Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720080005&lang=es vol. 136 num. 5 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[<b>Combatiendo la epidemia de enfermedad coronaria en Chile</b>: <b>Potencialidades y problemas en el control de los factores de riesgo</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000500001&lng=es&nrm=iso&tlng=es In this issue of the journal Lanas et al report an estimation of population attributable risk (PAR) for myocardial infarction (MI) derived from different risk factors in Chile. Cigarette smoking, dyslipidemia and hypertension accounted for 71% of total PAR. Mortality from MI has decreased in Chile, but epidemiologic surveys carried out in different hospitals across the country, strongly support that most of this effect comes from better treatment of MI. Recent changes in public health policies, favoring the treatment of hypertension and diabetes may help control cardiovascular morbidity and mortality. However, a really significant impact will be obtained when the development of the disease may be halted. To evaluate this possibility, newer methods to diagnose atherosclerosis non invasively may come to our rescue. On the other hand, pharmacologic treatment of dyslipidemia and hypertension continue to offer the most powerful way to decrease levels of cardiovascular risk factors. According to current knowledge, wise balance of non pharmacologic and pharmacologic means of primary prevention, with due respect for ethic aspects, is the most effective way to curve the epidemic of coronary artery disease in Chile <![CDATA[<b>Riesgo individual y poblacional en infarto agudo del miocardio</b>: <b>Estudio INTERHEART Chile</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000500002&lng=es&nrm=iso&tlng=es Acute myocardial infarction (AMI) is the first cause of death in Chile. Aim To assess the magnitude of risk of individuals and population associated with AMI risk factors. Material and methods: Case control study with incident cases and 2 controls paired by age and gender. History of diabetes, hypertension, smoking, stress, depression, diet, weight, height, hip and waist circumference, apolipoprotein (Apo) Al and B were determined. Odds ratio (OR) and population attributable risk (PAR) were calculated with 95% confidence interval. Results: Three hundred thirty two cases and 672 controls were included. Mean age was 61.6±12 years and 22% were women. The higher individual risk was associated with smoking: OR 3.1 (2.3-4.2), hypertension: 2.9 (2.1-3.9), permanent stress: 2.2 (1,3-2,8), increased apoB/ApoAl ratio: 2.1 (1.4-3.0) and diabetes: 2.0 (1.4-2.9). A protective effect of daily consumption of vegetables and/or fruits with and OR of 0.54 (0.4-0.8), was observed. The highest PAR was due to smoking: 42% (33.2-51.4), increased ApoB/ApoAl ratio: 35.2 (19.0-55.8) and hypertension: 32% (24.5-40.8). These three factors explained 71.3% of the AMI risk in Chile. A moderate effect on PAR was observed for abdominal obesity: 16.6% (2.4-61.2), permanent stress: 12.0% (2.3-44.1) and diabetes: 10.8% (6.1-18.3). Conclusions: Known risk factors ¡ike dyslipidemia, smoking and hypertension explain most of the AMI cases in Chile. The control of these risk factors should have a major effect on morbidity and mortality due to coronary artery disease in our country <![CDATA[<b>Frecuencia y pesquisa de síntomas en pacientes crónicos en fases avanzadas en un hospital clínico</b>: <b>¿Existe concordancia entre pacientes y médicos?</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000500003&lng=es&nrm=iso&tlng=es Physicians tend to over or underestimate symptoms reported by patients. Therefore standardized symptom scoring systems have been proposed to overcome this drawback. Aim: To estimate the prevalence and the diagnostic accuracy of physical and psychological symptoms and delirium in patients admitted to an internal medicine service at a university hospital. Material and Methods: We studied 58 patients, 45 with metastasic cancer and 13 with other advanced chronic diseases. The following scales were used: the Confusion Assessment Method for the diagnosis of delirium; the Edmonton Symptom Assessment Scale (ESAS) for pain and other physical symptoms; the Hospital Anxiety and Depression Scale to assess anxiety and depression. The ESAS was simultaneously applied to patients without delirium and their doctors to assess the level of diagnostic concordance. Results: Twenty two percent of patients had delirium. Among the 45 patients without delirium, 11 (25%) had at least eight symptoms and 39 (88.6%) had four symptoms. The prevalence of symptoms was very high, ranging from 22 to 78%. Pain, restlesness, anorexia and sleep disorders were the most common. The concordance