Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720160004&lang=pt vol. 144 num. 4 lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[<strong>Inappropriate medication use among Chilean older people</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000400001&lng=pt&nrm=iso&tlng=pt Background: Inappropriate medication use in older people is an important source of adverse events and complications. Aim: To determine the frequency of inappropriate medication use in the general population. Material and Methods: As part of the 2010 Chilean National Health Survey, 1,048 persons aged 65 years or more were interviewed about medication use. The information obtained was analyzed using standardized Beer’s criteria, adapted for the Chilean population, to define inappropriate medication use. A logistic regression model was performed to define risk factors for inappropriate medication use. Results: Ten percent of subjects had a high risk of inappropriate medication use. The most common medications used were chlorphenamine, amitriptyline, diazepam, chlorpromazine, chlordiazepoxide and piroxicam. The risk factors detected were female gender, polypharmacy and a bad health self-perception. Conclusions: Inappropriate medication use is common among Chilean older people and should be discouraged. <![CDATA[<strong>Assessment of the Chilean rural practitioner program by its participating physicians</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000400002&lng=pt&nrm=iso&tlng=pt Background: Rural areas have scarce medical resources. Initiatives to address this situation in Latin America exist, but have been poorly evaluated. The Chilean Rural Practitioner Program, a policy of recruitment and retention of physicians in rural areas, has been stable over time. Aim: To examine how physicians who participate in this program evaluate it. Material and Methods: Nationally representative cross sectional study. Physicians were chosen to respond online or by telephone a specially designed questionnaire about the Program. Results: 202 participants answered (response rate of 60%). The overall experience was evaluated with 5.75 points (in a 1 to 7 scale). Participants gave the best scores to climatic conditions and economic income, and rated infrastructure, human resources and workload the worst. The evaluation of social relationships at the destination place was the only condition associated significantly with the overall assessment of the experience. Seventy percent of physicians would return to the destination place as a specialist. The value given to social relations and infrastructure were associated positively with this potential return. Conclusions: Overall, the experience was positively evaluated. This study provides information to improve retention policies for human resources for health care in rural areas. <![CDATA[<strong>Reversion of methacholine induced bronchoconstriction with inhaled diazepam in patients with asthma</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000400003&lng=pt&nrm=iso&tlng=pt Background: Benzodiazepines have a direct bronchodilatory effect. Methacholine is a non-selective muscarinic receptor agonist causing bronchoconstriction. Aim: To examine the effects of inhaled benzodiazepines, modulating bronchoconstriction induced by methacholine in patients with asthma. Patients and Methods: Twelve patients with well controlled asthma were studied. On the first day, after determining the initial values of pulmonary function, a dose response curve was carried out with progressive doses of methacholine. After the last dose, when at least a 20% drop of the initial forced expiratory volume in the first second (FEV1) was achieved, vital capacity (VC) and FEV1 were measured at 7, 15 and 30 minutes after provocation. On the second day a diazepam aerosol was inhaled by the patients prior to the same protocol with methacholine. Results: In the first day of testing, methacholine inhalation (6 mg/mL) led to a significant drop in FEV1 from 2.98 to 1.69 L. On the second day of study, in the same patients, previous inhalation with diazepam reduced the changes of FEV1 after inhalation of methacholine. This parameter decreased from 2.48 to 2.21 L. Conclusions: Inhalation of benzodiazepines reduce bronchoconstriction after a methacholine challenge in patients with asthma.