Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720160002&lang=pt vol. 144 num. 2 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[<b><i>Benefit of adjuvant 5-fluorouracil based chemotherapy for colon cancer</i></b>: <b><i>a retrospective cohort study</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000200001&lng=pt&nrm=iso&tlng=pt Background: Multiple clinical trials have demonstrated the benefits of adjuvant 5-fluorouracil-based chemotherapy for patients with resectable colon cancer (CC), especially in stage III. Aim: To describe the clinical characteristics of a cohort of CC patients treated at a single university hospital in Chile since 2002, and to investigate if chemotherapy had an effect on survival rates. Material and Methods: Review of a tumor registry of the hospital. Medical records of patients with CC treated between 2002 and 2012 were reviewed. Death certificates from the National Identification Service were used to determine mortality. Overall survival was described using the Kaplan-Meier method. A multivariate Cox proportional hazard regression model was also used. Results: A total of 370 patients were treated during the study period (202 in stage II and 168 in stage III). Adjuvant chemotherapy was administered to 22 and 70% of patients in stage II and III respectively. The median follow-up period was 4.6 years. The 5-year survival rate for stage II patients was 79% and there was no benefit observed with adjuvant chemotherapy. For stage III patients, the 5-year survival rate was 81% for patients who received adjuvant chemotherapy, compared to 56% for those who did not receive chemotherapy (hazard ratio (HR): 0.29; 95% confidence interval (CI): 0.15-0.56). The benefit of chemotherapy was found to persist after adjustment for other prognostic variables (HR: 0.47; 95% CI: 0.23-0.94).Conclusions: Patients with colon cancer in stage III who received adjuvant chemotherapy had a better overall survival. <![CDATA[<b>Interaction between antihypertensive therapy and exercise training therapy requires drug regulation in hypertensive patients</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000200002&lng=pt&nrm=iso&tlng=pt Background: Exercise training could interact with the pharmacological therapy of hypertension, increasing the effects of these medications. Aim: To assess the effects of 12 weeks of physical training on blood pressure of hypertensive or diabetic patients, already receiving pharmacological therapy. Material and methods: Twelve participants with diabetes and hypertension, 16 participants with hypertension and 18 healthy participants were studied. During six weeks no intervention was carried out, except the treatment for their underlying conditions. During the ensuing six weeks, participants were subjected 12 sessions of physical training. Blood pressure was measured at baseline and after six and twelve weeks of intervention. Results: During the period without physical training, no changes in blood pressure were observed. After the physical training intervention systolic blood pressure decreased by 16, 17 and 20 mm Hg in participants with diabetes and hypertension, participants with hypertension and healthy participants, respectively. Diastolic blood pressure decreased by 9 and 6 mmHg in participants with diabetes and hypertension and hypertension alone, respectively. Conclusions: There is a decrease in blood pressure among hypertensive participants receiving pharmacological therapy, after a period of physical training. <![CDATA[<b>Erythema nodosum</b>: <b>Analysis of 91 hospitalized patients</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000200003&lng=pt&nrm=iso&tlng=pt Background: Erythema Nodosum (EN) is an acute nodular erythematous cutaneous eruption. It is presumed to be a hypersensitivity reaction and it may be idiopathic, or occur in association with diverse diseases and medications. Aim: To identify the main etiologies of EN among patients admitted to a medicine service of a clinical hospital. Material and Methods: Analysis of medical records of patients discharged with the diagnosis of EN during a ten years period. Patients were considered to have secondary EN when an underlying condition was found, and to have idiopathic EN when no such condition was found. Results: One hundred twenty nine patients were identified, but 91, aged 38 ± 14 years (86% females) had available clinical information. The etiology was idiopathic in 32% and secondary in 68% of patients. The leading etiologies were post-Streptococcal in 32%, followed by sarcoidosis in 11%, primary tuberculosis in 7%, Mycoplasma infection in 3%, Bartonella infection in 3%, Behçet’s syndrome in 2%, inflammatory bowel disease in 2%, drugs in 1% and other etiologies in 8%. Secondary cases of EN had higher levels of C Reactive Protein and leucocytes than idiopathic cases. Conclusions: The distribution of causes in our study population were similar to those reported in the literature (With smaller proportion of idiopathic), as was the man/woman (1/6) ratio, and the preponderance of cases in winter and spring. Infectious diseases were the leading