Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720120010&lang=es vol. 140 num. 10 lang. es <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[Detección de virus linfotrópico de células T humano-I/II en pacientes con enfermedades de transmisión sexual de Santiago]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001000001&lng=es&nrm=iso&tlng=es Background: The human T-lymphotropic virus I (HTLV-I) causes spastic para-paresis and adult T-cell leukemia/lymphoma. It can be sexually transmitted and is highly prevalent in Central and South America. Aim: To study HTLV-I/IIprevalence in serum samples obtained from two Sexually Transmitted Diseases (STD) clinics. Material and Methods: Two hundred serum samples were randomly chosen from two reference STD centers of Santiago. The presence of specific HTLV I/II antibodies was detected by indirect immunofluorescence. Results: The analyzed samples came from participants aged 14 to 70 years. Forty nine percent were women and 76% were heterosexual. Only one of the 200 samples was positive (0.5%) and it came from a 70 year-old woman, housewife, with a stable single partner, a history of recurrent genital ulcers, VDRL (-) and positive serology for herpes simplex virus. Conclusions: The prevalence of HTLV-I found in this group is similar to that demonstrated in other populations in Chile, except for aboriginal populations, and similar to international STD studies. Our data is consistent with the low transmissibility by sexual contact. <![CDATA[<b>Asociación entre polimorfismos del gen de adiponectina y estado nutricional en escolares de la comuna de Hualpén</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001000002&lng=es&nrm=iso&tlng=es Background: Several genetic polymorphisms of adiponectin have been associated to metabolic diseases as obesity and co-morbidities. Aim: To investigate if there are associations between +45TG, +276GT, -11,377CG y -11,391GA adiponectin SNPs (single nucleotide polymorphism) with obesity in a Chilean children population. Material and Methods: A case-control study was performed in 241 obese and 126 normal weight children (7-11 years old) from the urban community of Hualpén, Biobío region. Children were classified as normal or obese, according to age and gender-specificpercentiles defined by Centerfor Disease Control and Prevention (CDC). The analysis of serum markers was carried out using commercial kits. Adiponectin polymorphisms were determined through a High Resolution Melting (HRM)-enabled real time PCR and by DNA fragment sequencing. Results: The observed allelic frequencies of the studied SNPs were over 11%. The 11,377CG polymorphism was associated with a high risk of obesity, calculated by the additive inheritance model (odds ratio = 1.389, 95% confidence interval: 1.001-1.929,p = 0.049). Conclusions: Obese school children of the Biobío Region, have an increased risk of carrying the susceptibility allele polymorphism 11377CG of adiponectin gene. <![CDATA[<b>El cambio del perfil epidemiológico de la mortalidad materna en Chile dificultará el cumplimiento del 5° objetivo del Milenio</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001000003&lng=es&nrm=iso&tlng=es Background: The death of women during pregnancy, childbirth or puerperium, remains a serious public health problem worldwide. Chile is committed to comply with the Millennium 5th Goal of reducing maternal mortality to 9.9/100,000 live births in 2015. Aim: To analyze trends in maternal mortality in Chile during 2000-2009. Material and Methods: A descriptive population analysis using raw data obtained from the yearbooks of the National Institute of Statistics of Chile. Maternal mortality, causes of death and age of the dead mothers were evaluated. The causes of maternal death were classified according to the tenth revision of International Classification of Diseases. Trend studies were performed using Pearson correlation analysis. Results: In the studied period there were no significant changes in maternal mortality and fertility. The five major causes of maternal death were concurrent diseases, hypertension, abortion, obstetric embolism and postpartum hemorrhage. Mortality associated with concurrent illness showed a significant upward trend (r = 0.656, p = 0.035). Abortion associated mortality had a significant downward trend (r = -0.712, p = 0.023). The group of women 40 years and older significantly increased its birth rate (r = 0.930, p < 0.001), this group showed the highest maternal mortality, especially in association with concurrent diseases. Conclusions: The increased birth rate occurring in women over 40 years old and its larger maternal mortality rate, probably will hinder the fulfillment of the Millennium 5th goal in Chile. <![CDATA[<b>Influencia del estado nutricional, niveles hormonales séricos e historia familiar de cáncer en el desarrollo del cáncer de mama</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001000004&lng=es&nrm=iso&tlng=es Background: Several studies have analyzed the relation between obesity and the hormonal imbalances generated by overweight and a family history of breast cancer. All of these factors are potentially implicated in the early development of breast cancer. Aim: To verify the existence of a significant relation between the nutritional status of breast cancer patients, their hormone