Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720120001&lang=en vol. 140 num. 1 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[<strong>The 140th Anniversary of <i>Revista Médica de Chile</i></strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000100001&lng=en&nrm=iso&tlng=en Revista Médica de Chile was founded in 1872 and thus is one of the oldest medical journals being published since the 19th Century. The sponsoring institution -"Sociedad Médica de Santiago", founded in 1869- initially was the only scientific society in Chile, gathering medical doctors from every existing specialty. With the splitting of independent organizations representing specific specialties, including subspecial-ties of internal medicine, Sociedad Médica de Santiago focused its scope of action to become the "Chilean Society of Internal Medicine". Its official journal -Revista Médica de Chile- is currently a general and internal medicine journal that also publishes articles on scientific and technological advances in many fields of medicine and health sciences. While initially all authors were Chilean, the journal is now open to submissions from abroad and since the year 2000 articles are published in English when the local language of authors is not Spanish. The number of articles received determines an increasing administrative and editorial burden and, together with the high cost of publishing, will require changes in publication policies. The journal will participate in continuing medical education programs as soon as reaccreditation of medical specialties becomes officially organized in Chile. <![CDATA[<strong>Etiology and biomarkers of systemic inflammation in mild to moderate COPD exacerbations</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000100002&lng=en&nrm=iso&tlng=en Background: The etiology of acute exacerbations of chronic obstructive pulmonary disease (COPD) is heterogeneous and still under discussion. Inflammation increases during exacerbation of COPD. The identification of inflammatory changes will increase our knowledge and potentially guide therapy. Aim: To identify which inflammatory parameters increase during COPD exacerbations compared to stable disease, and to compare bacterial and viral exacerbations. Material and Methods: In 85 COPD patients (45 males, mean age 68 ± 8 years, FEV1 46 ± 17% of predicted) sputum, nasopharyngeal swabs and blood samples were collected to identify the causative organism, during a mild to moderate exacerbation. Serum ultrasensitive C reactive protein (CRP), fibrinogen and interleukin 6 (IL 6), neutrophil and leukocyte counts were measured in stable conditions, during a COPD exacerbation, 15 and 30 days post exacerbation. Results: A total of 120 mild to moderate COPD exacerbations were included. In 74 (61.7%), a microbial etiology could be identified, most commonly Mycoplasma pneumoniae (15.8%), Rhinovirus (15%), Haemophilus influenzae (14.2%), Chlamydia pneumoniae (11.7%), Streptococcus pneumoniae (5.8%) and Gram negative bacilli (5.8%). Serum CRP, fibrinogen and IL 6, and neutrophil and leukocyte counts significantly increased during exacerbation and recovered at 30 days post exacerbation. Compared to viral exacerbations, bacterial aggravations were associated with a systemic inflammation of higher magnitude. Conclusions: Biomarkers of systemic inflammation increase during mild to moderate COPD exacerbations. The increase in systemic inflammation seems to be limited to exacerbations caused by bacterial infections. <![CDATA[<strong>Risk factors for preterm deliveries in a public hospital</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000100003&lng=en&nrm=iso&tlng=en Background: Preterm births are responsible for 75 to 80% of perinatal mortality. Aim: To determine the factors associated with preterm births, using maternal clinical data, laboratory results and pathological placental findings. Patients and Methods: Retrospective study of 642 preterm single births at 22-34 weeks' gestation. Four hundred and seven cases with pathological placental studies were included. Births were subdivided into preterm births as a consequence of a medical indication and spontaneous births with or without premature rupture of membranes (PROM). Risk factors for preterm births were classified as maternal, fetal, placental, indeterminable and unclassifiable. Results: The proportions of preterm births were spontaneous 69% (with PROM 27% and with intact membranes 42%) and medically indicated births 31%. A risk factor associated with prematurity was identified in 98 and 85% of medically indicated and spontaneous