causes of EN in this group of patients, and a reasonable initial approach in the hospital should include a diligent medical history and physical examination, complete blood count, ESR, titles ASO, PPD tuberculin skin test, chest X-ray or CT scan and, where deemed appropriate, specific autoimmune and infectious serology. <![CDATA[<b>Frequency of oral squamous cell carcinoma and oral epithelial dysplasia in oral and oropharyngeal mucosa in Chile</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000200004&lng=pt&nrm=iso&tlng=pt Background: Oral cancer in Chile corresponds approximately to 1.6% of all cancer cases. There are few studies about oral epithelial dysplasia and oral squamous cell carcinoma in the Chilean population. Aim: To determine the frequency of hyperkeratosis, mild, moderate and severe oral epithelial dysplasia, in situ carcinoma and squamous cell carcinoma of the oral and oropharyngeal mucosa in a registry of the Oral Pathology Reference Institute of the Faculty of Dentistry, Universidad de Chile, in a ten years period. Material and Methods: Review of clinical records and pathological plates of 389 patients, obtained between 1990 and 2009. Cases were selected according to their pathological diagnosis, including hyperkeratosis, oral epithelial dysplasia, in situ carcinoma, squamous cell carcinoma and verrucous carcinoma. Results: Forty four percent of cases were squamous cell carcinoma, followed by hyperkeratosis in 37% and mild epithelial dysplasia in 11%. Squamous cell carcinoma was more common in men aged over 50 years. Most of the potentially malignant disorders presented clinically as leukoplakia and squamous cell carcinoma were clinically recognized as cancer. Conclusions: In this study, men aged over 50 years are the highest risk group for oral cancer. Early diagnosis is deficient since most of these lesions were diagnosed when squamous cell carcinoma became invasive. Leukoplakia diagnosis is mostly associated with hyperkeratosis and epithelial dysplasia, therefore biopsy of these lesions is mandatory to improve early diagnosis. <![CDATA[<b>Vitamin D levels among Chilean older subjects with low energy hip fracture</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000200005&lng=pt&nrm=iso&tlng=pt Background: Vitamin D deficiency is a common condition affecting 40-100% of geriatric population. Aim: To determine the prevalence of vitamin D insufficiency and deficiency in geriatric population surgically treated for hip fracture. Patients and Methods: Analysis of a database of patients aged over 60 years operated for a low energy hip fracture in a three years period. Vitamin D was measured in identified patients, using a blood sample obtained on admission to the hospital. A logistic regression was carried out to evaluate age, gender, morbidity index and season as predictors of vitamin D deficiency. Results: Two hundred and twenty-eight patients aged 84 ± 7 years (82% females), were included in the analysis. One hundred eighty-three patients (80%) presented vitamin D levels below 20 ng/dl (deficiency) and 39 patients (18%) presented with levels between 20 and 30 ng/dl (insufficiency), totaling 98% of patients with hypovitaminosis D. Vitamin D deficiency was especially common among patients with higher American Society of Anesthesiologists (ASA) Physical Status Classification System and during winter-spring period. A negative correlation between age and the proportion of subjects with vitamin D deficiency was found. There was no relation between gender and vitamin D levels. Conclusions: Vitamin D deficiency is especially prevalent in older subjects with hip fracture, reaching 98% in the studied population. <![CDATA[<b>Family structure of obese/overweight and normal weight adolescents in México</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000200006&lng=pt&nrm=iso&tlng=pt Background: Feeding modes and appetence toward certain foods are usually conditioned by the family. Obesity during adolescence usually persists during adulthood. Aim: To determine differences in family structure of adolescents according to their nutritional status. Material and Methods: A cross-sectional study was conducted in 60 overweight-obese and 60 normal weight adolescents. Family type was determined based on their conformation (kinship and cohabitation), development (if the mother had a remunerated job), demography (geographical area), integration (functions of the couple); life cycle stage and functionality. Results: Fifty eight percent of normal weight adolescents had simple nuclear families and 47% of overweight-obese adolescents had an extended family. Thirty one and 21% of overweight/obese and normal weight adolescents lived with an overweight/obese individual, respectively. Conclusions: There are differences in the family structure of overweight/obese and normal weight adolescents. <![CDATA[<b>Prevalence of genetic diseases in admissions to a tertiary care hospital pediatric service</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000200007&lng=pt&nrm=iso&tlng=pt Background: With the epidemiological changes, the role of genetic factors