Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720140002&lang=es vol. 142 num. 2 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[Proposición de nuevas ecuaciones para calcular valores espirométricos de referencia en población chilena adulta: Sociedad Chilena de Enfermedades Respiratorias (SER)]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000200001&lng=es&nrm=iso&tlng=es Background: To correctly interpret spirometric results, reference values should come from the same population. Current spirometric reference equations have been under scrutiny due to deficiencies to fit adequately for Chilean population, specially, for those aged over 65 years old. Aim: To develop new spirometric reference values for Chilean adults, based on national studies in which spirometries were performed in healthy non-smoker adults. Material and Methods: A standardized database of spirometric values was developed combining spirometric data collected from five population-based studies, in which healthy nonsmoker adults participated. Spirometries from 448 males aged 19 to 84 years and from 726 females aged 19 to 94 years, obtained according to guidelines from the American Thoracic and European Respiratory Societies, were analyzed. Using multiple regression models, which included height, gender, and age, the theoretical value and inferior limits of normality were calculated for 1st second (FEV1), forced vital capacity (FVC), FEV1/FVC, and forced mid-expiratory flow rate (FEF25-75). Results: Reference values and lower limits of normality (LLN) were constructed for Chilean adults of both genders. The new proposed set of equations had a better fit, when compared with the current reference values used in Chile. Conclusions: The new spirometric references values derived from this study, fit better than currently used ones. Therefore, they should be used as new references values for Chilean adults. <![CDATA[<strong>Aplicación de grupos clínicos ajustados como herramienta de ajuste de riesgo</strong>: <strong>evaluación en la distribución de recursos en programa de enfermedades crónicas</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000200002&lng=es&nrm=iso&tlng=es Background: There is increasing interest in the study and improvement of health system resource allocation. The Adjusted Clinical Groups (ACG) System measures the morbidity burden of patient populations based on disease patterns, age and gender. This system can be used in primary health care settings. Aim: To report the use of the ACG system as a risk based patient classification system and its potential as a resource allocation mechanism in primary health care. Material and Methods: Patient diagnoses from a sample of primary care establishments were processed using the Johns Hopkins ACG System. Linear regressions were used to measure the ACG System's ability to explain resource use and ambulatory visit rates. Results: The ACG System had a statistically significant capacity to explain primary health care costs with an adjusted R² of 0.26. These results are significantly better, compared with risk assessment models based on patients' age and sex, whose adjusted R² is 0.05. Conclusions: The use of risk adjustment mechanisms will contribute to improve health care resource allocation as well to know the disease profile of the population. <![CDATA[<strong>Evaluando la situación financiera de los hospitales públicos a partir de los costos actualizados de sus prestaciones</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000200003&lng=es&nrm=iso&tlng=es In 2011 the Chilean National Health Fund (FONASA) commissioned a study to assess the costs of the 120 most relevant hospital care services with an established fee, in a large sample of public hospitals. We herein report the cost evaluation results of such study, considering the financial condition of those hospitals in the year of the study. Based on the premise that the expenses derived from the provision of institutional and appraised hospital services should be identical to the billing of hospitals to FONASA, the prices are undervalued, since they cover only 56% of billing, generating a gap between expenses and invoicing. This gap shows an important limitation of tariffs, since their prices do not cover the real costs. However not all hospitals behave in the same way. While the provision of services of some hospitals is even higher than their billing, most hospitals do not completely justify their invoicing. These assumptions would imply that, generally speaking, hospital debts are justified by the costs incurred. However, hospitals have heterogeneous financial situations that need to be analyzed carefully. In particular, nothing can be said about their relative efficiency if cost estimations are not adjusted by the complexity of patients attended and comparison groups are not defined. <![CDATA[<strong>La edad de la mujer como factor de riesgo de mortalidad materna, fetal, neonatal e infantil</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000200004&lng=es&nrm=iso&tlng=es Background: Adolescent