<hr/>Antecedentes: Las benzodiacepinas tienen un efecto broncodilatador directo. La metacolina es un agonista muscarínico que causa bronco constricción. Objetivo: Evaluar el efecto modulador de la inhalación de diazepam sobre la bronco constricción inducida por metacolina. Pacientes y Métodos: Se estudiaron 12 pacientes con asma bien controlada. En el primer día, se determinó la curva dosis respuesta de parámetros de función pulmonar a una dosis progresiva de metacolina. Después de la última dosis, cuando se consiguió un 20% de reducción en la capacidad vital forzada en el primer segundo (FEV1), se midió FEV1 y la capacidad vital (CV) a los 7, 15 y 30 min después de la provocación. En el segundo día los pacientes se inhalaron con diazepam antes de hacer la prueba con metacolina. Resultados: En el primer día, el FEV1 bajo de 2,98 a 1,69 l con 6 mg/ml de metacolina. En el segundo día, la inhalación de diazepam redujo la respuesta a metacolina con una reducción de FEV1 de 2,48 a 2,21 L. Conclusiones: La benzodiacepinas reducen la respuesta de vasoconstricción a metacolina. <![CDATA[<strong>Intravenous thrombolysis for ischemic stroke</strong>: <strong>Experience in 54 patients</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000400004&lng=pt&nrm=iso&tlng=pt Background: Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) reduces disability in patients with ischemic stroke. However, its implementation in Chilean public general hospitals has been slow and faces some difficulties. Aim: To analyze the results of an intravenous thrombolysis protocol implementation in a public general hospital. Material and Methods: During a lapse of 28 months a standardized protocol for intravenous thrombolysis implemented in the emergency room of a public hospital, was prospectively evaluated. Fifty four patients with ischemic stroke were treated and assessed three months later as outpatients. Results: At three months of follow-up, 66.4% of patients subjected to thrombolysis had a favorable evolution, defined as having 0 to 1 points in the modified Rankin scale. Intracerebral hemorrhage rate was 11.1%, including 5.5% of symptomatic intracerebral hemorrhage. Four percent of patients had systemic bleeding complications after thrombolysis. The mortality rate was 14.8%. Conclusions: The success rates, mortality, and complications rate were comparable to the results obtained in international studies, despite of the absence of a stroke unit to manage stroke and its complications. <![CDATA[<strong>Usefulness of upper gastrointestinal series to detect leaks in the early postoperative period of bariatric surgery</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000400005&lng=pt&nrm=iso&tlng=pt Background: Postoperative leaks are the most undesirable complication of bariatric surgery and upper gastrointestinal (GI) series are routinely ordered to rule them out. Despite the published literature recommending against its routine use, it is still being customarily used in Chile. Aim: To examine the usefulness of routine upper GI series using water-soluble iodinated contrast media for the detection of early postoperative leaks in patients undergoing bariatric surgery. Material and Methods: A cohort of 328 patients subjected to bariatric surgery was followed from October 2012 to October 2013. Most of them underwent sleeve gastrectomy. Results: Upper GI series on the first postoperative day were ordered to 308 (94%) patients. Postoperative leaks were observed in two patients, with an incidence of 0.6%. The sensitivity for upper GI series detection of leak was 0% and the negative predictive value was 99%. Conclusions: Routine upper GI series after bariatric surgery is not useful for the diagnosis of postoperative leak, given the low incidence of this complication and the low sensitivity of the technique. <![CDATA[<strong>Cost effectiveness of a theoretical cardiac rehabilitation program after </strong><b> <strong>myocardial infarction</strong></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000400006&lng=pt&nrm=iso&tlng=pt Background: Secondary prevention programs are an essential part of comprehensive care of patients with cardiovascular disease (CVD), and its effectiveness in reducing morbidity or mortality has been proved. Aim: To determine the cost-effectiveness of a theoretical comprehensive cardiac rehabilitation (CCR) outpatient program after Myocardial Infarction, to be implemented in a Chilean Public Health System. Material and Methods: We designed a theoretical protocol of a CCR program based on recommendations of international guidelines, but adapted to local needs. A cost analysis was developed. Life years due to premature death were estimated with and