Scielo RSS <![CDATA[Revista médica de Chile]]> http://www.scielo.cl/rss.php?pid=0034-988720170002&lang=en vol. 145 num. 2 lang. en <![CDATA[SciELO Logo]]> http://www.scielo.cl/img/en/fbpelogp.gif http://www.scielo.cl <![CDATA[<strong><i>Health-related quality of life in Chilean patients with chronic obstructive pulmonary disease</i></strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000200001&lng=en&nrm=iso&tlng=en Background: Chronic obstructive pulmonary disease (COPD) has a relevant impact on health-related quality of life (HRQoL). Short Form 6 dimensions (SF-6D) quality of life tool allows researchers to calculate preference-based utilities using data from SF-12 or SF-36 questionnaires. Aim: To provide normative values of SF-6D derived from SF-12 for Chilean patients with COPD. Material and Methods: SF-6D utility index was calculated using data from the 2009/2010 Chilean National Health Survey. Sixty-nine male and 120 female patients with COPD participated in the survey. Data was stratified by gender, age, region, marital status, smoking status, monthly incomes, educational level and area. Results: The mean (± SD) SF-6D utility index for Chilean patients with COPD was 0.65 ± 0.15. The scores for men and women were 0.68 ± 0.15 and 0.64 ± 0.15, respectively. Patients with high incomes and educational level reported higher SF-6D scores. Ceiling effect was not a limitation when SF-6D was used in these Chilean patients. Conclusions: The current study provides normative values of SF-6D derived from SF-12 for Chilean patients with COPD. <![CDATA[<strong><i>A score to predict medical emergencies in hospitalized patients</i></strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000200002&lng=en&nrm=iso&tlng=en Background: The medical alert system (MAS) was created for the timely handling of clinical decompensations, experienced by patients hospitalized at the Medical Surgical Service (MSS) in a private clinic. It is activated by the nurse when hemodynamic, respiratory, neurological, infectious or metabolic alterations appear, when a patient falls or complains of pain. A physician assesses the patient and decides further therapy. Aim: To analyze the clinical and demographic characteristics of patients who activated or not the MAS and develop a score to identify patients who will potentially activate MAS. Material and Methods: Data from 13,933 patients discharged from the clinic in a period of one year was analyzed. Results: MAS was activated by 472 patients (3.4%). Twenty two of these patients died during hospital stay compared to 68 patients who did not activate the alert (0.5%, p < 0.01). The predictive score developed considered age, diagnosis (based on the tenth international classification of diseases) and whether the patient was medical or surgical. The score ranges from 0 to 9 and a cutoff ≥ 6 provides a sensitivity and specificity of 37 and 81% respectively and a positive likelihood ratio (LR+) of 1.9 to predict the activation of MAS. The same cutoff value predicts death with a sensitivity and specificity of 80% and a negative predictive value of 99.8%. Conclusions: This score may be useful to identify hospitalized patients who may have complications during their hospital stay. <![CDATA[<strong><i>Frailty in patients admitted to hospital with acute decompensated heart failure</i></strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000200003&lng=en&nrm=iso&tlng=en Background: Frailty is a geriatric syndrome characterized by a progressive impairment in the subjects’ ability to respond to environmental stress. Frailty is more commonly found in heart failure (HF) patients than in general population and it is an independent predictor of rehospitalization, emergency room visits and death. Aim: To estimate the prevalence of frailty in patients with decompensated HF admitted to four hospitals in Santiago, Chile. Material and Methods: Cross-sectional study. Subjects aged 60 or older consecutively admitted for decompensated HF to the study centers between August 2014 and March 2015 were included. Frailty was defined as the presence of three or more of the following criteria: unintended weight loss, muscular weakness, depression symptoms (exhaustion), reduced gait speed and low physical activity. Independent variables were tested for association using simple logistic regression. Variables associated with frailty (p < 0.05) were included in a multiple logistic regression model. Results: Seventy-nine subjects were included. The prevalence of frailty was 50.6%. Frail patients were mostly female (52.6%) and older than non-frail subjects (73.7± 7.9 vs 68.2 ± 7.1; p < 0.003). Independent predictors of frailty were age (Odds raio (OR) 1.10; 95% confidence intervals (CI): 1.03-1.17), quality of life measured with the Minnesota Living with Heart Failure Questionnaire (OR 1.07; IC95%: 1.03-1.11), previous hospitalizations (OR 2.56; 95%CI: 1.02-6.43) and number of medications (OR 4.46; 95%CI: 1.11-17.32). Conclusions: The prevalence of frailty in patients admitted to the hospital for decompensated heart failure is high. Age, quality of life, hospitalizations and polypharmacy were factors associated with frailty in this group of participants. <![CDATA[<strong><i>Validation of the successful aging inventory in chilean older people</i></strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000200004&lng=en&nrm=iso&tlng=en Background: There is a paucity of adequate and validated instruments for the measurement of successful aging for geriatric researchers in Chile. Aim: To validate the “Successful Aging Inventory” (SAI) in Chilean older people. Material and methods: SAI was answered by 777 older people aged 70 ± 7 years (63% women) living in urban and rural areas, including the highlands of a Northern desert region of Chile. Results: A Cronbach alfa of 0.92 was obtained for the general dimension of successful aging. The figures for each dimension included in the theoretical model (functional performance, intrapsychic factors, gero-transcendence; spirituality; purpose and life satisfaction), and ranged from 0.66 to 0.91. Confirmatory factorial analysis showed that the original inventory model, fits with the data collected from Chilean people. Conclusions: Successful Aging Inventory (SAI) is a reliable and adequate inventory, which can be used in Chilean older people. <![CDATA[<strong><i>Effectiveness of a structured educative program in Chilean diabetic patients</i></strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000200005&lng=en&nrm=iso&tlng=en Background: Structured educative programs have demonstrated their usefulness as a strategy to improve metabolic control in diabetic patients. Aim: To evaluate the effectiveness of a structured educative program for Chilean diabetic patients. Material and Methods: A randomized clinical trial in diabetic patients with glycosylated hemoglobin over 7.5%. One hundred fifteen patients were studied, 59 patients participated in the structured educative program (experimental group) and 56 patients received no structured education (control group). Patients were followed for 12 months. Results: Between baseline and 12 months of follow-up, glycosylated hemoglobin changed from 10.05 to 9.11% in experimental patients and from 9.86 to 9.25% in controls. No significant differences between experimental and control groups in other clinical and metabolic parameters were observed. In the experimental group, glycosylated hemoglobin reductions differed among the different educators who carried out the program. Conclusions: A structured educative program resulted in a 35% greater reduction in glycosylated hemoglobin levels, compared with a control group. Metabolic control improvement differed between the educators who carried out the program. <![CDATA[<strong><i>Usefulness of the activities of daily living questionnaire (T-ADLQ) in patients with minor stroke</i></strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000200006&lng=en&nrm=iso&tlng=en Background: The inability to carry out activities of daily living (ADL) is prevalent in elderly people and it is associated with hypertension and stroke. Aim: To evaluate ADLs using the T-ADLQ in hypertensive patients with minor stroke. Subjects and Methods: T-ADLQ, Cognitive tests (Minimental and Addenbrooke), and Hamilton depression test were applied to 100 hypertensive ambulatory patients (55 without symptomatic stroke and 45 with ischemic stroke, Rankin ≤ 2). Results: In stroke patients the ability to perform ADL was significantly reduced compared with hypertensive patients without stroke. Cognitive dysfunction and depressive symptoms were associated with a lower ADL performance. Conclusions: The T-ADLQ is useful to evaluate ADL in hypertensive ambulatory patients with ischemic stroke. <![CDATA[<strong><i>Incidence of aphasia in patients experiencing an ischemic stroke</i></strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000200007&lng=en&nrm=iso&tlng=en Background: Sequelae after a stroke are common and may lead to disability. Aphasia - defined as an acquired language disturbance - can cause important limitations in quality of life. Aim: To describe the epidemiological features of patients who