Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720100008&lang= vol. 138 num. 8 lang. <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<b>Predictive value of clinical features and nocturnal oximetry for the detection of obstructive sleep apnea syndrome</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000800001&lng=&nrm=iso&tlng= Background: Obstructive sleep apnea syndrome (OSA) is an important cause of morbidity and mortality in adults. Aim: To evaluate the diagnostic value of clinical features and oximetric data to screen for obstructive sleep apnea before performing polysomnograpy or respiratory polygraphy. Material and Methods: We studied 328 consecutive adult patients referred for snoring or excessive daytime sleepiness to a sleep clinic in whom a standardized questionnaire and the Sleepiness Epworth Scale were performed and body mass index (BMI), cervical circumference (CC), and nocturnal oximetry were measured. Results: Fifty three percent (n = 173) had evidence of clinically significant OSA (apnea/hypopnea index (AHI) > 15 events/h). Patients with OSA were more likely to be male, obese (BMI ≥ 26 kg/m²), smokers, to have a thick neck (CC > 41 cm), and to have a significant greater prevalence of relative reported apneas and excessive daytime sleepiness, as determined by Epworth scale. Male gender (Odds ratio (OR): 4.00; 95% confidence intervals (CI): 1.59-10.0, p = 0.003), BMI ≥ 26 kg/m² (OR: 3.68; 95%CI: 1.59-8.49, p = 0.002), smoking (OR: 2.29; 95% CI: 1.17-4.47, p = 0.015), Epworth index > 13 (OR: 2.65; 95% CI: 1.35-5.23, p = 0.005) and duration of symptoms over 2 years (OR: 2.35; 95% CI: 1.20-4.58, p = 0.012) were significant independent predictors of OSA. In nocturnal oximetry, the lowest SpO2 (SpO2 min) and the length of registries below 90% (CT-90) were independent predictors of OSA and both correlated significantly with AHI (r = -0.49 and r = 0.46 respectively, p < 0.001). Conclusions: No single factor was usefully predictive of obstructive sleep apnea. However, combining clinical features and oximetry data may be appropriate to detect clinically significant OSA patients. <![CDATA[<b>Association between varioliform gastritis and cirrhosis</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000800002&lng=&nrm=iso&tlng= Background: Varioliform gastritis (VG) is found in approximately 0.3 to 2.8% of upper gastrointestinal endoscopies. Its etiology is not known. We have observed a higher frequency of VG in patients with liver cirrhosis. Aim: To confirm if there is an association between VG and liver cirrhosis. Patients and Methods: Two case-control studies were done. A retrospective study, reviewing the endoscopy database of a gastroenterological unit. A prospective study, identifying cases with the endoscopic diagnosis of VG among all patients referred for upper gastrointestinal endoscopies. The presence of liver cirrhosis, based on clinical, laboratory, ultrasonographic and endoscopic features was registered among patients with VG. Results: VG was found in 549 of 11.659 upper gastrointestinal endoscopies. Fourteen percent of patients with VG had cirrhosis compared to 5.6% in control patients (c² 29,8; p < 0.01). The odds ratio (OR) for having cirrhosis of patients with VG was 9.3 (95% confidence intervals 3.4-25.5, p < 0,01), according to a logistic regression analysis. In the prospective study, that included 1.498 upper gastrointestinal endoscopies, VG was also significantly more common among patients with liver cirrhosis. Conclusions: A higher frequency of VG was found among patients with liver cirrhosis. Therefore, the endoscopic finding of VG should alert physicians to look for the presence of a coexistent liver cirrhosis. <![CDATA[<b>Systemic inflammation among stable ex smokers with chronic obstructive pulmonary disease</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000800003&lng=&nrm=iso&tlng= Background: Low grade systemic inflammation is commonly observed in chronic obstructive pulmonary disease (COPD). Aim: To evaluate the extent of systemic inflammation in a group of ex-smokers with COPD in stable condition and its relation with pulmonary function and clinical manifestations. Patients and Methods: We studied 104 ex-smokers aged 69 ± 8 years (62 males) with mild to very severe COPD and 52 healthy non-smoker subjects aged 66 ± 11 years (13 males) as control group. High sensitivity serum C reactive protein (CRP), interleukin 6 (IL6), fibrinogen (F) and neutrophil count (Nc) were measured. Forced expiratory volume in the first minute (FEV1), inspiratory capacity (IC), arterial blood gases, six minutes walking test, dyspnea and body mass index (BMI) were measured, calculating the BODE index. Health status was assessed using the Saint George Respiratory Questionnaire (SGRQ), the chronic respiratory questionnaire (CRQ), registering the number of acute exacerbations (AE) during the previous year and inhaled steroids’s use. Systemic inflammation was considered present when levels of CRP or IL6 were above the percentile 95 of controls (7.98 mg/L and 3.42 pg/ml, respectively). Results: COPD patients had significantly higher CRP and IL6 levels than controls. Their F and Nc levels were within normal limits. Systemic inflammation was present in 56 patients, which had similar disease severity and frequency of inhaled steroid use, compared with patients without inflammation. Patients