as a cause of morbidity and mortality is increasing, changing disease patterns of patients admitted to pediatric hospitals. Aim: To describe the prevalence of genetic diseases (GD) in patients admitted to a tertiary-care hospital Pediatric Service. Material and Methods: The clinical records of consecutive admissions to a Pediatric Service of a clinical hospital in 2011 were reviewed. Two categories were assigned: with GD and without GD. Both groups were compared according to days of hospitalization, type of admission, readmissions and mortality. Results: We reviewed the 98.1% of the 1,781 total annual admissions (1,459 cases), 322 of them were readmissions (187 cases). The mean age at admission was 54.8 ± 54 months and 55% were male. The mean hospitalization length was 4.9 ± 10 days. Of total admissions and individual cases, 52.7% (938/1,781) and 48% (705/1,459) were cases with GD, respectively. Within this group, 85% (597/705) were sub-categorized as having a significant genetic base. The differences between gender, age average income and hospital mortality were not significant between the two categories. Readmissions were more common for GD than for patients without GD (Odds ratio (OR): 2.6, confidence intervals (CI): 1.9-3.6). Average hospital stay was 27% higher among GD patients (p < 0.01). Conclusions: Our findings confirm the high prevalence of GD in pediatric hospitals (52.7%), with a higher risk for readmission in cases with GD compared with those without GD. <![CDATA[<b>Assessment of a nutrition education intervention among construction workers</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000200008&lng=pt&nrm=iso&tlng=pt Background: Unhealthy lifestyles and overweight are common among blue collar workers. Aim: To evaluate a nutrition education intervention in construction workers to prevent chronic diseases. Material and Methods: One hundred forty two participants were randomly assigned to an experimental group (n = 69) and or a control group (n = 73). The experimental group received nutrition education consisting in individual lifestyle counseling, group workshop, group counseling in healthy lifestyles, and environmental intervention. At baseline and after one year of intervention, clinical evaluations consisting in laboratory determinations, anthropometry and nutritional assessment evaluation were carried out. Results: The experimental group experienced a significant decrease in waist circumference, total cholesterol, triglycerides, and an increase in HDL cholesterol. A significant reduction in total calorie intake, especially at the evening snack was observed during week-days. The same reduction in total calories occurred at dinner during the week-end. A significant increase was observed in the consumption of fruits, vegetables and fish. In the control group there was a significant increase in weight, waist circumference, body mass index, glucose and insulin, without changes in total calorie intake or healthy food consumption. High soft drink consumption did not change in both groups. Conclusions: In construction workers, integral nutrition intervention at the individual, group and environmental level had an impact in nutritional and biochemical indicators. <![CDATA[<b><i>Early detection of lung cancer using</i></b><b> computed tomography among patients with chronic obstructive pulmonary disease</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000200009&lng=pt&nrm=iso&tlng=pt Background: Chest computed tomography (CT) scan may improve lung cancer detection at early stages in high risk populations. Aim: To assess the diagnostic performance of chest CT in early lung cancer detection in patients with chronic obstructive pulmonary disease (COPD). Patients and Methods: One hundred sixty one patients aged 50 to 80 years, active or former smokers of 15 or more pack-years and with COPD were enrolled. They underwent annual respiratory functional assessment and chest computed tomography for three years and were followed for five years. Results: Chest CT allowed the detection of lung cancer in nine patients (diagnostic yield: 5.6%). Three cases were detected in the initial CT and six cases in follow-up scans. Most patients were in early stages of the disease (6 stage Ia and 1 stage Ib). Two patients were diagnosed at advanced stages of the disease and died due to complications of cancer. Two thirds of patients had nonspecific pulmonary nodules on the initial chest CT scan (100 patients, 62%). Seventy four percent had less than three nodules and were of less than 5 mm of diameter in 57%. In 92% of cases, these were false positive findings. In the follow-up chest CT, lung nodules were detected in two thirds of patients and 94% of cases corresponded to false positive findings. Conclusions: Chest CT scans may detect lung cancer at earlier stages in COPD patients. <![CDATA[<b>Update on celiac disease</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000200010&lng=pt&nrm=iso&tlng=pt The prevalence of Celiac disease in the general population is approximately 1% and remains undiagnosed in a significant proportion of individuals. Its