births, respectively. Ascending bacterial infection (ABI) was the most frequently associated factor with spontaneous preterm delivery in 51% of women (142/280, p < 0.01) and with preterm births of less than 30 weeks in 52% of women (82/157, p < 0.01). Vaginal or urinary infection with Group B Streptococcus, was the most common clinical condition associated with ABI related deliveries. Hypertension was present in 94 of 127 medically indicated preterm deliveries (preeclampsia in 62% and chronic hypertension in 12%), and in 29% (preeclampsia 24%) of preterm births of more than 30 weeks. Congenital anomalies were mainly associated with a maternal age over 35 years in 15% (14/92) of women. The frequency of placental diseases was higher in spontaneous preterm deliveries (14%) and in pregnancies of more than 30 weeks in (14%). Conclusions: ABI was the most common factor associated with spontaneous preterm births at 2234 weeks, while preeclampsia is the most common factor associated with medically indicated preterm births. <![CDATA[<strong>Sick leaves motivated by severe diseases of children of less than one year of age</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000100004&lng=en&nrm=iso&tlng=en Background: The increase in expenses of the health care system caused by sick leaves, especially those granted to mothers with children of less than one year of age with severe diseases, is a topic of concern. Aim: To describe the rates of sick leaves granted to mothers with children of less than one year of age with severe diseases from 2004 to 2008. Material and Methods: Analysis of databases containing information about sick leaves coming from Chilean public and private health care subsystems. Leaves granted to mothers with sick children of less than one year were specifically analyzed in terms of days off work and the amount of monetary benefits. Results: A sustained increase, ranging from 20 to 120% in the number of sick leaves motivated by diseases of children of less than one year, was observed. Thirty four percent of maternity leaves concentrate immediately after finishing the legal period (24 weeks after birth) and almost 60% of them occured within the first 6 months after birth. The most frequent diagnoses that motivated the higher number of leaves were gas-troesophageal reflux and bronchitis. Conclusions: There is probably a bad use of the benefit in a percentage of leaves. The benefit is also regressive since it favors mostly mothers of a better socioeconomic condition. The law that will extend the postnatal maternity leave will solve in part these problems. <![CDATA[<strong>Veno-arterial difference of carbondioxide as a predictor of low cardiac output in an experimental pediatric model</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000100005&lng=en&nrm=iso&tlng=en Background: Cardiac output (CO) measurement is not a standard of care for critically ill children, but it can be estimated by indirect methods such as veno-arterial pCO2 difference (ΔVACO2). Aim: To determine the correlation between CO and ΔVACO2 and evaluate the usefulness of ΔVACO2 in the diagnosis of low CO in an experimental pediatric model. Materials and Methods: Thirty piglets weighing 4.8 ± 0.35 kg were anesthetized and monitored with transpulmonary thermodilution. Lung injury was induced with tracheal instillation of Tween 20®. Serial measurements of central venous and arterial blood gases, as well as CO, were obtained at baseline, 1, 2 and 4 h after lung injury induction. Low cardiac output (LCO) was defined as CO lower than 2.5 Llminlm². Results: There was an inverse correlation between CO and ΔVACO2 (r = -0.36, p < 0.01). ΔVACO2 was 14 ± 8 mmHg in LCO state and 8 ± 6 mmHg when this condition was not present (p < 0.01). Area under the receiver operating characteristic (ROC) curves of ΔVACO2 and LCO state was 0.78 (0.68-0.86). The best cut-point was 8.9 mmHg to determine LCO with a sensibility 0.78, specificity 0.7, positive predictive value 0.27 and negative predictive value 0.96. Conclusions: In this model there was an inverse correlation between ΔVACO2 and CO. The best cutoff value to discard LCO was ΔVACO2 of 8.9 mmHg, indicating that under this value the presence of LCO is very unlikely. <![CDATA[<strong>Cryopreservation in blastocyst stage effectively reduce the number of embryos cryopreserved</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000100006&lng=en&nrm=iso&tlng=en Background: Multiple pregnancies are the main complication associated to assisted reproduction, due to the transfer of more than one embryo. Embryo cryopre-servation allows