Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720110007&lang=es vol. 139 num. 7 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[<b>Tuberculosis</b>: <b>una dinámica continua entre el pasado y el presente, para imaginar el futuro</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000700001&lng=es&nrm=iso&tlng=es Progress in understanding the biological processes that allow Mycobacterium tuberculosis to be a successful parasite have accelerated in the last twenty years. This progress has been stimulated by the return of tuberculosis (TB) as an important disease in industrialized countries, by its increase in emergent nations in the tail of population increases and poverty and by the spread of multiple drug resistant (MDR) and extensively drug resistant (XDR) M. tuberculosis as a result of treatment failures. Progress on M. tuberculosis biology has also been fueled by advances in microbiology and molecular biology, including molecular genetics, genomics, proteomics and in vitro and in vivo models of infection. The study of latency or dormancy, a phenomenon central to understanding the persistence of M. tuberculosis and the development of TB in individuals, its spread in human populations and the emergence of antibiotic-resistant/tolerant organisms, has been preferred targets for investigators in this area. In this manner, factors that trigger M. tuberculosis latency (e. g, hypoxia, nutrient starvation, NO exposure) have been characterized and the metabolic shifts to host lipid utilization, tolerance to antimicrobials and resistance to host immune mechanisms involved in latency have been determined. Similarly, genetic changes and the resulting antimicrobial mechanisms mediating the MDR and XDR states have been characterized and potential new vaccines that avoid reactivation from latency and infection are being developed. Despite this progress, and given the fact that effective anti tuberculosis therapy was developed and first introduced clinically at the end of the 1940s, there are now more cases of latent and active TB worldwide than ever before. This reinforces the concept of TB as a bacterial disease with strong social and economical! determinants which are presently stimulating increased transmission in many human groups, undermining diagnostics, treatment and prevention. It suggests that in a scenario of global economical crisis the struggle against TB will be weakened, unless efforts are included to alleviate poverty, decrease economic inequality, improve public health and allow democracy and political organization. <![CDATA[<b>Inicio del brote de Influenza A (H1N1) pandémica en Chile</b>: <b>caracterización genética de los primeros casos detectados</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000700002&lng=es&nrm=iso&tlng=es Background: Following the announcement of the Influenza A(H1N1) pandemic by the World Health Organization in April 2009, a surveillance program was carried out in Chile to detect the introduction of the virus in the country and to monitor its propagation and impact. Aim: To describe the onset of the outbreak and the genetic characterization of the pandemic H1N1 influenza virus in the first detected cases in Chile. Material and Methods: Analysis of18 clinical samples coming from suspicious patients, received in a National Reference Laboratory. RNA reverse transcription and real time influenza gene DNA amplification was carried out in a 7500 Fast and Step One Real Time PCR Systems of Applied Biosystems and MxPro-Mx3000P thermocycler from Stratagene. Super Script III Platinum One-Step Quantitative RT-PCR was used. Results: The virus was first detected in three persons returning from the Dominican Republic via Panamá and a child from the east zone of Santiago. Genetic characterization of the virus showed that the child was infected by a different variant of the pandemic virus than the three persons returning from the Caribbean. Conclusions: The onset of the Influenza outbreak in Chile apparently carne from two different epidemiological groups. The spread of the virus detected in the voyagers was limited immediately However the virus of the fourth case was found in different regions of Chile. <![CDATA[<b>Encuesta nacional online aplicada en pacientes con enfermedad celíaca en Chile</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000700003&lng=es&nrm=iso&tlng=es Background: Celiac disease (CD) is an immune-mediated enteropathy triggered by the ingestion of gluten in genetically susceptible individuals. Its prevalence in Europe and the USA is 0.5 to 1%. Aim: To analyze epidemiological aspects and degree of compliance with gluten-free diet (GFD) among Chilean individuals with CD. Material and Methods: Subjects with confirmed or suspected CD were invited to answer an online survey published on the web at www.fundacionconvivir.cl. The answers were reinforced with a telephone interview. Results: The survey was answered by 1212 subjects (79% females). Median age at diagnosis was 25.8 years (range 1 to 84 years), with a bimodal curve with two peaks at less than 3 years and at 20 to 40 years of age. The diagnosis was made only by serologic markers in 9%, only by intestinal