serum levels (estrogens, prolactin, and progesterone), and the existence of a family history of breast cancer. Material and Methods: Retrospective data was collected from clinical records of524 women diagnosed with breast cancer in a Spanish hospital. Results: There was a positive association between estrogen, progesterone and prolactin serum levels and body mass index. The elevations in hormone levels occurred earlier in life among women with a family history of breast cancer. A two way ANOVA found a significant association between progesterone and prolactin levels with the age at diagnosis of breast cancer. Conclusions: Extreme serum levels of these hormones appear to be related to the early development of breast cancer, which in turn is influenced by the existence of a family history of cancer among those women with normal or average hormone levels. <![CDATA[<b>La presión arterial es un importante marcador de ateroesclerosis subclínica en niños</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001000005&lng=es&nrm=iso&tlng=es Background: Cardiovascular risk factors must be controlled since childhood. Aim: To assess the association of carotid intima media thickness (CIMT) with the components of the metabolic syndrome in Children. Material and Methods: Cross sectional assessment of 299 children aged 11.5 ± 0.9years (58% women) with and without metabolic syndrome components. Anthropometric parameters and blood pressure were measured and a blood sample was obtained to measure blood glucose and lipids. CIMT was measured using high resolution ultrasound. Results: Ninety three percent of children were post puberal, 64% were overweight and 25% had metabolic syndrome. Mean and maximum CIMT correlated with systolic blood pressure (r = 0.21 and 0.21 respectively p < 0.01). Children with a CIMTover the 75th percentile had higher blood pressure and lower HDL cholesterol. A stepwise logistic regression accepted both variables as predictors of CIMT with odds ratios for mean CIMT of 1.46 (1.19-1-79) and 0.81 (0.7-0.94) perfive units of change, respectively. Conclusions: In this group of children systolic blood pressure and HDL cholesterol are associated to CIMT. <![CDATA[<b>Variación de alelos del gen receptor de dopamina DRD4 en escolares chilenos de diferente origen étnico y su relación con riesgo de déficit atencional/hiperactividad</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001000006&lng=es&nrm=iso&tlng=es Background: Worldwide diversity of alleles of D4 receptor gene (DRD4), linked to attention deficit hyperactivity disorder (ADHD), is mostly the result of length and single nucleotide polymorphisms in a 48-bp tandem repeat (VNTR). Alleles containing from two (2R) to eleven (11R) repeats have been identified. The most common are 4R, 7R and 2R. Aim: To study the association of ADHD risk with DRD4 genotypes in Chilean students. Subjects and Methods: ADHD risk data were obtained through the abbreviated Conner's Scale for School Teachers in 66 Aymara children (11 cases and 55 controls), 91 Rapa-Nui children (60 cases ad 31 controls) and 96 children from a mixed urban population from Santiago (51 cases and 45 controls). DNA extracted from saliva was amplified by polymerase chain reaction (PCR) to genotype the DRD4 VNTR. Results: The distribution of DRD4 alleles reveals that, beneath the 4R allele, 7R exhibits the second highest frequencies in Aymara and Santiago children. In Polynesian children, 2R ranks after 4R. A statistically significant association between ADHD risk and 2R/4R genotype was identified in Polynesian children (p < 0.05; odds ratio = 3.7). Conclusions: Different DRD4 genotypes are associated with ADHDphenotype in Chilean populations, probably as a consequence of their initial colonization history. <![CDATA[<b>Efecto del ejercicio agudo sobre la expresión del receptor tipo Toll-4 y los mecanismos inflamatorios en corazón de rata</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001000007&lng=es&nrm=iso&tlng=es Background: Toll like receptor 4 (TLR-4) is a protein located in the cell membrane with an important function in the immune response of the organism. Its activation decreases heart contractility and activates nuclear transcription factor kappa B (NF-kB ). This in turn, increases the synthesis of different pro-inflammatory cytokines and the inducible enzyme nitric oxide (iNOS), which plays an important role in the inflammatory processes when nitric oxide production is enhanced. Aim: To determine if, after one session of acute exercise, expression of TLR-4 and iNOS, and activation of NF-kB are induced in rat cardiac tissue. Material and Methods: Exercise and control groups of eight male Wistar rats each, were studied. The exercise group was subjected to an acute exercise bout lasting one hour. After the exercise, the heart was excised to measure the expression of iNOS and TLR-4 genes by quantitative polyme-rase chain reaction, NF-kB activation by electrophoretic mobility shift assay (EMSA) and p50 by Western blot. Results: After exercise, there was an increase in TLR-4 and of iNOS mRNA levels (+46.7 and +74.3% respectively). NF-kB activation and the nuclear expression of its p50 subunit also increased significantly (+240 and +306% respectively). Conclusions: Increased expression of TLR4 following a session of acute exercise may contribute to the