the sequential transfer of all generated embryos, thus diminishing the risk of multiple pregnancies. However, it leads to accumulation of cryopreserved embryos. To reduce their accumulation in our unit, we started to preserve embryos as blastocysts, that have a rate of successful pregnancies of approximately 40%. Aim: To perform a sensitivity analysis of this change of policy on the accumulation of embryos. Material and Methods: Records of 571 cycles of in vitro fertilization since 2007 were reviewed, assuming a transference rate of two embryos in women aged less than 35 years and three embryos in older women. The number of embryos that would be preserved as zygotes, eight cell stage or blastocysts, was analyzed. Results: Multiple component logistic regression analysis showed a 20% reduction in the odds ratio of cryopreservation per year of age. There was a 95% reduction in the ratio, when comparing the preservation of third and first day embryos and a 99% reduction when comparing preservation of embryos in blastocyst stage and first day embryos. Conclusions: Cryopreservation at blastocyst stage effectively decreased the frequency of embryo cryopreservation. <![CDATA[<strong>Current epidemiological situation of HIV/AIDS in Latin America</strong>: Analysis of differences among countries]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000100007&lng=en&nrm=iso&tlng=en Background: There is a great regional heterogeneity in the prevalence of HIV/ AIDS. Aim: To analyze the current situation of HIV/AIDS in Latin America by means of a comparative analysis among countries. Material and Methods: In a descriptive study (document analysis), epidemiological data about HIV/AIDS in Latin America as well as population data were used. Prevalence indexes and the distribution of HIV/AIDS cases were compared according to gender, age and transmission mode. Results: Dominican Republic, Panama, El Salvador and Honduras are the countries with the highest prevalence indexes. Colombia is in the first position in percentage of young men with HIV/AIDS and it is in the second position in percentage of children. Costa Rica is the second country for percentage of young men and male adults infected with HIV/AIDS. Paraguay is in the second place for children with HIV/AIDS and it is the third country in young men living with HIV/AIDS. Dominican Republic is in the first position in the percentage of young and adult females living with HIV/AIDS. The main transmission mode in all Latin American countries is sexual intercourse (heterosexual and homo/bisexual). Conclusions: Latin America is a heterogeneous region in HIV/AIDS which should be considered in the development and establishment of prevention strategies. <![CDATA[<strong>Validation of "Action Research Arm Test" (ARAT) in Chilean patients with a paretic upper limb after a stroke</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000100008&lng=en&nrm=iso&tlng=en Background: Stroke is one of the main causes of disability and death in the world. Sixty three percent of stroke survivors require rehabilitation which is a complex functional recovery multidisciplinary task. Aim: To determine the psychometric properties of the Action Research Arm Test (ARAT), that is used to assess the functional recovery of a paretic upper limb. Patients and Methods: Eighty stroke survivors were assessed at their homes as a baseline and two months later applying ARAT and Motor Activity Log (MAL-30) assessments. In the latter evaluation quality of life was assessed with SIS 3.0 score and the General Health Questionnaire (GHQ-30) was applied. Participants received no intervention in the lapse between the two assessments. Results: Cronbach a values for ARAT were 0.88 and 0.89 at baseline and two months assessments, respectively. Temporary stability had an r value of 0. 93 (p < 0.01). The convergent validity with quality of movement of MAL-30 was r = 0.58 and r = 0.51. The figures with quantity of movement were r = 0.55 and r = 0.57. The convergent validity with SIS 3.0 was r = 0.53 for the hand, r = 0.57 for participation and r = 0.48 for recovery. ARATscores correlated inversely and significantly with age and pain. There was no discriminant validity between ARAT and emotion, memory, communication and mobility of SIS 3.0, GHQ-30 and the socio-economic level. Conclusions: ARAT is a reliable and valid instrument for assessing the functional recovery of paretic upper limbs after a stroke. <![CDATA[<strong>Glycemic control in diabetic patients hospitalized in a non-critical care hospital setting</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000100009&lng=en&nrm=iso&tlng=en