Scielo RSS <![CDATA[Revista médica de Chile]]> https://scielo.conicyt.cl/rss.php?pid=0034-988720130010&lang= vol. 141 num. 10 lang. <![CDATA[SciELO Logo]]> https://scielo.conicyt.cl/img/en/fbpelogp.gif https://scielo.conicyt.cl <![CDATA[<strong>Acute promyelocytic leukemia</strong>: <strong>Results of the Chilean protocol LPA2000</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013001000001&lng=&nrm=iso&tlng= Background: The current recommendations for treatment of patients with newly diagnosed acute promyelocytic leukemia (APL) include all-trans-retinoic acid (ATRA) and anthracycline based chemotherapy. Aim: To evaluate the results of the Chilean protocol following the LPA99 regimen of the Spanish PETHEMA group, except for the replacement of Idarubicin by Daunorubicin. Patients and Methods: Induction consisted of Daunorubicin 45 mg/m² on days 2, 4, 6 and 8 plus ATRA 45 mg/m² daily until complete remission. Patients in complete remission (CR) received three monthly chemotherapy courses: Daunorubicin 45 mg/m²/d/4days i.v. and ATRA 45 mg/m²/d/15 days p.o. (course no. 1); Mitoxantrone 10 mg/m²/d/5 days i.v. and ATRA 45 mg/m²/d/15 days p.o. (course no. 2); Daunorubicin 60 mg/m²/d/ day 1 i.v. in the low risk group, and 1 and 2 in the intermediate-high risk groups and ATRA 45 mg/m²/d/15 days p.o. (course no. 3). Maintenance therapy consisted of mercaptopurine 90 mg/m²/d p.o., methotrexate 15 mg/m²/wk p.o. and, ATRA intermittently, 45 mg/m²/d p.o. for 15 days every three months. Results: Between January 2000 and December 2005, 56 patients with newly diagnosed APL from 10 centers were enrolled. A total of 46 patients achieved CR (85%), 8 (15%) died of early complications, seven patients relapsed, with a 16% relapse risk at three years. The 5-year Kaplan-Meier estimates of overall survival and relapse-free survival were 64% and 84% respectively. Conclusions: These data indicate that this protocol has a good antileukemic effect but further reduction of early death and relapse, especially in the high risk group is needed. <![CDATA[Expression of RAGE in <i>Helicobacter pylori</i> infested gastric biopsies]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013001000002&lng=&nrm=iso&tlng= Background: Inflammation is a common phenomenon present in gastric mucosa of patients infected with H. pylori. Activation of the RAGE/multiligand axis is thought to be a relevant factor in cancer-mediated inflammation. RAGE is a membrane receptor, belonging to the immunoglobulin family, and the over-expression of RAGE has been associated with increased invasiveness and metastasis generation in different types of cancer, including gastric cancer. Furthermore recent experiences show that the use of its soluble form (sRAGE) or silencing of the gene coding for this receptor could provide therapeutic benefits in cancer. Aim: To evaluate the immunohistochemical expression of RAGE, MUC-1, β-Catenin free and phosphorylated, Cyclin-D1 and GSK3 in gastric biopsy specimens infected with H. pylori. Material and Methods: Immunohistochemical analysis was carried out in gastric biopsies from 138 patients: 55 with inflammatory injury (no atrophic gastritis), 42 with pre-cancerous conditions (atrophy or intestinal metaplasia) and 41 with dysplastic lesions or in situ adenocarcinoma. Results: There was a high rate of positive RAGE expression in the three groups of biopsies. Biopsies with dysplasia or in situ carcinoma had a significantly higher percentage of RAGE expression than the other groups of biopsies. Conclusions: The increased RAGE expression reported in both dysplasia and incipient cancer support the role of the multiligand/RAGE axis in gastric carcinogenesis. <![CDATA[Frequency of<i> Helicobacter pylori</i> infection in 144 school age Chilean children]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013001000003&lng=&nrm=iso&tlng= Background: A 73% prevalence of Helicobacter pylori infection was estimated in adults in the 2003 Chilean National Health Survey. However, this infection is usually acquired during childhood. Aim: To determine the frequency of H. pylori infection in healthy Chilean children from a school in Santiago. Material and Methods: A cross sectional study in a private/ subsidized school in Santiago. Children aged less than 18 years were invited to participate. The parents of those who accepted answered a demographic survey and a stool sample was obtained from participants to detect H. pylori antigen using a monoclonal antibody ELISA kit. Results: We studied 144 students aged 10.6 ± 3.1 years (54% females). Twenty six participants (18.1%, 95% CI: 12.4-24.9%) had a positive test. Children from higher socioeconomic levels had a non-significant lower frequency of infection. No differences in the frequency of infection were observed by age, gender, household type or number of people living in it or history of