biopsy in 17.5%, and by a combination of both methods in 70%o. Conditions associated with CD were reported by 30%&gt; of subjects and 20%&gt; had relatives with CD. The GFD was strictly adhered to by 70%&gt;, occasionally by 27%&gt; and never by 3%&gt;. Seventy five percent of subjects with a strict adherence to GFD had a favorable clinical response compared with 42%&gt; of those with incomplete or lack of adherence (odds ratio 4.0, 95%&gt; confidence intervals 2.8-5.7p < 0.01). Conclusions: In 30% of respondents, the diagnosis of CD was not confirmed according to international guidelines that require serology and duodenal biopsy. One third of subjects recognized a poor compliance with GFD. Those with a strict adherence to it had a more favorable clinical course. However, 25%&gt; did not experience a clinical improvement despite a strict GFD, a finding which requires further study. <![CDATA[<b>Diagnóstico y manejo de la hipoglicemia en adultos diabéticos hospitalizados</b>: <b>evaluación de competencias en un equipo profesional multidisciplinario de salud</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000700004&lng=es&nrm=iso&tlng=es Background: A tight glycemic control of hospitalized patients increases the risk of hypoglycemia, whose management is not always optimal. Aim: To assess the hypoglycemia management competences of a multidisciplinary team in a clinical hospital. Material and Methods: An anonymous questionnaire about hypoglycemia management was answered by 11 staff physicians, 42 residents and 28 nurses of the department of medicine and critical care unit ofa university hospital. Results: Respondents had a mean of 60% of correct answers, without significant differences between groups. The capillary blood glucose level that defines hypoglycemia was known by most of the respondents, but the value that defines severe episodes was known only by 60%. The initial management and follow up was well known only for severe episodes. Less than 50%o knew the blood glucose value that required continuing with treatment. Conclusions: Although most professionals are able to recognize hypoglycemia, the knowledge about is management if insufficient. <![CDATA[<b>Estudio cuantitativo del consumo de drogas y factores sociodemográficos asociados en estudiantes de una universidad tradicional chilena</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000700005&lng=es&nrm=iso&tlng=es Background: Drug abuse is one of the main public health problems and mostly involves young people. Aim: To determine the prevalence of drug consumption among university students and its associated social factors. Material ana Methods: A questionnaire exploring consumption of drugs and social-demographic, economic and religious variables, was applied to 1577 third year students aged 22 ±2 years (54% females) of a public university. Results: Sixty eight percent of the students were of middle socioeconomic class, 71 % belonged to some religion and 29% declared themselves as agnostic. Ninety six percent drank alcohol at least once and 29% never smoked. Among illicit drugs, marijuana was consumed by 22% followed by cocaine in 5.3%o, hallucinogenic drugs in 2.6 %>, inhalants in 2.3%> and cocaine free base in 1.4%). Six percent consumed stimulants and 13.8%>, sedatives. A higher economic income facilitated drug consumption and the adscription to a religion was protective against it. Conclusions: Alcohol is the most commonly consumed drug, and is the substance that generates more problems to students. <![CDATA[<b>Miocardiopatía no compactada</b>: <b>una serie de 15 casos</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000700006&lng=es&nrm=iso&tlng=es Background: Non compaction cardiomyopathy is a rare disorder caused by the arrest of myocardial compaction during embryogenesis, leading to a non compacted endocardial layer with marked hypertrabeculation and deep recesses. Aim: To report the clinical and echocardiographic characteristics of a series of 15 adult patients with non-compaction cardiomyopathy. Patients and Methods: We included a total of 15 patients aged 52 ± 17 years (40% males) diagnosed at our echocardiography laboratory between January 2001 and July 2010. Results: Theform of presentation was heart failure in 53% of subjects, syncope in 20%o, ventricular arrhythmias in 13%o and stroke in 7%>. Left ventricular end-diastolic diameter was 66 ±11 mm and estimated ejection fraction was 27 ± 10%>. Apical and/or mid-ventricular segments of the left ventricle were involved in all the cases. Pulmonary hypertension was present in 40%o. The average follow-up was 19 months and no patient died during this period. Sixty seven percent ofthe patients had manifestations of heart failure, 27%o presented sustained ventricular arrhythmias and 20%> had atrial fibrillation orflutter, whereas 13%o had cerebral embolic events. An automated internal cardioverter defibrillator was implanted in 47%o of patients. Conclusions: Non-compaction cardiomyopathy is associated with high cardiovascular morbidity. The diagnosis is made in advanced stages of the disease, with significant dilation and ventricular dysfunction. <![CDATA[<strong>Prevalencia de hipertensión