had an aphasia after a first episode of ischemic stroke and their functional outcome at six months. Material and Methods: Review of a database of a population study on the incidence, 30-day case fatality rate, and prognosis of stroke performed in a northern Chilean city between 2000 and 2002. Results: Aphasia was diagnosed in 28 of 142 patients in whom the disorder was sought (20%). The projected incidence rate in the city where the study was carried out is 7.06 per 100,000 inhabitants. The mean age of these 28 patients was 66 ± 20 years and 53% were women. The main risk factor for stroke was hypertension in 62%. The etiology of stroke was undetermined in 64% of these patients. Partial anterior circulation infarction was the most common stroke location in 61%. Conclusions: Twenty percent of patients with a first episode of ischemic stroke have aphasia <![CDATA[<strong><i>Association of physical activity and dietary habits with overweight in fertile Chilean women</i></strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000200008&lng=en&nrm=iso&tlng=en Background: Women in Chile are mainly responsible in the formation of eating habits in the population, particularly at their homes. Aim: To explore the association of physical activity and alimentary habits with overweight among adult Chilean women in fertile age. Material and Methods: Cross sectional study using the data from de National Health Survey 2009-2010. Socio-demographic variables, dietary issues, multidimensional physical activity, sedentary free time and their link with nutritional status were studied in a sample of 1,195 women aged between 20 and 44 years. Results: Sixty three percent of women were overweight. The factors positively associated overweight were having an age between 31 and 44 years (prevalence ratio (PR) = 1.4), having a lower education level (PR = 1.23), living in rural areas (PR = 2.21) and being exposed to work environment (PR = 1.29). The factors negatively associated with overweight were the consumption of whole grains at least once daily (PR = 0.59), being physically active according to a self-assessment scale (PR = 0.22) and being physically inactive during leisure time (PR = 0.61). Conclusions: The promotion whole grain cereal consumption and physical activity in women is advisable to prevent overweight, mostly in vulnerable groups such as those older than 31 years, with a low educational level and living rural areas. <![CDATA[<strong><i>Diverticular disease</i></strong>: <strong><i>myths and realities</i></strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000200009&lng=en&nrm=iso&tlng=en Diverticulosis and diverticular disease of the colon are common conditions in Western countries. The incidence and prevalence of these diseases are increasing and becoming significant for health systems. A growing body of knowledge is shifting the paradigm of the pathogenesis and treatment of diverticular disease. Low-grade inflammation, altered intestinal microbiota, visceral hypersensitivity, and abnormal colonic motility have been identified as factors leading to diverticular disease. The risk of developing diverticulitis among individuals with diverticulosis is lower than 10 to 25%. Studies indicate that diverticular disease may become a chronic disorder in some patients, not merely an acute illness. Contrary to the advice from international guidelines, studies have not shown that a high-fiber diet protects against diverticulosis. The evidence about the use of antibiotics in uncomplicated diverticulitis is sparse and of low quality. In relation to surgery, studies support a more conservative approach to prophylactic surgery in patients with recurrent disease or chronic symptoms. Finally, new pathophysiological knowledge suggests that other treatments may be useful (mesalamine, rifaximin and probiotics). However, more research is necessary to validate the safety, effectiveness and cost-effectiveness of these strategies. <![CDATA[<strong><i>Effects of prebiotics and probiotics on gastrointestinal tract lymphoid tissue in hiv infected patients</i></strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000200010&lng=en&nrm=iso&tlng=en HIV infection induces alterations in almost all immune cell populations, mainly in CD4+ T cells, leading to the development of opportunistic infections. The gut-associated lymphoid tissue (GALT) constitutes the most important site for viral replication, because the main target cells, memory T-cells, reside in this tissue. It is currently known that alterations in GALT are critical during the course of the infection, as HIV-1 induces