breastfeeding. Conclusions: In this sample of children, an 18.1% frequency of H. pylori infection was observed. <![CDATA[Testing the <i>Latino paradox</i> in Latin America: A population-based study of Intra-regional immigrants in Chile]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013001000004&lng=&nrm=iso&tlng= Background: Several studies in high-income countries report better health status of immigrants compared to the local population ("healthy migrant" effect), regardless of their socioeconomic deprivation. This is known as the Latino paradox. Aim: To test the Latino paradox within Latin America by assessing the health of international immigrants to Chile, most of them from Latin American countries, and comparing them to the Chilean-born. Material and Methods: Secondary data analysis of the population-based CASEN survey-2006. Three health outcomes were included: disability, illness/accident, and cancer/chronic condition (dichotomous). Demographics (age, sex, marital status, urban/rural, ethnicity), socioeconomic-status (SES: educational level, employment status and household income per-capita), and material standards (overcrowding, sanitation, housing quality). Crude and adjusted weighted regression models were performed. Results: One percent of Chile's population were immigrants, mainly from other Latin American countries. A "healthy migrant" effect appeared within the total immigrant population: this group had a significantly lower crude prevalence of almost all health indicators than the Chilean-born, which remained after adjusting for various demographic characteristics. However, this effect lost significance when adjusting by SES for most outcomes. The Latino paradox was not observed for international immigrants compared to the local population in Chile. Also, health of immigrants with the longest time of residency showed similar health rates to the Chilean-born. Conclusions: The Latino paradox was not observed in Chile. Protecting low SES immigrants in Chile could have large positive effects in their health at arrival and over time.<hr/>Antecedentes: Hay estudios que informan un mejor estado de salud de los inmigrantes en comparación con la población local (efecto del "migrante sano"), independientemente de su posición socioeconómica (PSE). Esto se conoce como la paradoja latina. Objetivo: Probar la paradoja latina dentro de América Latina en Chile. Material y Métodos: Análisis secundario de datos de la encuesta CASEN 2006. Tres resultados de salud se incluyeron: discapacidad, enfermedad/accidente, cáncer/enfermedad crónica (variables dicotómicas). Se consideraron datos demográficos (edad, sexo, estado civil, zona urbana/rural, grupo étnico), PSE (nivel educativo, situación laboral y el ingreso familiar per cápita), y condiciones materiales (hacinamiento, saneamiento, calidad de la vivienda). Modelos de regresión ponderados crudos y ajustados fueron analizados en STATA 11.0. Resultados: El uno por ciento de la población de Chile eran inmigrantes, principalmente de otros países de América Latina. Un efecto de "inmigrante sano" apareció dentro de la población inmigrante total: este grupo tenía una prevalencia cruda significativamente menor que la población chilena en todos los indicadores de salud. Sin embargo, este efecto de migrante sano pierde su significación al ajustar por PSE. Además, la salud de los inmigrantes con más tiempo de residencia mostró tasas similares de salud a la de origen chileno. Conclusiones: La paradoja latina no se observó en Chile. La protección de los inmigrantes de baja PSE podría tener grandes efectos positivos en su salud. <![CDATA[Prevalence of Gilbert syndrome and its genetic determinants in Chile]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013001000005&lng=&nrm=iso&tlng= Background: In Europeans the TATA box TA7 repeat promoter variant in the UGT1A1 gene (UGT1A1*28) is the major determinant of bilirubin levels. Aim: To study the prevalence of Gilbert Syndrome (GS) and its genetic determinants in Chile. Material and Methods: Three different studies were conducted. The prevalence of GS in Chile was assessed in 991 subjects with normal liver tests (ALT and GGT) from the 2nd National Health Survey. We defined GS as a total bilirubin (TB) between 1.4-5mg/dL. The second study assessed the genotype prevalence of SNP rs6742078 (in LD with UGT1A1*28) and rs4149056 in 500 DNA samples of non-related Hispanics. Finally, a case-control study was designed to assess the phenotype-genotype correlation. UGT1A1*28 and rs4149056 variants were determined by direct sequencing and allelic discrimination assays (TaqMan), respectively. Results: Prevalence of GS in the general Chilean population was 2.6% (4.5% in males and 0.5% in female). No correlation with age, educational level or home location was found. Genotypes for UGT1A1*28 (TA6/6 50.5%, TA6/7 37.8%, TA7/7 11.7%) and