Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720100005&lang=es vol. 138 num. 5 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[<b>Infección por <i>Helicobacter pylori </i>en pacientes sintomáticos con patología gastroduodenal benigna</b>: <b>Análisis de 5.664 pacientes</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000500001&lng=es&nrm=iso&tlng=es Infection with Helicobacter pylori (H. pylori) is highly prevalent in Chile, but there are no systematic studies in patients with upper gastrointestinal symptoms. Aim: To determine the prevalence of H. pylori infection, according to age, gender and endoscopic pathology in a large sample of patients. Methods: We studied 7,893 symptomatic patients submitted to upper gastrointestinal endoscopy between July 1996 and December 2003 in the context of a screening program of gastric cancer in a high risk population. H. pylori infection was determined by rapid urease test (RUT) in antral mucosa. We excluded 158 patients with gastric cancer (2%) and 2,071 patients without RUT. Results: We included 5,664 patients, mean age 50.7 ± 13.9 years, women 72.1%. Endoscopic diagnoses were normal in 59.3%, erosive esophagitis in 20%, gastric ulcer (GU) in 8.1%, duodenal ulcer (DU) in 6.4%, and erosive gastropathy in 6.2%. RUT was positive in 78% of patients. After adjusting for age and sex and with respect to patients with normal endoscopy, frequency of H. pylori infection was 86.6% in DU (OR 2.1, 95% CI 1.5-2.8, p < 0.001); 81.4% in GU (OR 1.8, 95% CI 1.4-2.4; p < 0.001 ); 79.9% in erosive gastropathy (OR 1.4, 95% CI 1.03-1.8; p = 0.03) and 77.4% in erosive esophagitis (OR 1.1, 95% CI: 0.9-1.3; p = NS). The probability of H. pylori infection decreased significantly with age, more markedly in men with normal endoscopy. Conclusions: Prevalence of H. pylori infection is very high in symptomatic Chilean patients and even higher in those with gastroduodenal ulcer or erosions, while in patients with erosive esophagitis is similar to those with normal endoscopy. The frequency of infection decreases with age, probably as a consequence of rising frequency of gastric mucosal atrophy. <![CDATA[<b>Caracterización de madres deprimidas en el posparto</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000500002&lng=es&nrm=iso&tlng=es Background: Postpartum depression (PPD) is a mood disorder that occurs during a specific period of women’s lifetime: puerperium. The prevalence of PPD ranges from 8% to 30%, and a three-fold increase is seen in emerging as compared to developed countries. Aim: To characterize women consulting in primary care facilities for PPD. Material and Methods: Social and demographic features, obstetrical history, clinical symptoms and puerperal care of 440 postpartum women that sought help in primary care and were diagnosed as depressed, are described. Results: These women had no paid employment (82.7%), had unplanned pregnancies (62.5%) and lacked adequate social support (59.4%). From the clinical viewpoint, most of these puerperal women had a family history of depression (64.2%) and 31% had suffered from previous depressive episodes. The clinical symptoms of these patients consisted of depressed mood (93.2%), anhedonia (87.9%) and fatigue (87%). Conclusions: Women depressed postpartum form a group that requires more clinical attention due to its great biological vulnerability, active depressive symptoms, and enormous psychosocial risk. The mother and child program, which benefits them, needs to be combined with a mental health component that can offer them a treatment adapted to their psychosocial context. <![CDATA[<b>Polimorfismos del gen del receptor de muerte celular programada 1 (<i>PDCD1</i>) y diabetes tipo 1 en población Chilena</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000500003&lng=es&nrm=iso&tlng=es Background: Programmed cell death 1 (PDCD-1) immune-receptor is a key element in the negative regulation of peripheral tolerance in T cells. Several polymorphisms of this gene have been described and it is linked with susceptibility to autoimmune diseases like Lupus and Multiple Sclerosis. Aim: To analyze four gene polymorphisms of PDCD-1 gene and explore its possible contribution as a susceptibility gene for type 1 diabetes (T1D). Patients and Methods: We analyzed 160 cases with T1D of recent diagnosis aged 9.5 ± 3.3 years and 160 control children aged 10.7 ± 3.1 years. Four genetic variants of PDCD-1 gene were studied (PD1.2; PD1.5; PD1.6 and PD1.9) by polymerase chain reaction and restriction enzymes. Autoantibodies GAD65 and anti-IA-2 were also measured in all studied children. The comparison of allelic and genotypic frequency and consistency with respect to Hardy-Weinberg equilibrium test were analyzed using Chi-square and Fisher exact test. Results: No differences