Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720120007&lang=es vol. 140 num. 7 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[Tradición y Progreso (1872-2012)]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000700001&lng=es&nrm=iso&tlng=es Background:The first issue of Revista Médica de Chile appeared in July, 1872. Since then it has been published monthly and thus it became one of the oldest medical journals being printed since the 19th Century. The opening Editorial in the first issue, labeled as "Prospecto"and written by the first editor, Germán Schneider, M.D., is reproduced. The current Editors comment the main statements found in that document establishing the purpose and scope of this journal. There are good reasons to sustain that through its 140 years of life, Revista Médica de Chile has fully accomplished the expectations of its founders and the owning institution: Sociedad Médica de Santiago-Chilean Society of Internal Medicine. The journal is serving well the medical community as a forum to present and discuss clinical experience, topics in scientific and technological advances related to medicine, medical education, medical ethics, and public health. <![CDATA[Fibrosis quística en el adulto: <b>experiencia de un centro de referencia nacional</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000700002&lng=es&nrm=iso&tlng=es Background:Although in most patients the diagnosis of cystic fibrosis (CF) is made during their first years of life, a proportion of patients is diagnosed during adulthood. Aim: To describe the features of adult patients diagnosed with CF. Materials and Methods: Analysis of medical records of patients diagnosed with CF in a public hospital devoted to respiratory diseases. Demographic, clinical, laboratory and microbiological data were recorded. Results: Fifty eight patients aged 25.4 ± 6.5 years were included. In 40% of them, CF was diagnosed after 15 years of age. The most common mutation found was AF508. Among clinical characteristics, lung involvement, mainly bronchiectasis, was found in 93%. The mean forced expiratory volume in the first second (FEV,) was 65,7 ± 27,1%. Fifteen patients were colonized with Pseudomonas aeruginosa. The main complication seen was hemoptysis, in 12% of patients. Five patients died, mostly due to respiratory distress associated with sepsis, while three were subjected to bilateral lung transplantation. Patients in whom the diagnosis of CF was made after 15 years of age, had lower frequency of AF508 mutation, were most commonly women and had a lower rate of pancreatic involvement. Conclusions: CF is a disease that is increasingly reaching adult population. CF must be suspected in adolescents and young adults who suffer chronic lung diseases such as bronchiectasis, particularly when they are colonized by Pseudomonas aeruginosa, or in patients who develop infections by uncommon organisms. <![CDATA[Impacto del <i>delirium</i> en pacientes de edad avanzada hospitalizados: un estudio prospectivo de cohortes]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000700003&lng=es&nrm=iso&tlng=es Background:Delirium is an important problem in older medical inpatients. Aim: To assess if delirium is associated with higher mortality, functional decline or higher rates of readmission or institutionalization in a one year follow-up period. Material and Methods: Prospective cohort study of consecutive patients 65 years and older, admitted to a general hospital medical ward. A psychogeriatric team assessed patients every 48 h using the Confusion Assessment Method (CAM), functionality, acute severity and comorbidity scores. Analysis of one year mortality and telephone functional assessment was performed. Results: Five hundred forty two patients were enrolled and 35.4% had delirium. After one year, mortality was 34.9 and 13% in delirium and non-delirium cohorts, respectively (p < 0.01). After adjustment for covariates, delirium was independently associated with higher mortality, and higher functional decline and institutionalization. No significant differences were seen in readmission rates. Conclusions: Delirium was significantly associated with higher mortality and functional decline over a one year follow up period in geriatric inpatients. <![CDATA[<b>Perfil clínico y epidemiológico de los casos de tuberculosis atendidos en una red de salud universitaria en Santiago de Chile entre los años 2000-2010</b>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000700004&lng=es&nrm=iso&tlng=es Background:The incidence and epidemiological profile of tuberculosis (TB) has changed significantly in the recent years in Chile. Aim: To evaluate the clinical and epidemiological characteristics of TB cases diagnosed in the last decade at a university hospital in Santiago. Material and Methods: The Mycobacterium tuberculosis culture registry of the microbiology laboratory was reviewed. Medical records