Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720110001&lang=pt vol. 139 num. 1 lang. pt <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<b>The relevance and fate of abstracts presented in scientific meetings</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000100001&lng=pt&nrm=iso&tlng=pt Abstracts presented in scientific meetings are indispensable tools to diffuse the latest research in thefield. They provide the authors with an opportunity to receive feedbackfrom a critica! audience so they can prepare a final manuscript to be submitted to a peer-reviewed journal. However, several studies in a wide range of medical specialties and other related sciences showed that no more than 50% of abstracts presented in annual meetings oflearned societies are published in a 5-year follow up after the meeting. Therefore, abstracts are considered "preliminary publications" and it is recommended not to include them as bibliographic references unless they have been published recently (less than 3 years) in peer-reviewed journals (regular issues or supplements) or in their official websites. Databases dependent ofthe National Library of Medicine (USA) or SciELO do not Índex individual abstracts from a meeting. Authors and reviewers should be reminded that manuscripts that have shaped current knowledge probably had also been presented as abstracts in scientific meetings, sometime before their final publication. <![CDATA[<b>Simultaneous kidney and pancreas transplantation (SKPT) in patients with type 1 diabetes and chronic renal failure</b>: <b>Experience in 12 patients in Chile</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000100002&lng=pt&nrm=iso&tlng=pt Background: Simultaneous kidney and páncreas transplantation (SKPT) is the best alternative for end stage renal disease among patients with insulin dependent diabetes mellitus. Aim: To report our experience with SKPT. Material andMethods: Retrospective analysis ofl2 recipients of SKPT transplanted in one center starting in 1994, with a meanfollow-upperiod of6.8years (2-15). Results: Eleven ofl2 recipients were in chronic hemodialysis before SKPT. Mean A, B, DR and HLA mismatch was 4.3. Mean preformed anti HLA antibodies was 3.3 %. Mean cold ischemia times for páncreas and kidney were 6 and 10 hours, respectively. In the first eight cases, the páncreas was drained to the bladder, and in the last four, an enteric drainage was performed. Eleven recipients were induced with antibodies, and maintenance immunosuppression consisted ofCyclosporine or Tacrolimusplus an antiproliferative agent. Ten year patient survival was 70 %. Páncreas and kidney survival, defined by insulin and dialysis independence, were 72 and 73% respectively. Fifty percent of recipients experienced acute graft rejection (cellular or humoral), with good response to treatment except in one case. Conclusions: This experience shows that SKPT is associated with an excellent patient survival associated to insulin and dialysis independence in 70% of patients at 10 years. <![CDATA[<b>Chilean results of the international registry of risk factors and treatment of unstable angina and non ST elevation myocardial infarction</b>: <b>ACCORD (ACute CORonary syndrome Descriptive study)</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000100003&lng=pt&nrm=iso&tlng=pt Background: Guidelines for the management of unstable angina (UA) and non ST elevation myocardial infarction (NSTEMI) have been issued, however cu-rrent practices are unknown in Chile. Aitn: To evalúate in a prospective cohort of NSTEMI patients the current practices, treatments and risk factors. Material and Methods: Oneyear prospective International non interventional registry, conducted in Chile between January 2005 and November 2006. Results: Two hundred thirty three Chilean NSTEMI patients were enrolled. Mortality was 5.5% at the end ofthe follow-up. Mean age was 61.6 years, and 30.6% were female. Most of the patients had at least one risk factor (98%): hypertension (84%), previous myocardial infarction (33%), dyslipidemia (54%), diabetes (33%), current smoking (30%). Main procedures duringthe hospitalization were coronary angiogram (67%), angioplasty (33%; 88% with stent) and coronary bypass surgery (7%). Duringprocedures, 31% of patients received clopidogrel, and 4.2% glycoprotein Ilb/IIIa antagonists. Medical management was selected for 60% of patients. In comparison to men, women received less interventional procedures despite havingmore risk factors. Treatments prescribed at discharge were aspirin (97%), clopidogrel (49%), beta blockers (78%), diuretics (21%), lipid lowering agents (78%), oral hypoglycemic agents (13%) and insulin (9%). At the end ofthe 1-year follow-up, treatments were aspirin (84%), beta blockers (72%), diuretics (19%), and dual antiplatelet therapy with clopidogrel (16%). Conclusions: A high prevalence of múltiple risk factors for cardiovascular disease in Chilean patients with NSTEMI was observed. More aggressive primary and secondary preventive measures are urgently needed. Use of therapies proposed in the