Background: During hospitalization, hyper and hypoglycemia impairs the prognosis of diabetic patients. Strict glycemic control improves survival in intensive care units. There is no evidence to support it for patients in non-critical wards. Aim: To evaluate the glycemic control of diabetic patients in a non-critical medical unit, and estimate its effect on hospitalization and survival. Material and Methods: Prospective study of all patients admitted to a non-critical ward with a fasting blood glucose (BG) &gt; 126 mg/dl or &gt; 200 mg /dl at any time, and patients with known diabetes. Age, sex, type of diabetes, time since diagnosis, chronic complications, prior treatment, length of stay, admission and discharge diagnosis were registered. All capillary BG levels obtained from each patient until discharge, death or transfer, were registered. Results: Ninety nine patients aged 63 ± 13.4 years (42 males,) were included. Ninety one percent had a type 2 diabetes with a mean duration of 13.8 years. Mean hospital stay was 10.9 days. At least one hypoglycemia below 70 mg/dl occurred in 21% of patients and 39.4% had at least one episode with blood glucose over 300 mg/dl. Median hospital stay of patients with no episode of BG &gt; 200 mg/dl was 6 days, 10.5 days among patients with at least one episode of BG &gt; 300 mg/dl and 13 days among patients that had at least one episode of hypoglycemia (p = 0.02). Diabetes lasted nine years more among the latter (p < 0.01). Three patients that suffered hypoglycemia and two in the rest of the groups, died (NS). Conclusions: Two of three diabetic patients admitted to our non-critical medical ward have a non-optimal glycemic control. Appearance of hypoglycemia is associated with a longer hospital stay. <![CDATA[<strong>Basic cardiopulmonary resuscitation</strong>: knowledge, practical skills and effectiveness of maneuvers of general physicians]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000100010&lng=en&nrm=iso&tlng=en Background: General physicians should be adequately trained to deliver effective resuscitation during ventricular fibrillation (VF). Aim: To assess the degree of knowledge, skills and practical effectiveness in cardiopulmonary resuscitation (CPR) of Chilean general physicians. Materials and Methods: Forty eight general physicians starting Anesthesiology or Internal Medicine residency programs were evaluated. They answered a modified American Heart Association Basic Life Support Course written test and individually participated in a witnessed VF cardiac arrest simulated scenario. Execution of resuscitation tasks in the correct order, the quality of the maneuvers and the use of defibrillator were registered. Results: All participants acknowledged the importance of uninterrupted CPR and early defibrillation. Seventy five percent knew the correct frequency of chest compressions, but only 6.25% knew all the effective chest compression characteristics. Ninety eight percent knew the recommended number of breaths per cycle. In practice, 58% performed effective ventilations, 33% performed uninterrupted compressions, 14% did them with adequate frequency and only 8% performed chest compressions adequately. Forty four percent requested a defibrillator within 30 seconds and 31% delivered the first defibrillation within 30 seconds of defibrillator arrival. Airway, breathing, circulation and defibrillation sequence was correctly performed by 12% of participants and 80% acknowledged that their medical training was inadequate or insufficient for managing a cardiac arrest. Conclusions: Despite an elevated degree of knowledge about key aspects of CPR, this group of Chilean physicians displayed suboptimal practical skills while performing CPR in a simulated scenario, specially delivering effective chest compressions and promptly asking for and using the defibrillator. <![CDATA[<strong>Hepatitis B virus immunoglobulin on demand to prevent infection recurrence among liver allograft recipients</strong>: Report of three cases]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000100011&lng=en&nrm=iso&tlng=en Infection recurrence rates among hepatitis B virus infected liver allograft recipients, may be as high as 80%. Immunoprophylaxis with anti HBVgammaglobulin may reduce these rates and improve survival. The dose of anti HBV gammaglobulin that must be used is not clearly defined. The most commonly accepted protocol uses 10,000 units during the anhepatic phase and 10,000 units daily during one week, followed by weekly doses of 10,000 units during one month and maintenance