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Differences in people's living conditions and unequal opportunities have become more visible than before (others are still hidden) and create an opportunity for changes that we must face together.Monomelic amyotrophy, also known as Hirayama disease, is a rare lower motor neuron syndrome due to localized lower motor neuron loss in the spinal cord at the cervical level. Clinically, monomelic amyotrophy is defined by the insidious onset of unilateral atrophy and weakness involving the hand and forearm, typically beginning in the second or third decade of life. We report 19-year-old man with a two years history of slowly progressive unilateral weakness and atrophy of his right-hand muscles. Neurological examination revealed weakness and atrophy in his intrinsic hand muscles, with sparing of the abductor pollicis brevis muscle. Also, mild atrophy of the ulnar aspect of the forearm was detected with sparing of the brachioradialis muscle. Electromyography showed active and chronic neurogenic changes affecting C8 and T1 myotomes, with mild chronic neurogenic changes on C7 myotome. Magnetic resonance imaging of his cervical spine revealed spinal cord atrophy involving C5 to C7 segments, associated with forward displacement of the posterior wall of the dura in cervical spine flexion. The clinical features associated with the imaging and electrophysiological findings support the diagnosis of monomelic amyotrophy.Reintervention of a mitral degenerated bioprosthesis has a high surgical risk, especially in elderly patients with multiple comorbidities. We report a 74 years old female with two previous cardiac surgical procedures and a new structural mitral bioprosthesis deterioration with severe mitral regurgitation. Considering her high-surgical risk, a fully percutaneous treatment was performed with a balloon-expandable aortic valve in mitral position (valve-in-valve) through a transseptal approach with a favorable outcome. This technique is an attractive and effective option with a relatively low rate of complications that could solve this challenging and complex disease.Primary aortoenteric fistula is the spontaneous communication between the lumen of the aorta and a portion of the digestive tract. The most common cause is the erosion of an abdominal aortic aneurysm into the 3rd or 4th portion of the duodenum. It manifests clinically as gastrointestinal bleeding, with or without abdominal pain and a pulsatile abdominal mass on physical exam. Gastrointestinal bleeding is initially recurrent and self-limiting and progresses to fatal exsanguinating hemorrhage. Endoscopic examination diagnoses only 25% of aortoenteric fistulas because these are usually located in the distal duodenum. Contrast computed tomography of the abdomen and pelvis is diagnostic in only 60% of cases. SIS3 clinical trial We report three cases with this condition. A 67-year-old male presenting with an upper gastrointestinal bleeding. He was operated and a communication between an aortic aneurysm and the duodenum was found and surgically repaired. The patient is well. A 67-year-old male with an abdominal aortic aneurysm presenting with abdominal pain. He was operated and anticoagulated. In the postoperative period he had a massive gastrointestinal bleeding and a new CAT scan revealed an aorto enteric fistula that was surgically repaired. The patient is well. An 82-year-old male with an abdominal aortic aneurysm presenting with hematochezia. A CAT scan revealed a communication between the aneurysm and the third portion of the duodenum, that was surgically repaired. The patient died in the eighth postoperative day.We report a 78-year-old man with a basal Rankin score of 2 points, last seen 10 hours before in good conditions, who arrived at the emergency department with left hemiparesis, hypoesthesia, and spacial neglect. Neuroimaging was compatible with stroke in the territory of the right middle cerebral artery. Due to the evolution time of the stroke, usual thrombolysis was contraindicated. Therefore, a thrombolysis with Tenecteplase was used with reversal of symptoms without symptomatic bleeding and with recovery of baseline functionality.

Training of health care students at universities is a great challenge for Medical Education Offices. link2 Our office made clear and explained the teaching-learning process from the perspective of teachers, programs, and students.

To report a ten years' analysis of a Medical Education Office (MEO) work, describing the different processes and systematized decisions aimed to improve the quality of the programs and learning results.

A 10 years retrospective analysis of the Medical Education Office processes directed to Medicine, Nursing, Physical Therapy, and Nutrition careers of a Faculty of Medicine. Flunks between 2013 and 2017 were compared.

A progressive reduction in flunks was observed in the four careers. Specifically, the proportion of flunks in Nutrition decreased from 30 to 9%. When comparing flunks using a Chi-square test of homogeneity in the four careers, a significant decrease in four of six courses was observed. link3 This led to a sustained increase in number of students who completed their career and obtained their title. Specifically, in Medicine there was a 7.5-fold increase in these figures. The Diploma course trained 90% of the teachers in charge of courses of the four careers. The master's degree generated research that allowed to increase the productivity in health sciences education.

The Office of Medical Education created knowledge and management models for the education of health sciences students, enhancing the quality of training and learning processes.

The Office of Medical Education created knowledge and management models for the education of health sciences students, enhancing the quality of training and learning processes.

