The standardization of clinical processes allowed the development of new skills such as the generation of clinical projects, an institutional methodology for managing change and sustainability through cycles of continuous improvement.We share the experience of a clinical relationship that arose between a medical student and a patient hospitalized due to a SARS-CoV-2 pneumonia. The analysis of this experience and the discussion of medical students’ possible role in patient care suggest that they should be included as members of the health care team during their clinical practice. This would mean a positive contribution for both the patients’ care and the students’ learning experience.Conventional radiography of hands has been the imaging technique used for the early diagnosis of rheumatoid arthritis, considering its easy access and ability to reveal structural damage. However, it does not provide information about inflammatory activity or prognosis of this disease. On the other hand, magnetic resonance imaging is becoming the technique of choice for the early diagnosis of this disease and for the assessment of treatment response. It has a better sensitivity for the detection of inflammatory findings that cannot be identified with physical examination, analytical and conventional imaging techniques. This article reports the imaging protocol for magnetic resonance of the hands used at our institution for the diagnosis and follow-up of patients with rheumatoid arthritis. We also review the main imaging findings of the disease.There is an important interindividual variability in dose requirement for coumarinic anticoagulants, which could be explained by genetic and non-genetic factors. Among hereditary factors, there are gene polymorphisms that code the therapeutic target and the main enzyme responsible for their metabolism. However, there are other candidate genes that could modulate dose requirements. The is a paucity of pharmacogenomic platforms to determine dose requirements of coumarinics in the Chilean population. Therefore, algorithms considering different variables to adjust individual dosages are required. Herein, we analyze the available evidence about factors that can modify the effects of vitamin K antagonists and that should be incorporated to dosing algorithms.We analyze the transmission routes, possible viral reservoirs in the oral cavity and considerations about dental care of SARS-CoV-2 virus infection. We also analyze the protocols required before and after a dental procedure, aiming to increase the awareness of dentists about the importance of virus spread prevention among health care workers and patients. The evaluation of symptoms associated with SARS- CoV-2 such as fever, fatigue, dry cough, myalgia, dyspnea, and the inquiry about possible contacts with infected people is of utmost importance. The tongue and oral mucosa are important viral reservoirs and the transmission of the virus occurs primarily by saliva droplets. Therefore, elective dental care should be postponed, attending only dental emergencies during this period, incorporating the use of protective personal equipment (PPE) and using manual instruments to prevent the production of aerosols.

Cardiogenic shock (CS) is uncommon in the cardiac catheterization laboratory (CCL) among patients undergoing coronary angiography. Periprocedural CS is more frequent in high-risk patients and in technically demanding procedures.

To describe the clinical outcomes of patients who underwent peripheral venoarterial extracorporeal membrane oxygenation (pVA-ECMO) for CS associated with interventional cardiology procedures.

Review of clinical records of seven patients treated between January 2014 and October 2018.

pVA-ECMO was implanted within 6 hours of the interventional cardiology procedure. All patients had coronary artery disease and one of them also had symptomatic severe aortic stenosis. One patient entered the CCL in cardiac arrest. Percutaneous coronary intervention (PCI) was performed in all patients; four patients underwent an emergency procedure and five patients experienced PCI complications. One patient undergoing transcatheter aortic valve replacement suffered acute severe aortic regurgitation. An intra-aortic balloon pump was inserted at the CCL in five patients. Six patients experienced cardiac arrest. Mean SAVE score was -4.3 and baseline lactate 55 mg/dl. pVA-ECMO mean duration was 5 ± 4 days. Survival after both hospital discharge and 12 months of follow-up was 85.7% Regarding vascular access complications, we observed one access site hematoma and one episode of cannulation site bleeding requiring surgical repair.

pVA-ECMO should be considered in patients with periprocedural CS as a bridge to recovery. Its use was associated with improved clinical outcomes in this series.

pVA-ECMO should be considered in patients with periprocedural CS as a bridge to recovery. Its use was associated with improved clinical outcomes in this series.

In Chile, there is little access to Dermatology outpatient consultations in the public health care system, which has favored the development of tele dermatology (TD).

To assess satisfaction levels of primary care providers with a TD channel via the social networking app WhatsApp® and the concordance between the diagnosis of general practitioners and dermatologists at Pontificia Universidad Católica de Chile.

An electronic survey was answered by the general practitioners who participate in the TD channel. In 417 cases, the diagnostic concordance between general practitioners and specialists was assessed.

The survey was answered by 84 practitioners. General satisfaction levels with the platform were over 95%. Satisfaction levels with the response speed and the management suggested by the specialist were over 90%. Over 80% of the practitioners read the consultation sent by dermatologists and considered that their dermatological knowledge improved. Diagnostic concordance between practitioners and specialists was 41%.

TD via a WhatsApp® group linked to a university is a low cost and easy to implement intervention, generating high levels of satisfaction among general practitioners.