with 10,000 units monthly, without measuring anti hepatitis B surface antigen antibodies (antiHBs). Some reports recommend the use of immunoglobulin on demand, to maintain antiHBs titers between 100 and 250 U/l. The infection recurrence rates among patients treated with immunoglobulin and Lamivudine fluctuates between 0 and 10%, during follow up periods of 13 to 30 months. We report three liver allograft recipients that received immunoglobulin on demand, using a mean of41,000 units, maintaining adequate antiHBs titers. <![CDATA[<strong>Placement of a biventricular resynchronization device in a patient with a persistent left superior vena cava</strong>: Report of one case]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000100012&lng=en&nrm=iso&tlng=en Persistent left superior vena cava is the most common venous congenital malformation and is usually asymptomatic. Its presence could increase the difficulty for transvenous lead implantation. We report a 71-year-old woman with an idiopathic dilated cardiomyopathy, atrial fibrillation and heart failure that required biventri-cular resynchronization therapy. During the placement of the device a persistent left superior vena cava was detected. The device was placed without problems and the patient had a satisfactory postoperative evolution. <![CDATA[<strong>Primary angioplasty for acute myocardial infarction with an anomalous origin of right coronary artery</strong>: Report of one case]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000100013&lng=en&nrm=iso&tlng=en Anomalous origin of coronary arteries is a rare anatomical defect and its association with acute myocardial infarction is unusual. We report a 58-year-old male with ST-Segment elevation. Myocardial infarction of the inferior wall caused by a total occlusion on the proximal third of an anomalous right coronary artery, that was effectively treated with primary angioplasty with stent placement. The patient had a favorable outcome and is asymptomatic after five years of follow up. <![CDATA[<strong>Prostatic tissue in a mature cystic teratoma of the ovary</strong>: Report of one case]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000100014&lng=en&nrm=iso&tlng=en Male accessory sexual glands arising in ovarian cystic teratoma are exceedingly rare. We report a 56-year-old female subjected to an ovariohysterectomy due to a left ovarian mass. The pathological study of the surgical piece revealed a tumor composed of different mature tissue elements and well defined nodules of benign prostatic tissue. <![CDATA[<strong>Review of nutritional and dietary management of anorexia nervosa</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000100015&lng=en&nrm=iso&tlng=en While numerous studies have highlighted the need to approach anorexia nervosa from a multidisciplinary perspective, the dietary and nutritional aspects of the disorder are rarely considered in depth. Basic guidelines to monitor food intake of patients, are available. A literature review was performed in Medline, searching for articles related to the dietary and nutritional management of anorexia nervosa and published over the last five years. Thefinal analysis focused on 102 articles. This review summarizes the different therapeutic contexts and objectives, nutritional support, the use of dietary supplements, the role of artificial nutrition, refeeding syndrome, involuntary treatment and nutritional education. <![CDATA[<strong>Bioethics in catastrophe situations such as earthquakes</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000100016&lng=en&nrm=iso&tlng=en A catastrophe of the magnitude of the earthquake and tsunami that hit Chile not long ago, forces us to raise some questions that we will try to answer from a philosophical, ethical and responsibility viewpoints. An analysis of the basic principles of bioethics is also justified. A natural catastrophe is not, by itself, moral or immoral, fair or unfair. However, its consequences could certainly be regarded as such, depending on whether they could have been prevented or mitigated. We will identify those individuals, who have the ethical responsibility to attend the victims and the ethical principles that must guide the tasks of healthcare and psychological support teams. The minimal indispensable actions to obtain an adequate social and legal protection of vulnerable people, must be defined according to international guidelines. These reflections are intended to improve the responsibility of the State and all the community, to efficiently prevent and repair the material and psychological consequences of such a