arterial y su asociación con la obesidad en edad pediátrica</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000700007&lng=es&nrm=iso&tlng=es Background: Hypertension in children is a frequently overlooked problem that is an important cardiovascular risk factor. Aim: To determine the prevalence of hypertension among school age children. Material and Methods: Cross-sectional study of 2980 children aged 10 ± 2years (48% females) from 10 schools of middle and lower class in Metropolitan Santiago. Blood pressure (BP) was measured in the sitting position on three occasions after a rest period, using a mercury sphygmomanometer with appropriate cuff arm diameter, averaging the results of the measurements. Systolic and diastolic hypertension were defined as blood pressure values over 95percentilefor age, sex and height. Results: The overall prevalence of hypertension was 12.2% in women and 15% in men (p < 0.05). According to nutritional status, the prevalence was 6.7, 8.9,13.6 and 26% in underweight, eutrophic, overweight and obese children, respectively (p < 0.01). Compared with normal weight children, the risk of being hypertensive for overweight children was 1.6 (95% confidence intervals (CI) 1.2-2.3) and for obese children was 3.6 (95% CI 2.8-4.7). Conclusions: The studied children had a high prevalence of hypertension, that was directly related to a higher body mass index. <![CDATA[<b>Un estudio de reclamos hospitalarios</b>: <b>el rol de la relación médico-paciente</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000700008&lng=es&nrm=iso&tlng=es Background: Medical practice in Chile has changed dramatically over the last few years. Patients have raised their expectations and there is a growing number of complaints, and malpractice lawsuits. The doctor-patient relationship plays a fundamental role in patient satisfaction and has also been identified as an issue in most medical lawsuits. Aim: To analyze the importance of doctor-patient communication in the complaints received in a university hospital in Chile. Material and Methods: Review ofall complaints received at the office for quality of care at a university hospital. Complaints classified in delay, manners and information categories were selected for further analysis. Results: Of a total of8931 complaints registered between 2001 and 2008, 635 (19%) involved a doctor. Fifty one per cent of the latter, were related to the doctor-patient relationship. Of these, 146 cases (45%) were further classified as "Dysfunctional delivery of Information", 74 cases (23%) as "Not understanding the patient/'family's perspective", 54 cases (17%) as "Discrediting the patient or family's views" and 49 cases (15%) as "Lack of communication". Conclusions: The percentage of complaints related to communication with the doctor is high, though lower than cited in other studies. The most common complaint is the dysfunctional delivery of information. <![CDATA[<b>Encuesta de síntomas SNOT-20 para rinitis alérgica y rinosinusitis</b>: <b>validación en Chile</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000700009&lng=es&nrm=iso&tlng=es Background: Allergic rhinitis and sinusitis are common diseases that affect quality of life of pediatric and adult patients. Aim: To adapt and validate the Sino-Nasal Outcome Test 20 indicators (SNOT-20) survey in Chilean subjects. Material and Methods: In a psychometric validation study, an adapted version of the SNOT-20 adapted version was applied to 181 volunteers on two different occasions, three weeks apart. Feasibility (response time and perceived difficulty), reliability (internal consistency and test-retest) and validity (concurrent validity, correlating results with an independent instrument; predictive validity assessing its sensitivity to detect changes and discriminate validity, assessing receiver operating characteristic (ROC) curves), were assessed. An exploratory factor analysis was performed to confirm the presence of previously described underlying constructs. Results: Eighty percent of participants considered SNOT-20 easy to complete. This task was completed in less than 5 minutes. Cronbach's alpha was 0.946. Temporal stability on a healthy subgroup was strong with an intraclass correlation coefficient of0.92. SNOT-20 had a correlation coefficient of0.82 with an independent instrument and its score significantly decreased after 3 weeks of treatment (p = 0.003). The area under ROC curve was 0.895. Factor analysis identified four principal components which possessed identical structure as previously described. Conclusions: SNOT-20 survey was valid, reliable and easy to implement among Chilean subjects. <![CDATA[<b>Asociación entre el tiempo dedicado a actividades sedentarias e índice de masa corporal en estudiantes universitarios en Belgrado</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000700010&lng=es&nrm=iso&tlng=es Background: Subjects that spend more time working on computers or watching television could have a higher body mass index. Aim: To assess the relationship between time spent in front of a screen and studying, body mass index (BMI), smoking, and sleep duration among university students. Material and