of patients with a positive culture registered between 2000 and 2010 were retrieved and analyzed. Results: Two hundred forty positive Mycobacterium tuberculosis cultures were identified and the medical records of 158 of these patients were accessed for analysis. The median age was 53 years (range: 3 to 89), 55.1% were female and nearly 42% had extra-pulmonary TB. Among known risk factors, 32.9% of patients were older than 65 years, 4.4% were health care workers and 3.9% immigrants. Twenty eight percent (41/145) had some type of immunosuppression at diagnosis: 11.7% HIV infection and 16.6% were using immunosuppressive drugs. In this group, a previous tuberculin skin test was done in only 5 cases (12.2%). Adverse events related to TB treatment were reported in 21.3% of cases (17/80). No cases of fulminant hepatitis or death from this cause were identified. Four of 92 patients that had a complete follow up during treatment, died. Two of these patients were receiving steroids. Conclusions:Almost one third of TB cases occurred among immunosuppressed patients and 42% were extra-pulmonary forms. The prevention of TB reactivation in this group should be strengthened. <![CDATA[Incidencia y mortalidad de bacteriemia en un hospital clínico docente en Santiago de Chile]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000700005&lng=es&nrm=iso&tlng=es Background:The incidence of bacteremia has increased over the last decade due to the aging of the population and the wide implementation of invasive nosocomial procedures and wide-spectrum antimicrobial treatments. Aim: To assess the epidemiology of hospital and ambulatory bacteremias in a public hospital in Santiago. Material and Methods: A prospective longitudinal cohort study of laboratory-confirmed adult patients with bacteremia was undertaken at a public hospital in Santiago, between June 1, 2007 and April 30, 2008. Demographic, clinical, and laboratory data was collected into a standardized study-specific form. Results: In the study period, 253 cases of true bacteremia were identified, with an incidence of 11 per 1,000 patient discharges (63.6% nosocomial, 36.7% fatal). Only 2/3 of the cohort was alive at day 28 of hospitalization. Variables associated with mortality were age with a hazard ratio (HR) of 2.31; (95% confidence intervals (CI) 1.42- 3.77); female gender (HR, 1.70; 95% CI 1.06- 2.71); shock (HR, 3.24; 95%CI 2.01-5.22); and C reactive protein (HR, 2.10; 95% CI 1.17- 3.78). The variable associated with lower mortality was surgery (HR, 0.43; 95% CI 0.25-0.75). Selective empiric treatment did not improve survival. Conclusions: Besides age and gender, survival can be influenced by modifiable variables such as presence of shock and surgical intervention, which may provide an opportunity to improve outcomes. <![CDATA[Reglas de decisión para la selección de sistemas de citas basadas en características del paciente y de la institución de salud]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000700006&lng=es&nrm=iso&tlng=es Background:Outpatient scheduling has a significant impact on the perceived quality of service by the users and the efficient use of resources in the health system. There are mathematical methods that assist in solving this problem, but are seldom applied. Aim: To propose decision rules that are based on the own conditions of each institution and indicate which appointment system is the most suitable for the decision makers. Material and Methods: Through computer simulation, the effect of a wide range of decision and environmental factors over the appointment systems performance was assessed, in order to determine how these factors affect them. Re-suits: Consideringperformance indicators associated to the patient's satisfaction and resources utilization, scheduling shorter length patients (e.g. check-up patients) in the beginning of the working day resulted to be in the efficient solutions frontier, as well as scheduling patients in one person blocks (shifting to multiple patient blocks only if resources utilization indicators are prioritized). Conclusions: Performance indicators are more sensitive to the sequence used to schedule different length patients, rather than the number of patients scheduled per block. Moreover, decision rules based on the institution priorities are proposed, which are quite robust to environmental factors. <![CDATA[Ideas autolíticas, violencia autoinfligida, y síntomas depresivos en escolares chilenos]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000700007&lng=es&nrm=iso&tlng=es Background: Suicidal behaviors and depression are prevalent phenomena among adolescents, and are considered a public health problem. Aim: To determine the prevalence of depressive symptoms and suicidal behaviors and the relationship between both phenomena, in a representative sample of students from ninth grade in Santiago, Chile. Material and Methods: We recruited a