Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720120009&lang=es vol. 140 num. 9 lang. es <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[Diagnóstico de intolerancia a la lactosa en adultos: <b>rendimiento comparativo de la clínica, test de hidrógeno espirado y test genético</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000900001&lng=es&nrm=iso&tlng=es Background: Genetically programmed adult-type hypolactasia affects 56% of Chilean population. Ideally, diagnosis should be confirmed. Aim: To compare diagnostic yield of genetic test, hydrogen (H2) expiratory test and a validated symptomatic structured survey (SS). Material and Methods: Patients submitted to H2 test answered a historic (anamnestic) and current SS (after the ingestion of 25 g of lactose). A blood sample was obtained for determination of genetic polymorphisms C/T_13910, C/G_13907 and G/A_22018 by polymerase chain reaction. The gold standard for diagnosis of lactose intolerance (LI) was the agreement of at least two of three tests. Results: Sixty-one participants aged 39 ± 12 years (21 males), were studied. Anamnestic SS was diagnostic of LI in all cases (score &gt; 7), while current SS detected LI in 27/61 (46%). H2 test (an increase &gt; 15 ppm after ingestion of 25 g of lactose) showed LI in 31/61 (51%). The locus C/G_13907 showed no polymorphism and locus G/A_22018 was in complete linkage disequilibrium with C/T_13910. Genotype C/C_13910, associated to hypolactasia, was present in 30/58 (52%). According to the gold-standard, 32/61 (52.5%) patients were diagnosed as LI. Sensitivity and specificity were, respectively, 79% and 69% for current SS, 93% and 93% for H2 test and 97% and 93% for the genetic test. The last two showed a positive likelihood ratio (LR) &gt; 10 and a negative LR < 0.1, figures within the range considered clinically useful. Conclusions: Genotype C/C_13910 is responsible for hypolactasia in this population. Anamnestic report of symptoms after milk ingestion and symptoms after lactose ingestion, are not accurate enough. H2 and genetic tests are simple and similarly accurate to diagnose lactose intolerance in adults. <![CDATA[<b>Expresión disminuida de caspasa 3 asociada al polimorfismo del gen del antígeno-4 asociado a linfocito T-citotóxico (CTLA4) en pacientes chilenos con diabetes tipo 1</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000900002&lng=es&nrm=iso&tlng=es Background: Several polymorphisms of the CTLA4 gene have been associated with autoimmune diseases. The activation of induced cell death is the major event and caspase 3 represents the main protein for the apoptotic machinery, especially in lymphocytes. Aim: To correlate CTLA4 polymorphisms with caspase 3 expression in peripheral blood mononuclear cells (PBMC) simulating in vitro the glucose effect. Material and Methods: CTLA4 polymorphisms were determined by restriction fragment length polymorphisms (RFLPs). PBMC from 21 patients with type 1 diabetes aged 8.5 ± 4.3 years and 21 healthy subjects aged 18.3 ± 1.8 years, were stimulated under normal (5 mM) and toxic (14 mM) glucose conditions to assess its effect on the expression and activity of caspase 3. Relative abundance of caspase 3 mRNA was measured by semi quantitative RT-PCR and its activity, by a colorimetric assay. Results: When stimulated with 14mM glucose, PBMC of G allele carriers with type 1 diabetes had significantly lower relative mRNA abundance of caspase 3 (median value = 0.12, range 0.01-0.70 AU) compared with non-carriers (median value = 0.81, range 0.06-1.09 AU). When the incubation was carried out with the lower glucose concentration, a similar profile of caspase 3 activity was observed in diabetic patients carrying G allele (median value = 0.57, range 0.13-1.20 AU) as compared with non-carriers (median value = 0.89, range 0.14-5.50 AU). No significant changes after stimulating with glucose, were observed in PBMCs of the control group. Conclusions: PBMC of recently diagnosed patients with T1D, carrying the G allele in + 49A/G polymorphisms of CTLA4, have a decreased expression and activity of caspase 3. <![CDATA[Utilidad del estudio PET con FDG en la evaluación de sarcomas de diverso origen y de tumores no sarcoma-no epiteliales]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000900003&lng=es&nrm=iso&tlng=es Background: The usefulness of positron emission tomography (PET) with fluorine-deoxyglucose (FDG) in sarcomas and non-sarcoma non-epithelial (NSNE) tumors is not clearly defined. Aim: To report a Chilean experience with NSNE tumors evaluated using PET with FDG. Material and Methods: Retrospective review of the database of a PET laboratory. Demographic data, indications and