loss of tissue integrity and promotes translocation of microbial products from the intestinal lumen to the systemic circulation, leading to a persistent immune activation state and immune exhaustion. Although antiretroviral treatment decreases viral load and substantially improves the prognosis of the infection, the alterations in GALT remains, having a great impact on the ability to establish effective immune responses. This emphasizes the importance of developing new therapeutic alternatives that may promote structural and functional integrity of this tissue. In this regard, therapy with probiotics/prebiotics has beneficial effects in GALT, mainly in syndromes characterized by intestinal dysbiosis, including the HIV-1 infection. In these patients, the consumption of probiotics/prebiotics decreased microbial products in plasma and CD4+ T cell activation, increased CD4+ T cell frequency, in particular Th17, and improved the intestinal flora. In this review, the most important findings on the potential impact of the probiotics/prebiotics therapy are discussed. <![CDATA[<strong><i>Understanding cortisol action in acute inflammation</i></strong>: <strong><i>A view from the adrenal gland to the target cell</i></strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000200011&lng=en&nrm=iso&tlng=en Glucocorticoids (cortisol in humans) are essential for numerous biological functions. Among critically ill patients, therapy with cortisol has gained strength in recent years, but clinical results have been mixed. A series of events, that may explain the diversity of clinical responses, occur from the synthesis of cortisol in the adrenal gland to the activation of the cortisol receptor by the hormone when it enters the nucleus of the target cell. Some of these events are revised; a proposition for identifying critically ill patients who may benefit with this therapy is suggested. <![CDATA[<strong><i>The impact of tap water fluoridation on human health</i></strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000200012&lng=en&nrm=iso&tlng=en The purpose of this review is to describe the osteological, neurological, endocrine and dermatological effects of fluoride ingestion. Additional aims are to evaluate whether the Chilean tap water fluoridation program has had any impact on dental health, and analyze the basis for the Chilean elementary school milk fluoridation program, which is targeted at children living in places where tap water has a fluoride concentration less than 0.3 mg/L, without any artificial fluoridation process. We discuss the finding that both public measures have no direct or remarkable effect on dental health, since topical dental hygiene products are the main and most effective contributors to the prevention of dental decay. We also suggest that the permanent and systematic ingestion of fluorides imposes health risks on the population. Therefore, we recommend reevaluating the national fluoridation program for public tap water and the elementary school milk program. <![CDATA[<strong><i>Cutaneous myiasis due to </i></strong><strong>Cochliomyia hominivorax <i>associated with seborrheic dermatitis</i></strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000200013&lng=en&nrm=iso&tlng=en Myiasis is an infestation of tissues and organs of humans and animals by Diptera larvae (flies, horseflies, mosquitoes). They are located at different body sites, and classified clinically as cutaneous, visceral and cavitary. We report a 26-year-old woman with a history of seborrheic dermatitis and recent trip to Brazil. She presented with a seven days history of suppurating wounds in the parieto-occipital area of the scalp. At physical examination we found three ulcers of approximately 1.5 cm each, with multiple mobile larvae inside. The obtained larvae were analyzed, identifying Cochliomyia hominivorax larvae at L2 and L3 stages. The patient was managed successfully with oral antimicrobials and local cleansing. The screwworm Cochliomyia hominivorax in our country is rare. Known risk factors are wounds, poor personal hygiene, extreme ages, psychiatric disorders, presence of specific dermatosis such as psoriasis and seborrheic dermatitis, among others. <![CDATA[<strong><i>Benign intraperitoneal metastatic leiomyomatosis</i></strong>: <strong><i>A case report</i></strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000200014&lng=en&nrm=iso&tlng=en Benign intraperitoneal metastatic leiomyomatosis is a rare benign disease that is observed when a leiomyoma is present in the peritoneal surface. Women who have undergone hysterectomy for leiomyomas