guidelines is high, but dual antiplatelet therapy is less than 50% at discharge and decreases during the one year-follow-up. <![CDATA[<b>Lymphomas associated with human immunodeficiency virus infection</b>: <b>Retrospective review of medical records</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000100004&lng=pt&nrm=iso&tlng=pt Background: The incidence oflymphoma increases enormously inpatients infecten with the human immunodeficiency virus (HIV). Aim: To describe the incidence, clinical and histológica! characteristics, treatments and survival of lymphomas associated with HTV infection. Material and Methods: Retrospective review of medical records ofpatients with HIV and lymphoma, treated in a public hospital, between January 2001 and June 2009. Results: Twenty-two mole patients were included but 14 had immunohistochemical confirmation ofthe lymphoma. The accumulated incidence for thisperiod was 2.8%. The median age at lymphoma diagnosis was 39.5 years. Twelvepatients (86%) had non-Hodgkin lymphoma (NHI) and two (14%) Hodgkin lymphoma. The main pathological type of non-Hodgkin lymphomas was diffuse large B cell in seven cases (50%). The mean CD4 cell count and viral load were 83 cell/mm³ (33.5-113.5) and 26.000 RNA copies/ml (1210-196500), respectively Twelve patients (86%) had B type symptoms of lymphoma at the moment of diagnosis. Eleven patients (29%) received chemotherapy with or without radiotherapy, onepatient (7%) received radiotherapy alone and two patients (14%) received palliative symptomatic treatment. Six cases (43%) received highly active antiretroviral therapy simultaneously with chemotherapy. Global mortality in this series was 57% (8patients) with a median survival time of 5.8 months (2.6-26.2). Conclusions: In this series ofpatients infected with HIV, a predominance of aggressive histológica! subtypes of lymphomas and low complete remission rates, were observed. <![CDATA[<b>Teaching of Medical Ethics</b>: <b>Students' perception in different periods of the course</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000100005&lng=pt&nrm=iso&tlng=pt Background: Medical Ethics is structured to guide doctors towards a better professional practice. However, its teaching in medical schools seems to be neglected. Aim: To evalúate the perception of Federal University of Sergipe medical students about ethical conflicts duringtheir academic practice, in two different periods of a medical course. Material ana Methods: A cross-sectional, analytic and observatio-nal study. Using a qualitative approach, analytic categories were identified using an open questionnaire answered by two groups of students, before and after attending the medical ethics course. Results: In everyday practice, the participants referred embarrassment in front of patients. When considering the relationship with the professional/professor, they identified negligence and conflicts of interests in their practice. The students also detected bad infrastructure and professional relationship in public services, when compared to prívate ones. The conflicts experienced by the students in their own practice were insecurity, inability to cope with patients' problems and inadequate perception of medical confidentiality limits. According to the respondents, contribution of ethics teaching varied from adequate, when itwas effective to orient their practice and provide confidence, to inadequate or absent be-cause of an overall superficial approach. Conclusions: Major deficiencies related to the teaching of medical ethics were identified, pointing to the need to change current medical education model.<hr/>Antecedentes: La ética médica debería guiar a los médicos hacia una mejor práctica profesional. Sin embargo, se enseña deficientemente en las escuelas de medicina. Objetivo: Identificar las percepciones de un grupo de estudiantes de medicina acerca de los conflictos éticos durante su práctica profesional en dos períodos distintos de un curso de medicina. Material y Métodos: Se efectuó un estudio transversal con un grupo de estudiantes de medicina que habían recibido el curso de bioética y otro grupo que no había recibido el curso. Ambos grupos respondieron un cuestionario abierto acerca de los conflictos que vivieron al enfrentar pacientes. Resultados: En la práctica diaria, los alumnos relataron sentir vergüenza al enfrentar pacientes. Acerca de su relación con los profesores, notaron negligencia y conflictos de intereses en su práctica. Los alumnos también detectaron una mala infraestructura y relación entre profesionales en servicios públicos, al ser comparados con clínicas privadas. Los conflictos que relataron los alumnos fueron inseguridad, incapacidad de enfrentar con los problemas de los pacientes y una percepción inadecuada de la confidencialidad médica. Los alumnos consideraron que la contribución de enseñar ética fluctuó desde ser adecuada cuando orientó su práctica profesional y les dio confianza hasta inadecuada o ausente, debido a ser enseñada en forma superficial. Conclusiones: Se identificaron las principales deficiencias en la