rs4149056 (TT 74.1%, CT 22.8%, and CC 3.1%) variants were similar to Europeans. In the case-control study, most patients with GS were homozygotes for UGT1A1*28 (TA7/7, 74%). Of note, 44% of patients with intermediate TB levels were also TA7/7, compared to 7% in normal subjects. SLCO1B1 genotype was not correlated with TB levels. Conclusions: While the prevalence of GS was lower in Chile compared to Europeans (~5%), the prevalence of UGT1A1*28 homozygotes was similar (~12%). In Chilean Hispanics, the UGT1A1*28 variant explain 75% of GS phenotype. <![CDATA[<strong>Suicidal behavior and psychiatric disorders in Chile. A population-based study</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013001000006&lng=&nrm=iso&tlng= Background: Suicidal behavior ranges from ideation to consummation of suicide. In Chile, rates of suicide increased from 4.8 to 12.7/100,000 in the period 1992-2009. Aim: To evaluate the prevalence of suicidal behavior and its relationship with sociodemographic factors and psychiatric diseases. Material and Methods: The Composite International Diagnostic Interview (CIDI), was applied to a representative sample of 2,978 Chilean participants. The prevalence of four suicidal behaviors (thinking about or wishing death, suicide ideation and suicide attempts) and of psychiatric diseases according to the revised third version of the Diagnostic and Statistical Manual of Mental Disorders (DSM III-R), was calculated. Results: The lifetime prevalence of suicidal conception was 14.3% and the suicide attempt 7.7%, the latest associated with sex, age, school years, smoking habits, being married or having a relationship, depressive disorders, dysthymia, and alcohol, drug and tobacco dependence. Conclusions: Rates founded exceed international prevalence data and extrapolated to current rates of completed suicide, higher levels of suicidal behavior should be expected. Considering the associated disorders we can infer that it is essential a correct diagnosis and treatment of mood disorders and substance consumption to any other specific interventions. <![CDATA[<strong>Validation of an instrument to measure health-related quality of life in Chilean children and adolescents</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013001000007&lng=&nrm=iso&tlng= Background: KIDSCREEN-52 is an instrument to assess health related quality of life in children and adolescents. Aim: To culturally adapt and validate the KIDSCREEN-52 questionnaire in Chileans. Material and Methods: Two independent translations from the English Spanish language were conciliated and retranslated to English. The conciliated version was tested during a cognitive interview to adolescents of different socioeconomic levels. The final version was validated in 7,910 school attending adolescents. Results: In the cross-cultural adaptation, 50 of the 52 items presented low or medium levels of difficulty and a high semantic equivalence. Distribution according to gender, grades and types of schools was similar to the sample. Single ages were not affected by sex distribution. The Confirmatory Factor Analyses were: X² (1229) = 20996.7, Root Mean Square Error of Approximation = .045 and Comparative Fit Index = .96. The instrument had a Cronbach’s alpha of .93. The domains had scores over 0.70 points, with the exception of the "Selfperception" domain, with a score of 0.62. Conclusions: The Chilean version of KIDSCREEN-52 is culturally appropriate and semantically equivalent in its English and Spanish versions (from Spain). Its reliability and validity were adequate. <![CDATA[<strong>Metabolic response to high intensity exercise training in sedentary hyperglycemic and hypercholesterolemic women</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013001000008&lng=&nrm=iso&tlng= Background: High intensity training could be an effective way of improving health on individuals at high metabolic risk. Aim: To investigate the effects of a high intensity training intervention on metabolic-related markers in sedentary women at high metabolic risk. Material and Methods: Forty six sedentary women with a body mass index (BMI) over 25 kg/m² were assigned to four groups, according to their metabolic profile; hyperglycemia (H, n = 12), hyperglycemia/hypercholesterolemia (HH, n = 13), normoglycemia (N, n = 10) and normoglycemia/hypercholesterolemia (NH, n = 11). For 12 weeks and five days per week, subjects performed seven intervals of high intensity training (20 to 30 seconds) during a training session of 20 minutes. Anthropometric (body weight, body mass index (BMI), waist circumference) and metabolic variables (glucose, total cholesterol, LDL, HDL and TG) were measured at baseline, at 6 and 12 weeks of intervention. Results: BMI and waist circumference decreased significantly after 12 weeks of intervention. Similarly, glucose decreased significantly