probability sample of 2,597 adolescents who answered a questionnaire with questions about suicidal behavior and the Beck Depression Inventory (BDI-II). Results: The lifetime prevalence of suicidal ideation and planning was 21 and 14%, respectively. The prevalence for the past two weeks was 6.7 and 4.4% for suicidal ideation and planning, respectively. Autolytic behaviors, once in lifetime and in the past week were referred by 26 and 4% of respondents, respectively. In one third of these, self-harm coincided with recent suicide ideation or planning. All levels of suicidal behavior were more frequently reported by women. Clinically significant depressive symptoms were present in 23.5% of adolescents. Females doubled male rates. Severe depressive symptoms were present in 9.4% of the sample. A higher level of suicidal behavior correlated with more severe forms of depression. Sixty percent of adolescents who reported recent self-harm, had clinically relevant depressive symptoms. Two thirds of them had severe symptoms. Conclusions: Suicidal behavior in Chilean adolescents is prevalent, and there is an association between this behavior and the level of depression. The school is a good place to identify and develop preventive measures for teenagers. <![CDATA[Respuesta inmunitaria a la vacuna de la hepatitis B en pacientes hemodializados en Brasil y sus factores asociados]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000700008&lng=es&nrm=iso&tlng=es Background:Patients on chronic hemodialysis have a lower immune response to vaccination against hepatitis B virus (HBV) than the general population. Aim: To identify factors that may interfere with immunization against hepatitis B virus (HBV) in Brazilian hemodialysis patients and analyze the evolution of the level of antibodies. Patients and Methods: A retrospective longitudinal study, using records of patients on hemodialysis in the years 2000-2008. Non-responder patients, defined as a level of anti-HBs less than 10 IU/mL, were identified. The effect of social and demographic factors, clinical and laboratory data on the lack of response was evaluated. Logistic regression analysis was used to assess the independent effect of each factor. The difference between initial and final anti-HBs levels (24 months), was also analyzed. Results: Fifty seven percent of patients responded adequately to vaccination. After adjustment with other variables, the only factor associated with immune response was serum ferritin. Responding patients of less than 40 years of age did not have a significant decrease in antibody titers over time. The initial anti-HBs title, influenced the final title. Fifty percent of non-responders achieved serum levels of protection after revaccination. Conclusions: The study showed that ferritin may be a marker of reduced immune response. Patients aged less than 40 years were the only ones who maintained over time their initial anti-HBs levels. <![CDATA[Genotipo y fenotipo de la enzima tiopurina metiltransferasa en población chilena]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000700009&lng=es&nrm=iso&tlng=es Background: Thiopurines (azathioprine and 6-mercaptopurine) are highly effective medications but with potential adverse effects. Thiopurine methyltransferase (TMPT) is the key enzyme in their pharmacokinetics and is genetically regulated. A low activity of TPMT is associated with myelotoxicity. The genotype and enzyme activity can vary by ethnicity. Aim: To study the activity and genotype of TPMT in a group of Chilean subjects. Material and Methods: In 200 healthy adult blood donors, TPMT activity was determined by high performance liquid chromatography (HPLC). Deficient, low, normal or high levels were defined when enzymatic activity was < 5, 6-24,25-55 and &gt; 56 nmol/grHb/h, respectively. Genotyping of TPMT (*1, *2, *3A, *3B, *3C) was performed by PCR. Results: Seventy seven women (38.5%) and 123 men (61.5%), with an average age of 34.9 years were studied. Eighteen subjects (9%) had a low enzymatic activity, 178 (89%) had normal activity, 4 (2%) had high activity and no genotype deficient subjects were identified. The wild type genotype (*1) was found in 184 (92%) individuals and 16 (8%) were heterozygous for the variants: *2 (n = 2), *3A (n = 13) and *3C (n = 1). No homozygous subjects for these variants were identified. Wild type genotype had an increased enzymatic activity (40.8 ± 7.2 nmol/gHb/h) compared to heterozygous group (21.2 ± 3 nmol/ gHb/h; p < 0.001). Conclusions: Less than 10% of a Chilean population sample has a low enzymatic activity or allelic variants in the TPMT gene, supporting the use of thiopurines according to international recommendations. <![CDATA[Marcadores de síndrome metabólico como predictores de elevación de alanino aminotransferasa en niños]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000700010&lng=es&nrm=iso&tlng=es Background: There is a high