TD via a WhatsApp® group linked to a university is a low cost and easy to implement intervention, generating high levels of satisfaction among general practitioners.

The Addenbrooke’s Cognitive Examination III (ACE-III) is widely used for evaluation of dementia.

To assess the psychometric properties of ACE-III, analyzing its factor structure, its reliability (from an Item Response Theory [TRI] model) and its diagnostic usefulness.

We studied 1101 older people without cognitive impairment and 63 currently having a diagnosis and receiving treatment for dementia.

The presence of two factors for the Attention subscale (Orientation and Attention, separately) was suggested. The factorial analysis showed adequate adjustment in all the subscales, except for the new Attention subscale. In the TRI analysis, the Attention subscale presented a greater number of items with lack of fit compared to the other subscales. Using a proposed threshold of 66 points or less to identify cognitive impairment related to dementia, a sensitivity of 0.97 and specificity of 0.81 was obtained.

ACE-III is a valid, reliable, and useful measure for the clinical detection of dementia. The combined use of Orientation and Memory subscales is proposed as an alternative and time-saving ACE-III indicator.

ACE-III is a valid, reliable, and useful measure for the clinical detection of dementia. The combined use of Orientation and Memory subscales is proposed as an alternative and time-saving ACE-III indicator.

Migratory processes may affect mental health. Data on the health status of migrants are necessary for an adequate public health approach.

To describe the prevalence of anxious and depressive symptoms in Colombian migrants living in Chile and to compare it with the Chilean population.

Beck and BDI scales for depression and BAI anxiety scale were applied to 1,932 participants living in Arica, Antofagasta and Santiago. Of these, 976 participants (51% women) aged 35 ± 10 years were first generation Colombian migrants and 956 participants aged 34 ± 14 years were Chilean.

The scores for depressive and anxious symptoms were higher in Chileans than in Colombians. Women reported worse mental health in both groups. Chilean and Colombian respondents residing in Arica and Antofagasta had a higher degree of anxiety and depression than their counterparts residing in Santiago.

Chileans have worse mental health indicators than Colombian migrants. There are differences by sex and city of residence.

Chileans have worse mental health indicators than Colombian migrants. There are differences by sex and city of residence.

The Chilean allocation system for liver transplantation (LT) uses the MELD/PELD score to prioritize candidates on the waiting list.

To assess if the Chilean allocation system for LT is equitable for pediatric candidates compared to their adult counterparts.

We used the Public Health Institute’s registry between October 2011 and December 2017. We analyzed candidates with chronic hepatic diseases listed for LT. The primary outcome was the cadaveric liver transplantation (CLT) rate. Secondary outcomes were death or disease progression in the waiting list and living donor liver transplant (LDLT) rate.

We analyzed 122 pediatric and 735 adult candidates. Forty one percent of pediatric candidates obtained a CLT compared to 48% of adults (p = NS). Among patients aged under two years of age, the access to CLT on the waiting list there was 28% of CLT, compared to 48% in adults (p = 0.001). Fifty-seven percent of candidates aged under two years were listed for cholestatic diseases, obtaining a CLT in 18% and requiring a LDLT in 49%. The median time in the waiting list for CLT was 5.9 months in pediatric candidates and 5.1 in adults, while the median time to death in the waiting list was 2.8 and 5.6 months, respectively. The mortality rate at one year in candidates under two years old was 38.1% compared to 32.5% in adults.

Pediatric candidates with chronic liver diseases, especially under two years of age, have greater access difficulties to CLT than adults. Half of the pediatric candidates die on the waiting list before three months. The mortality among candidates under two years of age in the waiting list is excessively high.

Pediatric candidates with chronic liver diseases, especially under two years of age, have greater access difficulties to CLT than adults. Half of the pediatric candidates die on the waiting list before three months. The mortality among candidates under two years of age in the waiting list is excessively high.

Vitamin K antagonist medications (VKA) are essential for the prevention of thromboembolic events, but their effectiveness is influenced by multiple factors, such as the type of medication chosen.

To evaluate the efficacy in anticoagulant control of the bioequivalent and non-bioequivalent drugs of acenocoumarol compared to the reference drug. To evaluate the efficacy of warfarin bioequivalents available in Chile. To contrast the overall anticoagulant control efficacy between acenocoumarol and warfarin.

The results of 69333 outpatient oral anticoagulation controls were analyzed. Patient were separated in groups according to the drug that they used. Subsequently, the proportions of controls outside the range for each of acenocoumarol and warfarin bioequivalent drugs were compared. Acenocoumarol non-bioequivalent drugs were also compared with the reference drug. Acenocoumarol was compared with warfarin.

Acenocoumarol bioequivalent drugs and the reference drug had a similar proportion of controls outside the range (Odds ratios (OR) 0.