metabolic findings were compared with conventional imaging in 88 adults and children with diverse bone and soft tissue sarcomas as well as 24 gastrointestinal stromal tumors (GIST), 6 pleural malignant mesotheliomas in adults, and 9 medulloblastomas in children. Results: FDG showed good concordance with conventional imaging in NSNE tumors. It was helpful for staging, restaging, follow-up after treatment and for the detection of new not previously suspected lesions. Conclusions: PET with FDG could have a prognostic role and help in patient management, mainly in musculos-keletal and high grade or less differentiated sarcomas. In GIST, it was a good tool for immunotherapy control. <![CDATA[Prevalencia de neuropatía periférica en diabéticos tipo 2 en el primer nivel de atención]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000900004&lng=es&nrm=iso&tlng=es Background: Neuropathy is a common complication of diabetic patients. Aim: To determine the prevalence of diabetic peripheral neuropathy in Type 2 diabetic patients attended at a family medicine unit. Material and Methods: Cross-sectional assessment of 348 type 2 diabetic patients aged 34-89 years (60% females) with a disease duration of 5 to 15 years. Peripheral neurological status was evaluated using The Michigan Neuropathy Screening Instrument, a tool that includes a self-assessment of symptoms and a physical examination. Results: Diabetic neuropathy was found in 240patients (69%). The prevalence in males and females was 72 and 67% respectively. The prevalence in patients with a disease duration of 5, 10 and 15 years, was 59, 69 and 77%, respectively. Fifty percent of patients with neuropathy complained of dry skin, 2% had ulcers, 43% had an abnormal perception of vibration and 29% had an abnormal monofilament test. Conclusions: The overall prevalence of peripheral neuropathy in this group of patients was 69% and was directly associated with the duration of the disease. <![CDATA[<b>Síndrome de Lynch</b>: <b>selección de pacientes para el estudio genético mediante análisis de inestabilidad microsatelital e inmunohistoquímica</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000900005&lng=es&nrm=iso&tlng=es Background: Selection of patients with Lynch Syndrome (LS) for a genetic study involves the application of clinical criteria. To increase the rate of identification of mutations, the use of molecular studies as Microsatellite Instability (MSI) and Im-munohistochemistry (IHC) in the tumor has been proposed. Aim: To demonstrate the usefulness of MSI and IHC in the detection of mutations in patients with LS. Material and Methods: From our Familial Colorectal Cancer Registry, families suspected of LS were selected according to Amsterdam or Bethesda clinical criteria. Screening of germline mutations of MLH1, MSH2 and MSH6 genes was performed. In addition, analysis of MSI and IHC were performed in colorectal tumors. Results: A total of 35 families were studied (19 met Amsterdam and 16 met Bethesda criteria). Twenty one families harbored a germline alteration in MLH1, MSH2 or MSH6 (18 Amsterdam and 3 Bethesda). In these families, eighteen different alterations were found, 15 of which were mutations and 3 corresponded to variants of uncertain pathogenicity. On the other hand, 80% of the tumors showed positive microsatellite instability (27 MSI-high and 1 MSI-low), and immunohistochemical testing showed that 77% of tumors had the loss of a protein. Correlation between results of tumor molecular studies and the finding of germline nucleotide change showed that IHC and MSI predicted mutations in 81 and 100% of patients, respectively. Conclusions: MSI and IHC can efficiently select patients with a high probability of carrying a mutation in DNA repair genes. <![CDATA[Prevalencia de consumo de alcohol en estudiantes de la Facultad de Medicina en la Universidad Católica del Maule]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000900006&lng=es&nrm=iso&tlng=es Background: Teenagers and university students are an especially vulnerable population towards unhealthy alcohol consumption Aim: To assess the actual consumption of alcohol among medical students at the Universidad Católica del Maule, Chile (UCM). Material and Methods: A cross sectional study of students who entered medical school between years 2004 and 2010.We applied CAGE questionnaire along with questions about frequency of alcohol consumption. Results: From a universe of 317students, 216 (age range 17-27 years, 54% females) answered the survey (68.8%), 64.2% admitted to consume alcohol and 6% had alcohol dependence. Seventy three percent of the alcohol drinkers were males. Conclusions: The prevalence of alcohol consumption