between cases and controls were observed for PDCD1.2; PDCD1.5 and PDCD1.9 polymorphisms. PDCD1.6 polymorphism (carriers of allele A) had a higher frequency in the control group (0.794 versus 0.644, p < 0.017). There was no particular association of these polymorphisms with anti- GAD65 and anti-IA-2 antibodies among patients with T1D. Conclusions: Only PDCD1.6 polymorphism showed differences between T1D cases and controls. Possibly, none of these genetic variants of PDCD1 has a relevant role as a marker for T1D in the Chilean population. <![CDATA[<b>Validación de la escala de autoeficacia general en Chile</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000500004&lng=es&nrm=iso&tlng=es Background: Self effcacy refers to an individual’s belief in his or her capability to produce given achievements and the individual’s perception of his or her ability to perform an action. Aim: To evaluate the psychometric properties of the General Self-effcacy Scale in Chilean population. Material and Methods: The study was carried out in 360 subjects, both sexes, 15-65 years of age, from Concepción, Chile, who answered Self-efficacy, Self-esteem and Health Status Perception instruments. Reliability was verified by Cronbach’s alpha coefficient and validity by expert re-vision, univariate statistics, correlations among items, item-scale correlations, and correlations with Self-esteem and Perception of Health Status constructs. Results: The structure of the scale is uni-dimensional, homogenous and positively related with the constructs examined. Conclusions: The General Self-efficacy Scale is a reliable and valid measure of the perception of self-efficacy in the Chilean population. <![CDATA[<b>Estudio retrospectivo de costos de tratamientos intensivos por paciente y día cama</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000500005&lng=es&nrm=iso&tlng=es Background: Intensive medicine is especially expensive and requires an efficient management. Aim: To measure the real costs of diseases treated in an intensive care unit and compare them with the costs assigned by the Chilean National Health Fund (FONASA) for 2008. Material and Methods: Retrospective review of 225 patients, representing 82% of discharges from an intensive care unit during 2008. Patients were classified according to their medical conditions as having sepsis, trauma, cardiovascular, respiratory or neurological diseases. Costs were calculated using the cost per activity system. Results: Trauma, sepsis and cardiovascular diseases had the greatest cost per inpatient day, corresponding to 294,779; 253,513 and 244,713 Chilean pesos, respectively. Seventy percent of costs correspond to human resources followed by complementary examinations, that represent up to 15% of costs. Patients with sepsis and cardiovascular diseases absorbed 28 and 26% of intensive care unit resources, respectively. Patients who died with these diseases absorbed 35 and 16% of resources, respectively. Conclusions: All diseases studied had significantly higher costs than those assigned by the National Health Fund. <![CDATA[<b>38 Años de vigilancia epidemiológica de labio leporino y paladar hendido en la maternidad del Hospital Clínico de la Universidad de Chile</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000500006&lng=es&nrm=iso&tlng=es Background: Orofacial clefts are common and have a great medical and social importance. The Latin American Study of Congenital Malformations (ECLAMC), has maintained an epidemiological surveillance of congenital malformations since 1969, allowing the evaluation of trends in the prevalence of malformations. Aim: To evaluate the evolution curve of prevalence rates of orofacial clefts from 1971 to 2008. Material and Methods: All cases of orofacial clefts, occurring in newborns from the maternity of a university hospital from January 2000 to December 2008, were recorded as part of the ECLAMC. Historical information about the rates of the malformation between 1971 and 1999, was obtained from previous manuscripts of the authors. Results: In the study period, 15,635 children were born and 46 had cleft lip-palate (3‰). This rate is significantly higher than those observed previously, that fuctuated between 1.5 and 1.7‰. The prevalence rates of cleft lip remained stable from 1971 to 1999 and suffered a brisk and significant rise in the period 2000-2008 When the period is analyzed year by year, the increase in rates is observed in the last two years. The rates of cleft palate suffered a slight non significant rise until 2000. Conclusions: The increased rates of cleft lip palate observed in the last two years of the observation period may be a random result and should be monitored in the future. <![CDATA[<b>Percolación de la epidemia de influenza AH1N1 en el mundo: Utilidad de los