after 12 weeks of intervention in all groups. The reduction was of higher magnitude in those groups with hyperglycemia (H = -16%, HH = -22%, N = -7,5%, NH = -9,6%). However, lipid profile (TG, total cholesterol, LDL and HDL) improved significantly only in the hypercholesterolemic groups. Conclusions: Physical activity programs incorporating high intensity training can improve glucose and lipid profile in women with metabolic disorders. Moreover, this benefit is greatest in those individuals with highest metabolic burden. <![CDATA[<strong>Congenital malformations among newborns of teenage mothers</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013001000009&lng=&nrm=iso&tlng= Background: The Chilean Ministry of Health has reported a meaningful increase of births from teenager mothers (aged less than 20 years) in the period 1990-2008. On the contrary, there was a decrease of births from teenage mothers at The University of Chile Clinical Hospital (HCUCH). Aim: To compare the prevalence rates at birth of congenital malformations (CMF) in newborns from mothers younger than 20 with those of mothers between 20 and 34 years old. Patients and Methods: The Latin American Collaborative Study of Congenital Malformations (ECLAMC) data base of the HCUCH, since 1969 was analyzed. The last ten years (2002-2011) were studied. Results: There were 15,636 births in the period studied, 153 of them were stillbirths (0.97%). There were 1174 newborns from teenage mothers, 82 of them had one or more congenital malformations (7%). We found an association between smoking and drug consumption in mothers and CMF in their newborns. Conclusions: The rate of congenital malformations among offspring of teenage mothers is lower than the rate for mothers between 20 and 34 years old. <![CDATA[<strong>Exercise and cardiac rehabilitation in secondary cardiovascular prevention</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013001000010&lng=&nrm=iso&tlng= Exercise and cardiac rehabilitation are indications with type I A evidence in most secondary cardiovascular prevention guidelines. Rehabilitation programs not only include exercise but also provide integral care and education about cardiovascular risk factors. However there is a paucity of such programs in Chile. Moreover there is a lack of awareness about the benefits of exercise and there is lack of knowledge about the details of exercise prescription in secondary prevention. Therefore, the divulgation of this knowledge is of utmost importance. <![CDATA[<strong>Use of platelet rich plasma in knee ligament surgery</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013001000011&lng=&nrm=iso&tlng= Platelet Rich Plasma (PRP) is used in musculoskeletal lesion surgery, including muscle, bone, tendons and ligaments. PRP might accelerate the healing process and the integration of the graft, allowing an earlier return to sports activities of patients. PRP is obtained from autologous blood, which is centrifuged, obtaining platelet and supposedly growth factor concentrations three to five times higher than those of regular blood. The clinical results of studies performed in Chile and elsewhere on PRP use in knee anterior cruciate ligament (ACL) reconstruction have been variable. Therefore, there is not enough evidence to support or deny the usefulness of PRP in ACL reconstructions. <![CDATA[<strong>The human body in Michelangelo's Moses</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013001000012&lng=&nrm=iso&tlng= What grips us so powerfully to a work of art is the artist's intention, if he succeeds to express it in his work and we are able to understand it. Michelangelo's Moses established the essential structures of an animate organism and the embodiment of consciousness in the world. Since the body is an expressive unit, it is possible to reconstruct a highly feasible sequence of movements that might have preceded the moment caught in the statue. It is an expression of the highest ideal of mental and spiritual achievement through the controlled tension between action and restraint. The phenomenon of embodiment and feeling the body as own is the basis of concrete human existence. <![CDATA[<strong>Accreditation of medical specialties programs in Chile</strong>: <strong>Position paper by the Chilean Academy of Medicine</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013001000013&lng=&nrm=iso&tlng= What grips us so powerfully to a work of art is the artist's intention, if he succeeds to express it in his work and we are able to understand it. Michelangelo's Moses established the essential structures of an animate organism and the embodiment of consciousness in the world. Since the body is an expressive unit, it is possible to reconstruct a highly feasible sequence of movements that might have preceded the moment caught in the statue. It is an expression of the highest