between symptoms reported by patients and those recorded by doctor was very low, with a Kappa index between 0.001 and 0.334. Conclusions: In our sample of chronic patients, there is a very high frequency of psychological and physical symptoms that are insufficiently recorded by the medical team <![CDATA[<b>Gasto energético y composición corporal en mujeres con obesidad severa y mórbida sometidas a <i>bypass </i>gástrico</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000500004&lng=es&nrm=iso&tlng=es The effects of gastric bypass (GBP) on resting energy expenditure (REE) are not well known. Aim: To evaluate the changes in REE and its relationship with body composition in severe and morbid obese women before and six and twelve months after GBP. Patients and methods: Twenty three women aged 37±10 years, with a body mass index of 44±4 kg/m², were evaluated before, six and twelve months after GBP. REE was measured in a Deltatrac indirect calorimeter and expressed as kcal/day Fat mass (EM), and fat free mass (EEM) were determined by double beam Xray densitometry (DEXA). Results: Body weight reduction six and twelve months after GBP was 29.0±4.3 and 35.8±6.9%, respectively. The best predictor of weight reduction was initial weight (p <0.01). At six and twelve months, REE decreased by 291.7±260.0 and 353.8±378.4 kcal/day, respectively. In the same periods REE/kg body weight increased by 3.3 and 4.8 kcal/kg respectively, compared to baseline. REE/kg EEM was unchanged. Conclusions: GBP was associated with significant changes in body composition after six and twelve months. However, despite weight reduction, resting energy expenditure per fat free mass unit did not change significantly <![CDATA[<b>Tuberculosis en individuos con infección por VIH en Chile</b>: <b>Estudio de prevalencia e impacto sobre mortalidad</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000500005&lng=es&nrm=iso&tlng=es Tuberculosis (TB) in Chile is reaching the elimination phase; however, in HIV positive individuals the incidence ofTB in still very high. Aim To describe the association between TB and HIV in different geographical regions in Chile, and to determine the association between TB and HIV/AIDS mortality. Patients and methods: A retrospective study that included individuals from the main HIV clinics from four regions with different TB prevalence in the general population (per 100,000): Arica (>30), Concepcion/Arauco (25-29), Valparaiso/San Antonio (20-24) and Metropolitana Sur-Oriente (SSMSO) (<20), attended between January 1998 and September 2004. Results: Nine hundred and twelve HIV positive individuals were included. Gobal prevalence ofTB was 6.2% [95% confidence intervals (Cl) 5.2-7.2%]. TB was more common in older subjects (p =0.039) and those with lower CD4 counts (p <0.001) and higher HIV viral load (p =0.033). In 66% of cases, the disease had a pulmonary localization. TB was the recorded cause of death in 7.4% of subjects. Only 29% of patients had a tuberculin skin test performed at the moment of HIV diagnosis. The prevalence of TB in HIV positive patients, followed the trend of TB prevalence in the general population: Concepcion/Arauco (11.9%), Valparaiso/San Antonio (7.1%) and SSMSO (3.9%). However HIV positive subjects from Arica showed an unexpectedly low TB prevalence (5.5%). Conclusions: TB in HIV/AIDS patients included in this study is over 300 times more prevalent than in the general population. TB prevalence in HIV positive subjects follows regional TB prevalence, excepting Arica. Effectiveness and feasibility of latent TB diagnostic strategies and treatment in HIV positive individuals should be reviewed <![CDATA[Neumonía adquirida en la comunidad en el anciano hospitalizado: Aspectos clínicos y nutricionales]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000500006&lng=es&nrm=iso&tlng=es Community acquired pneumonia (CAP) in the elderly has unique features and there is little information about the effects of nutrition status on its outcome. Aim: To assess the clinical manifestations and prognostic factors of CAP in immunocompetent elderly patients requiring hospitalization. Patients and methods: Prospective study of all patients with CAP, admitted to Puerto Montt Hospital, Chile over one year. Epidemiológica! and clinical information and laboratory results were recorded. A nutritional assessment was also performed. Outcomes of elderly (>65 years) and young patients were compared. Results: Two hundred patients aged 63± 19 years were studied. Of these, 109 were older than 65 years (78.4±8 years) and 91 were younger than 65years (45.5±11 years). Multiple associated diseases, altered mental status, absence of fever, malnutrition and mortality were more common in the older group. Suspected