i>Smoking and alcohol drinking among medical students</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001000019&lng=&nrm=iso&tlng= A toxicology testing is the search by the laboratory of the possible etiologic agents that can cause poisoning. Given the wide variety of substances that can poison a person, the laboratories should work coordinated with the emergency wards in order to determine the appropriate tests menu and the required turn around time according to the most frequent causes of intoxication in the local population. Toxicology laboratories should provide two tiers of drug testing: selected drug tests in blood/urine and comprehensive or broad-spectrum toxicological testing in the same or other samples. The medical order must always include the suspected diagnosis, which is responsibility of the physician requesting the test. A most important issue in the study of a poisoned patient is the opportunity when the samples are drawn, which should be at the emergency room since a delay in sample collection implies losing unrecoverable information. Samples should be sent to the laboratory for either immediate analysis or later comprehensive toxicological tests, so that laboratories must have procedures for the proper storage and preservation of samples. Poison control centers provide assistance to clinicians in considering certain drugs etiologies and in selecting specific tests.<hr/>Un estudio toxicológico es ¡a búsqueda por parte del laboratorio de ¡os posibles agentes etiológicos de un cuadro clínico de intoxicación. Dada la gran variedad de sustancias con que se puede intoxicar un individuo, los laboratorios deben trabajar coordinadamente con los Servicios de Urgencia para consensuar los exámenes necesarios en esta área y sus tiempos de respuesta, de acuerdo al tipo de población y las causas de intoxicaciones más frecuentes en su medio local. Los laboratorios toxicológicos deben proveer dos niveles de exámenes: los análisis específicos de drogas en sangre/orina y los estudios toxicológicos avanzados o ampliados en estas mismas muestras u otras. La orden médica siempre debe incluir ¡a sospecha diagnóstica, ¡o cual es responsabüidad del médico que solicita el examen. Lo más importante para el estudio de un paciente intoxicado es el momento de la obtención de las muestras, que debe ser al ingreso en el Servicio de Urgencia, ya que un retraso en tomarlas implicaría la pérdida de una información irrecuperable. Las muestras deben ser enviadas al laboratorio, ya sea para su análisis inmediato o para estudios toxicológicos ampliados posteriores, por lo que los laboratorios deben tener procedimientos para el correcto almacenamiento y preservación de las muestras. Los Centros de Información Toxicológica colaboran con el clínico orientándolo en la solicitud de exámenes, como también entregándole información acerca de las posibles drogas involucradas en una intoxicación <![CDATA[<b><i>Acute lobar nephronia</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872009001000020&lng=&nrm=iso&tlng= A toxicology testing is the search by the laboratory of the possible etiologic agents that can cause poisoning. Given the wide variety of substances that can poison a person, the laboratories should work coordinated with the emergency wards in order to determine the appropriate tests menu and the required turn around time according to the most frequent causes of intoxication in the local population. Toxicology laboratories should provide two tiers of drug testing: selected drug tests in blood/urine and comprehensive or broad-spectrum toxicological testing in the same or other samples. The medical order must always include the suspected diagnosis, which is responsibility of the physician requesting the test. A most important issue in the study of a poisoned patient is the opportunity when the samples are drawn, which should be at the emergency room since a delay in sample collection implies losing unrecoverable information. Samples should be sent to the laboratory for either immediate analysis or later comprehensive toxicological tests, so that laboratories must have procedures for the proper storage and preservation of samples. Poison control centers provide assistance to clinicians in considering certain drugs etiologies and in selecting specific tests.<hr/>Un estudio toxicológico es ¡a búsqueda por parte del laboratorio de ¡os posibles agentes etiológicos de un cuadro clínico de intoxicación. Dada la gran variedad de sustancias con que se puede intoxicar un individuo, los laboratorios deben trabajar coordinadamente con los Servicios de Urgencia para consensuar los exámenes necesarios en esta área y sus tiempos de respuesta, de acuerdo al tipo de población y las causas de intoxicaciones más frecuentes en su medio local. Los laboratorios toxicológicos deben proveer dos niveles de exámenes: los análisis específicos de drogas en sangre/orina y los estudios toxicológicos avanzados o ampliados en estas mismas muestras u otras. La orden médica siempre debe incluir ¡a sospecha diagnóstica, ¡o cual es responsabüidad del médico que solicita el examen. Lo más importante para el estudio de un paciente intoxicado es el momento de la obtención de las muestras, que debe ser al ingreso en el Servicio de Urgencia, ya que un retraso en tomarlas implicaría la pérdida de una información irrecuperable. Las muestras deben ser enviadas al laboratorio, ya sea para su análisis inmediato o para estudios toxicológicos ampliados posteriores, por lo que los laboratorios deben tener procedimientos para el correcto almacenamiento y preservación de las muestras. Los Centros de Información Toxicológica colaboran con el clínico orientándolo en la solicitud de exámenes, como también entregándole información acerca de las posibles drogas involucradas en una intoxicación