Methods: A cross-sectional study of 734 randomly selected students aged 21 ±2 years (450 females) that responded an anonymous, structured questionnaire about time spent watching television or in front of a computer, time spent studying, number of daily hours of sleep, smoking habits and number of daily meals. Body mass index was also calculated for all subjects Results: Among males, the number of daily sleep hours, time spent working with computers and number of daily meals were significantly higher and time spent studying was significantly lower than females. Nonsmokers ate a significantly higher number of meals and spent less time watching television. No association was observed between time spent in front of a screen and number of sleep hours of body mass index. Conclusions: Men and smokers spend more time working in computers. There is no association between body mass index and time spent in front of screens.<hr/>Antecedentes: Aquellos individuos que trabajan en computadores o ven televisión por mucho tiempo pudieran tener un índice de masa corporal mayor. Propósito: Evaluar la asociación entre el tiempo ocupado viendo televisión o trabajando en el computador, índice de masa corporal, hábito de fumar y horas diarias de sueño en estudiantes universitarios. Material y Métodos: Se efectuó un estudio transversal de 734 estudiantes elegidos al azar de 21 ±2 años de edad (450 mujeres), que respondieron una encuesta acerca del número de horas que pasaban viendo televisión, trabajando en un computator o estudiando, el número de horas diarias de sueño, hábito tabáquico y número diario de comidas. Además se calculó el índice de masa corporal de los encuestados. Resultados: Los hombres dormían más horas por día, pasaban más tiempo trabajando en computadores o viendo televisión y estudiaban menos horas por día que las mujeres. Los no fumadores comían más comidas por día y permanecían menos horas viendo televisión. No hubo una asociación significativa entre el número de horas enfrente de una pantalla o la cantidad de horas diarias de sueño con el índice de masa corporal. Conclusiones: Los hombres y los fumadores pasan más tiempo viendo televisión o trabajando en computadores. No se observó una relación entre el tiempo que se permanece frente a una pantalla y el índice de masa corporal <![CDATA[<b>Estudio de biodisponibilidad relativa entre dos formulaciones orales de micofenolato mofetilo en voluntarios sanos</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000700011&lng=es&nrm=iso&tlng=es Background: The bioequivalence of different formulations of a same pharmaceutical product must be tested empirically. Aim: To evaluate the relative bioavailability for an oralformulation of mycophenolate mofetil (MMF) (Linfonex™) compared to the reference formulation (Cellcept™) to determine the bioequivalence between both formulations. Material and Methods: A randomized, crossover, double-blind trial in 22 healthy male volunteers, who received a single oral dose of 1000 mg of Linfonex and Cellcept with a washout period of 10 days. Plasma levels of the drug were determined by high performance liquid chr ornatography. Plasma concentrations were plotted and maximum concentration, area under the plasma concentration versus time between 0 and 12 hours after administration and área under plasma concentration curve versus time after administration between 0 and infinity, were calculated for both products. Results: The active compound, mycophenolic acid, was similarly absorbed in both formulations. No statistically significant differences were found in calculated pharmacokinetic parameters between both formulations. Conclusions: Linfonex™ 500 mg is bioequivalent to Cellcept™ 500 mg. <![CDATA[<b>Uso de talidomida en sangrado recurrente por angiodisplasias gastrointestinales</b>: <b>Caso clínico</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000700012&lng=es&nrm=iso&tlng=es Chronic hemodialysis patients may have recurrent bleeding from gastrointestinal angiodysplasia, that often is diffusely located in the digestive tract or in places difficult to reach with traditional endoscopes. Therefore, they cannot be locally treated or removed. We report a 70 years old man on chronic hemodialysis, with severe and persistent anemia due to bleeding from angiodysplasia of the small bowel. Despite administration of high doses of erythropoiesis stimulating agents, intravenous iron, folate, B6 and B12 vitamins, his hemoglobin levels were < 6.5g/dL, becoming totally dependent on transfusions ofred blood cells (up to 46 units per year). Recurrent bleeding was refractory to conventional management and we decided to use thalidomide at doses of 50-100 mg/day achieving rapid control of gastrointestinal bleeding and significant increase of hemoglobin levels, not requiring further transfusions. <![CDATA[<b>Sarcoma mieloide</b>: <b>Caso clínico con trisomia 11</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000700013&lng=es&nrm=iso&tlng=es Myeloid sarcoma is a form of extra-medullary myeloid neoplasia. Cytogenetic characterization is hampered in the absence of invasion to the bone marrow, origin of cells that are usually studied in cytogenetic studies. We