activation of the NF-kB signaling route, promoting the synthesis of nitric oxide, which could influence negatively the cardiac response to high intensity physical exercise. <![CDATA[<b>Efectos del ejercicio físico de alta intensidad y sobrecarga en parámetros de salud metabólica en mujeres sedentarias, pre-diabéticas con sobrepeso u obesidad</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001000008&lng=es&nrm=iso&tlng=es Background: Physical activity is associated with an improvement in cardiovascular health, however there is a paucity of information about the effects of sprint interval training on individuals with high metabolic risk. Aim: To determine the effects of three exercise programs on anthropometric and metabolic markers in overweight, sedentary and prediabetic women. Material and Methods: Forty three women were ascribed to four groups matched by body mass index and body fat: high intensity intervals (HIT, n = 12), resistance (R, n = 8), combined group (HIT +R, n = 10) and control group (CG, n = 13). Participants completed 12 weeks of exercise intervention. Body mass index, waist circumference, percentage of fat mass measured by impedanciometry, blood pressure, fasting glucose, insulin and homeostasis model assessment for insulin resistance (HOMAlR) and fitness assessed using the two km walk test were measured at baseline and after the training period. Results: No changes in anthropometric and body composition variables were observed. However, in HIT and R groups, significant reductions were observed on fasting glucose (5.4 and 16.6% respectively), insulin (18.6 and 43.4% respectively) and HOMA IR (24.1 and 55.4% respectively), 72 hours after the intervention. No significant changes were found for the observed values in the combined and control groups. Conclusions: HIT and resistance training improve glycemic control and insulin sensitivity in females with a high metabolic risk. <![CDATA[<b>Perfil de riesgo de pacientes adultos sometidos a traslado secundario por móviles avanzados del sistema de atención médica de urgencia del Área Metropolitana</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001000009&lng=es&nrm=iso&tlng=es Background: Secondary transfers of critical patients between hospitals may be associated with risk of death and complications Aim: To determine the risk profile of adults subjected to secondary transfers using the Emergency Medical Attention System (SAMU) operating in Metropolitan Santiago. Material and Methods: Cross sectional study including 432 adults undergoing secondary transfers using SAMU between January 1 and June 30 2010. Demographic, biomedical, hemodynamic and transfer data were obtained. Cardiopulmonary arrests (CPR) and an increase in the Rapid Emergency Medicine Score (REMS) scale, were considered as outcome variables. Results: CPR occurred in 6.4% of the study population and was significantly associated with the initial REMS score and the need for hemodynamic and ventilator support. The initial REMS score was a good predictor of the final REMS score. The final REMS was significantly associated with the presence of comorbidities and the need for hemodynamic and ventilator support. Conclusions: REMS is a useful scale to assess the risk profile of critical patients requiring transfers between hospitals. <![CDATA[<b>Perfil clínico-epidemiológico de pacientes con endocarditis infecciosa, período 2003-2010 en el hospital de Temuco, Chile</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001000010&lng=es&nrm=iso&tlng=es Background: Mortality due to infective endocarditis (IE) in Chile is close to 30%. Aim: To report the experience with patients admitted with the diagnosis of IE in a regional tertiary hospital. Material and Methods: Retrospective study of 107 patients aged 50 ± 16years (75% males) discharged with a definitive diagnosis of IE according to modified DUKE criteria, between years 2003 and 2010. Demographic variables, severity scores, clinical characteristics, bacteriology and hospital evolution were recorded. Results: Fifty nine percent of patients had concomitant cardiovascular problems. APACHE II and Sequential Organ Failure Assessment (SOFA) scores on admission were 8.4 ± 4.7 and 2.7 ± 2.8 respectively. Native valves were affected in 91% of cases (aortic and mitral valves in 62% and 50% of cases respectively). Prosthetic valves were affected in 9.3% of cases. Rheumatic heart disease was the predominant primary lesion in 10% of patients. Antibiotics were used in 45.1% before blood cultures were performed. In 68% of patients blood cultures were positive. S. viridans (30.8%), S.aureus (18.6%) and coagulase negative Streptocicci (5.6%) were the identified microorganisms. Intensive care unit admission was required in 48% of patients. Renal, heart and neurological deterioration was observed in 53, 34 and 14% of patients, respectively. Twenty percent of patients developed systemic embolism and 37% required heart surgery. Mean hospital stay was 28.3 ± 19.1 days and 27% of patients died. Conclusions: In this series of patients, IE has a high mortality. Most patients studied were admitted in bad conditions. <![CDATA[<b>Linfangiectasia renal unilateral</b>: <b>Caso clínico</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001000011&lng=es&nrm=iso&tlng=es Background: Renal lymphangiectasia is a rare disorder