pregnancy and advanced maternal age are associated with increased risk for maternal, perinatal and infant death. However, the maternal age with the lowest reproductive risk has not been established. Aim: To determine the range of maternal age with the lowest reproductive risk. Material and Methods: A population-based study (2005-2010) was performed analyzing raw data from vital statistics yearbooks of the National Institute of Statistics of Chile. The association of maternal, fetal, neonatal and infant mortality with maternal age was analyzed. The latter was stratified in quinquenniums, between ages 10 and 54 years. Maternal, fetal, neonatal and infant mortality rates were calculated for each quinquennium. The lowest rate was selected as a control group for risk analysis, which was estimated according to Odds Ratio with 95% confidence intervals. Results: Women of 20-29, 25-34 and under 30 years, had the lowest rate of fetal, neonatal/infant and maternal death, respectively. Women aged 45-49 years had the higher rate of maternal, fetal, neonatal and infant mortality. The risk of fetal, neonatal and infant mortality doubled from 40-44 years onwards, and maternal mortality from the age of 30-34 years. Conclusions: Our results suggest that the maternal age range with the lesser general reproductive risk is between 20-29 years. This finding should be considered in future studies of reproductive risk and for an appropriate counseling about conception. <![CDATA[<strong>Asociación entre diabetes mellitus y patología cardiovascular en la población adulta de Chile</strong>: <strong>estudio de la Encuesta Nacional de Salud 2009-2010</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000200005&lng=es&nrm=iso&tlng=es Background: Diabetes mellitus (DM) is a recognized atherosclerotic cardiovascular disease (ACVD) risk factor. This association has yet to be quantified in the Chilean population. Aim: To compare the frequency of ACVD between diabetic and non-diabetic Chilean subjects. Material and Methods: Data was extracted from the Chile National Health Survey (ENS) performed in 2009-2010. DM diagnosis was made with fasting glucose. ACVD (coronary, cerebral and peripheral vascular disease) was established by self-report. Major cardiovascular risk factors were identified by clinical and laboratory assessment. Results: A total of 5,416 adults (2,200 men and 3,216 women) were surveyed in ENS 2009-2010. Of these, 508 were diabetic and 375 reported ACVD. ACVD frequency was 16.1% and 6.1% in diabetic and non-diabetic subjects, respectively. In diabetic men, the frequency of ACVD steadily increased with age, from 5.1% to 22.1%. In diabetic women, the highest frequency of ACVD (17.4%) was found in ages ranging from 45 to 54 years. In people younger than 54 years, the odds ratio for ACVD in diabetic compared to non-diabetic subjects, was 3.59 in men (χ2 = 4.03 p < 0.03) and 5.26 in women (χ2 = 7.7 p < 0.007). Cardiovascular risk factors and metabolic syndrome were significantly more common in diabetic subjects with reported ACVD. Conclusions: DM is associated with an increased frequency of ACVD and cardiovascular risk factors in Chilean adults. In line with international reports, our findings suggest that DM is also a cardiovascular risk factor in Chile, particularly relevant for women. <![CDATA[<strong>Evaluación de un programa de educación a distancia en Promoción de Salud para la Atención Primaria en Chile</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000200006&lng=es&nrm=iso&tlng=es Background: Health promotion in Chile is essential, considering its current epidemiologic status where chronic diseases are predominant. Aim: To report the evaluation of an on-line Diploma in health promotion for Primary Health Care professionals. Material and Methods: Two hundred sixty four professionals from all regions of the country (40% rural and 60% urban) took the Diploma. It lasted 8 months with 248 academic hours distributed in 5 modules with a total of 15 units. The program was evaluated with four surveys answered by the students (general description of participants, mid-term, final and follow-up). Results: Students were highly satisfied with the program and especially with its interactive methodology which included tutorials, individual and group assignments, online discussions and a final project. The drawbacks were time restrictions and limited internet access. Ninety percent of students completed the course with an overall mean grade of 5.57 (out of a 1-7 scale). The follow-up survey showed that students implemented the new health promotion knowledge acquired, and put in practice their final assignment in their local counties. Also, most students improved their working conditions. Conclusions: The on-line interactive and participative methodology applied in this Diploma had positive results and the evaluation model can be applied in other health promotion on-line education programs. <![CDATA[<b>Calidad de vida relacionada con la salud en una muestra de médicos internos residentes que realizan guardias en un