Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720130009&lang=es vol. 141 num. 9 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[<strong>Seguimiento de cobertura sanitaria universal con equidad en Chile entre 2000 y 2011 usando las Encuestas CASEN</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000900001&lng=es&nrm=iso&tlng=es Background: The Chilean health reform aimed to expand universal health coverage (UHC) with equity. Aim: To analyze progress in health system affiliation, attended health needs (health visit for a recent problem) and direct payment for services, between 2000 and 2011. Material and Methods: We evaluated these outcomes for adults aged 20 years or older, analyzing databases of five National Socioeconomic Characterization Surveys. Using logistic regression models for no affiliation and unattended needs, we estimated odds ratios (OR) and prevalences, adjusted for socio-demographic characteristics. Results: The unaffiliated population decreased from 11.0% (95% confidence interval (CI) 10.6-11.4) in 2000 to 3.0% (95% CI 2.8-3.2) in 2011. According to the model, self-employed workers had a higher adjusted prevalence of no affiliation: 27.4% (95% CI 24.1-30.6) in 2000 and 7.8% (95% CI: 5.9-9.7) in 2011. The level of unmet needs decreased from 33.5% (95% CI 31.8-35.1) to 9.1% (95% CI 8.1-10.1) in this period. Not being affiliated to the health system was associated with higher unmet needs in the adjusted model. Indigent affiliates, entitled to free care in the public system, reported payments for general and specialist visits in a much lower proportion than other groups. However, direct payments for visits increased for this group during the decade. Conclusions: Concurrent with the introduction of new health and social policies, we observed significant progress in health system enrolment and attended health needs. However, the percentage of impoverished people who made direct payments for services increased. <![CDATA[Nivel sérico de folato y vitamina B<sub>12</sub> en adultos mayores chilenos: Resultados de la Encuesta Nacional de Salud ENS 2009-2010]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000900002&lng=es&nrm=iso&tlng=es Supraphysiological levels (SFL) of serum folate (SF) derived from flour fortification with folic acid (FA) could be risky among older adults with low vitamin B12 (B12) levels. Aim: To describe and analyze SF and B12 levels in older Chileans and to identify risk groups. Material and Methods: Participants were 1.043 older people aged ≥ 65 years from the National Health Chilean Health Survey 2009-2010 (ChNHS 2009-10), a multistage stratified random sample, representative of the national population. SF (µg/L) and B12 (pg/ml) were determined in fasting samples by competitive chemoluminescence immunoassay. Mean, deciles and percentiles 5 and 95th were calculated. We defined SF categories: < 4.4 (deficit); 4.41-20 (normal) and SFL: 20.01-25.6; 25.6-29 and &gt; 29 µg/L (80th percentile of the distribution) and vitamin B12 categories: ≤ 200 (deficit); 200.1-299.5 (marginal deficit) and &gt; 299.5 (normal). Prevalence rates, multiple and logistic regression models were used and adjusted by sex and age, educational level and residence area. Results: SF and B12 mean and 95th percentiles were 21.2 ± 0.56/38.6 µg/L and 348.4 ± 7.6/637(pg/ml) respectively. Forty nine percent of participants had SFL. Folate and B12 deficiency were present in 0.3 and 8.1% of participants, respectively. Men had significantly lower prevalence of SFL &gt; 29 µg/L (OR adjusted odds ratio 0.47 95% confidence intervals: 0.26-0.84). B12 showed no significant variation by age and sex. The prevalence of SFL associated with B12 deficiency was 4.1%. No statistically significant association was observed between levels of folate and B12. Conclusions: Folate deficit is almost inexistent, but a significant percentage of participants had SFL suggesting the need for revising the current wheat flour fortification levels. <![CDATA[<strong>Aprendizaje autodirigido en estudiantes de primer año de medicina de la Universidad de Concepción y su relación con el perfil sociodemográfico y académico</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000900003&lng=es&nrm=iso&tlng=es Medical education must encourage autonomous learning behaviors among students. However the great income profile disparity among university students may influence their capacity to acquire such skills. Aim: To assess the association between self-directed learning, socio-demographic and academic variables. Material and Methods: The self-directed learning readiness