characterized by the presence of cystic masses in renal parenchyma, renal sinus or perinephric space. This condition, congenital or acquired, is probably caused by an alteration of renal lymphatic drainage to retroperitoneal lymph ducts. We report a 48-year-old woman, who consulted in the emergency room due to left flank pain and microscopic hematuria. Blood pressure and renal function were normal. A CT scan showed a multilocular cystic mass in the left renal sinus without alterations in the renal parenchyma. Renal lymphangiomatosis was diagnosed. The pain subsided with analgesics and did not recur. Annual clinical and ultrasound follow-up was suggested. <![CDATA[<b>Encefalopatía posterior reversible como primera manifestación del Síndrome de Guillain-Barré</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001000012&lng=es&nrm=iso&tlng=es Background: We report a 56year old male hypertensive, who presented with a posterior reversible encephalopathy syndrome (PRES) as an initial manifestation of Guillain-Barré syndrome (GBS). His first symptoms were right hemiparesis and hemihypoesthesia, followed by headache, dizziness, dysarthria and a general feeling of discomfort. On the third day, flaccid tetraparesis, impairment of consciousness, epileptic seizures and respiratory failure appeared, along with severe hypertension. Cerebral Magnetic Resonance Imaging showed the characteristic PRES lesions. Cerebrospinal fluid analyses revealed albumin-cytological dissociation and nerve conduction studies showed an axonal demyelinating polyradiculoneuropathy, which confirmed the diagnosis of GBS. Treatment with intravenous immunoglobulin was given together with antihypertensive therapy and mechanical ventilation, achieving an important clinical and imaging remission of PRES, but maintaining tetraparesis during the hospitalization. Twelve months after discharge and regular motor rehabilitation, the patient achieved complete autonomy on the activities of daily living. It has been postulated that the autonomic failure and the elevation of circulating pro-inflammatory cytokines in GBS may be the cause of a breach in the blood-brain barrier, thus causing PRES, that can completely remit with an adequate management. <![CDATA[Neoplasia blástica de células dendríticas plasmocitoides: Caso clínico]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001000013&lng=es&nrm=iso&tlng=es Background: We report a 74 years old male consulting for multiple painless non pruriginous pink plaques and nodules of truncal distribution that appeared 15 days earlier. A skin biopsy disclosed a blastic plasmocytoid dendritic cell neoplasm. A staging CAT scan showed lymphadenopathies located around the trachea and its bifurcation. A bone marrow biopsy did not show tumor infiltration. The patient has been treated with four cycles of cyclophosphamide-doxorubicin-vincristine-prednisone, obtaining a partial remission of the lesions. <![CDATA[<b>Aplicación de la capacidad bactericida del cobre en la práctica médica</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001000014&lng=es&nrm=iso&tlng=es Background: Copper is essential for cell metabolism in animals and plants and thus for life. Along centuries, copper has been identified as a metal containing antimicrobial properties. In recent years, laboratory assays and clinical studies have revealed that surfaces of metallic copper or its alloys, containing at least 70% copper, eliminate in a few hours several pathogenic organisms including bacterial strains associated with nosocomial infections, influenza virus, HIV, and fungi such as Candida albicans. In March 2008, the American Environmental Protection Agency (EPA), supported by scientific evidence gathered to date, registered copper as the first and only metal with antimicrobial properties. We herein review certain mechanisms proposed for the antibacterial, antiviral and antifungal activity of copper. We also discuss in vitro and clinical efficacy studies developed world wide and in Chile, focusing on bactericidal activity of copper surface areas in comparison to materials typically used in hospital environments such as stainless steel and polymers. Scientific evidence gathered to date, consistently shows that the use of copper surface areas in high contact critical points in hospitals, significantly reduces environmental bacterial load. This is associated with a decreased risk of pathogen transmission to patients and represents therefore an interesting complement to infection control programs. <![CDATA[<b>Actualización en lupus neuro-psiquiátrico con énfasis en déficit cognitivo</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001000015&lng=es&nrm=iso&tlng=es Background: physically and psychologically. We review herein the nomenclature and case definitions for neuropsychiatric lupus syndromes proposed by the American College of Rheumatology in 1999. We emphasize cognitive dysfunction and discuss etiological hypotheses, especially those related to the presence of antineuronal autoantibodies. <![CDATA[<b>Glomerulopatia colapsante</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001000016&lng=es&nrm=iso&tlng=es Background: Collapsing glomerulopathy is a cause of nephrotic syndrome with massive proteinuria secondary to podocyte proliferation and glomerular collapse. It is characterized by an almost inevitable