modelos predictivos basados en conectividad espacial</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000500007&lng=es&nrm=iso&tlng=es Background: The 2009 AH1N1 epidemics expanded rapidly around the world by the current connectivity conditions. The spread of epidemics can be described by the phenomenon of percolation, that allows the estimation of the threshold conditions that produce connectivity between different regions and that has been used to describe physical and ecological phenomena. Aim: To analyze the spread of AH1N1 epidemic based on information from the WHO. Material and Methods: The world was considered as composed of a set of countries and regular cells. The moment when the percolation occurred was analyzed and logistic regressions were adjusted to the change in the proportion of infected units versus time, comparing predicted and observed rates. Results: Percolation occurred in America on day 15, in Eurasia on day 32 and in the world on day 74. The models showed adequate predictive capacity. The predictions for the percolation of the epidemic in the world varied between days 66 and 75. The prediction based on countries was better than that based on cells. Conclusions: These results show that percolation theory fts well to the spread of epidemics. Predictions based only on data on-off (infected non infected) and in the progression of the proportion of infected cells are a good way of predicting the spread of an epidemic and when this crosses a region geographically. <![CDATA[<b>Hepatocarcinoma, porfiria y hemosiderosis. Una asociación no reportada en nuestro país</b>: <b>Caso clínico</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000500008&lng=es&nrm=iso&tlng=es Porphyria cutanea tarda (PCT) is a hereditary or acquired disease. It can be unleashed by iron overload, alcohol, estrogens and other conditions. In these patients, hepatic involvement can be associated to cirrhosis, iron overload or C and B viral infections, that are predisposing factors for hepatocellular carcinoma. We report a 69-year-old man with PTC, hemosiderosis and hepatocarcinoma. The tumor was diagnosed during a routine ultrasound examination for early detection of malignant lesions. The patient was subjected to a right hepatic excision. The pathological examination of the surgical piece confrmed the diagnosis and disclosed free surgical margins. After 18 months of follow up, the patient had a relapse and a liver transplantation was performed. <![CDATA[<b>Histoplasmosis oral localizada</b>: <b>Reporte de un caso clínico en Tucumán, Argentina</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000500009&lng=es&nrm=iso&tlng=es Histoplasmosis is an endemic deep mycosis produced by Histoplasma capsulatum, a dimorphic fungus. It penetrates into the organism by inhalation and spreads by lymphatic or hematic route. We report a 57-year-old immunocompetent male presenting with an enlargement of the tongue that also exhibited white pseudomembranes. There were also nodular lesions in the dorsum of the tongue, separated by deep grooves. The pathological study revealed a chronic infammatory process with granulomas. The microbiological examination with the Giemsa technique showed multiple yeasts of 4-5 mm of diameter with a clear halo inside macrophages and epithelial cells, compatible with the parasitic phase of Histoplasma capsulatum. Serology was positive for the histoplasmine antigen. The patient was treated with Itraconazole 200 mg/day, experiencing 40% remission of lesions during the frst month of treatment. <![CDATA[<b>Atrofia vellositaria duodenal inducida por micofenolato mofetil</b>: <b>Caso clínico</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000500010&lng=es&nrm=iso&tlng=es Mycophenolate mofetil (MMF) is an immunosupressor agent frequently used in patients after bone marrow or solid organ transplants. The most common adverse reactions of the drug are gastrointestinal, specially diarrhea and vomiting. We report a 53-year-old male, that received a heart transplant receiving immunosuppression with cyclosporine, mycophenolate mofetil and prednisone. Six months after the transplant, the patient started with diarrhea, anorexia and weight loss. A duodenal biopsy showed villous atrophy. Celiac disease and the presence of parasites were discarded. Mycophenolate mofetil was discontinued and one week later, diarrhea subsided. Two months later the patient was asymptomatic and recovered weight. A new duodenal biopsy showed absence of villous atrophy. <![CDATA[<b>Alteraciones genéticas en lesiones preneoplásicas y neoplásicas de la vesícula biliar</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000500011&lng=es&nrm=iso&tlng=es This article aims to review the most relevant morphological and molecular aspects involved in gallbladder (GB) cancer. In Chile, gallbladder cancer is the main cause of death due to cancer, among women older than 40 years. However, there is almost none information about the morphological changes and the genetic alterations in-volved in the beginning and development of this neoplasia. Two carcinogenic ways have been described. The sequence adenoma-carcinoma is accepted to be less frequent and important. The most important is the sequence where a metaplasia evolves to displasia that progresses to carcinoma in situ and fnally it becomes invasive. This progress requires 10 to 15 years approximately. During this time, a continue progression of injuries have been described. Molecular research studies show genetic anomalies in some genes which are temporary events in preneoplastic injuries of the gallbladder. Some of them even exist before the frst morphological changes, while the expression of tumor suppressor genes like p53, adhesion molecules and oncogenes, among others, can be related to late GB carcinogenesis. The K-ras gene seems to play a role in this neoplasia, mainly in those that present an abnormal biliopancreatic union. The microsatelital instability has been found in a small subset of preneoplastic and neoplastic lesions. The existence of methylation in the promotor gene areas has been related to the cellular proliferation, invasion and metastasis and also in cases of chronic cholecystitis, suggesting that this epigenetic phenomenon represents a crucial early event in GB carcinogenesis. <![CDATA[<b>Indicaciones de cirugía antirreflujo</b>: <b>¿Buenos y malos candidatos para la cirugía? </b><b>Revisión bibliográfica y experiencia personal</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000500012&lng=es&nrm=iso&tlng=es Antireflux laparoscopic surgery has excellent results in terms of improvement of symptoms, esophagitis, gastroesophageal sphincter competence and abnormal acid reflux. Indications for surgery are well established, however some of these are controversial. This is a review of the present indications for surgery in gastroesophageal reflux. The surgical indication should be the result of a complex clinical and laboratory work up. Patients with a clear cut surgical indication should be differentiated from those with doubtful indications, that require further analysis and those that are bad candidates for surgery. Young patients with macroscopic esophagitis, an incompetent sphincter, abnormal acid reflux test, that have a partial or negative response to treatment with proton pump inhibitors are those with the best surgical results. Bad candidates are patients with a psychiatric background, with atypical symptoms and those with a normal acid reflux test. In our experience with 935 patients, only 23% had a surgical indication. <![CDATA[<b>La aspergilosis pulmonar invasiva en la enfermedad pulmonar obstructiva crónica</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000500013&lng=es&nrm=iso&tlng=es Invasive pulmonary aspergillosis (IPA) is a severe disease, specially among immunocompromised patients. Its frequency increases in other patients such as those with Chronic Obstructive Pulmonary Disease (COPD), mainly when steroids are prescribed. The most common form of presentation is a respiratory tract infection with poor response to antimicrobial treatment. The delay in its diagnosis is one of the main causes of its high lethality. Once suspected, respiratory secretion cultures, chest X ray examination and computed tomography should be obtained and galactomannan, a marker of hematogenous dissemination of the microorganism, should be determined. Although the repeated isolation of Aspergillus spp is suggestive of invasive disease, the definitive diagnosis requires cytopathological confirmation. Further studies should be performed in these patients, since the available information was obtained from the observations made in immunocompromised patients, and may not be applicable accurately to API among COPD patients. <![CDATA[<b>Participación del sistema endocanabinoide en el desarrollo de obesidad</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000500014&lng=es&nrm=iso&tlng=es Endocannabinoids are the endogenous ligands for the cannabinoid receptors type 1 and 2. These membrane receptors are responsible for the psychotropic effects of Cannabis Sativa, when bound to its active component known as (-)-Δ9-tetrahydro-cannabinol. Cannabinoid receptors, endocannabinoids and the enzymes catalyzing their biosynthesis and degradation, constitute the endocannabinoid system (ECS), which has a remarkable role controlling energy balance, both at central nervous system and peripheral tissues. The ECS regulates food ingestion by stimulating a network of orexigenic neurons present in the hypothalamus and reinforcing motivation and reward to