clinical presentation includes the classical malabsorption syndrome, unspecific and extra-intestinal manifestations, and silent celiac disease. The serologic diagnosis has an elevated sensitivity and specificity and, at least in adult population, it must be confirmed by biopsy in every case. Diagnosis in subjects already on gluten free diet includes HLA typing and gluten challenge with posterior serologic and histologic evaluation. The core of the treatment is the gluten free diet, which must be supervised by an expert nutritionist. Monitoring must be performed with serology beginning at 3-6 months, and with histology two years after the diagnosis, unless the clinical response is poor. Poor disease control is associated with complications such as lymphoma and small bowel adenocarcinoma. In the future, it is likely that new pharmacologic therapies will be available for the management of celiac disease. <![CDATA[<b>Overview and perspectives of mesenchymal stem cell therapy in intensive care medicine</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000200011&lng=pt&nrm=iso&tlng=pt Development of innovative therapies in intensive care medicine is particularly important since diseases as sepsis, acute respiratory distress syndrome (ARDS) and acute renal injury (AKI) have an elevated morbidity and mortality in spite of current gold-standard approaches. Mesenchymal stem cells (MSC) may have a promising role due to their properties in immunomodulation, tissue reparation and microbial clearance. Preclinical data and results of a systematic review of PubMed, PMC and ClinicalTrials.gov have been included to review the role of MSC therapy in sepsis, ARDS and AKI. A description of MSC biology, sources and benefits in preclinical models was included. A phase I/II clinical trial (RCT) is recruiting neutropenic patients with septic shock. In ARDS, the START trial (Stem cells in ARDS Treatment) is a phase I/II study of bone marrow-derived human MSC (hMSC) that is currently recruiting patients. In AKI, a phase I study has demonstrated the safety of hMSCs infusion in patients undergoing cardiac surgery with high risk to develop AKI. A phase II study is still active. The results of these studies will determine the real feasibility of MSC therapy in critically ill patients. <![CDATA[<b>Hydroxychloroquine for autoimmune diseases</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000200012&lng=pt&nrm=iso&tlng=pt Hydroxychloroquine (HCQ) is by far the most frequently used antimalarial for the management of Systemic Autoimmune Diseases. It has immunomodulatory, hypolipidemic, hypoglycemic and antithrombotic properties and it diminishes the risk of malignancies. The most important mechanisms to explain the immunomodulatory actions are its ability to reduce inflammatory pathways and Toll-like receptors activation. The safety profile is favorable. In spite of its low frequency, retinal toxicity is potentially severe. In systemic lupus erythematous HCQ therapy reduces activity, the accrual of organ damage, risk of infections and thrombosis and improves the cardiometabolic profile. It contributes to induce lupus nephritis remission, spares steroid use and increases survival rates. In rheumatoid arthritis, it improves cardiometabolic risk and has a favorable effect in joint inflammation. In Sjögren’s syndrome, an increased lacrimal quality as well as an improvement in objective and subjective inflammatory markers has been demonstrated with HCQ. In Antiphospholipid Syndrome, HCQ is effective in primary and secondary thrombosis prevention. The effectiveness of the drug in other systemic autoimmune diseases is less established. HCQ therapy may improve dermatological manifestations in Dermatomyositis and may have a positive effects in the treatment of Sarcoidosis and Still disease. <![CDATA[<b>The human corpse in arts and bioethics</b>: <b>Michelangelo´s Pietà Rondanini</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000200013&lng=pt&nrm=iso&tlng=pt According to bioethics, life is a fundamental but not an absolute good. Therefore the value of a person resides in being alive, no matter in which state such person is. The concept of brain death is legally and ethically accepted as the definition of death. In artworks, human beings are revealed as they are. Michelangelo’s Pietà Rondanini captures and captures what a human corpse is, in its most intimate appearance. The artist boldly reveals its essence. <![CDATA[<b><i>Proposal to address the mental health problems detected after the February 27, 2010 earthquake</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000200014&lng=pt&nrm=iso&tlng=pt One of the most important topics mentioned by people from places affected by the February 27th, 2010 earthquake to the Presidential Delegation for the Reconstruction, was the urgent need of mental health care. Given the enormous individual and social burden of mental health sequelae after disasters, its treatment becomes a critical issue. In this article, we propose several actions to be implemented in Chile in the context of the process of recovery and reconstruction, including