Servicio de Urgencias</b>: <b>una perspectiva de género</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000200007&lng=es&nrm=iso&tlng=es Background: The high emotional burden of physicians working in emergency departments may affect their quality of life perception. Aim: To evaluate health related quality of life among resident physicians performing shifts at an emergency department. Material and Methods: Seventy one physicians aged 26,3 ± 1,7 years (47 women), working as residents in an emergency department, answered the short version of the Short-Form Health Survey Questionnaire (SF-36®). This questionnaire analyses eight domains: physical function, body pain, general health, vitality, social function, emotional role and mental health. Results: Women had a significantly worse perception than a reference population in four dimensions of the SF-36, especially mental health and social functioning. Men had scores similar to the reference population. Among women, vitality is the best predictor of mental health and social functioning. Conclusions: Women working as residents in an emergency department have a worse perception of their quality of life than men performing the same job. <![CDATA[<strong>Radioquimioterapia adyuvante en cáncer gástrico completamente resecado</strong>: <strong>experiencia del Instituto Nacional del Cáncer de Chile</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000200008&lng=es&nrm=iso&tlng=es Background: Gastric cancer is one of the most lethal tumors in the Chilean population. Aim: To report the results of adjuvant chemoradiotherapy in advanced gastric cancer. Material and Methods: Review of medical records of patients with locoregionally advanced gastric cancer, subjected to a curative resection and treated with adjuvant chemoradiotherapy. The treatment was based on the INT 0116/SWOG protocol, which includes 5-fuorouracil as a single agent. Patients were followed for a median of 58 months. Results: the records of 168 patients (99 men) treated between 2004 and 2011, were reviewed. Median survival was 41 months. Median lapses between surgery and onset of chemo and radiotherapy were 12 and 17 weeks, respectively. Overall three and five years survival was 53 and 41%, respectively. On multivariate analysis the factors associated with a lower survival were an antral location of the tumor, presence of signet ring cells and more than 15 involved lymph nodes. Conclusions: Three and five years survival of gastric cancer patients subjected to adjuvant chemoradiotherapy was 53 and 41% respectively. These results are similar to those reported elsewhere. <![CDATA[<strong>Neurobiología del trastorno de personalidad límite</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000200009&lng=es&nrm=iso&tlng=es Borderline personality disorder (BPD) is highly prevalent and associated with significant dysfunctional behavior and suicide risk. The association with psychosocial factors is well established, however its neurobiology is not fully unraveled. According with the revised studies, subjects with BPD have structural and functional brain alterations, particularly in areas involved in affective and cognitive regulation and control of impulses. These alterations allow us to understand the psychopathology of this disorder and partly explain its pathogenesis. <![CDATA[<strong>Obesidad y cáncer</strong>: <strong>la tormenta perfecta</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000200010&lng=es&nrm=iso&tlng=es While some genetic factors may explain the development of cancer, its main causes are related to environmental exposure to carcinogenic agents as well as to the effect of determined lifestyles and habits. Several epidemiological studies have shown a consistent relation between obesity and cancer. In non smokers, obesity is the most relevant risk factor in the development of malignant tumors. There is a clear association between obesity and endometrial cancer, breast cancer in postmenopausal women, pancreatic, esophageal and colon cancer. Sexual steroids, insulin like growth factor axis and adipokines are the three main models to explain the biological basis for the obesity-cancer relationship. However, these models do not explain all the biological mechanisms that link obesity to cancer. There are other factors in play such as chronic inflammation, hypoxia and oxidative stress. Obesity may hamper the screening, diagnosis and treatment of some tumors, increasing mortality rates. Obesity prevention and management, therefore, may be the most important modifiable factor in reducing both incidence and mortality in cancer. New studies are required to quantify the effect of intentional weight reduction on the incidence and relapse of cancer. Considering the efficacy of bariatric surgery for weight reduction, it is an attractive model to study this link. <![CDATA[<strong>Riesgo de diabetes mellitus tipo 2 asociado al uso de estatinas</strong>: <strong>evidencias y posibles mecanismos</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000200011&lng=es&nrm=iso&tlng=es In the last