with systemic inflammation had more AE in the previous year; lower inspiratory capacity, greater dyspnea during the six minutes walk test and worse SGRQ and CRQ scores. Conclusions: Low-grade systemic inflammation was found in 56 of 104 ex-smokers with COPD. This group showed a greater degree of lung hyperinflation, dyspnea on exercise and poor quality of life. <![CDATA[<b>Prevalence of mental health disorders among children and adolescents living in southern Chile</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000800004&lng=&nrm=iso&tlng= Background: The knowledge about prevalence of psychiatric disorders in all age groups is fundamental to plan an adequate mental health care. Aim: To determine the prevalence of DSM-IV psychiatric disorders in a representative sample of children and adolescents living in the province of Cautin, Chile. Material and Methods: Subjects aged between 4 and 18 years were selected in an aleatory stratified multistage fashion. As part of a national sample, four counties in Cautín were selected, then blocks, homes and the child or adolescent to be interviewed. Psychology graduate students applied the Spanish computer version of DISC-IV, as well as a questionnaire on family risk factors, socioeconomic index and service use. Results: A sample of 272 children and adolescents was evaluated, obtaining 93,4% of participation. Using the most stringent impairment algorithm, the prevalence rate for any psychiatric disorder was 16.8%, being 16.5% in boys and 17.1% in girls and mainly explained by anxiety and affective disorders. Prevalence was practically the same in the group aged 4 to 11 years than in those aged 12 to 18 years (16.7% and 16.8% respectively). Prevalence of anxiety disorders was the highest, but less associated with impairment. On the other hand, all children and adolescents with affective disorders were impaired. Conclusions: The prevalence of psychiatric disorders in Cautín is high in children and adolescents. <![CDATA[<b>Results of an integral lifestyle modification program to reduce weight among overweight and obese women</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000800005&lng=&nrm=iso&tlng= Background: In Chile, the Ministry of Health implemented an integral therapeutic program to reduce cardiovascular risk and increase physical activity (PA) among the population. Aim: To assess the effectiveness of the program in a group of overweight or obese adult women with a family history of Type 2 Diabetes and / or prehypertensive and / or prediabetes. Material and Methods: A group of 128 women aged 35 ± 10 years with a mean body mass index (BMI) of 33 kg/m2 were invited to participate in a program that lasted four months and included PA sessions and workshops with psychologists and nutritionists. Weight and waist circumference were measured at baseline and at four and six months of follow up. The blood glucose was measured at baseline and at 4 months, only in the affected income. Results: At four months the reduction in weight and waist circumference observed, was around 2%, and at 6 months the reductions was around 3%. The largest reductions were observed at 6 months in obese patients ≥ 40 years. Women that were more compliant with PA sessions had a greater weight reduction. The blood glucose levels decreased significantly independent of the reduction of anthropometric parameters. Conclusions: The program is considered successful to reduce cardiovascular risk factors and increase the practice of PA. The intervention was especially effective in patients > 40 years possibly due to higher food education, maturity and responsibility to the intervention. <![CDATA[<b>Surgical results among 100 patients with type A aortic dissection</b>: <b>Retrospective review</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000800006&lng=&nrm=iso&tlng= Background: Tipe A aortic dissection involves the ascending aorta and has high mortality rates without surgical treatment. Aim: To report the results of surgical treatment of type A aortic dissection. Material and Methods: Retrospective review of medical records of 100 patients aged 17 to 78 years (73% males) operated between January 2000 and August 2008, for type A aortic dissection. Follow up was performed with telephone interviews and review of national death records. Results: Eighty three percent of patients had an acute dissection. Operative mortality was 27 and 20% for patients with acute and chronic dissection, respectively. Mortality was 50% among patients aged 70 years or more, compared with 21% among their younger counterparts, The most common complication was bleeding that required a new surgical procedure in 18% of patients. Actuarial survival was 70% at five years. Cardiovascular problems caused the death of two of the nine patients that died during follow up. Conclusions: Surgical mortality among patients with type A aortic dissection was higher among patients with acute episodes and those aged 70 years or more <![CDATA[<b>Prevalence of negative stereotypes towards old age among personnel of a general hospital</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000800007&lng=&nrm=iso&tlng= Background: Social representations are value systems. Social stereotypes are a social consensus of traits associated with a specific group. Stereotypes about older subjects, generally have negative connotations. Aim: To assess the prevalence