report a 13years old mole presenting with a mass in the right shoulder. A biopsy of the tumor disclosed a Myeloid Sarcoma. A conventional cytogenetic study of a bone marrow aspirate did not show t (8;21) translocation. A fluorescent in situ hybridization (FISH) performed in the paraffin embedded biopsy of the tumor, detected a chromosome 11 trisomy. <![CDATA[<b>Síndrome de <i>Twiddler</i></b>: <b>una causa infrecuente de disfunción de marcapaso definitivo. </b><b>Caso clínico</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000700014&lng=es&nrm=iso&tlng=es We report a 26year old patient who had a single chamber pacemaker implantation one year before. During a routine pre-operative evaluation, pacemaker dysfunction was demonstrated due to sensing and pacing failure, associated to left pectoral muscle rhythmic contraction. Chest X-ray confirmed Twiddler syndrome, in which twisting or rotation of the device inside the pocket results in lead dislodgement and device malfunction. <![CDATA[<b>Parto tras la transferencia de embriones generados por fecundación de ovocitos vitrificados</b>: <b>Comunicación de un caso</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000700015&lng=es&nrm=iso&tlng=es We report the first successful live birth after the transfer of embryos obtained by fertilization of vitrified oocytes. A couple with primary infertility due to teratozoospermy and chronic an ovulation decided to undergo assisted reproductive technology after 4 failed cycles of super ovulation and intrauterine insemination. The woman underwent a standard luteal phase agonist protocol, with controlled ovarian hyper stimulation with daily 150IU recombinant gonadotropin and 75IU urinary gonadotropin for 12 days. Due to the high risk of ovarian hyper stimulation syndrome the couple was advised to delay embryo transfer. Eighteen mature oocytes were recovered, eight were vitrified and 10 fertilized and cryopreserved as pro-nuclei. Two months later, four vitrified oocytes were thawed, and three morphologically-normal embryos were transferred to an estrogen-progesterone-primed uterus, obtaining triple clinical pregnancy. The pregnancy was uneventful until 32 weeks of amenorrhea, when pre-term delivery started. After inducing lung maturity, a cesarean section was performed and three healthy fetuses were delivered. Nowadays, the babies are two and a half years old, and have had a normal psycho-motor development. <![CDATA[<b>Calidad de grasa, arterioesclerosis y enfermedad coronaria</b>: <b>efectos de los ácidos grasos saturados y ácidos grasos trans</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000700016&lng=es&nrm=iso&tlng=es Epidemiological, clinical and metabolic research has shown a strong association between dietary fatty acids intake and cardiovascular disease (CVD) risk factors and clinical events. Saturated fatty acids (SFA) and trans fatty acids (TFA) derived from industrial hydrogenation of oils have been associated with an increased prevalence of CVD. However experimental results on the relationship between physiological pathologic effects and specific functions of individual SFA are often contradictory. Therefore a more detailed exploration of the potential benefit and risks of specific saturated and trans fatty acids is needed in order to update dietary recommendations. In the case of TFAs, the deleterious effect on CVD has been well demonstrated and a maximum accepted level of 1 % of total energy has been agreed internationally. What is currently under discussion is what would be the best alternative to replace them in the diet. <![CDATA[<b>La reducción del sueño como factor de riesgo para obesidad</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000700017&lng=es&nrm=iso&tlng=es Nocturnal sleep patterns may be a contributing factor for the epidemic of obesity. Epidemiologic ana experimental studies have reported that sleep restriction is an independent risk factor for weight gain and obesity. Moreover, sleep restriction is significantly associated with incidence and prevalence of obesity and several non-transmissible chronic diseases. Experimental sleep restriction is related to altered plasma leptin and ghrelin concentrations. Both hormones are directly related to appetite and satiety mechanisms. Also, a higher activity of the orexin/hypocretin system has been reported, as well as changes in glucose metabolism and autonomic nervous system. Some studies indicate that these endocrine changes could be associated with a higher diurnal food intake and preference for energy- dense foods. All these changes could result in a positive energy balance, leading to weight gain and a higher obesity risk in the long-term. The present article summarizes the epidemiologic and experimental evidence related to sleep deprivation and higher obesity risk. The possible mechanisms are highlighted. <![CDATA[<b>Aplicando psicología positiva en educación médica</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000700018&lng=es&nrm=iso&tlng=es Today we are witnessing an exponential growth in positive psychology (PP), a scientific approach to the most significant purpose of human existence: happiness and meaning of life. As