food consumption in the nucleus accumbens. Regarding peripheral tissues, this system controls lipid and glucose metabolism at different levels, reduces energy expenditure and leads energy balance to fat storage. Metabolic alterations, includ-ing excessive accumulation of abdominal fat, dyslipidaemia and hyperglicaemia, are suggested to be associated to a hyperactivated ECS. Since obesity is one of the major health problems in modern societies, in this review we discuss the role of the endocannabinoid system in metabolic pathways associated to control mechanisms of energy balance and its involvement in overweight and obesity. In addition, we also discuss therapeutic possibilities and emergent problems due to cannabinoid receptor type 1 antagonism utilized as treatment for such alterations. <![CDATA[<b>Gestión y satisfacción en servicios de salud de Chile</b>: <b>Contraste entre las percepciones de los funcionarios y los usuarios</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000500015&lng=es&nrm=iso&tlng=es Background: Clients and providers of health care can have contrasting perceptions about the quality of service. Provider perceptions are mostly devoted to design and delivery of services while those of clients are focused in the attention received. Aim: To assess perceptions of health care providers and clients about client management and satisfaction with services provided. Material and Methods: Two public hospitals were surveyed. A qualitative analysis was performed first, reviewing reports and patient data bases and through informal meetings with providers and clients. In a second phase, an enquiry with Likert type questions was devised and answered by a total of 377 providers and 400 clients from both hospitals. Results: The median perception of clients about the quality of service was better than that of providers in both hospitals. The communication of hospitals with clients to offer timely information received a poor evaluation both from providers and clients. However the concern of hospitals about health care of the community was considered adequate. The degree of satisfaction with concrete issues such as information panels and physical infrastructure received similar evaluation both by providers and clients. Conclusions: This analysis can be useful for management decision making, identifying strengths and weaknesses of health care provided by these two public hospitals. This type of assessment can be replicated in other public and private health care facilities. <![CDATA[<b>Diez mitos sobre el retiro de la ventilación mecánica en enfermos terminales</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000500016&lng=es&nrm=iso&tlng=es The most difficult of treatment limitation decisions, both for physicians and families, is the withdrawal of mechanical ventilation (MV). Many fears and uncer-tainties appear in this decision. They are described as “ten myths” whose falseness is argued in this article. The myths are: 1) Withdrawing MV causes the patient’s death; 2) Withdrawing MV is euthanasia; 3) Withholding and withdrawing MV are morally different; 4) MV can be withdrawn only when the patient has asked for it; 5) Chilean law only authorizes to withdraw VM when brain death has occurred; 6) Withdrawing MV cannot be done if the patient is not an organ donor; 7) Physicians who withdraw MV are in high risk of legal claims; 8) To withdraw MV the physician needs an authorization from the hospital ethics committee, lawyer or institutional authority; 9) There is only one way to withdraw MV; 10) Withdrawing MV produces great suffering to the patient’s family. Making clear that these myths are false facilitates appropriate decisions, therefore preventing “therapeutic obstinacy” and more suffering of terminally ill patients, which favors their peaceful death. For the physician this goal should be as rewarding as preventing the death of a curable patient. <![CDATA[<b>Posición oficial de la Sociedad Chilena de Climaterio para el manejo clínico de la mujer climatérica</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000500017&lng=es&nrm=iso&tlng=es The health of many women is affected in the climacteric period, either by symp-toms that deteriorate their life quality (QL) or by chronic diseases that affect their life expectancy. Therefore, it is mandatory to evaluate these two aspects, having as core objectives for any eventual therapeutic intervention, the improvement of QL and the reduction of cardiovascular risk and fractures. To evaluate QL it is mandatory to follow structured interviews that weigh systematically climacteric symptoms such as the Menopause Rating Scale (MRS). The paradigm of the metabolic syndrome constitutes a suitable frame to evaluate cardiovascular risk. Age, a low body weight, a history of fractures and