optimization of social communication and media response to disasters; designing and deployment of a national strategy for volunteer service; training of primary care staff in screening and initial management of post-traumatic stress reactions; and training, continuous education and clinical supervision of a critical number of therapists in evidence-based therapies for conditions specifically related to stress. <![CDATA[<b>When the violation of medical confidentiality is imposed by law</b>: <b>Another side effect of Law N° 20.584</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000200015&lng=pt&nrm=iso&tlng=pt A law of rights and duties of patients was recently enacted in Chile (Law N° 20.584). When someone dies, the law allows his inheritors to have access to part or the totality of the medical record. Therefore, they may become acquainted of information that the patient gave in confidence to his physician, protected by “the medical confidentiality”. The original bill included the possibility that a doctor could deny information that could cause harm to the former holder of the clinical record, but this precaution was banned by congressmen, seriously damaging the institution of “medical confidentiality”, a cornerstone of the medical-patient relationship since the beginning of medicine. <![CDATA[<b>Spontaneous coronary artery dissection</b>: <b>Report of two cases</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000200016&lng=pt&nrm=iso&tlng=pt Spontaneous coronary artery dissection is a rare condition that usually causes a coronary syndrome, but may also cause sudden death. It is more common in women and is associated with factors such as the peripartum period and oral contraceptive use. We report two cases. A 45-year-old woman with hepatitis C, presenting in the emergency room with angina. An intravascular ultrasound showed a dissecting hematoma involving the left, anterior descending and circumflex coronary arteries. She was initially managed with nitroglycerin, anticoagulation and anti-platelet drugs but due to persistence of symptoms, she required surgical revascularization. A 32-year-old woman presenting in the emergency room with angina. A coronary angiogram revealed a dissection of the anterior descending coronary artery. Eight days later an intravenous ultrasound showed a retrograde progression of the dissection and she was subjected to a surgical revascularization. <![CDATA[<b>Chronic eosinophilic pneumonia</b>: <b>Report of one case</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000200017&lng=pt&nrm=iso&tlng=pt Chronic eosinophilic pneumonia (CEP) is uncommon and predominantly seen in women. More than 6% of eosinophils in peripheral blood and more than 25% in bronchoalveolar lavage are diagnostic criteria. Secondary causes of hypereosinophilic pneumonia must be ruled out. We report a 72-year-old non-smoker man presenting in the emergency room with a history of cough, fever, and moderate dyspnea. He was not taking any medication. A chest-X ray showed a left lower lobe (LLL) consolidation, and was started on broad-spectrum antibiotics with a presumptive diagnosis of pneumonia. There was no improvement after therapy. A chest CT scan showed increased LLL consolidation and new left upper lobe ground glass opacities as well as a moderate left pleural effusion. Flexible bronchoscopy was performed and bronchoalveolar lavage showed 95% eosinophils, and had negative cultures. No parasites were identified. Transbronchial biopsies demonstrated eosinophil accumulation in alveoli and interstitium and pleural fluid was composed by 85% eosinophils. With the diagnosis of CEP, systemic corticosteroids were used with favorable clinical and radiological response. <![CDATA[<b>Chile's report card on physical activity: contributing to a global initiative for more active children and adolescents</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000200018&lng=pt&nrm=iso&tlng=pt Chronic eosinophilic pneumonia (CEP) is uncommon and predominantly seen in women. More than 6% of eosinophils in peripheral blood and more than 25% in bronchoalveolar lavage are diagnostic criteria. Secondary causes of hypereosinophilic pneumonia must be ruled out. We report a 72-year-old non-smoker man presenting in the emergency room with a history of cough, fever, and moderate dyspnea. He was not taking any medication. A chest-X ray showed a left lower lobe (LLL) consolidation, and was started on broad-spectrum antibiotics with a presumptive diagnosis of pneumonia. There was no improvement after therapy. A chest CT scan showed increased LLL consolidation and new left upper lobe ground glass opacities as well as a moderate left pleural effusion. Flexible bronchoscopy was performed and bronchoalveolar lavage showed 95% eosinophils, and had negative cultures. No parasites were identified. Transbronchial biopsies demonstrated eosinophil accumulation in alveoli and interstitium and pleural fluid was composed by 85% eosinophils. With the diagnosis of CEP, systemic corticosteroids were used with favorable clinical and radiological response. <![CDATA[<b>Adherence to treatment