enseñanza de ética médica, señalando la necesidad de cambiar el modelo educacional utilizado actualmente. <![CDATA[<b>Development and validation of a questionnaire on perception of portfolio by undergraduate medical students</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000100006&lng=pt&nrm=iso&tlng=pt Background: Portfolio is an innovative instrument that promotes reflection, creativity and professionalism among students. Aitn: To describe the development and validation process of a questionnaire to evalúate the use of portfolio in undergraduate medical students. Material andMethods: Focus groups with students and teachers were employed to identify aspects related with portfolio in undergraduate teaching. The Delphi technique was used to prioritize relevant aspects and construct the questionnaire. The validated questionnaire, consistingin 43 Ítems and 6factors, was appliedto 97students (response rote of99.9%) in2007and 100students (99.2%) in 2008. Each question had to be answered using a Likert scale,from 0 (completely disagree) to 4 (completely agree) The validity and reliability of the questionnaire was evaluated. Results: The questionnaire showed a high reliability (Cronbach alpha = 0.9). The mean total scores obtained in 2007 and 2008 were 106.2 ± 21.2 (61.7% ofthe maximal obtainable score) and 104.6 ± 34.0 (60.8% ofthe maximal obtainable score), respectively No significant differences were seen in the analysis by factors. Changes in portfolio during 2008 showed differences in Ítems related with organization, evaluation and regulation. Conclusions: The questionnaire is a valid and highly reliable instrument, measuringperceptions about the portfolio by undergraduate medical students. The students perceived an improvement in their creativity and professionalism as one ofthe strengths of portfolio. The weaknesses identified during the implementation process helped us to focus changes in organization and evaluation to improve the portfolio as a dynamic process. <![CDATA[<b>Transcranial sonography for the diagnosis of Parkinson disease</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000100007&lng=pt&nrm=iso&tlng=pt Background: The detection of hyperechogenicity of the substantia nigra using trans cranial sonography can bepredictive ofthe diagnosis of Parkinson Disease. Aim: To report an experience with transcranial sonography for the diagnosis of Parkinson disease. Material ana Methods: One hundred sixteen patients with movement disorders were subjected to a transcranial sonograpy to detect the presence ofhyper-chogenicity of the substantia nigra and basal ganglia. Afterwards, two physicians, unaware ofthe results ofthe sonography, examined the patients and reached a clinical diagnosis. The concordance between ultrasound results and the clinical diagnosis was analyzed. Results: In 64 patients, a clinical diagnosis of Parkinson disease was reached. Ofthese, 52 patients had substantia nigra hyperechogenicity and in 12, it was normal. On the other hand ultrasound was normal in 42 of43 patients without a clinical diagnosis of Parkinson disease. Therefore the sensitivity and specificity of trans cranial ultrasound for the diagnosis of Parkinson disease was 81 and 97%, res-pectively. Conclusions: Transcranial sonography has agood sensitivity and specificity for the diagnosis of Parkinson disease. <![CDATA[<b>Effectiveness of a home visit program for adolescent mothers and their children</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000100008&lng=pt&nrm=iso&tlng=pt Background: Home visiting is effective for the promotion and prevention of mother-child health in other countries, especially in vulnerable populations such as pregnant teenagers. Aim: To evalúate the association between receiving a home visiting program duringpregnancy and child development during thefirstyear oflife, maternal mental health, perception of social support and school attendance. Material and Methods: Cross sectional assessment of 132 teenage mother-sibling pairs. Ofthese, 87 received home visits and 45 were randomly assigned to a control group. The assessed variables were maternal mental health, perception of social support, Ufe satisfaction, incorporation of mothers to school after delivery, child development and frequency of child abuse and neglect. Results: Mothers that received home visits had a better mental health and went back to school in a higherproportion. No significant differences between groups were observed on perception of social support or child development. Conclusions: These results suggest the effectiveness of domiciliary visits performed by non-professionals, to improve mental health and social integration of teenage mothers. <![CDATA[<b>Nugent and Spiegel criteria for the diagnosis of bacterial vaginosis. Analysis of discordant specimens by the Ison and Hay method</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000100009&lng=pt&nrm=iso&tlng=pt Background: Vaginal infection is the commonest cause of genital symptoms and has obstetric and gynecological implications. Aim: To compare the Nugent and