prevalence of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) among pediatric patients. The identification of clinical predictors of these conditions would allow a timely treatment. Aim: To evaluate the relationship between serum alanine aminotransferase levels and parameters of metabolic syndrome in asymptomatic school students without hepatic illness. Subjects and Methods: A randomized sample of 175 children aged between 9 and 14 years (54% females) was selected, from a database of 3010 students living in Santiago, Chile. Weight, height, abdominal circumference, systolic and diastolic blood pressure were measured. A fasting blood sample was obtained to measure glucose, total cholesterol, HDL, LDL-cholesterol, triglycerides, alanine aminotransferase (ALT) and insulin levels. Results: Forty percent of participants were obese, 17% had metabolic syndrome and 13.1% had abnormal ALT levels. Compared with children with normal ALT levels, the latter had significantly higher waist obesity, body mass index, systolic and diastolic blood pressure and triglycerides. However on multiva-riate analysis, only waist obesity was independently associated with abnormal ALT levels (adjusted odds ratio 3.93, 95% confidence intervals 1.44-10.78, p = 0.008). Conclusions: Only waist obesity was independently associated with abnormal ALT levels in this sample of children. <![CDATA[Linfoma de Hodgkin con compromiso hepático tratado con esquema gemcitabina, dexametasona y cisplatino como puente para terapia estándar: Caso clínico]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000700011&lng=es&nrm=iso&tlng=es Background: The initial presentation of Hodgkin lymphoma with liver involvement is rare. In these patients, the standard first-line therapy with ABVD (Adriamycin, Bleomycine, Vinblastine, Dacarbazine) imply an additional risk for liver toxicity. We report a 64-year-old woman who presented with jaundice, choluria, malaise and weight loss. In the initial evaluation she had jaundice and palpable groin lymph nodes. An obstructive biliary disease was ruled out with magnetic resonance imaging studies. A lymph node biopsy showed a Hodgkins lymphoma, Mixed-cellularity subtype. Considering the liver dysfunction, an alternative scheme of chemotherapy with dexamethasone, gemcitabine and cisplatin (GDP) was administered. After 4 cycles, a significant improvement in liver hepatic function tests was reached and a conventional chemotherapy (ABVD) was begun. While the literature provides some low toxicity protocols for patients with liver involvement, favorable results of our clinical case report allows us to postulate GDP as an alternative for salvage therapy in these patients. <![CDATA[Leiomiomatosis intravenosa de origen pelviano con extensión intracardiaca: Reporte de dos casos]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000700012&lng=es&nrm=iso&tlng=es Background: symptoms predominate. Diagnosis is based on clinical findings and appropriate imaging. We report two females, aged 35 and 51 years. One of them presented with a pelvic mass and dyspnea, the other patient had severe cardiac failure on admission. Computed axial tomography scan allowed an accurate preoperative diagnosis on both patients. Successful one stage resection of the tumor was performed under cardiopulmonary bypass. Both patients are asymptomatic on follow up at 6 months and 25 years. <![CDATA[Angiomatosis bacilar por <i>Bartonella quintana</i> como primera manifestación de infección por VIH: Report of one case]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000700013&lng=es&nrm=iso&tlng=es Background: Bacillary angiomatosis is an unusual infectious disease, with angioproliferative lesions, typical of immunocompromised patients. It is caused by Bartonella quintana and Bartonella henselae, two infectious agents of the genus Bartonella, which trigger variable clinical manifestations, including cutaneous vascular and purpuric lesions, and regional lymphadenopathy, and even a systemic disease with visceral involvement. We report a 38-year-old HIV positive male presenting with a history of six months of cutaneous growing purple angiomatous lesions, located also in nasal fossae, rhi-nopharynx and larynx. The skin biopsy was compatible with bacillary angiomatosis. Polymerase chain reaction of a tissue sample showed homology with B. quintana strain Toulouse. The patient was treated with azithromycin and ciprofloxacin with a favorable evolution. <![CDATA[Lesiones en la cavidad bucal en reflujo gastroesofágico]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000700014&lng=es&nrm=iso&tlng=es Patients with gastroesophageal reflux may have extra-esophageal manifestations. We report a 46 years old ex-smoker woman presenting with a sensation of burning mouth, xerostomia and glossitis. The patient had a history of heartburn, dysphonia and cough. Mouth examination showed a bad hygiene and abundant accumulation of plaque. Esophageal pH measurement was abnormal. Laryngoscopy showed a posterior laryngeal inflammation and mucous secretion. With these data, a diagnosis of gastroesophageal reflux was reached.