in chronic diseases and the patient’s experience</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000200019&lng=pt&nrm=iso&tlng=pt Chronic eosinophilic pneumonia (CEP) is uncommon and predominantly seen in women. More than 6% of eosinophils in peripheral blood and more than 25% in bronchoalveolar lavage are diagnostic criteria. Secondary causes of hypereosinophilic pneumonia must be ruled out. We report a 72-year-old non-smoker man presenting in the emergency room with a history of cough, fever, and moderate dyspnea. He was not taking any medication. A chest-X ray showed a left lower lobe (LLL) consolidation, and was started on broad-spectrum antibiotics with a presumptive diagnosis of pneumonia. There was no improvement after therapy. A chest CT scan showed increased LLL consolidation and new left upper lobe ground glass opacities as well as a moderate left pleural effusion. Flexible bronchoscopy was performed and bronchoalveolar lavage showed 95% eosinophils, and had negative cultures. No parasites were identified. Transbronchial biopsies demonstrated eosinophil accumulation in alveoli and interstitium and pleural fluid was composed by 85% eosinophils. With the diagnosis of CEP, systemic corticosteroids were used with favorable clinical and radiological response. <![CDATA[<b>Fifty years of the Family Planning Program in Chile</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000200020&lng=pt&nrm=iso&tlng=pt Chronic eosinophilic pneumonia (CEP) is uncommon and predominantly seen in women. More than 6% of eosinophils in peripheral blood and more than 25% in bronchoalveolar lavage are diagnostic criteria. Secondary causes of hypereosinophilic pneumonia must be ruled out. We report a 72-year-old non-smoker man presenting in the emergency room with a history of cough, fever, and moderate dyspnea. He was not taking any medication. A chest-X ray showed a left lower lobe (LLL) consolidation, and was started on broad-spectrum antibiotics with a presumptive diagnosis of pneumonia. There was no improvement after therapy. A chest CT scan showed increased LLL consolidation and new left upper lobe ground glass opacities as well as a moderate left pleural effusion. Flexible bronchoscopy was performed and bronchoalveolar lavage showed 95% eosinophils, and had negative cultures. No parasites were identified. Transbronchial biopsies demonstrated eosinophil accumulation in alveoli and interstitium and pleural fluid was composed by 85% eosinophils. With the diagnosis of CEP, systemic corticosteroids were used with favorable clinical and radiological response. <![CDATA[<b><i>The VIP Patient</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000200021&lng=pt&nrm=iso&tlng=pt Chronic eosinophilic pneumonia (CEP) is uncommon and predominantly seen in women. More than 6% of eosinophils in peripheral blood and more than 25% in bronchoalveolar lavage are diagnostic criteria. Secondary causes of hypereosinophilic pneumonia must be ruled out. We report a 72-year-old non-smoker man presenting in the emergency room with a history of cough, fever, and moderate dyspnea. He was not taking any medication. A chest-X ray showed a left lower lobe (LLL) consolidation, and was started on broad-spectrum antibiotics with a presumptive diagnosis of pneumonia. There was no improvement after therapy. A chest CT scan showed increased LLL consolidation and new left upper lobe ground glass opacities as well as a moderate left pleural effusion. Flexible bronchoscopy was performed and bronchoalveolar lavage showed 95% eosinophils, and had negative cultures. No parasites were identified. Transbronchial biopsies demonstrated eosinophil accumulation in alveoli and interstitium and pleural fluid was composed by 85% eosinophils. With the diagnosis of CEP, systemic corticosteroids were used with favorable clinical and radiological response. <![CDATA[<b>Respuesta del Editor</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000200022&lng=pt&nrm=iso&tlng=pt Chronic eosinophilic pneumonia (CEP) is uncommon and predominantly seen in women. More than 6% of eosinophils in peripheral blood and more than 25% in bronchoalveolar lavage are diagnostic criteria. Secondary causes of hypereosinophilic pneumonia must be ruled out. We report a 72-year-old non-smoker man presenting in the emergency room with a history of cough, fever, and moderate dyspnea. He was not taking any medication. A chest-X ray showed a left lower lobe (LLL) consolidation, and was started on broad-spectrum antibiotics with a presumptive diagnosis of pneumonia. There was no improvement after therapy. A chest CT scan showed increased LLL consolidation and new left upper lobe ground glass opacities as well as a moderate left pleural effusion. Flexible bronchoscopy was performed and bronchoalveolar lavage showed 95% eosinophils, and had negative cultures. No parasites were identified. Transbronchial biopsies demonstrated eosinophil accumulation in alveoli and interstitium and pleural fluid was composed by 85% eosinophils. With the diagnosis of CEP, systemic corticosteroids were used with favorable clinical and radiological response.