of negative stereotypes towards older subjects among health care personnel. Material and Methods: A questionnaire about stereotypes towards old age, with Likert type questions that included health, social motivations and personality-character domains, was applied to 52 doctors, 12 residents, 80 general nurses, 36 auxiliary nurses, four social workers and 10 medical assistants, working at a general hospital. Results: The mean age of the professionals who answered the questionnaire was 38 years (95% confidence intervals (CI) 37-39 years) and 78% were women. The prevalence of a Global negative stereotype was 65.0%(95% CI: 59.5-70.5). The figure for the health domain was 64.5% (IC95%; 59.0-70.0), for the social motivation domain was 60%(5%CI: 54.3-65.7) and for the character personality domain was 64% (95%CI: 58.4-69.6). Conclusions: There is a high prevalence of a negative stereotype towards old age among health care personnel. <![CDATA[<b>Theoretical estimation of the epidemiological impact of hepatitis A infection in Colombia</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000800008&lng=&nrm=iso&tlng= Background: Hepatitis A vaccination is justified in areas with an intermediate endemicity of the infection. Aim: To estimate the epidemiological impact of hepatitis A infection in Colombia. Material and Methods: Epidemiological indicators of hepatitis A infection prevalence by age, morbidity by age, and lethality by age were estimated from a literature search. These measures were projected on a hypothetical cohort of children followed from birth until 15 years of age. The number of cases of infection, jaundice, hepatic failure, hospitalizations and deaths were estimated. Results: From birth to adolescence, a cohort of 872 923 urban children in Colombia would generate between 312,331 and 598,591 infections, between 13,586 and 25,960 hospitalizations, between 213 and 407 hepatic failures and between 107 and 204 deaths. Conclusions: The impact of hepatitis A infection in Colombia, is important. Introducing hepatitis A vaccination would reduce a substantial number of severe hepatitis A cases. <![CDATA[<b>Reversible cerebral vasoconstriction syndrome</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000800009&lng=&nrm=iso&tlng= Background: Reversible cerebral vasoconstriction syndrome is characterized by thunderclap headache associated with multifocal vasoconstriction of cerebral arteries in patients without aneurysmal subarachnoid hemorrhage (SAH). The vasoconstriction reverts within three months. We report a 44-year-old man who had a thunderclap headache during sexual intercourse. A similar episode occurred at rest 36 hours later. The patient had already experienced a thunderclap headache 10 years earlier, during coitus. There were no abnormalities on examination. His brain computed tomography scan was normal and cerebrospinal fluid analysis showed no xanthochromia, 15 WBC/mm³ and 10 RBC/mm³. Lumbar puncture was repeated two days later (WBC = 3/mm³ and RBC = 43/mm³). An initial digital cerebral angiography showed a diffuse segmental intracerebral vasospasm. A new angiography after 15 days was normal. He remains headache-free after twenty six months. In conclusion, patients who have thunderclap headache with normal brain CT and cerebrospinal fluid without xantochromia should be investigated for this syndrome.<hr/>El síndrome de vasoconstricción cerebral reversible se caracteriza por una cefalea lancinante asociada a una vasoconstricción multifocal de las arterias cerebrales, en pacientes sin hemorragia subaracnoidea causada por aneurismas. La vasoconstricción se revierte en un plazo de tres meses. Presentamos un paciente varón de 44 años que experimentó una cefalea lancinante durante el acto sexual. Un episodio similar repitió 36 horas después, pero mientras estaba en reposo. El paciente había sufrido una cefalea lancinante durante el coito, 10 años antes. El examen físico fue normal. La tomografía cerebral estaba normal y el líquido cefalorraquídeo era claro, con 15 leucocitos y 10 eritrocitos por mm³. Una angiografía cerebral digital mostró un vasoespasmo intracerebral difuso segmentario. Una nueva angiografía, efectuada 15 días después, fue normal. El paciente está libre de cefaleas después de 26 meses de seguimiento. <![CDATA[<b>Bony metaplasia of the endometrium. Report of two cases</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000800010&lng=&nrm=iso&tlng= We report a 28 year old female consulting for infertility and a 26-year-old woman consulting for severe dysmenorrhea. In both patients a osseous metaplasia of the endometrium was found. Both patients were subjected to a hysteroscopic resection of the osseous material and both achieved spontaneous pregnancies and term deliveries following the procedures. If the bony material is removed, normal pregnancies and deliveries are feasible afterwards, no matter how extensive is the the osseus metaplasia. <![CDATA[<b>Longterm remission of left posterior fascicular ventricular tachycardia due to mechanical trauma</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000800011&lng=&nrm=iso&tlng= We present a case of a 28 year old woman with paroxysmal left posterior fascicular ventricular tachycardia (LPFVT). Ventricular tachycardia was not inducible after completing of left ventricle 3D reconstruction. Even though catheter ablation was not performed, no LPFVT recurrence has been documented during 60 months’ follow-up. We surmise that we caused mechanical trauma during the mapping of the posterior fascicle that damaged arrhythmogenic structures and subsequently led to long term remission of the left posterior fascicular ventricular tachycardia.