scale was applied to 202 medical students aged between 17 and 25 years (64% males). Simultaneously information about each surveyed participant was obtained from the databases of the medical school. Results: There is an association between socio-demographic and academic variables with the general scale of self-directed learning and the subscales learning planning and willingness to learn. Participants coming from municipal schools have a greater willingness to learn than their counterparts coming from subsidized and private schools. High school grades are related to self-directed learning and the subscales learning planning and self-assessment. Conclusions: Among the surveyed medical students, there is a relationship between self-directed learning behaviors, the type of school where they come from and the grades that they obtained during high school. <![CDATA[<strong>Identificación de las necesidades de capacitación docente de los jefes de programa de especialización médica</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000900004&lng=es&nrm=iso&tlng=es Training of postgraduate medical specialty program managers (PMSPM) is essential for the proper development of their programs. Aim: To identify the main training needs of PMSPM at a medical school. Material and Methods: A mixed-methodology approach was implemented including focus group/interviews and the administration of the Program Managers Training Needs Assessment Questionnaire (PROMANAQ) developed by an expert panel with 59 items (with two sections: relevance/performance-self-perception). Higher priority was assigned to items with high relevance and low performance. Results: Forty five PMSPM completed the PROMANAQ (81.8% response rate). Both sections of PROMANAQ were highly reliable (Cronbach alpha of 0.95/0.97 for relevance/performance-self-perception, respectively). The items with higher priority value were evaluation of clinical educators, evaluation of teaching programs and accreditation of programs. Ten PMSPM were included in the focus group (18.2% of the universe). The findings of the qualitative component were concordant with the areas explored in the questionnaire. Conclusions: The PROMANAQ is valid and reliable to identify the training needs of PMSPM. The views of PMSPM must be taken into account for faculty development planning. <![CDATA[Perfusión y función ventricular en SPECT cardiaco y coronariografía del mismo día según localización en enfermedad de un vaso]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000900005&lng=es&nrm=iso&tlng=es Single-photon emission computed tomography (SPECT) can be used as a non-invasive tool for the assessment of coronary perfusion. Aim: To assess ventricular perfusion and function by SPECT in patients with single vessel coronary artery disease. Material and Methods: Among patients with indications for a coronary artery angiography, those with significant lesions in one vessel, were selected for the study. Within 24 hours, cardiac SPECT examinations on basal conditions and after high doses of dipyridamole, were performed. SPECT data from 38 patients with a low probability of coronary artery disease was used for comparisons. Results: Ten patients aged 61 ± 8 years (seven men) were studied. Visual analysis of SPECT revealed signs suggestive of ischemia in eight patients. The remaining two patients did not have perfusion disturbances. SPECT detected eight of ten abnormal vessels reported in the coronary artery angiography. There were two false negative results Summed stress, summed rest and summed difference scores were 9.78 ± 6.51, 3.22 ± 5.07 and 6.33 ± 4.97, respectively. The ejection fractions under stress and at rest were 53 ± 11.7% and 61 ± 15.7% respectively (p < 0.01). The figures for the control group were 69.1 ± 13.5% and 75.2 ± 12.04% respectively (significantly different from patients). Two patients had a summed motion score above 14.9. Likewise, two patients had a summed thickening score above 10.9. Conclusions: SPECT detected 80% of coronary lesions found during coronary artery angiography. Visual analysis of perfusion is highly reliable for diagnosis. Quantitative parameters must be considered only as reference parameters. <![CDATA[Validación de un instrumento para evaluar calidad de vida asociada a hipertrofia mamaria en mujeres chilenas]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000900006&lng=es&nrm=iso&tlng=es Breast hypertrophy has been associated with a significant impact on quality of life. Aim: To validate a specific scale to evaluate quality of life of Chilean women with symptomatic breast hypertrophy. Material