in medical students of the UCM is significantly lower than the prevalence in students of another University surveyed in 2005 (74%) and it is similar to the national statistics. Alcohol consumption was higher in men that in women. <![CDATA[Evaluación multidimensional de los servicios de salud para adolescentes en centros de Atención Primaria en una comuna de Santiago]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000900007&lng=es&nrm=iso&tlng=es Background: Adolescents are an especially vulnerable age group in terms of behavioral issues and require skilled teams in health centers. Aim: To assess the quality of health services provided to teenage users in Primary Health Care. Material and Methods: A study of multiple cases was carried out in two family health centers in Puente Alto, Chile. Health services delivered to adolescents were evaluated from the provider's perspective, through qualitative design of focus groups and interviews to the care teams at each centre. For technical quality, comparing electronic records of two tracer conditions (prenatal care and depression) with technical standards established by Delphi methodology and from teenage users perspective, through a survey of service satisfaction. Results: In both centers, providers perceived a lack of training in adolescent care, a deficient preventive approach and a limited access to care. The technical evaluation showed an inappropriate recording of both tracer conditions. The instrument used to assess user satisfaction survey was reliable and showed that the best perceived issue was medical care and treatment, and the least perceived, was the access to the services. Conclusions: Professionals working in these health care facilities, feel unprepared to provide comprehensive approach to adolescents. The surveyed teenagers complained of limited access to care. Therefore this age group continues to be as a non-priority group for health care. <![CDATA[Validación de un cuestionario para evaluar riesgos psicosociales en el ambiente laboral en Chile]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000900008&lng=es&nrm=iso&tlng=es Background: The measurement of psychosocial risk among workers is becoming increasingly important. Aim: To adapt, validate and standardize a questionnaire to measure psychosocial risks in the workplace. Material and Methods: The Spanish version of the Copenhagen Psychosocial Questionnaire was adapted and evaluated. Its contents were first validated with a panel of experts. Afterwards a semantic adaptation of the questionnaires was carried out applying it to a pilot sample. Finally, it was applied to 1,557workers (65% men). Results: A preliminary questionnaire containing 97 questions was constructed. A good item-test correlation was found, the factorial structure was similar to the original questionnaire and it had a good internal consistency, convergent validity with the Goldberg Health Questionnaire and test-retest correlation. Ranges for the different dimensions and sub-dimensions of psychosocial risk were calculated by tertiles. Conclusions: The resulting questionnaire is useful for measuring psychosocial risk factors at work, with good psychometric properties. <![CDATA[Asociación entre el test de caminata de seis minutos y factores de riesgo cardiovascular en portugueses obesos]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000900009&lng=es&nrm=iso&tlng=es Background: A better physical fitness may have survival advantages in adults. Aim: To analyze the relationship between cardiorespiratory fitness and cardiovascular risk factors among obese subjects aged 58 years and older. Material and Methods: Cardiorespiratory fitness using the six-minute walk test, body composition by dual-energy x-ray absorptiometry and blood pressure were measured in a non-representative sample of 76 obese Portuguese subjects aged 58 to 87 years (55 women). Participants were stratified in tertiles of walking capacity according to the six-minute walk test. Results: Six minutes walk test results were negatively correlated with percentage body fat (r = -0.28; p = 0.012) and systolic blood pressure (r = -0.23; p = 0.045). Participants located in the lowest tertile for the six minutes walk test had an odds ratio of4.34 (95% confidence intervals: 1.02-18.43) for elevated blood pressure. Conclusions: A lower six minutes walk test result is associated with a higher risk for high blood pressure.