progression to end stage renal failure, poor response to treatment and high post-transplant recurrence. Its frequency has increased in recent years due to its common association with Human Immunodeficiency Virus (HIV) infection and the growing recognition of new etiologic agents such as drugs and parvovirus B19. Therefore, it is a disease of growing interest for clinicians. The aim of this review is to update the clinical presentation, diagnosis, pathogenesis and therapeutic alternatives of this disease. <![CDATA[<b>Consentimiento informado en la nueva ley de derechos de los pacientes</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001000017&lng=es&nrm=iso&tlng=es Background: The new regulation of patients' rights creates the right to informed consent, which allows accepting or refusing any medical treatment. Also, the patient has the right to be appropriately informed about a variety of aspects determined by the law. Patient's autonomy has limits. Artificial acceleration of death, euthanasia or assisted suicide are not permitted. The problem is that the law does not define those situations. The law provides the intervention of Ethics Committees when the doctor considers that the patient exposes himself to severe harm or the risk of death which would be avoided. This intervention impinges on patient's autonomy. Patients have the right to request discharge and medical facilities could discharge patients against their will if they do not accept medical recommendations. These limitations on autonomy should be explained because the law apparently makes the distinction between killing, letting die and the Double Effect Doctrine. There is plenty of literature questioning the validity of both. The law fails to regulate part of the medical practice, regarding life and death decisions. A lack of consensus could explain this omission. Doctors have a right to conscientious objection to some patient's requests. <![CDATA[<b>Trasplante de órganos, una mirada desde el judaísmo en el siglo XXI</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001000018&lng=es&nrm=iso&tlng=es Background: Organ transplantation frequently constitutes a source of public concern. Dealing with such a complex medical problems requires a process of recognition of the different attitudes that social groups have toward organ transplantation attitudes which might vary accordingly to cultural and religious diversity. Judaism is the focus of this review. Our objective is to contribute to the knowledge that Chilean health professionals have about the Jewish point of view on organ transplantation. The supreme value of life is a premise of Judaism, so saving a life should precede the enforcement of certain Old Testament's prohibitions. However, it is difficult and misleading to attempt to define a unique point of view-even though there is an overwhelming majority who are in favor of organ donation-because different theological interpretations and recommendations are continuously in debate. We conclude that the mainstream Jewish position is not significantly different from the contemporary Western thought, even though a minority in Judaism is opposed to cadaveric organ donation. https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001000019&lng=es&nrm=iso&tlng=es <![CDATA[El papiro de Edwin Smith y su trascendencia médica y odontológica]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001000020&lng=es&nrm=iso&tlng=es Background: The historical bases of occidental medicine precede the Hippocratic corpus. Between the third and first millennium B.C. Egyptian medicine developed a model of medical practice that was a reference horizon for other Mediterranean cultures. There are a great number of papyri of that time, which gathered the medical and surgical skills and that are matter of study. The Edwin Smith papyrus (PES) is one of them. We analyzed the PES in its historical context, its history, its structure and its medical and dental significance. Finally, we analyzed the relevance of PES as a sign of a change in the medicine study method in the ancient Egypt. PES is an insight into how medicine was practiced in ancient Egypt. Historically, it is also the first medical document based on objective observations, excluding all magical and religious perceptions, as well as the underlying cultural framework. The similarity between the current clinical method and that described in the Smith papyrus, strongly suggests the idea that part of the origin of medicine, can be found in ancient Egypt. <![CDATA[<b>La investigación en salud</b>: <b>más allá de la ayuda internacional</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001000021&lng=es&nrm=iso&tlng=es Background: The historical bases of occidental medicine precede the Hippocratic corpus. Between the third and first millennium B.C. Egyptian medicine developed a model of medical practice that was a reference horizon for other Mediterranean cultures. There are a great number of papyri of that time, which gathered the medical and surgical skills and that are matter of study. The Edwin Smith papyrus (PES) is one of them. We analyzed the PES in its historical context, its history, its structure and its medical and dental significance. Finally, we analyzed the relevance of PES as a sign of a change in the medicine study method in the ancient Egypt. PES is an insight