and Methods: We included 80 women, 40 patients (20 undergoing reduction mammoplasty) and 40 controls. The Breast Related Symptoms (BRS) questionnaire in Spanish was used. The results are expressed as a score ranging from 0 to 100, with higher values representing better specific quality of life. Internal consistency, reliability and validity of the test were evaluated. The results of patients and controls and the scores of patients undergoing reduction mammoplasty, before and after surgery, were compared. A receiver operating characteristic (ROC) curve was constructed to define the score cutoff point defining symptomatic breast hypertrophy. Results: The Cronbach´s alpha was 0.96, linear weighed kappa test-retest was 0.87 [95% confidence intervals (CI) 0.31-1] and inter-observer variability was 0.79 [95% CI 0.71-0.87]. Participants with breast hypertrophy had a lower specific quality of life than the control group (25 (2-71) and 91 (25-100) respectively, p < 0.01). In patients undergoing surgery, the preoperative score was lower than the postoperative figures (37 (12-71) and 96 [94-100] respectively, p < 0.01). The area under the ROC curve was 0.97 (p < 0,001) and the cutoff point for symptomatic breast hypertrophy was a score below 72.1. Conclusions: The Spanish version of the BRS questionnaire is a valid and reliable instrument to measure specific quality of life in Chilean women with mammary hypertrophy. <![CDATA[Efecto <i>in vitro</i> de los terpenos lupeol y casearina G sobre células sanguíneas y tumorales]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000900007&lng=es&nrm=iso&tlng=es Background: The rainforest is an important source of natural compounds with therapeutic properties. Although there are many anti-inflammatory and antineoplastic drugs available to the clinician, there is an ongoing need for new therapeutic drugs with fewer serious adverse effects. Aim: To evaluate the in vitro cytotoxic effects of lupeol and casearin G on tumor cells, on phagocytic activity and nitric oxide (NO) production by blood mononuclear cells. Material and Methods: The cytotoxic effect of these compounds on cell lines MCF-7 (human breast adenocarcinoma) and PC-3 (human prostate cancer) was measured by a colorimetric assay (MTS/PMS) and the sulphorhodamine B assay. Peripheral blood mononuclear cells were obtained from eight healthy volunteers. The effect of these compounds on nitric oxide (NO) production was measured using the Griess reaction. Their effect on phagocytic activity of PBMC was also evaluated. Results: Lupeol (≥ 2 mM) resulted in a reduction of both the phagocytic index and the percentage of phagocytic monocytes and macrophages. Treatment of monocytes/macrophages with lupeol (72 µM) and casearin G (4 µM) reduced the production of NO. Neither lupeol (< 969 µM) nor casearin G (< 55 µM) had cytotoxic effects on PBMC. Casearin G showed both cytotoxic (IC50, LC50) and cytostatic (GI50) effects against tumor cells, PC-3 (IC50 = 12.5 µM; GI50 = 13.3 µM; LC50 = 51.9 µM) and MCF-7 (IC50 = 112.8 µM; GI50 = 11.8 µM; LC50 = 49.4 µM), as well as a hemolytic effect (≥ 182 µM). Conclusions: These observations indicate that lupeol and casearin G might be useful compounds in the preparation of anti-inflammatory drugs, whereas casearin G might be useful in the elaboration of antitumor drugs. <![CDATA[<strong>Rol de infliximab en enfermedad inflamatoria intestinal</strong>: <strong>Experiencia local</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000900008&lng=es&nrm=iso&tlng=es Background: Biological therapy has an important role in the treatment of Inflammatory Bowel Disease (IBD). However, the use of these drugs is resisted due to fears about their side effects. Aim: To report the experience with the use of Infliximab in patients with IBD. Material and Methods: Descriptive study of a historical cohort of patients with IBD treated between 2007 and 2012 with Infliximab. A favorable clinical response was considered when general, intestinal and extra-intestinal symptoms subsided after the second or third dose of the drug. Endoscopic or imaging response was evaluated between three and six months of treatment. Results: Twenty five patients aged 18 to 61 years (12 women) were included. Sixteen had Cohn’s Disease and 9 had Ulcerative Colitis. Treatment was indicated due to refractory disease in 13 patients, perianal involvement in nine, stenosis in two and pyoderma gangrenosum in one. Ten patients initiated Infliximab within less than two years of diagnosis. Twenty-two patients received combined treatment with immunosuppressive medications and the