Spiegel methods for the diagnosis of bacterial vaginosis (BV) and to analyze discordant specimens using Ison and Hay (Ison/Hay) criteria. Material and Methods: After discardingcases with Candidiasis, deficientspecimens or those lacking bacteria, a total of348 Gram-stained smears vaginal specimens receivedfor the diagnosis of BV, were analyzed. Results: Vaginal microbiota was classified as normal in 203 and 237 samples (58 and 68% of samples), accordingto Nugent and Spiegel criteria, respectively One hundred andfive (30%) and 111 samples (32%), were classified as VB accordingto Nugent and Spiegel criteria, respectively. Both criteria were concordant in 308 samples (88.5%). The 40 (11.5%) discordant specimens were classified as intermedíate microflora by the Nugent system and as normal or BV by Spiegel. Among these, the Ison/Hay procedure identified four categories of microbiota. Ten (25%) specimens were classified as grade II microbiota, confirming their categorization by Nugent as intermedíate microbiota, six (15%) were classified in the III category, confirming the diagnosis ofBV by Spiegel, 13 (32.5%) corresponded to the category III, that does not exist in the Nugent and Spiegel categorization systems. Finally, 11 specimens could not be assigned to one category due to microscopic limitations to distinguish bacterial morphotypes. Conclusions: The systems proposed by Spiegel, Nugent and Ison I Hay are comparable for the diagnosis of BV. However, we recommend the use of Ison/ Hay procedure to evalúate vaginal microbiota, due to its wider range of categories, allowing a better discrimination ofthe vaginal microbiota. <![CDATA[<b>Congenital malformations in Latin America in the period 1995-2008</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000100010&lng=pt&nrm=iso&tlng=pt Background: The Latin American Study of Congenital Malformations (ECLAMC) hasperformed an epidemiológica! surveillance of congenital malformations since 1967. This allows to detectany unexpected change in the incidence of malformations, possibly caused by a new environmental teratogenic agent. Aim: To report a summary ofthe results thusfar obtained in this study. Material ana Methods: The ECLAMC datábase was analyzed and all Uve births and stillbirths ofmore than 500 grams in the period 1995-2008, were analyzed. Results: There were 2,409,407 births in the nine participant countries. Ofthese 31,516 (1.3%) were stillbirths. The global rate of congenital malformations in this sample was 2.7%. In the studied period, there was a significant reduction in the rates of anencephaly and spina bifida in Chile and Argentina. In the rest ofthe countries, the global rates of malformations increased. Venezuela had the higher rate of teenage pregnancies (25%), followed by Colombia (23%). Chile had the higherpercentage ofwomen aged 35years or moregiving birth (14%), followed by Uruguay (13%). However, Chile had the higher rate of Down syndrome and Uruguay, the lowest (24.7 and 13.6per 10000). Conclusions: There is a tendency towards an increase in the rates of congenital malformations in this sample, with significant differences among countries. <![CDATA[<b>Recurrence of stress cardiomyopathy after an earthquake</b>: <b>Report of one case</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000100011&lng=pt&nrm=iso&tlng=pt Stress-induced cardiomyopathy is characterized by transient systolic dysfunction ofthe apical or mid segments ofthe left ventricle that mimics myocardial infarction in the absence of obstructive coronary artery disease. Symptoms recur after a phy-sical or emotional stress. We report a 77 years oíd femóle that in 2004, suffered an episode of stress cardiomyopathy after an intense physical effort. In February 2010, immediately after the earthquake that occurred in Chile, the patient consulted for chestpain, STsegment elevation and enzyme elevation. An echocardiography showed a left ventricular anteroseptal akinesia with an ejection fraction of 35%. Coronary arteriography did not show significant alterations. <![CDATA[<b>Combined periampullary adenocarcinoma and neuroendocrine tumor in type 1 neurofibromatosis</b>: <b>Report of one case</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000100012&lng=pt&nrm=iso&tlng=pt Neurofibromatosis is a hereditary autosomal-dominant disease, with high rates ofde novo mutations and carries a high risk ofneoplasms. It affects both sexes and all races and ethnic groups. It is characterized by múltiple cutaneous lesions and tumors, both benign and malignant, especially in the nervous system. We report a 52 years old woman with a type 1 neurofibromatosis, presenting with fever, jaundice and weight loss. Onphysical examination, thepatientwasjaundiced and had "café au lait" spots in the skin. A magnetic resonance imaging showed bile duct dilation and a possible ampullarcarcinoma. Thepatientwas operated, duringthe exploration shepresented a periampullary tumor and múltiple small nodular lesions in the stomach, the tumor was resected with a pancreático dúo denectomy and the nodular gastric lesions were