<hr/>Los pacientes con reflujo gastroesofágico pueden tener manifestaciones extra esofágicas. Presentamos una mujer ex fumadora de 46 años que se presentó con sensación de quemazón en la boca, xerostomia y glositis. La paciente tenía además una historia de pirosis retroesternal, disfonía y tos. El examen bucal mostró una mala higiene bucal con abundante acumulación de sarro. Una medición de pH esofágico fue anormal. La laringoscopia mostró una inflamación laríngea posterior y secreción mucosa. Con estos antecedentes se llegó al diagnóstico de reflujo gastroesofágico. <![CDATA[Síndrome de ovario poliquístico y embarazo]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000700015&lng=es&nrm=iso&tlng=es Background: Polycystic ovary syndrome (PCOS) is a common endocrine metabolic dysfunction closely associated with insulin resistance and obesity, which predisposes to pregnancy complications and prenatal programming of the offspring. The aim of this review is to report our experience in PCOS patients who became pregnant and were followed during the whole pregnancy. Firstly, we analyzed the effect of pregnancy on PCOS pathophysiology and secondly the role of PCOS in pregnancy outcomes. Regarding the firstpoint, during normal pregnancy a progressive insulin resistance, serum lipid changes and an increase in androgen levels is observed, which is exacerbated in the PCOS condition. This adverse intrauterine environment could have a prenatal programming effect with detrimental consequences for female or male fetuses. Regarding the second point, PCOS is associated with an increased risk for maternal complications such as gestational diabetes (GDM) and pregnancy-induced hypertension. Moreover, these adverse pregnancy outcomes are more frequently associated with an increase in low birth weight and high birth weight newborns. According to our clinical experience, PCOS patients who became pregnant and were not treated with metformin during the whole pregnancy, showed a higher prevalence of gestational diabetes and SGA newborns, which was improved with metformin treatment. In summary, pregnancy may constitute a period in which an abnormal condition is established or aggravated in the fetus of a PCOS mother. Moreover, PCOS enhanced adverse obstetric and neonatal outcomes. <![CDATA[Fenotipos clínicos en enfermedad pulmonar obstructiva crónica: ¿volver al futuro?]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000700016&lng=es&nrm=iso&tlng=es Background: Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous disease, that is defined by the degree of obstruction rendered by the forced expiratory volume in the first second (FEVj). This is a good parameter to define the severity of the disease but does not account for its heterogeneity and does not provide a good comprehension of its different clinical behaviors and responses to treatment. Therefore, the classification of these patients in different clinical phenotypes has been attempted, trying to search for common clinical behaviors and responses to treatment. These phenoptypes must be validated in longitudinal studies. Some of the phenotypes detected are COPD with chronic respiratory failure and responsive to home oxygen therapy, COPD with upper lobe emphysema and responsive to volume reduction surgery, COPD with frequent exacerbation behavior, COPD resembling bronchitis and responsive to Roflumilast and possibly, COPD with systemic involvement. Historically, the phenotypes pink puffer, blue bloater, chronic bronchitis were defined. In the next years, we will know if the definitions of these phenotypes will aid in the management of patients with COPD. <![CDATA[Revisión por pares en la Revista Médica de Chile, año 2011]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000700017&lng=es&nrm=iso&tlng=es Background: Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous disease, that is defined by the degree of obstruction rendered by the forced expiratory volume in the first second (FEVj). This is a good parameter to define the severity of the disease but does not account for its heterogeneity and does not provide a good comprehension of its different clinical behaviors and responses to treatment. Therefore, the classification of these patients in different clinical phenotypes has been attempted, trying to search for common clinical behaviors and responses to treatment. These phenoptypes must be validated in longitudinal studies. Some of the phenotypes detected are COPD with chronic respiratory failure and responsive to home oxygen therapy, COPD with upper lobe emphysema and responsive to volume reduction surgery, COPD with frequent exacerbation behavior, COPD resembling bronchitis and responsive to Roflumilast and