decade, an increased number of new cases of type 2 diabetes mellitus (T2DM) among patients who use statins have been reported. The aim of the present review is to compile the most relevant information about the risk of T2DM associated with the use and dose of different statins, especially based on meta-analysis considering different studies worldwide. To explain this relationship, several studies have reported the effect of statins on insulin resistance in dyslipidemic non-diabetic patients, reporting different findings according to the types of statins. In addition, some reports -based on culture of β pancreatic cells- have evaluated the effect of these drugs in certain cellular events that are essential for insulin secretion. Clearly, further studies in humans are needed -applying more robust tests than those used up to date- in order to define more precisely the potential mechanisms explaining the higher incidence of T2DM among statin users. <![CDATA[<strong>Proceso de alta hospitalaria, revisión de la literatura</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000200012&lng=es&nrm=iso&tlng=es Discharge is one of the most important processes that hospitalized patients must endure. This process is complex, requires coordination among several professionals and transfers an overwhelming amount of information to patients. Often, it is limited to the writing of the discharge summary, with a primary emphasis on the drug list. Since the rise of hospitalism in 1996, a greater emphasis has been placed on understanding this process and in developing interventions to make it more effective and safe. In our country, little is known about how this process is taking place. Probably the absence of financial penalties for readmissions has influenced in the lack of study and development of this process. In the USA the knowledge of the discharge process is well advanced, and several strategies have been developed for reducing adverse events, medication errors, and 30-days readmissions. Other interventions have increased patient satisfaction and the degree of knowledge about their conditions. The aim of this paper is to do a comprehensive review of the literature, to provide healthcare teams with various tools that could improve both the discharge process as well as the discharge summary. The final objective is to optimize the safety and satisfaction of our patients and the hospital metrics of quality. <![CDATA[<strong>Estrategias terapéuticas para aumentar la eficacia de la tos en pacientes con enfermedades neuromusculares</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000200013&lng=es&nrm=iso&tlng=es Cough is a natural reflex that protects respiratory airways against infections or mucus retention. Cough maintains an adequate cleaning of the airways and is a mainstay of respiratory therapy. It can be triggered voluntarily by the patient or by a specific cough device. Peak cough flow (PCF) is used to assess the effectiveness of the cough. When this value is below 160 L/min, cough is considered inefficient and becomes a risk factor for respiratory problems. Patients with weak cough, especially those with neuromuscular disease, have in common a low tidal volume and a decreased maximum insufflation capacity. Both factors directly affect the inspiratory phase previous to cough, which is considered vital to obtain the optimum flow for a productive cough. Different therapeutic measures may help to increase cough efficiency among patients with cough weakness. These interventions may be performed using manual techniques or by mechanical devices. The aim of this review is to analyze the different techniques available for cough assistance, set a hierarchy of use and establish a scientific basis for their application in clinical practice. <![CDATA[<strong>Rotura espontánea de válvula tricúspide en un paciente con hipertensión pulmonar secundaria a VIH</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000200014&lng=es&nrm=iso&tlng=es Acute primary tricuspid regurgitation (TR) secondary to papillary muscle rupture is an extremely rare clinical situation. We report a 42-year-old male with pulmonary artery hypertension (PAH) secondary to HIV infection, who presented with an acute TR due to spontaneous papillary muscle rupture. He remained in cardiogenic shock despite therapy with inotropic drugs and pulmonary vasodilator therapy. He was subjected to a tricuspid valve replacement. In the postoperative period the patient had severe PAH, which was successfully controlled with inhaled nitric oxide. Tricuspid valve replacement and adjunctive use of pulmonary vasodilator therapy can be a life saving and useful approach in this condition. <![CDATA[<strong>Feocromocitoma </strong><strong>:presentación como síndrome coronario agudo</strong>: Reporte de un caso]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000200015&lng=es&nrm=iso&tlng=es The typical symptoms of pheochromocytoma are palpitations, sweating, headaches and hypertension. We report a 70-year-old female admitted to the hospital due to a sudden onset of