are most commonly affected. Patients are usually asymptomatic at presentation, being frequently an incidental finding in imaging studies. Ultrasound and CT play an important role in the diagnosis. The lesions are histologically identical to their uterine counterparts. There are different theories about the pathogenesis of the disease, including peritoneal seeding after laparoscopic hysterectomy. Others support the hypothesis of multiple independent foci of smooth muscle proliferation. Treatment, as in uterine leiomyomatosis, is generally conservative. We report a 53-year-old hysterectomized woman with intraperitoneal leiomyomas detected in a routine physical examination as mobile abdominal masses who underwent successful laparoscopic resection. <![CDATA[<strong><i>Shock as an adverse reaction to rituximab</i></strong>: <strong><i>Case report</i></strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000200015&lng=en&nrm=iso&tlng=en Rituximab is a plausible alternative first-line treatment of ANCA-associated vasculitis. Adverse effects related to its infusion are common and usually have a benign course. However, there have been reports of refractory cardiogenic shock simulating septic shock. We report an 81-year-old male with the diagnosis of ANCA associated vasculitis. Rituximab 500 mg was administered intravenously for a relapse. The infusion proceeded without incident. However, 24 hours after its administration the patient began with fever, chills, coughing and strong malaise. The patient was transferred to the critical patient unit where a septic shock was suspected and resuscitative measures were started. However, the fast response to moderate doses of vasoactive drugs and complementary tests did not support an infectious etiology for the shock. Antimicrobials were discontinued and systemic corticosteroids were maintained, achieving remission of the symptoms. Shock as an unusual adverse reaction to Rituximab was suspected. <![CDATA[<strong><i>Eyelid retraction of neurologic origin</i></strong>: <strong><i>Report of three cases</i></strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000200016&lng=en&nrm=iso&tlng=en Eyelid retraction, has received limited attention and it has passively been interpreted as the result of an overactive levator palpebrae superioris muscle secondary to midbrain injury. However, eyelid retractions can occur in other neurological diseases, not directly related with the midbrain. We report three patients who developed eyelid retraction. One patient had a bilateral eyelid retraction, related with Creutzfeldt-Jakob disease (CJD). Another patient had a unilateral right eyelid retraction associated with a thalamic-mesencephalic infarct. The third patient had a bilateral pontine infarction on magnetic resonance imaging. In the patient with CJD, eyelid retraction did not subside. Among patients with infarctions, the retraction persisted after focal symptoms had subsided, showing an evolution that was apparently independent of the basic process. The analysis of these patients allows us to conclude that the pathogenesis of eyelid retraction includes supranuclear mechanisms in both the development and maintenance of the phenomenon. Unilateral or bilateral eyelid retraction does not alter the normal function of eyelid, which ever had normal close eye blink. In these reported cases, a hyperactivity of levator palpebrae superioris muscle was clinically ruled out. <![CDATA[<strong>It is time to focus on unpaid caregiving</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000200017&lng=en&nrm=iso&tlng=en Eyelid retraction, has received limited attention and it has passively been interpreted as the result of an overactive levator palpebrae superioris muscle secondary to midbrain injury. However, eyelid retractions can occur in other neurological diseases, not directly related with the midbrain. We report three patients who developed eyelid retraction. One patient had a bilateral eyelid retraction, related with Creutzfeldt-Jakob disease (CJD). Another patient had a unilateral right eyelid retraction associated with a thalamic-mesencephalic infarct. The third patient had a bilateral pontine infarction on magnetic resonance imaging. In the patient with CJD, eyelid retraction did not subside. Among patients with infarctions, the retraction persisted after focal symptoms had subsided, showing an evolution that was apparently independent of the basic process. The analysis of these patients allows us to conclude that the pathogenesis of eyelid retraction includes supranuclear mechanisms in both the development and