aspiration pneumonia was more common in younger patients, probably related to alcoholism. Malnutrition was associated with longer hospital stay and mortality at any age. An univariate analysis showed that a low serum albumin (<3.4 g/dl) and a mid arm muscle circumference below the 25th percentile were associated with higher mortality. Conclusions: CAP in the elderly has specific features and malnutrition is associated with a worse prognosis in young and elderly patients <![CDATA[<b>Resultados de la cirugía laparoscópica en el tratamiento electivo de la enfermedad diverticular de colon</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000500007&lng=es&nrm=iso&tlng=es The laparoscopic approach is an alternative for the elective treatment of diverticular colon disease (DCD). Aim: To analyze the results of patients electively operated for DCD using a laparoscopic technique. Material and Methods: Data of patients with DCD operated using laparoscopy at the Catholic University of Chile Clinical Hospital were prospectively recorded from January 1999 to August 2006. Indications for surgery were repetitive crises of acute diverticulitis, the persistence of the symptoms or anatomic deformity after the first crisis and complicated diverticulitis (Hinchey 1-2) that responded to the medical treatment. The laparoscopic technique used five ports and the surgical specimen was extracted through a suprapubic approach. Results: One hundred and six patients aged 32 to 82 years (49% females) were operated in the study period. Fifty five percent had a previous abdominal surgery. The mean operative time was 213 minutes (range: 135-360). Four patients were converted to open surgery (3.7%). One or more early post-operative complications were observed in five patients (4.7%). The mean time for passing gases and reinitiate liquid diet was 1.7 and 2.4 days respectively. The median post operative stay after surgery was 4 days. There was no operative mortality. Mean follow-up time was 27 months and only one patient (0.9%) had a new episode of acute diverticular disease, with a satisfactory response to medical treatment. No patient has developed bowel obstruction. Conclusions: The laparoscopic approach is a safe alternative in the elective surgical treatment of DCD <![CDATA[<b>Rendimiento de la colangiografía por resonancia magnética en el diagnóstico de coledocolitiasis</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000500008&lng=es&nrm=iso&tlng=es Magnetic resonance cholangiopancreatography MRCP) is a non-invasive diagnostic method for choledocholithiasis. Aim: To evaluate the results of MRCP in the diagnosis of choledocholithiasis. Patients and methods: Retrospective review of MRCP reports performed between October 2001 and December 2004. We included patients with suspected choledocholithiasis who were studied with MRCP and some other confirmatory test such as endoscopic retrograde cholangiopancreatography ERCP), surgical common bile duct exploration or transcystic colangiography TC). Results: One hundred and twenty five patients aged 58±20 years 70 females) were included. In 54 patients 43%) we compared the results of MRCP with the findings of surgical common bile duct exploration or TC and in 71 57%) we did so with ERCP. MRCP suggested choledocholithiasis in 93 patients and in 32 it was negative. Eighty six 67%) patients had choledocholithiasis according to TC or ERCP, including 3 patients who had a negative MRCP. Therefore the sensibility was 97%, specificity 74% positive predictive value 89%, negative predictive value 90% and accuracy of MRCP was 90% for the diagnosis of choledocholithiasis. Conclusions: MRCP has a high accuracy for the diagnosis of choledocholithiasis <![CDATA[<b>Caracterización molecular en aislados chilenos de <i>Streptococcus agalactiae</i></b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000500009&lng=es&nrm=iso&tlng=es Streptococcus agalactiae is the main causing organism of invasive infections such as sepsis and meningitis in the newborn. Aim: To perform a genotype characterization of Streptococcus agalactiae strains coming form invasive infections of newborns and colonized pregnant women. Material and methods: A group of 58 strains not related epidemiologically isolated from colonized pregnant women and invasive infections in newborns, were studied. Pulsed field electrophoresis (PFGE) and polymerase chain reaction amplification of hylB and IS 1548 genes, as possible virulence markers, were performed. Results: Among the studied strains, 37 genetic subtypes were observed. There were nine groups of identical PFGE patterns. Three corresponded to serotype la and six to serotype III. An erythromycin and clindamycin resistant clone was identified in three colonized women