An increasingly large proportion of clinical trials is being conducted at non-traditional geographic regions such as Latin America. However, concerns have been raised that hosting countries may lack adequate research regulations and that clinical trials may not address local health needs. In this context, Chile has been hosting a relatively large proportion of clinical trials and has introduced new regulatory protections.

To study trends and characteristics of clinical trials in Chile, including the effects of regulatory protections and whether clinical trials are aligned with the local burden of diseases.

Data from clinical trials on pharmaceutical products registered over the last decade in Chile's Institute of Public Health was reviewed. Clinical trials were analyzed according to sponsorship, phase, disease studied, and whether distribution of trials according to diseases was aligned with the local burden of diseases measured in disability-adjusted life years.

Most of the 876 clinical trials analyz aligned with local disease burden. The introduction of regulatory protections was followed by changes in the distribution of diseases studied.

Physical inactivity and sedentariness are independent risk factors for mortality. Physical inactivity is defined as engaging in insufficient moderate/vigorous physical activity (i.e. not meeting the WHO's recommendations). Sedentariness is defined according to sedentary behavior; evidence suggests that > 8 h/d could serve to consider a person as sedentary. The Chilean National Health Survey 2016-2017 (NHS), using a single question (Question-NHS), considered as "sedentary" those who did not engage in sports or physical activity for ≥ 30 min, ≥ 3 times/wk. Thus, it attempted to estimate sedentariness without considering sedentary behavior.

To determine the prevalence of physical inactivity and sedentariness in Chile, and to contrast such results with the Question-NHS.

We analyzed data from 5564 participants of the 2016-2017 NHS, aged ≥ 18 years. The Global Physical Activity Questionnaire was used to determine moderate/vigorous physical activity and sedentary behavior. We defined physical inactivity as having < 600 MET × min/wk of moderate/vigorous physical activity, and sedentariness as having > 8 h/d of sedentary behavior.

The prevalences [95% confidence intervals] of physical inactivity and sedentariness were 32% [29-34] and 6% [5-7] respectively, while 3% [2-4] were both physically inactive and sedentary. The Question-NHS classified 88% [86-89] as "sedentary", but among them, 35% were physically inactive and 6% were sedentary.

One third of adults are inactive, one out of ten is sedentary, and one out of twenty is inactive and sedentary. The Question-NHS overestimates the population at risk.

One third of adults are inactive, one out of ten is sedentary, and one out of twenty is inactive and sedentary. The Question-NHS overestimates the population at risk.Glomerular filtration rate (GFR) is routinely estimated using endogenous biomarkers due to the complexity of direct measurement methods. Cystatin C is a protease inhibitor produced in all nucleated cells. It is freely filtered and then catabolized by renal tubular cells. Therefore, plasma concentration of cystatin C depends primarily on GFR. Serum cystatin C is less affected by muscle mass, diet, race, gender and age than creatinine. In the general population, equations to estimate GFR based on cystatin C do not have a better performance than those based on creatinine. However, formulas that combine creatinine and cystatin C are more accurate and precise. Estimation of GFR based on cystatin C could be useful in populations in which creatinine value may be biased, such as people with extremely low or high muscle mass, cirrhosis and chronic cardiorenal syndrome. Due to its higher cost in comparison to creatinine, we recommend measuring cystatin C on these clinical situations and when a more accurate estimation of GFR is required.Arterial hypertension is one of the biggest public health problems. The research in this area has been relentless and productive, allowing to identify new pathophysiological mechanisms from which new therapeutic options are under development. Despite the recognized efficacy and tolerability of currently available drugs, a high number of patients still do not comply with treatment and maintain inadequate blood pressure levels. This review summarizes the literature about new pharmacological alternatives to treat hypertension. The development state of these new medications ranges from a preclinical state to their clinical use in hypertensive patients. Technological strategies aiming at increasing the compliance with anti-hypertensive medications are also mentioned.Amyloid angiopathy (AA) is a selective deposition of amyloid in the walls of the brain vessels. It is a form of sporadic and localized amyloidosis, constituted by the Aβ4 protein, the same of Alzheimer's disease senile plaques. The most consistent clinical effect of AA is spontaneous brain hemorrhage (BH). It is the second most common cause of BH after arterial hypertension (HT). Other clinical manifestations are cognitive impairment and transient focal neurological episodes. AA BH is characteristically localized in the cerebral cortex and subcortical white matter (lobar hemorrhage), consistent with the preferential deposit of amyloid in the walls of leptomeningeal and intracortical small cerebral vessels. Other types of AA hemorrhagic complications are microbleeds (MB), cerebral convexity subarachnoid hemorrhage (cSAH) and superficial hemosiderosis (cSS). The diagnosis of AA BH is based on the Boston criteria. Using these criteria, several non-hemorrhagic biomarkers of AA have been identified that can be useful in its diagnosis.