a consequence of PP studies, happiness and wellbeing are now accepted as valid topics of research, despite their subjective and supposedly unscientific essence. Experimental evident indicates that happiness and wellbeing have biological bases and, thus, can be scientifically approached and eventually changed. We believe that we need to learn from this new discipline and apply its discoveries in our profession as medical educators to foster the full development of our students. In this review, we will summarize the major developments and discoveries of PP, and open the debate on the implications of PP offer to medical education. <![CDATA[<b>Revisión por pares en la Revista Médica de Chile, año 2010</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000700019&lng=es&nrm=iso&tlng=es Today we are witnessing an exponential growth in positive psychology (PP), a scientific approach to the most significant purpose of human existence: happiness and meaning of life. As a consequence of PP studies, happiness and wellbeing are now accepted as valid topics of research, despite their subjective and supposedly unscientific essence. Experimental evident indicates that happiness and wellbeing have biological bases and, thus, can be scientifically approached and eventually changed. We believe that we need to learn from this new discipline and apply its discoveries in our profession as medical educators to foster the full development of our students. In this review, we will summarize the major developments and discoveries of PP, and open the debate on the implications of PP offer to medical education. <![CDATA[<b>Neruda y la resistencia a los antibióticos </b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000700020&lng=es&nrm=iso&tlng=es Antimicrobial resistance has been a problem in medicine, since their incorporation to clinical practice. Numerous papers have been written on the subject. The analysis of two poems by Pablo Neruda "How much does a man live" and "Larynx", included in the volume "Estravagario" and published for the first time in 1957 and 1958, give us an incredible revelation about the concept of resistance. In these poems aureomycin, the first antimicrobial of the family of tetracycline’s, was included as a poetic figure and the therapeutic action of antimicrobials was described. "Never so much bugs died I tons of them fell I but the few that remained olive I manifested their perversity". These writings incorporated novel concepts, even for physicians of that time and described the closeness of death that a patient may perceive during the course of a given disease. The capacity of Pablo Neruda to extract the essence of situations and to anticipate to conditions that only years later became clinically relevant problems, is noteworthy. <![CDATA[<b>Salud Mental en Adolescentes Privados de Libertad</b>: <b>una deuda pendiente</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000700021&lng=es&nrm=iso&tlng=es Antimicrobial resistance has been a problem in medicine, since their incorporation to clinical practice. Numerous papers have been written on the subject. The analysis of two poems by Pablo Neruda "How much does a man live" and "Larynx", included in the volume "Estravagario" and published for the first time in 1957 and 1958, give us an incredible revelation about the concept of resistance. In these poems aureomycin, the first antimicrobial of the family of tetracycline’s, was included as a poetic figure and the therapeutic action of antimicrobials was described. "Never so much bugs died I tons of them fell I but the few that remained olive I manifested their perversity". These writings incorporated novel concepts, even for physicians of that time and described the closeness of death that a patient may perceive during the course of a given disease. The capacity of Pablo Neruda to extract the essence of situations and to anticipate to conditions that only years later became clinically relevant problems, is noteworthy. <![CDATA[<b>Diagrama de Flujo para la Evaluación de Programas de Formación de Postgrado</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872011000700022&lng=es&nrm=iso&tlng=es Antimicrobial resistance has been a problem in medicine, since their incorporation to clinical practice. Numerous papers have been written on the subject. The analysis of two poems by Pablo Neruda "How much does a man live" and "Larynx", included in the volume "Estravagario" and published for the first time in 1957 and 1958, give us an incredible revelation about the concept of resistance. In these poems aureomycin, the first antimicrobial of the family of tetracycline’s, was included as a poetic figure and the therapeutic action of antimicrobials was described. "Never so much bugs died I tons of them fell I but the few that remained olive I manifested their perversity". These writings incorporated novel concepts, even for physicians of that time and described the closeness of death that a patient may perceive during the course of a given disease. The capacity of Pablo Neruda to extract the essence of situations and to anticipate to conditions that only years later became clinically relevant problems, is noteworthy.