into how medicine was practiced in ancient Egypt. Historically, it is also the first medical document based on objective observations, excluding all magical and religious perceptions, as well as the underlying cultural framework. The similarity between the current clinical method and that described in the Smith papyrus, strongly suggests the idea that part of the origin of medicine, can be found in ancient Egypt. <![CDATA[<b>Síndrome del recomendado</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001000022&lng=es&nrm=iso&tlng=es Background: The historical bases of occidental medicine precede the Hippocratic corpus. Between the third and first millennium B.C. Egyptian medicine developed a model of medical practice that was a reference horizon for other Mediterranean cultures. There are a great number of papyri of that time, which gathered the medical and surgical skills and that are matter of study. The Edwin Smith papyrus (PES) is one of them. We analyzed the PES in its historical context, its history, its structure and its medical and dental significance. Finally, we analyzed the relevance of PES as a sign of a change in the medicine study method in the ancient Egypt. PES is an insight into how medicine was practiced in ancient Egypt. Historically, it is also the first medical document based on objective observations, excluding all magical and religious perceptions, as well as the underlying cultural framework. The similarity between the current clinical method and that described in the Smith papyrus, strongly suggests the idea that part of the origin of medicine, can be found in ancient Egypt. <![CDATA[<b>Modafinilo, internet y redes sociales</b>: <b>potencial uso en la vigilancia en salud</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001000023&lng=es&nrm=iso&tlng=es Background: The historical bases of occidental medicine precede the Hippocratic corpus. Between the third and first millennium B.C. Egyptian medicine developed a model of medical practice that was a reference horizon for other Mediterranean cultures. There are a great number of papyri of that time, which gathered the medical and surgical skills and that are matter of study. The Edwin Smith papyrus (PES) is one of them. We analyzed the PES in its historical context, its history, its structure and its medical and dental significance. Finally, we analyzed the relevance of PES as a sign of a change in the medicine study method in the ancient Egypt. PES is an insight into how medicine was practiced in ancient Egypt. Historically, it is also the first medical document based on objective observations, excluding all magical and religious perceptions, as well as the underlying cultural framework. The similarity between the current clinical method and that described in the Smith papyrus, strongly suggests the idea that part of the origin of medicine, can be found in ancient Egypt. <![CDATA[<b>Integrando la irradiación parcial acelerada de la mama en la práctica clínica</b>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001000024&lng=es&nrm=iso&tlng=es Background: The historical bases of occidental medicine precede the Hippocratic corpus. Between the third and first millennium B.C. Egyptian medicine developed a model of medical practice that was a reference horizon for other Mediterranean cultures. There are a great number of papyri of that time, which gathered the medical and surgical skills and that are matter of study. The Edwin Smith papyrus (PES) is one of them. We analyzed the PES in its historical context, its history, its structure and its medical and dental significance. Finally, we analyzed the relevance of PES as a sign of a change in the medicine study method in the ancient Egypt. PES is an insight into how medicine was practiced in ancient Egypt. Historically, it is also the first medical document based on objective observations, excluding all magical and religious perceptions, as well as the underlying cultural framework. The similarity between the current clinical method and that described in the Smith papyrus, strongly suggests the idea that part of the origin of medicine, can be found in ancient Egypt. <![CDATA[FE DE ERRATAS]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872012001000025&lng=es&nrm=iso&tlng=es Background: The historical bases of occidental medicine precede the Hippocratic corpus. Between the third and first millennium B.C. Egyptian medicine developed a model of medical practice that was a reference horizon for other Mediterranean cultures. There are a great number of papyri of that time, which gathered the medical and surgical skills and that are matter of study. The Edwin Smith papyrus (PES) is one of them. We analyzed the PES in its historical context, its history, its structure and its medical and dental significance. Finally, we analyzed the relevance of PES as a sign of a change in the medicine study method in the ancient Egypt. PES is an insight into how medicine was practiced in ancient Egypt. Historically, it is also the first medical document based on objective observations, excluding all magical and religious perceptions, as well as the underlying cultural framework. The similarity between the current clinical method and that described in the Smith papyrus, strongly suggests the idea that part of the origin of medicine, can be found in ancient Egypt.