<hr/>Presentamos una mujer de 28 años, portadora de una taquicardia fascicular posterior izquierda paroxística que no pudo ser inducida después de completar una reconstrucción en tres dimensiones del ventrículo izquierdo. A pesar no haber efectuado una ablación por electrofulguración, la taquicardia no ha reaparecido después de 60 meses de seguimiento. Suponemos que causamos un trauma mecánico durante el mapeo del fascículo posterior, que dañó las estructuras arritmogénicas. Esto llevó a una remisión a largo plazo de la arritmia. <![CDATA[<b>The metabolic syndrome</b>: <b>From an aggravating condition to a pathogenic risk factor for chronic diseases</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000800012&lng=&nrm=iso&tlng= In recent years, a rapidly increasing number of studies have focused on the association between metabolic syndrome and several chronic diseases. However, it is difficult to determine a well defined pathogenic relationship, due to the etiological heterogeneity and comorbidities of these diseases. Research efforts are aiming to identify the convergent biological mechanisms that mediate the effects of hyperinsulinemia, hyperglycemia, dyslipidemia, and hypertension. All these conditions define the metabolic syndrome, that increases the risk for several diseases. The knowledge of these biological mechanisms associated with this syndrome will elucidate the pathogenic association between a variety of chronic diseases, including its pathogenic link with cardiovascular diseases and the most common forms of dementia. The development of new therapeutic and preventive strategies for these diseases will be a corollary of this research. <![CDATA[<b>The association of intestinal microbiota with obesity</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000800013&lng=&nrm=iso&tlng= Intestinal microbiota (IM) plays a role in the development of obesity and its associated low grade inflammation. Bacterial colonization of the gastrointestinal tract of germ free mice (without microbiota) increases by 60% their fat mass, alters their fasting glucose and insulin levels, triples their hepatic triglycerides and induces adipocyte hypertrophy. IM favors fat storage in adipocytes through the inhibition of Fiaf (Fasting Induced Adipocyte Factor), an inhibitor of lipoprotein lipase. Compared with normal weight subjects, the IM from obese exhibits a higher proportion of Firmicutes/Bacteroidetes and is more efficient in extracting energy from foodstuffs. The loss of bodyweight by a hypocaloric diet reverts the proportion of bacteria to that of lean subjects. The intake of a high fat diet also alters the IM, affecting intestinal barrier function and favoring endotoxinemia. These events increase oxidative and pro-inflammatory processes in plasma and peripheral tissues and increment the risk of insulin resistance. Such events are reverted by the administration of pre-biotics which stimulate the growth of Bifdobacterium and Lactobacillus species in the colon, reestablishing the gut homeostasis. Interestingly, products resulting from the fermentation of prebiotics stimulate the differentiation of enteroendocrine cells and the release of glucagon like peptide 1 and peptide YY, that have insulin like and anorexigenic activities, thus contributing to body weight equilibrium. <![CDATA[<b>Heart energy metabolism and its role in the treatment of heart failure</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000800014&lng=&nrm=iso&tlng= It is unknown why heart failure progresses even when patients are treated with the best therapy available. Evidences suggest that heart failure progression is due to loss of neurohumoral blockade in advanced stages of the disease and to alterations in myocardial metabolism induced, in part, by this neurohumoral activation. Alterations in cardiac energy metabolism, especially those related to substrate utilization and insulin resistance, reduce the efficiency of energy production, causing a heart energy reserve deficit. These events play a basic role in heart failure progression. Therefore, modulation of cardiac metabolism has arisen as a promissory therapy in the treatment of heart failure. This review describes myocardial energy metabolism, evaluates the role of impaired energy metabolism in heart failure progression and describes new therapies for heart failure involving metabolic intervention. <![CDATA[<b>Health care reform in Chile</b>: <b>2005 to 2009</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000800015&lng=&nrm=iso&tlng= Five years ago Chile implemented a Health Care Reform to reduce the great inequalities in health care provision that affects the low- income, high-risk segment of its population. A universal care plan ("AUGE") was designed to make medical coverage available to all Chilean citizens suffering from one of a specifed, growing list of diseases (66 at present time). The diseases are prioritized by the Ministry of Health and its inclusion in the plan is revised periodically by an Advisory Committee according to four cardinal criteria: burden of disease, effectiveness of treatment, specific capacity of the health system and financial costs. The plan is funded by the state and enforced by law through a set of four specific guarantees: access, opportunity, quality and financial protection. This paper reviews the origin and development of the reform, the benefits and drawbacks of the application of the specific guarantees and the perception of the public regarding its strengths and weaknesses. <![CDATA[<b>Doctor patient communication</b>: <b>Which skills are effective?