maintenance of the phenomenon. Unilateral or bilateral eyelid retraction does not alter the normal function of eyelid, which ever had normal close eye blink. In these reported cases, a hyperactivity of levator palpebrae superioris muscle was clinically ruled out. <![CDATA[<strong>A modification of Cronbach’s alpha coefficient by correlated errors</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000200018&lng=en&nrm=iso&tlng=en Eyelid retraction, has received limited attention and it has passively been interpreted as the result of an overactive levator palpebrae superioris muscle secondary to midbrain injury. However, eyelid retractions can occur in other neurological diseases, not directly related with the midbrain. We report three patients who developed eyelid retraction. One patient had a bilateral eyelid retraction, related with Creutzfeldt-Jakob disease (CJD). Another patient had a unilateral right eyelid retraction associated with a thalamic-mesencephalic infarct. The third patient had a bilateral pontine infarction on magnetic resonance imaging. In the patient with CJD, eyelid retraction did not subside. Among patients with infarctions, the retraction persisted after focal symptoms had subsided, showing an evolution that was apparently independent of the basic process. The analysis of these patients allows us to conclude that the pathogenesis of eyelid retraction includes supranuclear mechanisms in both the development and maintenance of the phenomenon. Unilateral or bilateral eyelid retraction does not alter the normal function of eyelid, which ever had normal close eye blink. In these reported cases, a hyperactivity of levator palpebrae superioris muscle was clinically ruled out. <![CDATA[<strong>Reliability calculation using the McDonald’s Omega coefficient</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000200019&lng=en&nrm=iso&tlng=en Eyelid retraction, has received limited attention and it has passively been interpreted as the result of an overactive levator palpebrae superioris muscle secondary to midbrain injury. However, eyelid retractions can occur in other neurological diseases, not directly related with the midbrain. We report three patients who developed eyelid retraction. One patient had a bilateral eyelid retraction, related with Creutzfeldt-Jakob disease (CJD). Another patient had a unilateral right eyelid retraction associated with a thalamic-mesencephalic infarct. The third patient had a bilateral pontine infarction on magnetic resonance imaging. In the patient with CJD, eyelid retraction did not subside. Among patients with infarctions, the retraction persisted after focal symptoms had subsided, showing an evolution that was apparently independent of the basic process. The analysis of these patients allows us to conclude that the pathogenesis of eyelid retraction includes supranuclear mechanisms in both the development and maintenance of the phenomenon. Unilateral or bilateral eyelid retraction does not alter the normal function of eyelid, which ever had normal close eye blink. In these reported cases, a hyperactivity of levator palpebrae superioris muscle was clinically ruled out. <![CDATA[<strong>Ethical Challenges in Nephrological Clinic</strong>]]> http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872017000200020&lng=en&nrm=iso&tlng=en Eyelid retraction, has received limited attention and it has passively been interpreted as the result of an overactive levator palpebrae superioris muscle secondary to midbrain injury. However, eyelid retractions can occur in other neurological diseases, not directly related with the midbrain. We report three patients who developed eyelid retraction. One patient had a bilateral eyelid retraction, related with Creutzfeldt-Jakob disease (CJD). Another patient had a unilateral right eyelid retraction associated with a thalamic-mesencephalic infarct. The third patient had a bilateral pontine infarction on magnetic resonance imaging. In the patient with CJD, eyelid retraction did not subside. Among patients with infarctions, the retraction persisted after focal symptoms had subsided, showing an evolution that was apparently independent of the basic process. The analysis of these patients allows us to conclude that the pathogenesis of eyelid retraction includes supranuclear mechanisms in both the development and maintenance of the phenomenon. Unilateral or bilateral eyelid retraction does not alter the normal function of eyelid, which ever had normal close eye blink. In these reported cases, a hyperactivity of levator palpebrae superioris muscle was clinically ruled out.