ideal of mental and spiritual achievement through the controlled tension between action and restraint. The phenomenon of embodiment and feeling the body as own is the basis of concrete human existence. <![CDATA[<strong>Odds ratio</strong>: <strong>Theoretical and practical issues</strong>]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013001000014&lng=&nrm=iso&tlng= Odds Ratio (OR) is an effect measure frequently used to communicate results of health research. Mathematically, OR is the quotient between two odds, being odds an alternative way to express possibility of occurrence of an outcome or presence of an exposition. From a methodological perspective, OR can be calculated from prospective, retrospective and cross-sectional designs, and under certain conditions it can replace the Relative Risk. Based on a series of questions and examples, this article explains theoretical and methodological grounds underlying the concept of OR, in order to facilitate its interpretation for clinicians and researchers.<hr/>Odds Ratio (OR) es una medida de efecto comúnmente utilizada para comunicar los resultados de una investigación en salud. Matemáticamente un OR corresponde a un cociente entre dos odds, siendo un odds una forma alternativa de expresar la posibilidad de ocurrencia de un evento de interés o de presencia de una exposición. Desde un punto de vista metodológico, los OR pueden ser calculados en diseños prospectivos, retrospectivos y transversales, y bajo ciertas condiciones pueden reemplazar al Riesgo Relativo. En base a una serie de preguntas y ejemplos, el presente artículo explica los fundamentos matemáticos y metodológicos subyacentes al concepto de OR, con el objetivo de facilitar su interpretación a clínicos e investigadores. <![CDATA[Critically appraised article: A prospective cohort study challenging the effectiveness of population-based medical intervention for smoking cessation]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013001000015&lng=&nrm=iso&tlng= Objective: To examine the population effectiveness of nicotine replacement therapies (NRTs), either with or without professional counselling, and provide evidence needed to better inform healthcare coverage decisions. Methods: A prospective cohort study was conducted in three waves on a probability sample of 787 Massachusetts adult smokers who had recently quit smoking. The baseline response rate was 46%; follow-up was completed by 56% of the designated cohort at wave 2 and 68% at wave 3. The relationship between relapse to smoking at follow-up interviews and assistance used, including NRT with or without professional help, was examined. Results: Almost one-third of recent quitters at each wave reported to have relapsed by the subsequent interview. Odds of relapse were unaffected by use of NRT for > 6 weeks either with (p = 0.117) or without (p = 0.159) professional counseling and were highest among prior heavily dependent persons who reported NRT use for any length of time without professional counselling (OR 2.68). Conclusions: This study finds that persons who have quit smoking relapsed at equivalent rates, whether or not they used NRT to help them in their quit attempts. Cessation medication policy should be made in the larger context of public health, and increasing individual treatment coverage should not be at the expense of population evidence-based programmes and policies. <![CDATA[Electrical storm in Brugada syndrome successfully treated with isoproterenol. Report of a case]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013001000016&lng=&nrm=iso&tlng= We report a 22-year-old male who experienced several episodes of syncope within a timeframe of few hours. In the emergency room, multiple ventricular fibrillation episodes where documented along with a type 1 Brugada ECG pattern. Isoproterenol in continuous infusion was started, normalizing the ECG and avoiding further arrhythmia recurrences. The patient was implanted with an automated defibrillator and discharged 3 days after admission. <![CDATA[Portal vein thrombosis and nodular regenerative hyperplasia associated with the use of bevacizumab and oxaliplatin. Report of one case]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013001000017&lng=&nrm=iso&tlng= Nodular regenerative hyperplasia (NRH) consists in diffuse transformation of the hepatic parenchyma into small regenerative nodules without fibrosis, secondary to vascular occlusion and flow alterations. This gives a nodular appearance to theliver, as there is atrophy and compensatory hypertrophy of hepatocytes. We reporta 69-year-old male who suffered of colon cancer and was treated with Oxaliplatin (OX) and Bevacizumab (B). During treatment with B the patient presented a partial thrombosis of the portal vein, that one year later became permeable. Esophageal varices were found in an upper digestive endoscopy. Hepatic