catastrophe. <![CDATA[<strong>Surrogate outcomes</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000100017&lng=en&nrm=iso&tlng=en A catastrophe of the magnitude of the earthquake and tsunami that hit Chile not long ago, forces us to raise some questions that we will try to answer from a philosophical, ethical and responsibility viewpoints. An analysis of the basic principles of bioethics is also justified. A natural catastrophe is not, by itself, moral or immoral, fair or unfair. However, its consequences could certainly be regarded as such, depending on whether they could have been prevented or mitigated. We will identify those individuals, who have the ethical responsibility to attend the victims and the ethical principles that must guide the tasks of healthcare and psychological support teams. The minimal indispensable actions to obtain an adequate social and legal protection of vulnerable people, must be defined according to international guidelines. These reflections are intended to improve the responsibility of the State and all the community, to efficiently prevent and repair the material and psychological consequences of such a catastrophe. <![CDATA[Critically appraised article]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000100018&lng=en&nrm=iso&tlng=en Background: Angiotensin receptor blockers (ARB) and angiotensin converting enzyme (ACE) inhibitors are known to reduce proteinuria. Their combination might be more effective than either treatment alone, but long-term data for comparative changes in renal function are not available. We investigated the renal effects of ramipril (an ACE inhibitor), telmisartan (an ARB), and their combination in patients aged 55 years or older with established atherosclerotic vascular disease or with diabetes with end-organ damage. Methods: The trial ran from 2001 to 2007. After a 3-week run-in period, 25,620 participants were randomly assigned to ramipril 10 mg a day (n = 8,576), telmisartan 80 mg a day (n = 8,542), or to a combination of both drugs (n = 8,502; median follow-up was 56 months), and renal function and proteinuria were measured. The primary renal outcome was a composite of dialysis, doubling of serum creatinine, and death. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00153101. Findings: 784 patients permanently discontinued randomised therapy during the trial because of hypotensive symptoms (406 on combination therapy, 149 on ramipril, and 229 on telmisartan). The number of events for the composite primary outcome was similar for telmisartan (n = 1,147 [13.4%]) and ramipril (1,150 [13.5%]; hazard ratio [HR] 1.00, 95% CI 0.92-1.09), but was increased with combination therapy (1,233 [14.5%]; HR 1.09, 1.01-1.18, p = 0.037). The secondary renal outcome, dialysis or doubling of serum creatinine, was similar with telmisartan (189 [2.21%]) and ramipril (174 [2.03%];HR 1.09, 0.89-1.34) and more frequent with combination therapy (212 [2.49%]: HR 1.24,1.01-1.51, p = 0.038). Estimated glomerular filtration rate (eGFR) declined least with ramipril compared with telmisartan (-2.82 [SD 17.2] mL/min/1.73 m² vs -4.12 [17.4], p < 0.0001) or combination therapy (-6.11 [17.9], p < 0.0001). The increase in urinary albumin excretion was less with telmisartan (p = 0.004) or with combination therapy (p=0.001) than with ramipril. Interpretation: In people at high vascular risk, telmisartans effects on major renal outcomes are similar to ramipril. Although combination therapy reduces proteinuria to a greater extent than monotherapy, overall it worsens major renal outcomes. <![CDATA[<strong>Paul Hamilton Wood</strong>: The foremost British clinical cardiologist of the 20th century]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000100019&lng=en&nrm=iso&tlng=en In the United Kingdom, during the mid-20th century, Paul Wood appears as the new leader of European cardiology. He introduced rigorous bed-side diagnostic methods and the confirmation of these clinical findings by cardiac catheterization, in an effort to demonstrate the pathophysiological causes of cardiac disease. In his search for the correct diagnosis, his comments, which could be caustic, both impressed and offended many. He had a strong commanding personality and was intensely honest in his appreciations. His showmanship and diagnostic ability became renown. In 1950, the publishing of the first edition of his textbook "Diseases of the Heart and Circulation" brought him worldwide recognition. In this book, Wood introduces his personal fresh style of narrative and his physiologic approach to cardiology. His intense professional