and a newborn with sepsis, which were not epidemiologically related. The hylB gene was equally present in cases of neonatal meningitis or colonized pregnant women. Conclusions: There was a great degree of polymorphism among the studied strains. The ample presence of hylB gene and the absence of the insertion element IS1548 in the hylB gene in invasive and colonizing strains, indicates that both groups of strains are potentially pathogenic <![CDATA[<b>Costo de una canasta básica de alimentos para celíacos en Chile</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000500010&lng=es&nrm=iso&tlng=es Celiac disease requires a strict gluten free diet for life for proper recovery. This results in higher feeding costs. Aim: To analyze the cost of basic food basket (BFB) compared to a basket especially designed for celiac patients in Chile and to estimate the increment in food spending that these patients experience. Material and Methods: The cost of a daily BFB was calculated using the National Socioeconomic Characterization Enquiry (CASEN) methodology of the Ministry of Planning and the food prices delivered by the National Institute of Statistics for consumers, adjusted according to consumer prices at june 2007. To calculate the cost of the basket for celiac disease, equivalent foods without gluten were considered. Their daily and monthly values and the percentage difference between them were analyzed, by food groups and type of basket. Results: The monthly value of BFB and a basket for a celiac is, at june 2007, Ch $ 30.251 and Ch $ 57.250, respectively. This represents an increase in feeding costs for celiac patients of 89%. Conclusions: The greater cost of food without gluten represents a ¡imitation in the budget of celiac patients <![CDATA[<b>Manifestaciones purpúricas atípicas por parvovirus B19 en dos miembros de una familia</b>: <b>Caso clínico</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000500011&lng=es&nrm=iso&tlng=es Two atypical cases of parvovirus B19 infection occurred consecutively within a family. A 14 year-old patient presented an extended papular-purpuric "gloves and socks" syndrome and two weeks later his mother developed a predominantly unilateral purpuric rash in the limbs with severe malaise. Specific IgM antibodies in the boy and polymerase chain reaction (PCR) and serology in the mother, confirmed parvovirus B19 infection. We emphasize the variable presentation of B19 infection within a family. The importance ofetiologic studies in the presence of atypical exanthemas and the utility of PCR in the diagnosis ofB19 are undesrscored <![CDATA[<b>Efectos sobre la función renal fetal y neonatal del tratamiento con antagonista del receptor de angiotensina II en el embarazo</b>: <b>Caso clínico</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000500012&lng=es&nrm=iso&tlng=es Fetal renal structure and function can be altered by medications prescribed to pregnant women. We report a chronic hypertensive pregnant woman treated with ¡osarían before and throughout pregnancy. At 30 weeks the patient was referred to our Fetal Medicine Unit due to absent amniotic fluid with normal uterine artery Doppler and fetal growth. During her hospitalization a new scan was performed showing that both fetal kidneys were enlarged and slightly hyperechogenic and placental and fetal artery Doppler showed signs of hypovolemia or increased resistance to feto-placental blood flow. Ductus venosous was normal. The fetus was delivered after three days by caesarean section at 30+4 weeks of gestation due to abnormal fetal heart rate tracing. Following delivery, the preterm newborn was treated for a transient renal failure characterized by anuria-oliguria and high plasma creatinine levels (from 3.8 mg/dL at day 5 to 0.8 mg/dL at 16 days). At 30 days of age, ultrasound showed kidneys of normal form and size. The adverse effects of Angiotensin II receptor antagonists in fetal nephrogenesis and function are discussed <![CDATA[<b>Sirolimus en trasplante de órgano sólido pediátrico</b>: <b>Experiencia en 5 casos</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000500013&lng=es&nrm=iso&tlng=es Sirolimus (SRL) is an immunosuppressive drug increasingly used in children undergoing solid organ transplantation. SRL does not cause glucose intolerance, hypertension, nephrotoxicity or neurotoxicity offering significant potential advantages over calceneurin inhibitors (CM). Aim: To report five children treated with SRL. Material and methods: A retrospective review of four children undergoing orthotopic liver transplantation (OLT) and one undergoing renal transplantation with recurrent acute rejection (RAR), chronic rejection (CR) or toxicity due to CM, treated with SRL between June 2001 and November 