possibly, COPD with systemic involvement. Historically, the phenotypes pink puffer, blue bloater, chronic bronchitis were defined. In the next years, we will know if the definitions of these phenotypes will aid in the management of patients with COPD. <![CDATA[Ley chilena de tolerancia cero al alcohol: fortalezas, falencias y carencias que no deben ser obviadas]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000700018&lng=es&nrm=iso&tlng=es Background: Chile has recently entered into force Act No. 20.580, which modifies the legal limits of blood alcohol concentration in drivers and increases the penalties for driving under the influence of alcohol, narcotics or psychotropic substances. The aim of this review was to give an account of the strengths of this new law but, at the same time, to alert the scientific and legal community about its flaws. We also present some shortcomings of Chilean regulatory framework that remain uncorrected, those that should be considered in the design of public policies for improving road safety and the criteria that judges should ponder during judgment, to determine either conviction or acquittal. <![CDATA[Enseñanza de Psicología Médica en las escuelas de medicina chilenas]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000700019&lng=es&nrm=iso&tlng=es Background: Physicians should be exposed, during their training to basic concepts in psychology. Aim: To describe the current status of the formal teaching of health psychology or medical psychology in Chilean medical schools. Material and Methods: We reviewed the programs of the courses including topics of Medical Psychology, Health Psychology and Behavioral Medicine at 18 medical schools in Chile, using a focused coding method. The contents and the time spent on these courses were considered and analyzed. Results: Eighty three percent of medical schools have a Medical Psychology or related program, 56.3% are carried out during the first year of medical School teaching and the weekly load has an average of 4 hours. The contents are mixed and predominantly concerning general and developmental psychology, but also address specific issues of Medical Psychology in most cases. Conclusions: There is little clarity about the training issues to be addressed in medical psychology for medical students in Chile. It is necessary to define the minimum content that all medical graduates should learn. <![CDATA[Caracterización de la ingestión por sobredosis de paracetamol]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000700020&lng=es&nrm=iso&tlng=es Background: Physicians should be exposed, during their training to basic concepts in psychology. Aim: To describe the current status of the formal teaching of health psychology or medical psychology in Chilean medical schools. Material and Methods: We reviewed the programs of the courses including topics of Medical Psychology, Health Psychology and Behavioral Medicine at 18 medical schools in Chile, using a focused coding method. The contents and the time spent on these courses were considered and analyzed. Results: Eighty three percent of medical schools have a Medical Psychology or related program, 56.3% are carried out during the first year of medical School teaching and the weekly load has an average of 4 hours. The contents are mixed and predominantly concerning general and developmental psychology, but also address specific issues of Medical Psychology in most cases. Conclusions: There is little clarity about the training issues to be addressed in medical psychology for medical students in Chile. It is necessary to define the minimum content that all medical graduates should learn. <![CDATA[Hallazgo incidental de un quiste hepático no parasitario gigante]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872012000700021&lng=es&nrm=iso&tlng=es Background: Physicians should be exposed, during their training to basic concepts in psychology. Aim: To describe the current status of the formal teaching of health psychology or medical psychology in Chilean medical schools. Material and Methods: We reviewed the programs of the courses including topics of Medical Psychology, Health Psychology and Behavioral Medicine at 18 medical schools in Chile, using a focused coding method. The contents and the time spent on these courses were considered and analyzed. Results: Eighty three percent of medical schools have a Medical Psychology or related program, 56.3% are carried out during the first year of medical School teaching and the weekly load has an average of 4 hours. The contents are mixed and predominantly concerning general and developmental psychology, but also address specific issues of Medical Psychology in most cases. Conclusions: There is little clarity about the training issues to be addressed in medical psychology for medical students in Chile. It is necessary to define the minimum content that all medical graduates should learn.