biopsied. Thepathological study revealed a combined adenocarcinoma and neuroendocrine duodenal tumor. The study ofthe stomach lesions revealed a gastrointestinal stromal tumor. Four months after surgery, the patient is in good conditions. <![CDATA[<b>Antagonism of tamoxifen and antidepressants among women with breast cancer</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000100013&lng=pt&nrm=iso&tlng=pt Tamoxifen is used as an adjuvant therapy to reduce breast cáncer recurrence among women with estrogenreceptor positive tumors. Antidepressants are also com-monly used in such women, to treat depression or to manage hotflush.es, afrequent tamoxifen secondary effect. Some antidepressants couldpotentially inhibit cytochrome P450 2D6, required to actívate tamoxifen, interfering with its action. Although there is not a clear cut directive on the subject, it is nowadays recommended to treat women with antidepressants with the lower cytochrome P450 2D6 inhibition potential to avoid apossible antagonism that may reduce tamoxifen s prevention of breast cáncer recurrence at least in some patients with CYP2D6 genetic variation. The recommended antidepressants are desvenlafaxine, milnacipran, venlafaxin, escitalopram and citalopram. <![CDATA[<b>Autonomic disturbances in Parkinson disease</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000100014&lng=pt&nrm=iso&tlng=pt The current concept of Parkinson Disease comprises a group of non-motor symptoms. Among these, dysautonomia is a common problem that deteriorates the quality oflife ofpatients. In this article we review the most common dysautonomic manifestations that are observed in cardiovascular, gastrointestinal, urinary, genital and skin systems. Their possible role as risk factors, premotor symptoms and their implications in the pathogenesis of Parkinson Disease are discussed. A general appro-ach to the main syndromes, based in the available evidence and in our experience is also presented. <![CDATA[<b>Injudicious and excessive use of antibiotics</b>: <b>Public health and salmon aquaculture in Chile</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000100015&lng=pt&nrm=iso&tlng=pt Salmón aquaculture was one ofthe major growing and exporting industries in Chile. Its development was accompanied by an increasing and excessive use oflarge amounts of antimicrobials, such as quinolones, tetracyclines and florfenicol. The examination of the sanitary conditions in the industry as part of a more general investigation into the uncontrolled and extensive dissemination of the ISA virus epizootic in 2008, found numerous and wide-ranging shortcomings and limitations in management of preventive fish health. There was a growing industrial use of large amounts of antimicrobials as an attempt at prophylaxis of bacterial infections resulting from widespread unsanitary and unhealthy fish rearing conditions. As might be expected, these attempts were unsuccessful and this heavy antimicrobial use failed to prevent viral and parasitic epizootics. Comparative analysis of the amounts of antimicrobials, especially quinolones, consumed in salmón aquaculture and in human medicine in Chile robustly suggests that the most important selective pressurefor antibiotic resistant bacteria in the country will be excessive antibiotic use in this industry. This excessive use will facilitate selection of resistant bacteria and resistance genes in water environments. The commonality of antibiotic resistance genes and the mobilome between environmental aquatic bacteria, fishpathogens and pathogens of terrestrial animáis and humans suggests that horizontal gene transfer occurs between the resistome of these apparently independent and isolated bacterial populations. Thus, excessive antibiotic use in the marine environment in aquaculture is not innocuous and can potentially negatively affect therapy of bacterial infections of humans and terrestrial animáis. <![CDATA[<b>Presentation of the third edition of a text book on medical history taking and physical examination, by A. Goic, G. Chamorro and H. Reyes (Editors)</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000100016&lng=pt&nrm=iso&tlng=pt Clinicians know that the clinical encounter with the patient constitutes thefore-most aspect in diagnosis and therapeutics. We also remember that ourfirst contad with clinicalpractice was to learn how to perform a good clinical history and thorough physical examination. Even afteryears of practice we are still learning how to listen to the patient, see, pálpate and auscúltate but most importantly, to approach a patient with warmth and kindness to unveil the mysteries of diseases and ailments. Books will not teach us these skills and practice is the basis ofthis learningprocess, but the text book by Drs. Goic, Chamorro and Reyes is ofgreat help and orientation, when we drift through the different chapters devoted to medical history taking, physical signs, syndromes and laboratory tests. This third edition includes the late Dr. Chamorro as co-editor, because outstandingpeople do notpass, only transcend. Medical students will enjoy this book and clinicians will also appreciate it, since we are all aware that we never stop learning until we pass... or transcend. <![CDATA[<b>A tribute to Professor Héctor Croxatto Rezzio, M.D.