Autorización para el ejercicio profesional médico en Chile: experiencia de la comisión de reválida de la Escuela de Medicina de la Universidad de Chile período 1984-1999 / Medical practice licensing in Chile: experience of the re-valuation committee of the medical school of Universidad de Chile, 1984-1999

We report the experience of the re-valuation committee of the University of Chile Medical School, in the period 1984-1999. This experience is relevant to the licensing processes in Latin America. We report the political, legal and regulatory backup and the academic criteria used to esatblish different evaluation methodologies. We also communicate the main results obtained. Factors such as the country and University conferring a title, nationality and length of service of the applicant, influence in the percentage of licensure exammination approval. Some modifications to the licensure process should be incorporated but, the overall results obtained, fully justify the existence of this licensure committee

La calcificación del anillo mitral en pacientes con esclerosis valvular aórtica se asocia a mayor compromiso de la función ventricular segmentaria / Calcification of the mitral annulus in patients with aortosclerosis is associated to a worse left ventricular segmental function

Existe una asociación independiente entre la esclerosis fibrocálcica aórtica (EFCA) y una mayor incidencia de muerte de origen coronario. Se pretende hacer una estimación de la prevalencia EFCA y su significado cuando coexiste compromiso del anillo mitral (CAM). Se estudia una serie de 433 ecocardiogramas Doppler consecutivos, de calidad satisfactoria y evaluados por dos observadores. Se definió la EFCA como áreas de aumento de ecogenicidad y engrosamiento de los velos aórticos en ausencia de aorta bicúspide y patología reumática mitrálica; el CAM se consideró cuando se demostró ecogenicidad cálcica. Se excluyeron los casos en que la velocidad máxima anterógrada aórtica era de > igual 2,5 m/seg. Resultados: 105 casos (24 por ciento) mostraron evidencias de esta patología, 74 (70 por ciento) eran de sexo masculino, su edad media de 68,1 ñ 11 años, su vmax aórtico fue de 1,51 ñ 0,36 m/seg. En 44 casos se estudió la motilidad segmentaria de acuerdo a scorer recomendado por la ASAECO. Se dividió la casuística en G1 individuos con EFCA exclusiva y G2 con compromiso mitroaórtico. Ambos grupos no tenían diferencias significativas en edad, sexo y velocidad máxima aórtica. El scorer ecocardiográfico de motilidad segmentaria para el G1 fue de 1,0839 ñ 0,17 y para el G2 de 1,30 ñ 0,412 p< 0,05. Conclusión: la prevalencia de la EFCA con o sin CAM es similar a lo comunicado recientemente, destaca que el trastorno cuantificado (scorer) de la motilidad segmentaria, es significativamente mayor en los casos que coexisten ambas lesiones (G2), lo que hace suponer que G2 tiene una mayor asociación a cardiopatía coronaria que G1

Acreditación de títulos profesionales e instituciones formadoras: el caso de Chile / Acreditation of professionals and teaching institutions: the case of Chile

Accreditation has acquired special relevance for the habilitation of professional practice, considering the proliferation of teaching institutions, the variety of training programs and the increasing amount of professionals requiring accreditation or revalidation of their titles. The internationalization of professional activities requires global and uniform accreditation procedures to avoid inequalities in evaluation of different professionals coming from abroad or from Chile. In the scope of medical practice, these concepts acquire special relevance, considering the appearance of new medical schools in the last decade and the increasing number of foreign physicians that need to revalidate their titles. In the period between January 1996 and September 1997, 192 foreign physicians applied to revalidate their titles and only 55 were approved. Therefore, the establishment of and effective evaluation system will correct deficiencies in the accreditation process and will promote the revision of training programs and the progress of teaching institutions. The organisms that will require to be accredited must be confident that this action will improve the quality of Chilean professional training

Endocarditis infecciosa: factores pronósticos de mortalidad en 131 casos / Infectious endocarditis: prognostic factors of mortality in 131 cases

We followed during their hospital stay, 129 patients aged 14 to 74 years old, who had 131 episodes of infective endocarditis. Clinical assessment, echocardiography and microbiological study was done to all patients. Surgical indications were those derived from complications. Thirty three patients died during hospital stay (25.2 percent). There were no differences between survivors and deceased patients in the lapse between onset of symptoms and hospital admission, presence of fever, dyspnea or heart murmurs. Skin and mucosal septic manifestations occured with higher frequency in deceased patients (57.1 and 24.3 percent respectively). Blood cultures were positive in 55 percent in survivors and 48 percent in those who died. The most frequent infecting organisms were staphilococci and streptococci. Vegetations were found with greater frequency in aortic position in both groups of patients. Deceased patients had a higher frequency of cardiac failure (84 and 65 percent respectively) and embolic episodes (77 and 46 percent respectively) than survivors. Antimicrobial treatment was successfull in 94 percent of survivors and 15 percent of those who died. Forty percent of survivors and 54 percent of deceased patients were subjected to surgical procedures. The most important predictor of hospital mortality in this series of patients with infective endocarditis was antimicrobial treatment failure