without participation in CCR. The gained life-years and cost-effectiveness of the program were thus calculated. Results: The annual cost of cardiac rehabilitation center is $ 64,407,065 Chilean pesos (CLP). The Incremental Cost Effectiveness Ratio (ICER) considering a reduction of late mortality of 25%, is $ 475,209.7 CLP per year of life gained. Since this figure is lower than one unit of per capita gross domestic product, the intervention is considered very cost-effective. Conclusions: A comprehensive cardiac rehabilitation program after myocardial infarction is very cost-effective in the context of its implementation in a public health service. <![CDATA[<strong>Smoking and alcohol use among Chilean teenagers aged 10 to 14 years</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000400007&lng=pt&nrm=iso&tlng=pt Background: Smoking and alcohol use are risky behaviors that can start early in life. Aim: To determine the lifetime prevalence of tobacco and alcohol use in adolescents aged 10 to 14 years and related factors. Subjects and Methods: A survey about smoking and alcohol use was answered by 1,392 teenagers aged 10 to 14 years (46% women) from seven schools in a small city near Santiago. Personal, family, and school factors were evaluated through self-report scales. Smoking and alcohol use, as dichotomous dependent variables, were defined as having consumed any of these substances throughout life. Prevalence was calculated as percentages with 95% confidence intervals. Association analyses were conducted using multivariable logistic regression models. Results: Six and eleven percent of participants reported having smoked and used alcohol in their life, respectively. Smoking was associated with age, having behavioral problems, mothers’ smoking, perceiving that parents had drug problems, and not living with both parents. Alcohol use was mainly associated with age, having behavioral problems, perceiving that other students consumed drugs, alcohol use by both parents, and perceiving a lack of family support. Conclusions: Tobacco and alcohol use is highly prevalent in adolescents aged 10-14 years. There were common risk factors for smoking and alcohol use such as age and having behavioral problems, while other factors were more specific such as mothers’ smoking, or parental alcohol use. <![CDATA[<strong>Obesity, a risk factor for ascending bacterial infection during pregnancy</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000400008&lng=pt&nrm=iso&tlng=pt Background: Obesity in pregnancy is associated with significantly higher rates of infection. Aim: To compare the infectious morbidity in pregnant women with normal and altered body mass index (BMI). Material and Methods: Cross sectional retrospective study of 6,150 patients who had delivery or second trimester abortion during 2012. The patients were classified according to BMI as underweight, normal weight, overweight and obese. We compared the frequency of pregnancy and perinatal complications related to ascending bacterial infection (ABI). The data was obtained from the hospital’s databases. Results: Obese patients had higher rates of pregnancy and perinatal complications related to ABI compared to patients with normal weight. The odds ratios (OR) and 95% confidence intervals (CI) for second trimester abortion were 3.45 (1.63-7.31) p < 0.01, for preterm delivery 2.42 (1.51-3.87) p < 0.01, for labor and puerperium infections 3.42 (2.06-5.68) p < 0.01 and for early neonatal infectious and perinatal mortality 4.46 (1.75-11.37) p < 0.01. A logistic regression analysis revealed that obesity is an independent risk factor for second trimester abortion related to ABI with an OR of 3.18 (CI 95% 1.46-6.91), premature delivery related to ABI with an OR of 2.51 (CI 95% 1.54-4.09) and for delivery and postpartum infections with an OR of 4.44 (CI 95% 2.62 to 7.51). Conclusions: Obese pregnant women had a 2.5 to 4.5 times increased risk of infectious morbidity compared to normal weight patients. Obesity is an independent risk factor for second trimester abortion and preterm delivery related to ABI and delivery and postpartum infectious. <![CDATA[<strong>Recent case law about the right to die</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000400009&lng=pt&nrm=iso&tlng=pt This paper reviews the sentences dictated between 1993 and 2002 by the Supreme Courts of Canada and the Unites States, the House of Lords and Supreme Court of the United Kingdom and the European Human Rights Court, about the validity