</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000100017&lng=pt&nrm=iso&tlng=pt Clinicians know that the clinical encounter with the patient constitutes thefore-most aspect in diagnosis and therapeutics. We also remember that ourfirst contad with clinicalpractice was to learn how to perform a good clinical history and thorough physical examination. Even afteryears of practice we are still learning how to listen to the patient, see, pálpate and auscúltate but most importantly, to approach a patient with warmth and kindness to unveil the mysteries of diseases and ailments. Books will not teach us these skills and practice is the basis ofthis learningprocess, but the text book by Drs. Goic, Chamorro and Reyes is ofgreat help and orientation, when we drift through the different chapters devoted to medical history taking, physical signs, syndromes and laboratory tests. This third edition includes the late Dr. Chamorro as co-editor, because outstandingpeople do notpass, only transcend. Medical students will enjoy this book and clinicians will also appreciate it, since we are all aware that we never stop learning until we pass... or transcend. <![CDATA[<b>Pseudomonas aeruginosa septic arthritis ofthe temporomandibular joint in ayoung patient without malignant otitis externa</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000100018&lng=pt&nrm=iso&tlng=pt Clinicians know that the clinical encounter with the patient constitutes thefore-most aspect in diagnosis and therapeutics. We also remember that ourfirst contad with clinicalpractice was to learn how to perform a good clinical history and thorough physical examination. Even afteryears of practice we are still learning how to listen to the patient, see, pálpate and auscúltate but most importantly, to approach a patient with warmth and kindness to unveil the mysteries of diseases and ailments. Books will not teach us these skills and practice is the basis ofthis learningprocess, but the text book by Drs. Goic, Chamorro and Reyes is ofgreat help and orientation, when we drift through the different chapters devoted to medical history taking, physical signs, syndromes and laboratory tests. This third edition includes the late Dr. Chamorro as co-editor, because outstandingpeople do notpass, only transcend. Medical students will enjoy this book and clinicians will also appreciate it, since we are all aware that we never stop learning until we pass... or transcend. <![CDATA[<b>Nuevo presidente de la Academia Chilena de Medicina</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000100019&lng=pt&nrm=iso&tlng=pt Clinicians know that the clinical encounter with the patient constitutes thefore-most aspect in diagnosis and therapeutics. We also remember that ourfirst contad with clinicalpractice was to learn how to perform a good clinical history and thorough physical examination. Even afteryears of practice we are still learning how to listen to the patient, see, pálpate and auscúltate but most importantly, to approach a patient with warmth and kindness to unveil the mysteries of diseases and ailments. Books will not teach us these skills and practice is the basis ofthis learningprocess, but the text book by Drs. Goic, Chamorro and Reyes is ofgreat help and orientation, when we drift through the different chapters devoted to medical history taking, physical signs, syndromes and laboratory tests. This third edition includes the late Dr. Chamorro as co-editor, because outstandingpeople do notpass, only transcend. Medical students will enjoy this book and clinicians will also appreciate it, since we are all aware that we never stop learning until we pass... or transcend. <![CDATA[<b><i>II Chilean Congress of Public Health</i></b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000100020&lng=pt&nrm=iso&tlng=pt Clinicians know that the clinical encounter with the patient constitutes thefore-most aspect in diagnosis and therapeutics. We also remember that ourfirst contad with clinicalpractice was to learn how to perform a good clinical history and thorough physical examination. Even afteryears of practice we are still learning how to listen to the patient, see, pálpate and auscúltate but most importantly, to approach a patient with warmth and kindness to unveil the mysteries of diseases and ailments. Books will not teach us these skills and practice is the basis ofthis learningprocess, but the text book by Drs. Goic, Chamorro and Reyes is ofgreat help and orientation, when we drift through the different chapters devoted to medical history taking, physical signs, syndromes and laboratory tests. This third edition includes the late Dr. Chamorro as co-editor, because outstandingpeople do notpass, only transcend. Medical students will enjoy this book and clinicians will also appreciate it, since we are all aware that we never stop learning until we pass... or transcend.