precordial pain with electrocardiographic changes. After admission the patient evolved with recurrent chest pain accompanied by hypertensive paroxysms and a pheochromocytoma was suspected. Measurement of catecholamines and metanephrines confirmed the diagnosis and an abdominal magnetic resonance localized the tumor. The patient underwent surgery with successful removal of the pheochromocytoma and was discharged in good conditions. <![CDATA[<strong>Ascitis dolorosa y masiva como forma de presentación de una reactivación lúpica</strong>: <strong>Presentación de un caso</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000200016&lng=es&nrm=iso&tlng=es Lupus peritonitis (LP) is extremely rare. Acute LP is characterized by rapid onset of ascites and severe abdominal pain, in addition to other well-recognized clinical features of a general systemic lupus erythematosus (SLE) fare. Ascites associated with acute LP has been rarely reported as the prominent feature of a SLE fare. We report a 39-year-old woman who developed massive, painful ascites as the presenting manifestation of a SLE fare. Diagnostic workup ruled out the possibility of hepatic, cardiovascular, infectious, or malignant diseases, and confirmed the presence of a SLE fare. The patient was treated with methyl prednisolone and hydroxychloroquine resulting in dramatic improvement of her condition. During ambulatory follow up, she has remained asymptomatic up to the moment of this writing. Adrenal steroids and hydrocychloroquine may be useful for the management of SLE fares in patients with massive, painful ascites due to acute LP.<hr/>La peritonitis lúpica es rara. El cuadro agudo se caracteriza por ascitis de comienzo rápido, dolor abdominal severo y otras manifestaciones de una recidiva de un lupus eritematoso sistémico (LES). Sólo ocasionalmente e ha informado que la ascitis y peritonitis lúpica sean las principales manifestaciones de una recidiva lúpica. Presentamos a una mujer de 39 años que presentó ascitis masiva y dolorosa como la primera manifestación de una reactivación lúpica. El estudio diagnóstico descartó problemas hepáticos, pulmonares, cardiacos, cáncer o infecciones y confirmó la reactivación lúpica. La paciente se trató con metilprednisolona y cloroquina, resultando en una mejoría dramática. Al momento de preparar este informe, la paciente permanece asintomática en control ambulatorio. Los corticoides y cloroquina pueden ser medicamentos útiles para el tratamiento de pacientes con ascitis dolorosa y masiva secundaria a peritonitis lúpica. <![CDATA[<strong>Neumonía criptogénica organizada como diagnóstico diferencial de neumonía que no responde a tratamiento</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000200017&lng=es&nrm=iso&tlng=es Non-resolving pneumonia is a common clinical problem that prolongs morbidity and increases hospitalization costs. We report an 82 year-old non-smoking female who was admitted with chronic diarrhea and later developed nosocomial pneumonia. Lung infiltrates did not resolve despite sequential antibiotic treatments. Infectious causes such as resistant nosocomial pathogens, respiratory viruses, tuberculosis, Legionellosis, cytomegalovirus or agents associated with HIV infection were discarded. Non-infectious causes such as thromboembolic lung disease, neoplasms and rheumatic disorders were also ruled out. An exudative pleural effusion was detected, but the study was unremarkable. Fiberoptic bronchoscopy and a transbronchial biopsy, revealed nonspecific findings. The patient persisted febrile, required non-invasive mechanical ventilation and displayed a migratory pattern of lung infiltrates that motivated a second biopsy, this time by open thoracotomy, showing a cryptogenic organizing pneumonia. The patient's conditions improved after treatment with adrenal steroids. In patients with non-resolving pneumonia, a dedicated and comprehensive study should be done using invasive procedures and considering both infectious and non-infectious causes. Cryptogenic organizing pneumonia is one of the alternatives that is potentially treatable, but often underdiagnosed. <![CDATA[<strong>Día Mundial del Riñón</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000200018&lng=es&nrm=iso&tlng=es Non-resolving pneumonia is a common clinical problem that prolongs morbidity and increases hospitalization costs. We report an 82 year-old non-smoking female who was admitted with chronic diarrhea and later developed nosocomial pneumonia. Lung infiltrates did not resolve despite sequential antibiotic treatments. Infectious causes such as resistant nosocomial pathogens, respiratory viruses, tuberculosis, Legionellosis, cytomegalovirus or agents associated with HIV infection were discarded. Non-infectious causes such as thromboembolic lung disease, neoplasms and rheumatic disorders were also ruled out. An exudative pleural effusion was detected, but the study was unremarkable. Fiberoptic bronchoscopy and a transbronchial biopsy, revealed nonspecific findings. The patient persisted febrile, required non-invasive