steroid use are risk factors for fractures. A proper evaluation will allow the detection of patients with a low QL or a high risk for chronic disease, therefore identifying those women who require therapy. The clinical management should include recommendations to improve lifestyles, increase physical activity, avoidance of smoking and to follow a low calorie diet rich in vegetables and fruits. Hormonal therapy is the most effcient treatment to improve the QL and its risk is minimized when it is used in low doses or by the transdermal route. Tibolone is an alternative, especially useful in patients with mood disorders and sexual dysfunction. Vaginal estrogens are also a good option, when urogenital symptoms are the main complaint. Some antidepressants can be an effective therapy in patients with vasomotor symptoms who are not willing or cannot use estrogens. The effectiveness of any alternative therapy for menopausal symptoms has not been demonstrated. Dyslipidemia, hypertension, obesity and insulin resistance should be managed ac-cording to guidelines. Calcium and vitamin D have positive effects on bone density and certain tendency to reduce vertebral fractures. Bisphosphonates decrease the risk of vertebral fractures. <![CDATA[<b>Índice de riesgo cardiovascular y nutrición adecuada</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000500018&lng=es&nrm=iso&tlng=es The health of many women is affected in the climacteric period, either by symp-toms that deteriorate their life quality (QL) or by chronic diseases that affect their life expectancy. Therefore, it is mandatory to evaluate these two aspects, having as core objectives for any eventual therapeutic intervention, the improvement of QL and the reduction of cardiovascular risk and fractures. To evaluate QL it is mandatory to follow structured interviews that weigh systematically climacteric symptoms such as the Menopause Rating Scale (MRS). The paradigm of the metabolic syndrome constitutes a suitable frame to evaluate cardiovascular risk. Age, a low body weight, a history of fractures and steroid use are risk factors for fractures. A proper evaluation will allow the detection of patients with a low QL or a high risk for chronic disease, therefore identifying those women who require therapy. The clinical management should include recommendations to improve lifestyles, increase physical activity, avoidance of smoking and to follow a low calorie diet rich in vegetables and fruits. Hormonal therapy is the most effcient treatment to improve the QL and its risk is minimized when it is used in low doses or by the transdermal route. Tibolone is an alternative, especially useful in patients with mood disorders and sexual dysfunction. Vaginal estrogens are also a good option, when urogenital symptoms are the main complaint. Some antidepressants can be an effective therapy in patients with vasomotor symptoms who are not willing or cannot use estrogens. The effectiveness of any alternative therapy for menopausal symptoms has not been demonstrated. Dyslipidemia, hypertension, obesity and insulin resistance should be managed ac-cording to guidelines. Calcium and vitamin D have positive effects on bone density and certain tendency to reduce vertebral fractures. Bisphosphonates decrease the risk of vertebral fractures. <![CDATA[<b>Réplica del autor aludido</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000500019&lng=es&nrm=iso&tlng=es The health of many women is affected in the climacteric period, either by symp-toms that deteriorate their life quality (QL) or by chronic diseases that affect their life expectancy. Therefore, it is mandatory to evaluate these two aspects, having as core objectives for any eventual therapeutic intervention, the improvement of QL and the reduction of cardiovascular risk and fractures. To evaluate QL it is mandatory to follow structured interviews that weigh systematically climacteric symptoms such as the Menopause Rating Scale (MRS). The paradigm of the metabolic syndrome constitutes a suitable frame to evaluate cardiovascular risk. Age, a low body weight, a history of fractures and steroid use are risk factors for fractures. A proper evaluation will allow the detection of patients with a low QL or a high risk for chronic disease, therefore identifying those women who require therapy. The clinical management should include recommendations to improve lifestyles, increase physical activity, avoidance of smoking and to follow a low calorie diet rich in vegetables and fruits. Hormonal therapy is the most effcient treatment to improve the QL and its risk is minimized when it is used in low doses or by the transdermal route. Tibolone is an alternative, especially useful in patients with mood disorders and sexual dysfunction. Vaginal estrogens are also a good option, when