<hr/>Antecedentes: Una mejor condición física se asocia a mejor sobrevida en adultos. Objetivos: Estudiar la relación entre condición física y factores de riesgo cardiovascular en obesos mayores de 58 años. Material y Métodos: Se midió la capacidad cardiorrespiratoria mediante la prueba de caminata de seis minutos, composición corporal mediante densitometría de doble fotón y presión arterial en una muestra no representativa de 76 portugueses de 58 a 87 años (55 mujeres). Los participantes se estratificaron en terciles de acuerdo a los resultados de la prueba de seis minutos. Resultados: Los resultados de la prueba de caminata de seis minutos se correlacionaron negativamente con el porcentaje de grasa corporal (r = -0,28; p = 0,012) y presión sistólica (r = -0,23; p = 0,045). Los participantes ubicados en el tercil más bajo de la prueba de caminata de seis minutos tenían una razón de riesgo para hipertensión arterial de 4,34 (intervalos de confianza de 95%: 1,02- 18,43). Conclusiones: Una prueba de caminata de seis minutos con bajos resultados se asocia a un mayor riesgo de hipertensión arterial. <![CDATA[Encefalitis autoinmune reversible y anticuerpos anti-receptores de N-metil-D-aspartato: Report of one case]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000900010&lng=es&nrm=iso&tlng=es Background: Limbic encephalitis is a subacute syndrome characterized by memory impairment, confusion, seizures, hypothalamic dysfunction and psychiatric symptoms. It has been associated to tumors located outside of the central nervous system. In 2007, anti-N-methyl-D-aspartate receptors (NMDAr) antibodies were found in serum and CSF of patients with this particular type of encephalitis. We report a 25-year-old female who, following upper respiratory tract symptoms, developed serious behavioral and consciousness impairment that progressed to coma. Cerebrospinal fluid (CSF) analysis showed a lymphocyte pleocytosis, the electroencephalogram was altered with a slow encephalopathic rhythm and a brain magnetic resonance imaging was normal. Infectious etiologies were ruled out. CSF and serum anti NMDA receptors antibodies were positive. <![CDATA[Enfermedad de Ménétrier con compromiso gástrico difuso y duodenal: <b>Caso</b><b> clínico</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000900011&lng=es&nrm=iso&tlng=es Background: Ménétrier disease is a rare disorder of the stomach, characterized by giant hypertrophic folds that usually involve the gastric body and fundus, associated to hypoalbuminemia due to serum protein loss across the gastric mucosa. We report a 55-years-old male presenting with abdominal pain, vomiting, weight loss and hypoalbuminemia. Diffuse hypertrophic gastric folds, elevated ulcerated sessile lesions and focal duodenal involvement were seen at endoscopy. Biopsies showed foveolar hyperplasia and glandular atrophy with cystic dilatation. A total gastrectomy was performed with a good outcome. <![CDATA[Tumor sólido pseudopapilar de páncreas: Presentación de un caso]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000900012&lng=es&nrm=iso&tlng=es Solid-pseudopapillary tumor of pancreas is a rare neoplasm which occurs pre-dominantely in young females. This tumor generally is asymptomatic or minimally symptomatic and some imaging tests are useful for its diagnosis. We report a 17 years-old woman with dyspeptic symptoms submitted to an abdominal ultrasound (US), that revealed a hypoechogenic mass between the liver, right kidney and pancreas. Computer tomography (CT) scan showed a hypodense and heterogeneous mass on pancreas head. The patient underwent elective resection of the mass and the histopathology was consistent with a solid-pseudopapillary tumor of pancreas. Immunohistochemical positivity for NSE (neuron-specific enolase), progesterone receptor, alfa-1-antitrypsin, vimentin, AE1/AE3, and negativity for synaptophysin and chromogranin A confirmed the diagnosis. After four years of clinical follow-up, the patient remains in a good general condition without signs of tumor recurrence.<hr/>El tumor sólido pseudopapilar de páncreas es una neoplasia poco frecuente, que ocurre predominantemente en mujeres jóvenes. Este tumor generalmente es asintomático o mínimamente sintomático y las imágenes son útiles para su diagnóstico. Presentamos una mujer de 17 años de edad con dispepsia que fue sometida a una ecografía abdominal que reveló una masa tumoral hipoecogénica entre el hígado, el riñón derecho y el páncreas. La tomografía computarizada mostró una masa hipodensa y heterogénea en la cabeza del páncreas. La paciente fue sometida a resección electiva de la masa y la histopatología fue consistente con el tumor sólido pseudopapilar de páncreas. La inmunohistoquímica fue positiva para NSE (enolasa neuronal específica), receptor de progesterona, alfa-1-antitripsina, vimentina, AE1/ AE3, y negativa para sinaptofisina y cromogranina A, lo que confirmó el diagnóstico. Después de cuatro años