mechanical ventilation and displayed a migratory pattern of lung infiltrates that motivated a second biopsy, this time by open thoracotomy, showing a cryptogenic organizing pneumonia. The patient's conditions improved after treatment with adrenal steroids. In patients with non-resolving pneumonia, a dedicated and comprehensive study should be done using invasive procedures and considering both infectious and non-infectious causes. Cryptogenic organizing pneumonia is one of the alternatives that is potentially treatable, but often underdiagnosed. <![CDATA[<strong>Atención médica de urgencias</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000200019&lng=es&nrm=iso&tlng=es Non-resolving pneumonia is a common clinical problem that prolongs morbidity and increases hospitalization costs. We report an 82 year-old non-smoking female who was admitted with chronic diarrhea and later developed nosocomial pneumonia. Lung infiltrates did not resolve despite sequential antibiotic treatments. Infectious causes such as resistant nosocomial pathogens, respiratory viruses, tuberculosis, Legionellosis, cytomegalovirus or agents associated with HIV infection were discarded. Non-infectious causes such as thromboembolic lung disease, neoplasms and rheumatic disorders were also ruled out. An exudative pleural effusion was detected, but the study was unremarkable. Fiberoptic bronchoscopy and a transbronchial biopsy, revealed nonspecific findings. The patient persisted febrile, required non-invasive mechanical ventilation and displayed a migratory pattern of lung infiltrates that motivated a second biopsy, this time by open thoracotomy, showing a cryptogenic organizing pneumonia. The patient's conditions improved after treatment with adrenal steroids. In patients with non-resolving pneumonia, a dedicated and comprehensive study should be done using invasive procedures and considering both infectious and non-infectious causes. Cryptogenic organizing pneumonia is one of the alternatives that is potentially treatable, but often underdiagnosed. <![CDATA[<b>Síndrome de <i>Hibris</i></b>: <b>descripción y tratamiento</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000200020&lng=es&nrm=iso&tlng=es Non-resolving pneumonia is a common clinical problem that prolongs morbidity and increases hospitalization costs. We report an 82 year-old non-smoking female who was admitted with chronic diarrhea and later developed nosocomial pneumonia. Lung infiltrates did not resolve despite sequential antibiotic treatments. Infectious causes such as resistant nosocomial pathogens, respiratory viruses, tuberculosis, Legionellosis, cytomegalovirus or agents associated with HIV infection were discarded. Non-infectious causes such as thromboembolic lung disease, neoplasms and rheumatic disorders were also ruled out. An exudative pleural effusion was detected, but the study was unremarkable. Fiberoptic bronchoscopy and a transbronchial biopsy, revealed nonspecific findings. The patient persisted febrile, required non-invasive mechanical ventilation and displayed a migratory pattern of lung infiltrates that motivated a second biopsy, this time by open thoracotomy, showing a cryptogenic organizing pneumonia. The patient's conditions improved after treatment with adrenal steroids. In patients with non-resolving pneumonia, a dedicated and comprehensive study should be done using invasive procedures and considering both infectious and non-infectious causes. Cryptogenic organizing pneumonia is one of the alternatives that is potentially treatable, but often underdiagnosed. <![CDATA[<strong>La farsa de la homeopatía</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872014000200021&lng=es&nrm=iso&tlng=es Non-resolving pneumonia is a common clinical problem that prolongs morbidity and increases hospitalization costs. We report an 82 year-old non-smoking female who was admitted with chronic diarrhea and later developed nosocomial pneumonia. Lung infiltrates did not resolve despite sequential antibiotic treatments. Infectious causes such as resistant nosocomial pathogens, respiratory viruses, tuberculosis, Legionellosis, cytomegalovirus or agents associated with HIV infection were discarded. Non-infectious causes such as thromboembolic lung disease, neoplasms and rheumatic disorders were also ruled out. An exudative pleural effusion was detected, but the study was unremarkable. Fiberoptic bronchoscopy and a transbronchial biopsy, revealed nonspecific findings. The patient persisted febrile, required non-invasive mechanical ventilation and displayed a migratory pattern of lung infiltrates that motivated a second biopsy, this time by open thoracotomy, showing a cryptogenic organizing pneumonia. The patient's conditions improved after treatment with adrenal steroids. In patients with non-resolving pneumonia, a dedicated and comprehensive study should be done using invasive procedures and considering both infectious and non-infectious causes. Cryptogenic organizing pneumonia is one of the alternatives that is potentially treatable, but often underdiagnosed.