other three patients were treated exclusively with Infliximab. A favorable clinical response was observed in 88% after the second dose and 64% had endoscopic or imaging remission after 3-6 months. Twelve patients discontinued Infliximab, due to bad response to treatment in three patients, economic cost in three patients, and patient/doctor decision in six. Only three patients had side effects (herpes zoster and sinusitis). None of these motivated the discontinuation of treatment. Conclusions: In this cohort of patients with IBD, the use of Infliximab was associated with endoscopic or imaging remission in 64% of cases after 3-6 months of treatment with no major side effects. <![CDATA[<strong>Mutación del gen KRAS en el cáncer de colon y recto</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000900009&lng=es&nrm=iso&tlng=es Background: KRAS oncogene is involved in colorectal carcinogenesis in 22 to 45% of cases. Aim: To determine the frequency, types and distribution of KRAS mutations in colorectal cancer. Material and Methods: KRAS mutations studies were carried out in primary tumors and metastases of colo-rectal cancer from 56 women aged 60 ± 14 years and 53 men aged 61 ± 11 years. Formalin fixed and paraffin embedded tissue samples were evaluated using RFLP (Restriction Fragment Length Polymorphism) and direct sequencing. Results: Primary tumors were located in the colon and rectum in 82 (75.2%) and 24 cases (20%), respectively. In three cases the extraction site of the tumor sample was unknown. In 46 cases (42.2%) KRAS mutations were demonstrated. The main point mutations were located in codon 12 (80.4%), G12D (39.1%), G12V (24.2%), G12S (6.5%), G12A (4.3%); G12C (4.3%), G12R (2.1%) and 19.6% at codon 13 (G13D). No differences were demonstrated in the frequency and distribution of mutations by gender, age, primary versus metastatic tumors or tumor location. Conclusions: In this series, 42% of colorectal cancer tissue samples had KRAS mutations. Their frequency and distribution are similar to those reported in the literature, except for G12C mutation. <![CDATA[Actualización del <i>bundle</i> de reanimación inicial y monitorización integral de la perfusión tisular en la sepsis severa]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000900010&lng=es&nrm=iso&tlng=es Sepsis is a global health problem. Despite recent advances in understanding its pathophysiology and clinical trials testing potential new therapies, mortality remains unacceptably high. In fact, sepsis is the leading cause of death in non-coronary intensive care units around the world. However, during the past decade, some studies have highlighted that early recognition of sepsis and an appropriate initial approach are fundamental determinants of prognosis. A systematic approach to the harmful triad of sepsis-related hypotension, tissue hypoperfusion and organ dysfunction, with low-cost, easy to implement, and effective interventions, can significantly improve the chances of survival. In this article, we will update the evidence supporting the initial resuscitation bundle for patients with severe sepsis, and discuss the physiological basis for perfusion monitoring during septic shock resuscitation. <![CDATA[Remodelación ósea en espondiloartritis]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000900011&lng=es&nrm=iso&tlng=es Spondyloarthritis is a group of several related but phenotypically distinct chronic inflammatory diseases, characterized by progressive new bone formation which leads to ankylosis and functional disability. Radiographic images evidence not only erosive changes but also overgrowth of bony structures called syndesmophytes. These inflammation, bone destruction and new bone formation are located in the entheses, which constitutes the primary organ of the disease. As a consequence, the inflammatory process results in excess of bone formation and the impact depends on the location, cell type, cytokines and local microenvironment factors. Several molecules playing a role as immune modulators or regulators of bone homeostasis, mediate the imbalance between bone resorption and formation. In the same way, animal models suggest that joint ankylosis may be independent from the effects of tumor necrosis factor alpha. Therefore, the process of new tissue (bone) formation can be considered as an additional therapeutic target. The Wnt signaling pathway, which is considered the primary regulator of osteoblastogenesis, constitutes a new research field of great interest in the last decade. <![CDATA[<strong>Información médica a pacientes y familiares</strong>: <strong>aspectos clínicos, éticos y legales</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000900012&lng=es&nrm=iso&tlng=es Providing information to patients and relatives (IPAR) is a clinical, ethical and legal need. IPAR is inherent to the medical team work as diagnostic and therapeutic procedures are. In some cases, it is a key step for patient's recovery. From an ethical point of view, the patient is not only the subject of the medical work but also its main owner and who must, previously informed, decide about options which would directly affect him. After the promulgation of a special law in Chile, this prerogative became a legal right. This paper proposes an empirically developed model or protocol that should be used to inform hospitalized patients and their relatives about their disease, in a pertinent way. Considering that IPAR is a skill that should be learned and practiced, the written protocol is provided to neurology residents as supporting material. Although IPAR protocols are completely justified, they have not been evaluated in terms of efficiency of communication, user satisfaction, patient and relatives reassurance and clinical impact. Therefore, they require a prospective validation. <![CDATA[La vara de Esculapio, símbolo de la medicina]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000900013&lng=es&nrm=iso&tlng=es Symbolism is one of the most archaic forms of human thoughts. Symbol derives from the Latin word symbolum, and the latter from the Greek symbolon or symballo, which means “I coincide, I make matches”. The Medicine symbol represents a whole series of historical and ethical values. Asclepius Rod with one serpent entwined, has traditionally been the symbol of scientific medicine. In a misconception that has lasted 500 years, the Caduceus of Hermes, entwined by two serpents and with two wings, has been considered the symbol of Medicine. However, the Caduceus is the current symbol of Commerce. Asclepius Rod and the Caduceus of Hermes represent two professions, Medicine and Commerce that, in ethical practice, should not be mixed. Physicians should be aware of their real emblem, its historical origin and meaning. <![CDATA[Ritmo nodal secundario a descarga eléctrica de alto voltaje]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000900014&lng=es&nrm=iso&tlng=es Electrical shock can cause a direct myocardial damage and different types of arrhythmias, which are uncommon and occur more often when there is a high voltage exposure. We report a 19-year-old male that received a high voltage shock, falling thereafter from an altitude of four meters. On admission to the emergency room, he had second and third degree burns in the right hand and the left thigh. The electrocardiogram showed a nodal rhythm of 72 beats per minute. After four hours of monitoring, sinus rhythm returned spontaneously. <![CDATA[Accidente cerebrovascular embólico por endocarditis de Libman-Sacks como manifestación inicial de síndrome antifosfolípidos primario en una paciente de 17 años]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000900015&lng=es&nrm=iso&tlng=es Libman-Sacks endocarditis is a non-infectious valvular damage associated with autoimmune disorders such as Systemic Lupus Erythematosus and Antiphospholipid Syndrome. We report a 17-year-old female consulting in the emergency room due to a right hemiparesis and aphasia. A magnetic resonance imaging showed multiple infarctions in the territory of the left middle cerebral artery, presumably of embolic origin. A trans-esophageal echocardiogram showed a vegetation in the mitral valve. Blood cultures were negative. Antinuclear antibodies and serological tests for antiphospholipid syndrome were positive. Oral anticoagulation was started and the patient was discharged. After six months of follow up, antiphospholipid antibodies are still positive. <![CDATA[<strong>Síndrome anti-GQ1b</strong>: <strong>Descripción de cuatro pacientes y revisión de la literatura</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000900016&lng=es&nrm=iso&tlng=es Anti-GQ1b syndrome includes Miller Fisher Syndrome (MFS), Guillain Barré Syndrome (GBS), Bickerstaff`s brain stem encephalitis (BBE) and Acute Ophtamoplegia (AO). We report four patients aged 16 to 76 years, with anti-GQ1b syndrome. All presented with MFS, one of them evolved to GBS pharyngeal-cervical-brachial variant and other to GBS with BBE. All had a previous history of diarrhea or upper respiratory tract infection. All had positive anti-GQ1b serum antibodies. Both brain magnetic resonance imaging and cerebrospinal fluid analysis were