</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000800016&lng=&nrm=iso&tlng= Effective Communication Skills form part of what is being a good doctor. There is a solid evidence base that defines the components of effective communication. This article offers a practical conceptual framework to improve physician patient communication to a professional level of competence. There are six goals that physicians and patients work to achieve through their communication with each other. These are to construct a relationship, structure an interview, start the interview, gather information, explain, plan and close the interview. The outcomes that can be improved with an effective communication and the "first principles" of communication are described. A brief look at the historical context that has influenced our thinking about communication in health care is carried out. Finally, the Calgary Cambridge Guide, an approach for delineating and organizing the specific skills required of an effective communication with patients is described. It is clear from the literature that better communication skills improve patient satisfaction and clinical outcomes. <![CDATA[<b>Description of Assessment Processes at the Medical School of the Pontificia Universidad Católica de Chile</b>: <b>A Ten year experience</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000800017&lng=&nrm=iso&tlng= Globalization of health care seems to be irreversible and beyond cultural differences and local realities; consequently, medical education needs to have a common set of core principles or standards that may be applied worldwide. The aim of participating in assessment processes is to guarantee that medical education takes place in a sufficiently rich environment to promote extensive academic purposes. The Medical School of the Pontificia Universidad Católica de Chile (PUC) participated in three assessment processes that included three stages: internal assessment, external assessment, and accreditation judgment. Two of these assessments were voluntarily carried out following the standards set by the Liaison Committee on Medical Education-LCME, and they took place in 1997 and 2007. The other assessment was based on standards set by the Chilean accrediting organism, the National Committee for Undergraduate Program Accreditation (Comité Nacional de Acreditación de Pregrado-CNAP) and took place in the year 2001. In all three experiences, internal assessment was the most enriching stage, stimulating refections among students and teachers in order to recognize areas of strengths and weaknesses. External assessment processes, especially those based on international standards, are very important for the institutional and program development of Medical Schools. The PUC Medical School on its whole learnt how to carry out an assessment process and was able to improve several weaknesses without pressure, moving from quality assurance to quality enhancement. The present paper analyzes the major challenges involved in an external assessment process. <![CDATA[<b><i>A new Accreditation Agency for Health Sciences in Chile</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000800018&lng=&nrm=iso&tlng= Globalization of health care seems to be irreversible and beyond cultural differences and local realities; consequently, medical education needs to have a common set of core principles or standards that may be applied worldwide. The aim of participating in assessment processes is to guarantee that medical education takes place in a sufficiently rich environment to promote extensive academic purposes. The Medical School of the Pontificia Universidad Católica de Chile (PUC) participated in three assessment processes that included three stages: internal assessment, external assessment, and accreditation judgment. Two of these assessments were voluntarily carried out following the standards set by the Liaison Committee on Medical Education-LCME, and they took place in 1997 and 2007. The other assessment was based on standards set by the Chilean accrediting organism, the National Committee for Undergraduate Program Accreditation (Comité Nacional de Acreditación de Pregrado-CNAP) and took place in the year 2001. In all three experiences, internal assessment was the most enriching stage, stimulating refections among students and teachers in order to recognize areas of strengths and weaknesses. External assessment processes, especially those based on international standards, are very important for the institutional and program development of Medical Schools. The PUC Medical School on its whole learnt how to carry out an assessment process and was able to improve several weaknesses without pressure, moving from quality assurance to quality enhancement. The present paper analyzes the major challenges involved in an external assessment process. <![CDATA[<b><i>Usefulness of a Brief Informant