of the legal prohibition of assistance for suicide. These sentences constituted a judicial consensus about the right to die. This consensus recognized the legal right of patients to reject medical treatments but did not recognize the right to be assisted by a physician to commit suicide. This exclusion is changing in the recent case law of Canada and the United Kingdom, which accepts the fundamental right of terminal patients to medically assisted suicide. <![CDATA[<strong>Towards an integral management of inflammatory bowel disease</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000400010&lng=pt&nrm=iso&tlng=pt Inflammatory Bowel Disease (IBD) is a chronic inflammatory condition of the gastrointestinal tract with medical and psychological complications. Addressing psychosocial aspects of treatment, such as quality of care and disability remains a challenge. The quality of care for IBD patients is not optimal at the present time and there is a variation in the care provided by specialists. Therefore, it is necessary to develop well defined quality indicators to assure the delivery of an adequate care to these patients. The delivery of healthcare for IBD patients is often complex and requires multidisciplinary teams. The ultimate objectives in the treatment of IBD should be to prevent bowel damage, reduce long-term disability and maintain a normal quality of life. <![CDATA[<strong><i>Reality and challenges of the oral health for older adults in Chile and the role of a new discipline</i></strong>: <strong><i>geriatric dentistry</i></strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000400011&lng=pt&nrm=iso&tlng=pt Chile is experiencing one of the fastest aging processes in Latin America. The implications derived from this phenomenon involve many aspects of the society, especially health care. In particular, insufficient oral health coverage in the country limits oral care provision for a population with a high prevalence and severity of oral diseases. These conditions include dental caries, periodontal disease, tooth loss, defective prostheses, oral mucosa lesions and xerostomia, among others, and strongly affect quality of life of the elderly population. Furthermore, dental curriculum of most dental schools lack specific training of students in geriatric dentistry or gerodontology. Hence, newly graduated professionals are not competent to satisfy the needs of this growing and increasingly demanding population of older adults. Within this demanding context, Chile may find the potential to become a model and referent to deal with the challenge, incorporating innovative changes in education and public health strategies for the older population by an interdisciplinary approach. <![CDATA[<strong>History of scrofula</strong>: <strong>from humoral dyscrasia to consumption</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000400012&lng=pt&nrm=iso&tlng=pt The term “scrofula” was used for a long time to designate a chronic swelling of cervical lymph nodes. This paper outlines the prevalent ideas on the nature, pathogenesis and the treatment of this disorder, from classical Greek medicine up to the 18th century. A Hippocratic treatise regarded scrofula as produced by an accumulation of phlegm, with a consequent imbalance or dyscrasia of the body humors. It was believed that it could heal spontaneously; but it could also soften, open through the skin and have an obstinate course. The treatment consisted mainly on local applications, incision to evacuate the soft content, or extirpation of the abnormal mass. In France and England, crowds of scrofulous patients were touched by the kings who were supposed to have a hereditary miraculous power to cure the disease. A Medieval text mentioned that scrofula could also affect other parts of the body. In the 17th century, scrofula was reputed as a frequent condition and was attributed to blood acrimony which coagulated in spongy organs. It was associated to phthisis or consumption due to the lethal outcome in some patients and to a cheese-like appearance of the pulmonary and the scrofulous lesions. <![CDATA[<strong>Association between microRNA single nucleotide polymorphisms and the risk of hepatocellular carcinoma</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000400013&lng=pt&nrm=iso&tlng=pt Background: Hepatocellular carcinoma (HCC) has a high morbidity and mortality. Single nucleotide polymorphisms (SNPs) of microRNA (miRNA) may be associated with the susceptibility to develop certain malignant