2006. Results: As primary immunosuppressive therapy, all patients received 3 drugs: CM (Tacrolimus (FK) or Cyclosporine), mycophenolate mofetil and steroids. Mean age at treatment with SRL was 98 months. Children undergoing OLT had a ¡ate introduction of SRL (mean time after OLT: 37 months), and mean follow-up was 24 months. In this group rescue indications of SRL were RAR in one, CR in one, thrombotic thrombocytopenic purpura (TTP) in one, food allergy in one and other CM toxicity in three. Only one did not experience adverse events due to SRL, but no one required discontinuation of SRL. There were remissions of RAR, CR, TTP and food allergy. The patient with RT was switched from FK to SRL at day 18th after RT, but he had severe neutropenia that led to discontinuation of SRL. Conclusions: SRL may be useful in pediatric solid organ transplant recipients suffering from RAR, CR, TTP, food allergy and CM toxicity. Careful attention should be directed to detect side effects and avoid severe complications <![CDATA[<b>Consideraciones acerca del uso de la variable etnia/raza en investigación epidemiológica para la Salud Pública</b>: <b>A propósito de investigaciones en inequidades</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000500014&lng=es&nrm=iso&tlng=es Epidemiology analyzes differences in states of health and disease of populations. Public Policies are established considering inequities associated with ethnicity and race. In this context, the identification of vulnerable groups for concentration of resources is relevant. Nevertheless, the lack of a clear definition of these variables might lead to biased results and interpretations. Two problems about the use of these variables are discussed. First, lack of a measurable and objective characteristic, even considering self reference (gold standard), considering that the opinion of a person can change in time. The second problem is a consequence of the former, basing research on a poorly defined variable. Uses of ethnicity and race variables between 1920-1999 in the American Journal of Epidemiology, Health Services Research and American Journal of Public Health were reviewed. In 919 articles, 27 different names identified to describe these variables and more than half did not describe the reason to use these variables. Almost half did not describe analytical methods. Although some articles found statistically significant relationships, ¡ess than half discussed those results. It has been suggested that there is enough evidence to exclude these variables in biomedical investigations. However, others propose that they cannot be excluded, given their multidimensional condition that includes social, cultural and genetic features. Therefore, provided the lack of clear definition, the assessment of ethnicity and race effects must be done as rigorously as possible <![CDATA[<b>La bioinformática en la práctica médica</b>: <b>Integración de datos biológicos y clínicos</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000500015&lng=es&nrm=iso&tlng=es The aim of our work is to describe essential aspects of Medical Informatics, Bioinformatics and Biomedical Informatics, that are used in biomedical research and clinical practice. These disciplines have emerged from the need to find new scientific and technical approaches to manage, store, analyze and report data generated in clinical practice and molecular biology and other medical specialties. It can be also useful to integrate research information generated in different areas of health care. Moreover, these disciplines are interdisciplinary and integrative, two key features not shared by other areas of medical knowledge. Finally, when Bioinformatics and Biomedical Informatics approach to medical investigation and practice are applied, a new discipline, called Clinical Bioinformatics, emerges. The latter requires a specific training program to create a new professional profile. We have not been able to find a specific training program in Clinical Bioinformatics in Spain <![CDATA[<b>En referencia al plagio intelectual. Documento de la Comisión de Ética de la Facultad de Medicina de la Universidad de Chile</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000500016&lng=es&nrm=iso&tlng=es Plagiarism is defined as the intellectual fraud in which an individual attempts to unduly appropriate, for his/her own benefit, the knowledge, ideas or discoveries of someone else. It is not uncommon in academic settings where research is conducted and a creative work is carried out. Due to the dismal consequences of plagiarism, cautionary measures and sanctions are required to avoid it. This paper is intended to warn and promote a discussion about plagiarism. The Faculty of Medicine of the University of Chile and its ethics committee believe that a fight against these type of actions will contribute to prevent their detrimental effects on the moral and intellectual patrimony of our society <![CDATA[<b>Bioética de la anorexia nerviosa ¿autonomía, beneficencia o responsabilidad?