Interview to Detect Dementia, translated into Spanish (AD8-Ch)</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000800019&lng=&nrm=iso&tlng= Globalization of health care seems to be irreversible and beyond cultural differences and local realities; consequently, medical education needs to have a common set of core principles or standards that may be applied worldwide. The aim of participating in assessment processes is to guarantee that medical education takes place in a sufficiently rich environment to promote extensive academic purposes. The Medical School of the Pontificia Universidad Católica de Chile (PUC) participated in three assessment processes that included three stages: internal assessment, external assessment, and accreditation judgment. Two of these assessments were voluntarily carried out following the standards set by the Liaison Committee on Medical Education-LCME, and they took place in 1997 and 2007. The other assessment was based on standards set by the Chilean accrediting organism, the National Committee for Undergraduate Program Accreditation (Comité Nacional de Acreditación de Pregrado-CNAP) and took place in the year 2001. In all three experiences, internal assessment was the most enriching stage, stimulating refections among students and teachers in order to recognize areas of strengths and weaknesses. External assessment processes, especially those based on international standards, are very important for the institutional and program development of Medical Schools. The PUC Medical School on its whole learnt how to carry out an assessment process and was able to improve several weaknesses without pressure, moving from quality assurance to quality enhancement. The present paper analyzes the major challenges involved in an external assessment process. <![CDATA[<b><i>Was Fray Camilo Henríquez also a physician?</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000800020&lng=&nrm=iso&tlng= Globalization of health care seems to be irreversible and beyond cultural differences and local realities; consequently, medical education needs to have a common set of core principles or standards that may be applied worldwide. The aim of participating in assessment processes is to guarantee that medical education takes place in a sufficiently rich environment to promote extensive academic purposes. The Medical School of the Pontificia Universidad Católica de Chile (PUC) participated in three assessment processes that included three stages: internal assessment, external assessment, and accreditation judgment. Two of these assessments were voluntarily carried out following the standards set by the Liaison Committee on Medical Education-LCME, and they took place in 1997 and 2007. The other assessment was based on standards set by the Chilean accrediting organism, the National Committee for Undergraduate Program Accreditation (Comité Nacional de Acreditación de Pregrado-CNAP) and took place in the year 2001. In all three experiences, internal assessment was the most enriching stage, stimulating refections among students and teachers in order to recognize areas of strengths and weaknesses. External assessment processes, especially those based on international standards, are very important for the institutional and program development of Medical Schools. The PUC Medical School on its whole learnt how to carry out an assessment process and was able to improve several weaknesses without pressure, moving from quality assurance to quality enhancement. The present paper analyzes the major challenges involved in an external assessment process. <![CDATA[<b><i>Zolpidem induced sleep related eatins disorder</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000800021&lng=&nrm=iso&tlng= Globalization of health care seems to be irreversible and beyond cultural differences and local realities; consequently, medical education needs to have a common set of core principles or standards that may be applied worldwide. The aim of participating in assessment processes is to guarantee that medical education takes place in a sufficiently rich environment to promote extensive academic purposes. The Medical School of the Pontificia Universidad Católica de Chile (PUC) participated in three assessment processes that included three stages: internal assessment, external assessment, and accreditation judgment. Two of these assessments were voluntarily carried out following the standards set by the Liaison Committee on Medical Education-LCME, and they took place in 1997 and 2007. The other assessment was based on standards set by the Chilean accrediting organism, the National Committee for Undergraduate Program Accreditation (Comité Nacional de Acreditación de Pregrado-CNAP) and took place in the year 2001. In all three experiences, internal assessment was the most enriching stage, stimulating refections among students and teachers in order to recognize areas of strengths and weaknesses. External assessment processes, especially those based on international standards, are very important for the institutional and program development of Medical Schools. The PUC Medical School on its whole learnt how to carry out an assessment process and was able to improve several weaknesses without pressure, moving from quality assurance to quality enhancement. The present paper analyzes the major challenges involved in an external assessment process.