seguimiento clínico, la paciente permanece en buen estado general sin signos de recurrencia del tumor. <![CDATA[Enfermedad de Dupuytren: <b>revisión</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000900013&lng=es&nrm=iso&tlng=es Background: Dupuytren disease (DD) is a connective tissue disorder that consists in fibroma-tosis of the palmar and digital fascia (in form of nodules or flanges) that leads to the development of flexion contractures of the palm and fingers. The little and ring finger are particularly affected. The disease can limit hand function, reducing the quality of life. The disease can have a traumatic origin and is also associated with conditions such as diabetes mellitus, alcoholism, dyslipidemia, epilepsy and AIDS, among others. However, none of these conditions can fully explain the genesis of DD. A hereditary component is described in 40% of patients and is attributed to an autosomal dominant gene of variable penetrance, probably related to collagen synthesis. However there are also spontaneous and recessive inheritance cases. The diagnosis is clinical and based on physical examination. Treatment ranges from observation or use of injectable collagenase to the surgical option in cases with significant functional limitations. <![CDATA[Evaluación de la enfermedad de Alzheimer en etapa temprana: <b>biomarcadores y pruebas neuropsicológicas</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000900014&lng=es&nrm=iso&tlng=es Background: Alzheimer disease is a neurodegenerative condition that affects cognitive, behavioral and global functioning of patients. Currently and due to the lack of conclusive biological testing, Alzheimer's disease diagnosis is based primarily on clinical criteria. Since its early diagnosis allows clinical interventions when neurological damage is relatively mild, the development of early detection tools has become a major topic of interest. In this article, we review the main neuro-biological and neuropsychological features of Alzheimer's disease, analyzing the use of biomarkers and neuropsychological testing for early detection. <![CDATA[<b>Lo público, lo privado y el espacio universitario</b>: <b>Reflexión</b><b> bioética</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000900015&lng=es&nrm=iso&tlng=es Background: In contemporary democracies, rules of conduct, in public places, are established by law and in private places, by morality. Between both, there is a middle area or interface given by community consensus. In the Community area, rules are consensual among its members. Institutions are an example of such situation. The University, as an institution, without contradicting the law, regulates and requires a behavior that is consistent with its purpose, beyond the private sphere, especially in the Schools of Medicine. We analyze what happens and the underlying purposes that represent the concept of University and Medicine. Special importance is given to ethical, social and cultural analyses. <![CDATA[Primeros diez trasplantes autólogos de progenitores hematopoyéticos en adultos, en el servicio público de salud en Chile]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000900016&lng=es&nrm=iso&tlng=es Background: Hematopoietic stem cell transplantation (HSCT) is an effective therapy for hematological diseases such as lymphoma and multiple myeloma. In 2004, the Cancer Unit of the Ministry of Health incorporated the HSCT to the National Cancer Program in Adults. Until 2008 we purchased services to private institutions while implementing the national center for HSCT of adults in the Hospital del Salvador. Aim: To report the first ten HSCT conducted in this center. Material and Methods: All cases were approved by a national commission for adult HSCT. The entire process was carried out based on evidence-based protocols. Results: Six patients with Hodgkin lymphoma, three with multiple myeloma and one with a diffuse large B cell lymphoma were transplanted. Age range was 19 to 48 years and five patients were male. An average of 2.2 aphereses per patient was required. The CD 34 stem cell collection was 5.06 x 10(6) x Kg. The conditioning regimes were BEAM (carmus-tine, etoposide, cytosine arabinoside, melphalan) and melphalan 200 according to the underlying disease. Seventy percent of the patients developed mild to moderate mucositis and 50% had febrile neutropenia, with good response to treatment. In two cases there was an association with influenza. The engraftment of neutrophils and platelets was achieved on day +10 and +11 respectively. At follow-up until day +100, there was no morbidity or mortality. Conclusions: These results confirm the quality standard that this intervention