urogenital symptoms are the main complaint. Some antidepressants can be an effective therapy in patients with vasomotor symptoms who are not willing or cannot use estrogens. The effectiveness of any alternative therapy for menopausal symptoms has not been demonstrated. Dyslipidemia, hypertension, obesity and insulin resistance should be managed ac-cording to guidelines. Calcium and vitamin D have positive effects on bone density and certain tendency to reduce vertebral fractures. Bisphosphonates decrease the risk of vertebral fractures. <![CDATA[<b>Rol de las Sociedades Médicas Científicas en la formación y certificación de especialistas</b>: <b>el caso de Anestesiología en Chile</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000500020&lng=es&nrm=iso&tlng=es The health of many women is affected in the climacteric period, either by symp-toms that deteriorate their life quality (QL) or by chronic diseases that affect their life expectancy. Therefore, it is mandatory to evaluate these two aspects, having as core objectives for any eventual therapeutic intervention, the improvement of QL and the reduction of cardiovascular risk and fractures. To evaluate QL it is mandatory to follow structured interviews that weigh systematically climacteric symptoms such as the Menopause Rating Scale (MRS). The paradigm of the metabolic syndrome constitutes a suitable frame to evaluate cardiovascular risk. Age, a low body weight, a history of fractures and steroid use are risk factors for fractures. A proper evaluation will allow the detection of patients with a low QL or a high risk for chronic disease, therefore identifying those women who require therapy. The clinical management should include recommendations to improve lifestyles, increase physical activity, avoidance of smoking and to follow a low calorie diet rich in vegetables and fruits. Hormonal therapy is the most effcient treatment to improve the QL and its risk is minimized when it is used in low doses or by the transdermal route. Tibolone is an alternative, especially useful in patients with mood disorders and sexual dysfunction. Vaginal estrogens are also a good option, when urogenital symptoms are the main complaint. Some antidepressants can be an effective therapy in patients with vasomotor symptoms who are not willing or cannot use estrogens. The effectiveness of any alternative therapy for menopausal symptoms has not been demonstrated. Dyslipidemia, hypertension, obesity and insulin resistance should be managed ac-cording to guidelines. Calcium and vitamin D have positive effects on bone density and certain tendency to reduce vertebral fractures. Bisphosphonates decrease the risk of vertebral fractures. <![CDATA[<b>Primer Curso Latinoamericano de Cuidados Paliativos en Diálisis y Nefrología</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872010000500021&lng=es&nrm=iso&tlng=es The health of many women is affected in the climacteric period, either by symp-toms that deteriorate their life quality (QL) or by chronic diseases that affect their life expectancy. Therefore, it is mandatory to evaluate these two aspects, having as core objectives for any eventual therapeutic intervention, the improvement of QL and the reduction of cardiovascular risk and fractures. To evaluate QL it is mandatory to follow structured interviews that weigh systematically climacteric symptoms such as the Menopause Rating Scale (MRS). The paradigm of the metabolic syndrome constitutes a suitable frame to evaluate cardiovascular risk. Age, a low body weight, a history of fractures and steroid use are risk factors for fractures. A proper evaluation will allow the detection of patients with a low QL or a high risk for chronic disease, therefore identifying those women who require therapy. The clinical management should include recommendations to improve lifestyles, increase physical activity, avoidance of smoking and to follow a low calorie diet rich in vegetables and fruits. Hormonal therapy is the most effcient treatment to improve the QL and its risk is minimized when it is used in low doses or by the transdermal route. Tibolone is an alternative, especially useful in patients with mood disorders and sexual dysfunction. Vaginal estrogens are also a good option, when urogenital symptoms are the main complaint. Some antidepressants can be an effective therapy in patients with vasomotor symptoms who are not willing or cannot use estrogens. The effectiveness of any alternative therapy for menopausal symptoms has not been demonstrated. Dyslipidemia, hypertension, obesity and insulin resistance should be managed ac-cording to guidelines. Calcium and vitamin D have positive effects on bone density and certain tendency to reduce vertebral fractures. Bisphosphonates decrease the risk of vertebral fractures.