tumors. Aim: To study the association between SNPs of miRNA and hepatocellular carcinoma in peripheral blood samples. Material and Methods: Three SNPs in miRNA were studied in peripheral blood samples of 498 patients with HCC and 520 controls. Results: A significant association was observed between rs13299349 in miRNA3152 and HCC. AA genotype or A allele were significantly associated with increased risk of HCC. A allele was associated with the size and number of tumor foci. There was also a relationship between rs10061133 in miRNA449b and HCC. The G allele was significantly associated with increased risk of HCC compared with A allele. Conclusions: This study links rs13299349 in miRNA3152 and rs10061133 in miRNA449b with the risk of developing HCC.<hr/>Antecedentes: El carcinoma hepatocelular (CHC) tiene una alta morbilidad y mortalidad. Polimorfismos de un nucleótido (SNP) presentes en el microRNA (miRNA) circulante pueden asociarse a ciertos tumores. Objetivo: Estudiar la asociación entre la presencia de SNPs en miRNA circulante y la presencia de carcinoma hepatocelular. Material y Métodos: Se determinó la presencia de tres SNP en microRNA de sangre periférica en 498 pacientes con CHC y 520 controles. Resultados: El SNP rs13299349 en el miRNA3152 se asoció con CHC. El genotipo AA o el alelo A se asociaron con un riesgo mayor de presentar un CHC. El alelo A se asoció además con el tamaño y número de focos del tumor. Se observó también una relación entre el SNP rs10061133 en el miRNA449b y HCC. En este caso, el alelo G se relacionó con un mayor riesgo de CHC. Conclusiones: Los SNP rs13299349 en el miRNA3152 y rs10061133 en el miRNA449b se asocian al riesgo de desarrollar CHC. <![CDATA[<strong>Chronic kidney disease associated with Poems syndrome</strong>: <strong>Report of one case</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000400014&lng=pt&nrm=iso&tlng=pt POEMS syndrome is characterized by Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal protein and Skin changes. We report a woman with the syndrome, who had peripheral polyneuropathy, osteosclerotic myeloma, monoclonal IgA elevation, hypothyroidism, hypogonadotrophic hypogonadism, hyperprolactinemia, adrenal insufficiency, hepatosplenomegaly, lymphadenopathy, thyroid and parotid enlargement, Castleman’s disease, papilledema, stiff and hyperpigmented skin, white nails, clubbing, ascites and chronic diarrhea. She had also a nephropathy characterized by microscopic hematuria, proteinuria, renal insufficiency and a unilateral kidney retraction. She was treated with melphalan and prednisone, achieving remission of the disease and nephropathy. She survived twelve years and died due to a myocardial infarction 20 years after POEMS diagnosis. <![CDATA[<strong>Cerebellar hemangioblastoma and thrombocytopenia</strong>: <strong>Report of one case</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000400015&lng=pt&nrm=iso&tlng=pt The association between vascular tumors and thrombocytopenia is rare. Kasabach-Merritt Syndrome is seen in childhood and is characterized by hemangiomas and thrombocytopenia. A 42 years-old man with a cerebellar hemangioblastoma and thrombocytopenia, admitted with a subarachnoid hemorrhage is reported. The patient was operated and required a splenectomy to manage the thrombocytopenia. After the splenectomy the patient developed a subdural hematoma that was operated. Despite the surgical treatment, the patient died. <![CDATA[<strong><i>Suicide attempts and self inflicted harm</i></strong>: <strong><i>a one year follow up of risk behaviors among out of treatment cocaine users</i></strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000400016&lng=pt&nrm=iso&tlng=pt Background: Cocaine users tend to have a higher frequency of risk behaviors. Aim: To compare risk behaviors of out ­of ­treatment Cocaine Base Paste (CBP) and Cocaine Hydrochloride (CH) users, by means of Privileged Access Interviewing in a one­ year prospective study. Material and Methods: Twenty ­eight interviewers were trained to recruit and administer a questionnaire on substance use patterns and related risk behaviors. Intentioned sampling was carried out in four municipalities of Santiago, Chile. Subjects who used CBP (group 1) or CH (group 2) at least once in the last month, with primary current use of CBP (group 1) or CH (group 2), and without treatment for substance abuse in the last six months were interviewed. Generalized Estimating Equations (GEE) were employed to compare risk behaviors during follow ­up. Results: Four hundred and two of 467 subjects (86.1%) were followed up for one year. CBP users (n = 204) reported greater frequency of self ­inflicted injuries (Odds Ratio (OR): 1.97 [95% confidence intervals (CI): 1.07­3.66]) and suicide attempts (OR: 2.68 [95% CI: 1.19­6.01]) than CH users. Conclusions: CBP users had a greater frequency of self ­inflicted injuries and suicide attempts, both life threatening risk behaviors, than CH users. This profile shows the high vulnerability of CBP users and should encourage further research and design of outreach interventions, particularly focused on this group. <![CDATA[<strong>ETESA, spheres and STS</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000400017&lng=pt&nrm=iso&tlng=pt Background: Cocaine users tend to have a higher frequency of risk behaviors. Aim: To compare risk behaviors of out ­of ­treatment Cocaine Base Paste (CBP) and Cocaine Hydrochloride (CH) users, by means of Privileged Access Interviewing in a one­ year prospective study. Material and Methods: Twenty ­eight interviewers were trained to recruit and administer a questionnaire on substance use patterns and related risk behaviors. Intentioned sampling was carried out in four municipalities of Santiago, Chile. Subjects who used CBP (group 1) or CH (group 2) at least once in the last month, with primary current use of CBP (group 1) or CH (group 2), and without treatment for substance abuse in the last six months were interviewed. Generalized Estimating Equations (GEE) were employed to compare risk behaviors during follow ­up. Results: Four hundred and two of 467 subjects (86.1%) were followed up for one year. CBP users (n = 204) reported greater frequency of self ­inflicted injuries (Odds Ratio (OR): 1.97 [95% confidence intervals (CI): 1.07­3.66]) and suicide attempts (OR: 2.68 [95% CI: 1.19­6.01]) than CH users. Conclusions: CBP users had a greater frequency of self ­inflicted injuries and suicide attempts, both life threatening risk behaviors, than CH users. This profile shows the high vulnerability of CBP users and should encourage further research and design of outreach interventions, particularly focused on this group. <![CDATA[<strong>Talented students from vulnerable contexts and their admission into Medical Schools</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000400018&lng=pt&nrm=iso&tlng=pt Background: Cocaine users tend to have a higher frequency of risk behaviors. Aim: To compare risk behaviors of out ­of ­treatment Cocaine Base Paste (CBP) and Cocaine Hydrochloride (CH) users, by means of Privileged Access Interviewing in a one­ year prospective study. Material and Methods: Twenty ­eight interviewers were trained to recruit and administer a questionnaire on substance use patterns and related risk behaviors. Intentioned sampling was carried out in four municipalities of Santiago, Chile. Subjects who used CBP (group 1) or CH (group 2) at least once in the last month, with primary current use of CBP (group 1) or CH (group 2), and without treatment for substance abuse in the last six months were interviewed. Generalized Estimating Equations (GEE) were employed to compare risk behaviors during follow ­up. Results: Four hundred and two of 467 subjects (86.1%) were followed up for one year. CBP users (n = 204) reported greater frequency of self ­inflicted injuries (Odds Ratio (OR): 1.97 [95% confidence intervals (CI): 1.07­3.66]) and suicide attempts (OR: 2.68 [95% CI: 1.19­6.01]) than CH users. Conclusions: CBP users had a greater frequency of self ­inflicted injuries and suicide attempts, both life threatening risk behaviors, than CH users. This profile shows the high vulnerability of CBP users and should encourage further research and design of outreach interventions, particularly focused on this group. <![CDATA[<strong>An unusual case of rupture of a nonaneurysmal aorta secondary to Salmonella aortitis</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000400019&lng=pt&nrm=iso&tlng=pt Background: Cocaine users tend to have a higher frequency of risk behaviors. Aim: To compare risk behaviors of out ­of ­treatment Cocaine Base Paste (CBP) and Cocaine Hydrochloride (CH) users, by means of Privileged Access Interviewing in a one­ year prospective study. Material and Methods: Twenty ­eight interviewers were trained to recruit and administer a questionnaire on substance use patterns and related risk behaviors. Intentioned sampling was carried out in four municipalities of Santiago, Chile. Subjects who used CBP (group 