has achieved in our institution. The Chilean National Center for HSCT on Adults should be established as a public core care, teaching and research facility. <![CDATA[<b><i>"Curriculum</i></b><b> oculto" en medicina</b>: <b>una reflexión docente</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000900017&lng=es&nrm=iso&tlng=es Background: Medical education must ascribe to a curriculum but clinical teaching poses special difficulties that go beyond any programming attempt. Attitudes and skills learned during tutored clinical practice are called the "hidden curriculum". The figure and personal features of the teacher, his environment and the atmosphere that projects every particular medical school, are essential to shape the characteristics of the student. Paradoxically, it is almost impossible to measure the impact of this hidden curriculum. This article is a reflection on an issue that is acquiring special relevance in medical education. <![CDATA[William Osler: <b>el hombre y sus descripciones</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000900018&lng=es&nrm=iso&tlng=es Background: William Osler was generally regarded as the greatest and most respected physician of his time. This paper describes Osler's life, his philosophy and views. He was an outstanding clinician who emphasized bedside teaching and observation. He possessed an extraordinary charm that inspired many others. As Professor of Medicine at four institutions in three countries, he was a great influence on medical education. He was a prolific writer, and his textbook became the most popular and widely read treatise on medicine in the world. He also was a medical historian, a classical scholar, and an avid bibliophile. He emphasized the value of hard work and ongoing education. His compassion and concern for patients and colleagues reflected his personality. We summarize Osler's descriptions, and some of his aphorisms. His wisdom is as relevant now, as it was in his time. Osler blended the art and science of Medicine perhaps better than anyone else, and remains a valuable role model for students and physicians more than ninety two years after his death. (Rev Med Chile 2012; 140:1218-1227). <![CDATA[Las arañas sinantrópicas peligrosas de Chile]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000900019&lng=es&nrm=iso&tlng=es Background: William Osler was generally regarded as the greatest and most respected physician of his time. This paper describes Osler's life, his philosophy and views. He was an outstanding clinician who emphasized bedside teaching and observation. He possessed an extraordinary charm that inspired many others. As Professor of Medicine at four institutions in three countries, he was a great influence on medical education. He was a prolific writer, and his textbook became the most popular and widely read treatise on medicine in the world. He also was a medical historian, a classical scholar, and an avid bibliophile. He emphasized the value of hard work and ongoing education. His compassion and concern for patients and colleagues reflected his personality. We summarize Osler's descriptions, and some of his aphorisms. His wisdom is as relevant now, as it was in his time. Osler blended the art and science of Medicine perhaps better than anyone else, and remains a valuable role model for students and physicians more than ninety two years after his death. (Rev Med Chile 2012; 140:1218-1227). <![CDATA[<b>Pérdida reversible del sentido del gusto asociado al uso de clopidogrel</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000900020&lng=es&nrm=iso&tlng=es Background: William Osler was generally regarded as the greatest and most respected physician of his time. This paper describes Osler's life, his philosophy and views. He was an outstanding clinician who emphasized bedside teaching and observation. He possessed an extraordinary charm that inspired many others. As Professor of Medicine at four institutions in three countries, he was a great influence on medical education. He was a prolific writer, and his textbook became the most popular and widely read treatise on medicine in the world. He also was a medical historian, a classical scholar, and an avid bibliophile. He emphasized the value of hard work and ongoing education. His compassion and concern for patients and colleagues reflected his personality. We summarize Osler's descriptions, and some of his aphorisms. His wisdom is as relevant now, as it was in his time. Osler blended the art and science of Medicine perhaps better than anyone else, and remains a valuable role model for students and physicians more than ninety two years after his death. (Rev Med Chile 2012; 140:1218-1227).