activity, teaching, lecturing and preparing the third edition of his book, plus the fact that he was a heavy smoker, must have been the factors that lead to a myocardial infarction and death at the early age of 54. As Paul Dudley White and Ignacio Chávez in America, Paul Wood in Europe will be remembered as the emblematic figure leading the transition of cardiology into the modern era. <![CDATA[<b><i>Towards a new framework for health research in Chile</i></b>: <b><i>a proposal</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000100020&lng=en&nrm=iso&tlng=en In the United Kingdom, during the mid-20th century, Paul Wood appears as the new leader of European cardiology. He introduced rigorous bed-side diagnostic methods and the confirmation of these clinical findings by cardiac catheterization, in an effort to demonstrate the pathophysiological causes of cardiac disease. In his search for the correct diagnosis, his comments, which could be caustic, both impressed and offended many. He had a strong commanding personality and was intensely honest in his appreciations. His showmanship and diagnostic ability became renown. In 1950, the publishing of the first edition of his textbook "Diseases of the Heart and Circulation" brought him worldwide recognition. In this book, Wood introduces his personal fresh style of narrative and his physiologic approach to cardiology. His intense professional activity, teaching, lecturing and preparing the third edition of his book, plus the fact that he was a heavy smoker, must have been the factors that lead to a myocardial infarction and death at the early age of 54. As Paul Dudley White and Ignacio Chávez in America, Paul Wood in Europe will be remembered as the emblematic figure leading the transition of cardiology into the modern era. <![CDATA[<b><i>Importance of the use of interferon-gamma release assays in the epidemiological surveillance of tuberculosis</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000100021&lng=en&nrm=iso&tlng=en In the United Kingdom, during the mid-20th century, Paul Wood appears as the new leader of European cardiology. He introduced rigorous bed-side diagnostic methods and the confirmation of these clinical findings by cardiac catheterization, in an effort to demonstrate the pathophysiological causes of cardiac disease. In his search for the correct diagnosis, his comments, which could be caustic, both impressed and offended many. He had a strong commanding personality and was intensely honest in his appreciations. His showmanship and diagnostic ability became renown. In 1950, the publishing of the first edition of his textbook "Diseases of the Heart and Circulation" brought him worldwide recognition. In this book, Wood introduces his personal fresh style of narrative and his physiologic approach to cardiology. His intense professional activity, teaching, lecturing and preparing the third edition of his book, plus the fact that he was a heavy smoker, must have been the factors that lead to a myocardial infarction and death at the early age of 54. As Paul Dudley White and Ignacio Chávez in America, Paul Wood in Europe will be remembered as the emblematic figure leading the transition of cardiology into the modern era. <![CDATA[ <b><i>How respected is the physician's word, nowadays</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000100022&lng=en&nrm=iso&tlng=en In the United Kingdom, during the mid-20th century, Paul Wood appears as the new leader of European cardiology. He introduced rigorous bed-side diagnostic methods and the confirmation of these clinical findings by cardiac catheterization, in an effort to demonstrate the pathophysiological causes of cardiac disease. In his search for the correct diagnosis, his comments, which could be caustic, both impressed and offended many. He had a strong commanding personality and was intensely honest in his appreciations. His showmanship and diagnostic ability became renown. In 1950, the publishing of the first edition of his textbook "Diseases of the Heart and Circulation" brought him worldwide recognition. In this book, Wood introduces his personal fresh style of narrative and his physiologic approach to cardiology. His intense professional activity, teaching, lecturing and preparing the third edition of his book, plus the fact that he was a heavy smoker, must have been the factors that lead to a myocardial infarction and death at the early age of 54. As Paul Dudley White and Ignacio Chávez in America, Paul Wood in Europe will be remembered as the emblematic figure leading the transition of cardiology into the modern era.