tests were normal. Aliver biopsy was performed and informed nodular regenerative hyperplasia. Thus, the different factors that could explain this pathology are analyzed. B, a monoclonal antibody against vascular endothelial growth factor, reduces the anti-apoptotic, anti-inflammatory and survival effects produced by this factor, affecting the vascular protection of the endothelial cell. On the other hand, OX activates metalloproteinasesand depletes sinusoidal glutathione producing sinusoidal lesions. Thus, (OX) would be associated with sinusoidal obstruction and NRH sporadically. It is important to discuss the possible etiologic factors that can cause NRH reviewing the hepatotoxic effects caused by both drugs. <![CDATA[Out of Bounds. Medicine and the Hundred Acre Wood]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013001000018&lng=&nrm=iso&tlng= Nodular regenerative hyperplasia (NRH) consists in diffuse transformation of the hepatic parenchyma into small regenerative nodules without fibrosis, secondary to vascular occlusion and flow alterations. This gives a nodular appearance to theliver, as there is atrophy and compensatory hypertrophy of hepatocytes. We reporta 69-year-old male who suffered of colon cancer and was treated with Oxaliplatin (OX) and Bevacizumab (B). During treatment with B the patient presented a partial thrombosis of the portal vein, that one year later became permeable. Esophageal varices were found in an upper digestive endoscopy. Hepatic tests were normal. Aliver biopsy was performed and informed nodular regenerative hyperplasia. Thus, the different factors that could explain this pathology are analyzed. B, a monoclonal antibody against vascular endothelial growth factor, reduces the anti-apoptotic, anti-inflammatory and survival effects produced by this factor, affecting the vascular protection of the endothelial cell. On the other hand, OX activates metalloproteinasesand depletes sinusoidal glutathione producing sinusoidal lesions. Thus, (OX) would be associated with sinusoidal obstruction and NRH sporadically. It is important to discuss the possible etiologic factors that can cause NRH reviewing the hepatotoxic effects caused by both drugs. <![CDATA[A tribute to Richard V. Lee, M.D.]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013001000019&lng=&nrm=iso&tlng= Richard V Lee, MD, MACP, FRGS, Professor of Medicine and Pediatrics and Obstetrics, Adjunct Professor of Anthropology and Social and Preventive Medicine. Director, Division of Maternal & Adolescent Medicine, and Director, Division of Geographic Medicine, Department of Medicine, State University of New York at Buffalo, USA, passed away on May 7,2013. His academic degrees and university positions are a vivid testimony of his wide professional interests and capabilities. As a humanist and ecologist, he became involved in a broad range of medical and research activities in the Brazilian Amazon, the Chilean Southern Andes, the African deserts and highlands, India, the Himalayas, and China. His extensive bibliography on ecology, the health status of geographically isolated populations and the role of physicians on cultural and macro environmental factors, has been summarized in his posthumous book "Out of Bounds. Medicine and The Hundred Acre Wood", recently published by the Royal Society of Medicine, London. The Sociedad Médica de Santiago-Chilean Society of Internal Medicine and its journal Revista Médica de Chile are indebted to his enthusiastic contributions and advice. <![CDATA[Neurocysticercosis: Five years follow-up of 21 patients]]> https://scielo.conicyt.cl/scielo.php?script=sci_arttext&pid=S0034-98872013001000020&lng=&nrm=iso&tlng= Richard V Lee, MD, MACP, FRGS, Professor of Medicine and Pediatrics and Obstetrics, Adjunct Professor of Anthropology and Social and Preventive Medicine. Director, Division of Maternal & Adolescent Medicine, and Director, Division of Geographic Medicine, Department of Medicine, State University of New York at Buffalo, USA, passed away on May 7,2013. His academic degrees and university positions are a vivid testimony of his wide professional interests and capabilities. As a humanist and ecologist, he became involved in a broad range of medical and research activities in the Brazilian Amazon, the Chilean Southern Andes, the African deserts and highlands, India, the Himalayas, and China. His extensive bibliography on ecology, the health status of geographically isolated populations and the role of physicians on cultural and macro environmental factors, has been summarized in his posthumous book "Out of Bounds. Medicine and The Hundred Acre Wood", recently published by the Royal Society of Medicine, London. The Sociedad Médica de Santiago-Chilean Society of Internal Medicine and its journal Revista Médica de Chile are indebted to his enthusiastic contributions and advice.