1) or CH (group 2) at least once in the last month, with primary current use of CBP (group 1) or CH (group 2), and without treatment for substance abuse in the last six months were interviewed. Generalized Estimating Equations (GEE) were employed to compare risk behaviors during follow ­up. Results: Four hundred and two of 467 subjects (86.1%) were followed up for one year. CBP users (n = 204) reported greater frequency of self ­inflicted injuries (Odds Ratio (OR): 1.97 [95% confidence intervals (CI): 1.07­3.66]) and suicide attempts (OR: 2.68 [95% CI: 1.19­6.01]) than CH users. Conclusions: CBP users had a greater frequency of self ­inflicted injuries and suicide attempts, both life threatening risk behaviors, than CH users. This profile shows the high vulnerability of CBP users and should encourage further research and design of outreach interventions, particularly focused on this group. <![CDATA[<strong>Why do pre graduate medical interns go into strike in Perú?</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000400020&lng=pt&nrm=iso&tlng=pt Background: Cocaine users tend to have a higher frequency of risk behaviors. Aim: To compare risk behaviors of out ­of ­treatment Cocaine Base Paste (CBP) and Cocaine Hydrochloride (CH) users, by means of Privileged Access Interviewing in a one­ year prospective study. Material and Methods: Twenty ­eight interviewers were trained to recruit and administer a questionnaire on substance use patterns and related risk behaviors. Intentioned sampling was carried out in four municipalities of Santiago, Chile. Subjects who used CBP (group 1) or CH (group 2) at least once in the last month, with primary current use of CBP (group 1) or CH (group 2), and without treatment for substance abuse in the last six months were interviewed. Generalized Estimating Equations (GEE) were employed to compare risk behaviors during follow ­up. Results: Four hundred and two of 467 subjects (86.1%) were followed up for one year. CBP users (n = 204) reported greater frequency of self ­inflicted injuries (Odds Ratio (OR): 1.97 [95% confidence intervals (CI): 1.07­3.66]) and suicide attempts (OR: 2.68 [95% CI: 1.19­6.01]) than CH users. Conclusions: CBP users had a greater frequency of self ­inflicted injuries and suicide attempts, both life threatening risk behaviors, than CH users. This profile shows the high vulnerability of CBP users and should encourage further research and design of outreach interventions, particularly focused on this group. <![CDATA[<strong>Effect of the -1639G > A polymorphism of the VKORC1 gene on the dose of oral anticoagulants acenocoumarol, and warfarin in Chilean patients: alternative models of inheritance</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000400021&lng=pt&nrm=iso&tlng=pt Background: Cocaine users tend to have a higher frequency of risk behaviors. Aim: To compare risk behaviors of out ­of ­treatment Cocaine Base Paste (CBP) and Cocaine Hydrochloride (CH) users, by means of Privileged Access Interviewing in a one­ year prospective study. Material and Methods: Twenty ­eight interviewers were trained to recruit and administer a questionnaire on substance use patterns and related risk behaviors. Intentioned sampling was carried out in four municipalities of Santiago, Chile. Subjects who used CBP (group 1) or CH (group 2) at least once in the last month, with primary current use of CBP (group 1) or CH (group 2), and without treatment for substance abuse in the last six months were interviewed. Generalized Estimating Equations (GEE) were employed to compare risk behaviors during follow ­up. Results: Four hundred and two of 467 subjects (86.1%) were followed up for one year. CBP users (n = 204) reported greater frequency of self ­inflicted injuries (Odds Ratio (OR): 1.97 [95% confidence intervals (CI): 1.07­3.66]) and suicide attempts (OR: 2.68 [95% CI: 1.19­6.01]) than CH users. Conclusions: CBP users had a greater frequency of self ­inflicted injuries and suicide attempts, both life threatening risk behaviors, than CH users. This profile shows the high vulnerability of CBP users and should encourage further research and design of outreach interventions, particularly focused on this group. <![CDATA[<strong>Los autores aludidos ofrecieron la siguiente réplica</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000400022&lng=pt&nrm=iso&tlng=pt Background: Cocaine users tend to have a higher frequency of risk behaviors. Aim: To compare risk behaviors of out ­of ­treatment Cocaine Base Paste (CBP) and Cocaine Hydrochloride (CH) users, by means of Privileged Access Interviewing in a one­ year prospective study. Material and Methods: Twenty ­eight interviewers were trained to recruit and administer a questionnaire on substance use patterns and related risk behaviors. Intentioned sampling was carried out in four municipalities of Santiago, Chile. Subjects who used CBP (group 1) or CH (group 2) at least once in the last month, with primary current use of CBP (group 1) or CH (group 2), and without treatment for substance abuse in the last six months were interviewed. Generalized Estimating Equations (GEE) were employed to compare risk behaviors during follow ­up. Results: Four hundred and two of 467 subjects (86.1%) were followed up for one year. CBP users (n = 204) reported greater frequency of self ­inflicted injuries (Odds Ratio (OR): 1.97 [95% confidence intervals (CI): 1.07­3.66]) and suicide attempts (OR: 2.68 [95% CI: 1.19­6.01]) than CH users. Conclusions: CBP users had a greater frequency of self ­inflicted injuries and suicide attempts, both life threatening risk behaviors, than CH users. This profile shows the high vulnerability of CBP users and should encourage further research and design of outreach interventions, particularly focused on this group. <![CDATA[<strong>Andropause and vulnerability in health</strong>: <strong>when do we start to educate men and health professionals?</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000400023&lng=pt&nrm=iso&tlng=pt Background: Cocaine users tend to have a higher frequency of risk behaviors. Aim: To compare risk behaviors of out ­of ­treatment Cocaine Base Paste (CBP) and Cocaine Hydrochloride (CH) users, by means of Privileged Access Interviewing in a one­ year prospective study. Material and Methods: Twenty ­eight interviewers were trained to recruit and administer a questionnaire on substance use patterns and related risk behaviors. Intentioned sampling was carried out in four municipalities of Santiago, Chile. Subjects who used CBP (group 1) or CH (group 2) at least once in the last month, with primary current use of CBP (group 1) or CH (group 2), and without treatment for substance abuse in the last six months were interviewed. Generalized Estimating Equations (GEE) were employed to compare risk behaviors during follow ­up. Results: Four hundred and two of 467 subjects (86.1%) were followed up for one year. CBP users (n = 204) reported greater frequency of self ­inflicted injuries (Odds Ratio (OR): 1.97 [95% confidence intervals (CI): 1.07­3.66]) and suicide attempts (OR: 2.68 [95% CI: 1.19­6.01]) than CH users. Conclusions: CBP users had a greater frequency of self ­inflicted injuries and suicide attempts, both life threatening risk behaviors, than CH users. This profile shows the high vulnerability of CBP users and should encourage further research and design of outreach interventions, particularly focused on this group. <![CDATA[<strong>Dr. Alejandro Fajuri Noemi (1944-2016)</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872016000400024&lng=pt&nrm=iso&tlng=pt Background: Cocaine users tend to have a higher frequency of risk behaviors. Aim: To compare risk behaviors of out ­of ­treatment Cocaine Base Paste (CBP) and Cocaine Hydrochloride (CH) users, by means of Privileged Access Interviewing in a one­ year prospective study. Material and Methods: Twenty ­eight interviewers were trained to recruit and administer a questionnaire on substance use patterns and related risk behaviors. Intentioned sampling was carried out in four municipalities of Santiago, Chile. Subjects who used CBP (group 1) or CH (group 2) at least once in the last month, with primary current use of CBP (group 1) or CH (group 2), and without treatment for substance abuse in the last six months were interviewed. Generalized Estimating Equations (GEE) were employed to compare risk behaviors during follow ­up. Results: Four hundred and two of 467 subjects (86.1%) were followed up for one year. CBP users (n = 204) reported greater frequency of self ­inflicted injuries (Odds Ratio (OR): 1.97 [95% confidence intervals (CI): 1.07­3.66]) and suicide attempts (OR: 2.68 [95% CI: 1.19­6.01]) than CH users. Conclusions: CBP users had a greater frequency of self ­inflicted injuries and suicide attempts, both life threatening risk behaviors, than CH users. This profile shows the high vulnerability of CBP users and should encourage further research and design of outreach interventions, particularly focused on this group.