normal. Electrophysiology studies were compatible with a demyelinating disease. Two patients needed airway protection with an orotracheal tube and developed dysautonomia. All four patients were treated with immunomodulation. On the sixth month follow-up, patients had only minimal alterations in the neurological examination. <![CDATA[Pacientes estandarizados en la formación de habilidades clínicas, en educación médica de pregrado]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000900017&lng=es&nrm=iso&tlng=es Anti-GQ1b syndrome includes Miller Fisher Syndrome (MFS), Guillain Barré Syndrome (GBS), Bickerstaff`s brain stem encephalitis (BBE) and Acute Ophtamoplegia (AO). We report four patients aged 16 to 76 years, with anti-GQ1b syndrome. All presented with MFS, one of them evolved to GBS pharyngeal-cervical-brachial variant and other to GBS with BBE. All had a previous history of diarrhea or upper respiratory tract infection. All had positive anti-GQ1b serum antibodies. Both brain magnetic resonance imaging and cerebrospinal fluid analysis were normal. Electrophysiology studies were compatible with a demyelinating disease. Two patients needed airway protection with an orotracheal tube and developed dysautonomia. All four patients were treated with immunomodulation. On the sixth month follow-up, patients had only minimal alterations in the neurological examination. <![CDATA[<strong>Pacientes Estandarizados en la Formación de Habilidades Clínicas en Educación Médica de Pregrado</strong>: <strong>Réplica</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000900018&lng=es&nrm=iso&tlng=es Anti-GQ1b syndrome includes Miller Fisher Syndrome (MFS), Guillain Barré Syndrome (GBS), Bickerstaff`s brain stem encephalitis (BBE) and Acute Ophtamoplegia (AO). We report four patients aged 16 to 76 years, with anti-GQ1b syndrome. All presented with MFS, one of them evolved to GBS pharyngeal-cervical-brachial variant and other to GBS with BBE. All had a previous history of diarrhea or upper respiratory tract infection. All had positive anti-GQ1b serum antibodies. Both brain magnetic resonance imaging and cerebrospinal fluid analysis were normal. Electrophysiology studies were compatible with a demyelinating disease. Two patients needed airway protection with an orotracheal tube and developed dysautonomia. All four patients were treated with immunomodulation. On the sixth month follow-up, patients had only minimal alterations in the neurological examination. <![CDATA[<strong>Observando bajo el agua</strong>: <strong>la evaluación de proceso en investigación en salud</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000900019&lng=es&nrm=iso&tlng=es Anti-GQ1b syndrome includes Miller Fisher Syndrome (MFS), Guillain Barré Syndrome (GBS), Bickerstaff`s brain stem encephalitis (BBE) and Acute Ophtamoplegia (AO). We report four patients aged 16 to 76 years, with anti-GQ1b syndrome. All presented with MFS, one of them evolved to GBS pharyngeal-cervical-brachial variant and other to GBS with BBE. All had a previous history of diarrhea or upper respiratory tract infection. All had positive anti-GQ1b serum antibodies. Both brain magnetic resonance imaging and cerebrospinal fluid analysis were normal. Electrophysiology studies were compatible with a demyelinating disease. Two patients needed airway protection with an orotracheal tube and developed dysautonomia. All four patients were treated with immunomodulation. On the sixth month follow-up, patients had only minimal alterations in the neurological examination. <![CDATA[<strong>Comparación de datos regionales de efectividad de tratamiento de HTA según la ENS e informes REM</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872013000900020&lng=es&nrm=iso&tlng=es Anti-GQ1b syndrome includes Miller Fisher Syndrome (MFS), Guillain Barré Syndrome (GBS), Bickerstaff`s brain stem encephalitis (BBE) and Acute Ophtamoplegia (AO). We report four patients aged 16 to 76 years, with anti-GQ1b syndrome. All presented with MFS, one of them evolved to GBS pharyngeal-cervical-brachial variant and other to GBS with BBE. All had a previous history of diarrhea or upper respiratory tract infection. All had positive anti-GQ1b serum antibodies. Both brain magnetic resonance imaging and cerebrospinal fluid analysis were normal. Electrophysiology studies were compatible with a demyelinating disease. Two patients needed airway protection with an orotracheal tube and developed dysautonomia. All four patients were treated with immunomodulation. On the sixth month follow-up, patients had only minimal alterations in the neurological examination.