</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000500017&lng=es&nrm=iso&tlng=es In patients with anorexia nervosa, ethical dilemmas will appear in case of difficult and serious medical situations. Although the principle of beneficence could be used to argue for the use of coercive medical therapies, the respect for autonomy must take precedence. The latter is a central principle of bioethics. However, the interactions between autonomy, beneficence, non-maleficence, and justice become quite complex when these patients need to be treated. Difficulties must be overcome and a balance between these considerations must be reached. This paper gives an account of ethical values relevant to moral assessment in anorexia nervosa: conviction, responsibility and care <![CDATA[<b>Homenaje a los profesores de la Cátedra de Medicina Legal de la Universidad de Chile</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000500018&lng=es&nrm=iso&tlng=es The outstanding work of professors of the chair of Forensic Medicine at the School of Medicine of the University of Chile is highlighted. This chair is divided in three periods, that are paralell to the history of Chilean medicine. During these periods, the chair initiated, developed and fortified its teaching activities. The practice of forensic medicine was institutionalized and spread throughout the country. Its field of action and knowledge areas also increased <![CDATA[<b>Episodio maníaco asociado al uso de sibutramina</b>: <b>Reporte de un nuevo caso</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000500019&lng=es&nrm=iso&tlng=es The outstanding work of professors of the chair of Forensic Medicine at the School of Medicine of the University of Chile is highlighted. This chair is divided in three periods, that are paralell to the history of Chilean medicine. During these periods, the chair initiated, developed and fortified its teaching activities. The practice of forensic medicine was institutionalized and spread throughout the country. Its field of action and knowledge areas also increased <![CDATA[<b>El dilema ético de la fluoración de agua potable</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000500020&lng=es&nrm=iso&tlng=es The outstanding work of professors of the chair of Forensic Medicine at the School of Medicine of the University of Chile is highlighted. This chair is divided in three periods, that are paralell to the history of Chilean medicine. During these periods, the chair initiated, developed and fortified its teaching activities. The practice of forensic medicine was institutionalized and spread throughout the country. Its field of action and knowledge areas also increased <![CDATA[<b>El colesterol es inocente</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000500021&lng=es&nrm=iso&tlng=es The outstanding work of professors of the chair of Forensic Medicine at the School of Medicine of the University of Chile is highlighted. This chair is divided in three periods, that are paralell to the history of Chilean medicine. During these periods, the chair initiated, developed and fortified its teaching activities. The practice of forensic medicine was institutionalized and spread throughout the country. Its field of action and knowledge areas also increased <![CDATA[<b>Hipertensión arterial</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000500022&lng=es&nrm=iso&tlng=es The outstanding work of professors of the chair of Forensic Medicine at the School of Medicine of the University of Chile is highlighted. This chair is divided in three periods, that are paralell to the history of Chilean medicine. During these periods, the chair initiated, developed and fortified its teaching activities. The practice of forensic medicine was institutionalized and spread throughout the country. Its field of action and knowledge areas also increased <![CDATA[<b>COMO ESCRIBIR Y PUBLICAR TRABAJOS CIENTÍFICOS</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872008000500023&lng=es&nrm=iso&tlng=es The outstanding work of professors of the chair of Forensic Medicine at the School of Medicine of the University of Chile is highlighted. This chair is divided in three periods, that are paralell to the history of Chilean medicine. During these periods, the chair initiated, developed and fortified its teaching activities. The practice of forensic medicine was institutionalized and spread throughout the country. Its field of action and knowledge areas also increased